REVIEW article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
The progression of TRAb-positive subacute thyroiditis and its differential diagnosis from Graves' disease
Provisionally accepted
- 1The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- 2Shandong Second Medical University, Weifang, China
- 3Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, China
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Abstract: 16 Subacute thyroiditis (SAT) is a self-limiting thyroiditis with an unclear pathogenesis. Human 17 leukocyte antigen (HLA)-B*35 is considered a predisposing factor, and viral infection is believed to 18 be a trigger. In recent years, elevated levels of thyroid-stimulating hormone receptor antibodies (TRAb) 19 have been observed in some patients with SAT. Typically, these elevated TRAb levels may 20 spontaneously revert to negative as the disease improves. The mechanism of TRAb production may be 21 related to abnormalities in immune surveillance and viral infections. Critically, the presence of TRAb 22 can influence clinical manifestations, complicate diagnosis, and affect recovery in SAT. There are three 23 types of TRAb, yet studies on their changing patterns during SAT remain scarce. Both SAT and Graves' 24 disease (GD) can cause thyrotoxicosis, leading to difficulties in clinical differential diagnosis, 25 especially when SAT presents with positive TRAb. Currently, studies on TRAb-positive SAT are 26 relatively limited. Therefore, this article reviews the pathogenesis of TRAb-positive SAT and its 27 differential diagnosis from GD, aiming to enhance the understanding of this disease among clinicians.
Keywords: Autoimmunity, differential diagnosis, Graves' disease, subacute thyroiditis, Thyroid-stimulating hormone receptor antibody, viral triggers
Received: 20 Oct 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Yuan, Zhao, Liu, Yao and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Junyu Zhao
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