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Clinical characteristics of G raves' orbitopathy in patients showing discrepancy between levels from TBII assays and TSI bioassay
Author(s) -
Jang Sun Young,
Shin Dong Yeob,
Lee Eun Jig,
Yoon Jin Sook
Publication year - 2014
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12318
Subject(s) - medicine , gastroenterology , analysis of variance , graves' disease , endocrinology , thyroid
Objective To investigate clinical characteristics of patients with G raves' orbitopathy ( GO ) who showed discrepancies between levels of thyroid‐stimulating immunoglobulin ( TSI ) and thyrotropin‐binding inhibitory immunoglobulin ( TBII ). Design Comparative case series. Patients A total of 317 patients with GO in whom Mc4‐ TSI and M22‐ TRA b (third‐generation TBII ) were measured simultaneously. Patients were divided into four groups according to TRA b levels as followings: G roup 1, TBII and TSI < median value; G roup 2, TBII ≥ median, TSI < median; G roup 3, TBII < median, TSI ≥ median; G roup 4, both TBII and TSI ≥ median. Measurement Endocrine and ophthalmic clinical manifestations in each group. Results The median value of M 22‐ TRA b was 6·11 IU /l and that of M c4‐ TSI was 415·1 ( SRR %). One hundred seventeen patients were classified as G roup 1, 41 patients as G roup 2, 41 patients as group 3 and 118 patients as group 4. Mean CAS was significantly higher in G roups 3 (2·2) and 4 (2·2) than in G roups 1 (1·6) and 2 (1·4; P = 0·001, anova ). Mean modified NOSPECS scores were significantly higher ( P < 0·001, anova ) in G roups 3 (4·1) and 4 (4·1) than in G roups 1 (3·1) and 2 (2·3). The proportion of patients with hyperthyroidism was larger in Group 2 (85·4% [35/41 patients]) than in G roup 3 (48·8% [20/41 patients]; P = 0·002). Conclusions GO is more active and severe in patients with predominant M c4‐ TSI than in patients with predominant M 22‐ TRA b. Patients with hyperthyroidism were more likely to be included with patients with predominant M 22‐ TRA b than with predominant M c4‐ TSI .