AUTHOR=Park Jungyul , Kim Jaehyun , Kim Sang Soo , Choi Hee-Young 

TITLE=Prognostic significance of thyroid-stimulating hormone receptor antibodies in moderate-to-severe graves’ orbitopathy

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1153312

DOI=10.3389/fendo.2023.1153312

ISSN=1664-2392

ABSTRACT=Purpose: To assess the changes in TSH-R antibody levels following treatment in patients with moderate-to-severe and active GO and to investigate the correlation between these antibodies and treatment response.
Methods: The subjects of this study were patients newly diagnosed with moderate-to-severe and active GO within the age range of 19 to 79 years. All participants underwent IVMP therapy for a duration of 12 weeks. Patients with a clinical activity score (CAS) decrease to or less than 3 and no symptom recurrence for at least 3months after the last dose of IVMP were classified as “Group 1”. Those with a CAS equal to or greater than 4 were classified as “Group 2”.  TSH-R antibody levels were measured prior to and following IVMP treatment and treatment response was evaluated after the completion of IVMP therapy. All patients were monitored for a minimum of 6 months post-treatment, with ocular examinations and laboratory tests at the initial visit being included in the analysis.
Results: Seventy-five patients were response and 21 were non-responsive to IVMP treatment. A higher TRAb and TSAb following treatment were associated with a high risk of no treatment response (P = 0.017; P = 0.047, respectively). TRAb and TSAb levels before treatment were significantly related to TRAb and TSAb levels after treatment (P < 0.001, respectively). The cut-off values for the prediction of poor treatment response of the TRAb and TSAb before and after treatment were 8.305 IU/L, 5.035 IU/L and 449.5%, 361%, respectively.
Conclusion: Elevated levels of TRAb and TSAb prior to IVMP treatment were positively correlated with post-treatment levels of these antibodies. Furthermore, in cases of non-response to IVMP therapy, a diminished decline in both antibodies was observed, and elevated levels of TRAb and TSAb post-treatment were found to be a significant predictor of poor treatment outcome. Measurement of TRAb and TSAb throughout the course of treatment may offer valuable insights into treatment prognosis and aid in the decision-making process regarding the potential need for increased IVMP dosage or alternative therapeutic strategies.