Diagnostic Utility of a New Assay for Thyroid Stimulating Immunoglobulins in Graves’ Disease and Thyroid Eye Disease

Thyroid ◽  
2021 ◽  
Author(s):  
Marius Nicolae Stan ◽  
Alicia Algeciras-Schimnich ◽  
Vishakantha Murthy ◽  
Prabin Thapa ◽  
Naohiro Araki
Keyword(s):  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Graves Disease ◽  
Diagnostic Utility ◽  
Thyroid Stimulating Immunoglobulins

scholarly journals AB1043 AWARENESS OF THYROID EYE DISEASE, AN AUTOIMMUNE CONDITION, AMONG RHEUMATOLOGISTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1813.1-1813
Author(s):  
B. Lamoreaux ◽  
M. Francis-Sedlak ◽  
R. Holt ◽  
J. Rosenbaum
Keyword(s):  
Rheumatoid Arthritis ◽  
Lupus Erythematosus ◽  
Granulomatosis With Polyangiitis ◽  
The United States ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Infusion Therapy ◽  
Graves Disease ◽  
Ocular Motility ◽  
Referral Patterns

Background:Autoimmune inflammatory conditions of the eye may be associated with rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, and granulomatosis with polyangiitis. This is also observed with thyroid eye disease (TED). Loss of immune tolerance to the thyroid stimulating hormone receptor has thyroidal consequences and nearly 40% of patients with Graves’ disease also have clinically evident Graves’ orbitopathy or TED.1TED results from tissue inflammation that causes retro orbital fat expansion2and extraocular muscle enlargement2and stiffening.3Because the orbital cavity is bony and of limited volume, proptosis and, in severe cases, optic nerve compression, can result. In many patients, muscle changes also cause ocular motility issues and double-vision. Because TED can have a similar presentation to other inflammatory orbital diseases (e.g., granulomatosis with polyangiitis) and Graves’ disease patients frequently have other autoimmune conditions (10% of Graves’s patients also have rheumatoid arthritis),4rheumatologists are likely to care for, or even diagnose, patients with TED.Objectives:This analysis sought to understand rheumatologists’ knowledge, and degree of participation in the treatment, of TED including referral patterns from ophthalmologists and endocrinologists for infusion therapies.Methods:Rheumatologists practicing in the United States attended an educational session and agreed to complete a 12-item survey regarding TED awareness, referral patterns, and management.Results:Of the 47 rheumatologists surveyed, 45 (96%) were familiar with TED. Ten (21%) physicians reported managing patients with TED, but the majority of physicians (62%) reported that they co-managed other autoimmune diseases in patients who also had TED. Additionally, 98% and 64% of polled rheumatologists had received referrals from ophthalmologists and endocrinologists, respectively, for autoimmune disease management or infusion therapy. Ophthalmology referrals for intravenous (IV) medication administration were most frequently for biologics (82%), but some referrals were also made for corticosteroids (2%) or other medication (13%) infusions. Only 23% of rheumatologists had administered a biologic specifically for TED (rituximab: 17%, tocilizumab: 2%, other: 4%), but 89% expressed an interest in administering a TED-specific monoclonal antibody therapy, awaiting FDA approval.Conclusion:Nearly all surveyed rheumatologists were aware of the signs and symptoms of TED, although most did not actively manage or administer medication for TED. Given the high level of interest in infusing novel, TED-specific biologics, rheumatologists may become an integral part of TED patient management with the approval of a new biologic, teprotumumab, for thyroid eye disease.References:[1]Bartley GB, et al.Am J Ophthalmol1996;121:284-90.[2]Forbes G, et al.AJNR Am J Neuroradiol1986;7:651-656.[3]Simonsz HJ, et al.Strabismus1994;2:197-218.[4]Cardenas Roldan J, et al.Arthritis2012 2012;864907.Disclosure of Interests:Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Megan Francis-Sedlak Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Robert Holt Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, James Rosenbaum Consultant of: AbbVie, Corvus, Eyevensys, Gilead, Novartis, Janssen, Roche, UCB Pharma; royalties from UpToDate

scholarly journals Prevalence of thyroid eye disease in Graves’ disease: A meta‐analysis and systematic review

2020 ◽  
Vol 93 (4) ◽  
pp. 363-374 ◽  
Author(s):  
Yip Han Chin ◽  
Cheng Han Ng ◽  
Ming Hui Lee ◽  
Jeffery Wei Heng Koh ◽  
Jolene Kiew ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Graves Disease

scholarly journals B-cell autoepitopes on the acetylcholinesterase-homologous region of human thyroglobulin: association with Graves' disease and thyroid eye disease

2001 ◽  
pp. 119-127 ◽  
Author(s):  
A Thrasyvoulides ◽  
M Sakarellos-Daitsiotis ◽  
G Philippou ◽  
A Souvatzoglou ◽  
C Sakarellos ◽  
...  
Keyword(s):  
Solid Phase ◽  
Significant Proportion ◽  
Terminal Region ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Homologous Region ◽  
Graves Disease ◽  
Healthy Controls ◽  
Autoimmune Thyroid Diseases ◽  
Autoimmune Thyroid

OBJECTIVE: Thyroglobulin (Tg) is a large autoantigen involved in autoimmune thyroid diseases. Tg epitopes have, so far, been identified within large peptides. In the present study, we used small synthetic peptides to finely map serological epitopes on the highly immunogenic C-terminal region of Tg. Homology of this region to acetylcholinesterase (AChE) has been implicated in the pathogenesis of thyroid eye disease (TED) through cross-reactive antibodies. METHODS: We tested total IgG purified from four pilot Graves' disease (GD) sera reactive with both Tg and AChE and from three healthy controls, for reactivity against overlapping 20mer peptides (pin synthesis) covering the sequence 2171-2748 of human Tg. Antibody-reactive peptides were subsequently synthesized by a solid-phase technique for confirmation with a large number of sera: 99 GD, 32 Hashimoto's thyroiditis (HT) and 45 healthy controls. RESULTS: Peptides TgP15, TgP26 and TgP41 (amino acids 2339-2358, 2471-2490 and 2651-2670 respectively) were found to be targets of autoantibodies on intact Tg, recognized by a statistically significant proportion of GD sera (22.2%, 35.4% and 30.3% respectively), compared with HT (0%, 15.6% and 6.3% respectively) and healthy controls (0%, 4.4% and 4.4% respectively). The majority of GD sera (56.6%) were positive for at least one of the three peptides. In GD, TgP26 reactivity was found to be associated with TED (48.6% with TED versus 25.5% without TED, P<0.05). CONCLUSION: Some epitopes on the C-terminal region of Tg are associated with GD. A subset of Tg-reactive autoantibodies, directed to this region, is associated with TED and may be involved in the development of the disease.

Thyroid Eye Disease

2011 ◽  
pp. 178-182
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak ◽  
Robert B. Daroff
Keyword(s):  
Clinical Practice ◽  
Thyroid Function ◽  
Clinical Signs ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Graves Disease ◽  
Common Cause ◽  
Orbital Disease

Thyroid eye disease is the most common cause of orbital disease encountered in clinical practice. It often occurs in patients with Graves’ disease, but it is not always associated with abnormal thyroid function. In this chapter, we review the clinical signs, investigation, and treatment of thyroid eye disease.

Proportion and Clinical Profile of Thyroid Ophthalmopathy in Patients with Graves’ Disease Presenting at a Tertiary Care Centre in Kerala

2021 ◽  
Vol 8 (32) ◽  
pp. 3028-3033
Author(s):  
Liya K.Y ◽  
Naina Jabeen Hyder ◽  
Neeta Sidhan ◽  
Shaji Ankan
Keyword(s):  
Tertiary Care ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Clinical Activity ◽  
P Value ◽  
Graves Disease ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Clinical Activity Score ◽  
Active Disease

BACKGROUND Thyroid eye disease is a relatively rare condition, with an incidence of 2.9 to 16.0 cases per 100 000 population per year. Approximately 50 % of patients with Graves’ disease (GD) develop clinically apparent thyroid eye disease. It may cause severe damage to vision and orbital architecture. It is the most frequent cause of unilateral or bilateral proptosis in adults. METHODS A cross sectional study of 80 patients with GD was carried out in association with thyroid clinic of Government Medical college Thiruvananthapuram for a period of 1 year from April 2017 to March 2018. Subjects who have a prior diagnosis of Graves’ disease including those who are on antithyroid drugs were included in the study. Patients who are sick due to other systemic diseases like cardiac failure and end stage renal disease were excluded. RESULTS Eighty patients with mean age of 45.31 years were studied. Out of them, 66% were females and 34% were males. Ophthalmopathy was present in 38.8%.Majority had mild and bilateral disease (61.2 %). Only a small percentage had sight threatening disease (6.4 %).The mean age of patients with ophthalmopathy was 47.93. Major population with ophthalmopathy was females. Majority of patients with ophthalmopathy (64.5 %) retained a good visual acuity better than 6 / 9. Lid retraction was the most common manifestation among patients with Graves’ ophthalmopathy that is 74.2% followed by exophthalmos (64.5 %) and eye movement restriction and soft tissue involvement (58.1 %). Diplopia, optic nerve dysfunction were rare (3.2 %). Only 19.3 % patients had active disease according to clinical activity score. Major clinical sign of activity was redness of conjunctiva. Maximum no. of patients with active disease had a clinical activity score of 4. Smoking showed a significant association with the severity of ophthalmopathy. (p value 0.001) There was a significant association between age and activity of disease. (p value 0.021). No association was found between duration of disease with presence or severity of ophthalmopathy. There was no association between co- morbidities with presence or severity of ophthalmopathy. No association was found between hormone status and presence or severity of ophthalmopathy. CONCLUSIONS Our results indicated that the prevalence of ophthalmopathy in our population with GD evaluated at our tertiary care centre was similar to that reported in the Caucasians of European origin. Clinically active and sight threatening ophthalmopathy was uncommon. KEYWORDS Graves’ Disease, Ophthalmopathy

Thyroid Eye Disease

2009 ◽  
Vol 19 (9) ◽  
pp. 282-286 ◽  
Author(s):  
Neil C Modi ◽  
Jennifer James ◽  
Tamsin Sleep
Keyword(s):  
Optic Neuropathy ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Graves Disease ◽  
Ocular Motility ◽  
Double Vision ◽  
Ocular Irritation ◽  
Periorbital Swelling ◽  
Orbital Disease

Introduction Thyroid eye disease (TED), also known as Graves opthalmopathy is the most common orbital disease and affects 25–50% of patients with Graves' disease (Kuryan et al 2008). Most patients are only mildly affected, suffering ocular irritation with redness and watering, ‘staring eyes' due to retraction of the eyelids, exophthalmos (protrusion of the eyeballs) and periorbital swelling (Figure 1). A minority of patients (around 28%) will develop ocular motility problems, leading to diplopia (double vision), exposure/damage to the cornea and optic neuropathy (Kumar & Clarke 2002, Forbes & Jackson 2003, Meyer 2006).

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