PMID- 30401900
OWN - NLM
STAT- MEDLINE
DCOM- 20190704
LR  - 20220419
IS  - 1476-5454 (Electronic)
IS  - 0950-222X (Print)
IS  - 0950-222X (Linking)
VI  - 33
IP  - 2
DP  - 2019 Feb
TI  - Serial TSH-receptor antibody levels to guide the management of thyroid eye 
      disease: the impact of smoking, immunosuppression, radio-iodine, and 
      thyroidectomy.
PG  - 212-217
LID - 10.1038/s41433-018-0242-9 [doi]
AB  - The Thyrotropin receptor antibody (TRAb) is the main driver of Graves' disease 
      (GD) and its most common extra-thyroidal manifestation: thyroid eye disease 
      (TED). Though key to diagnosis, it has not been used routinely as a marker of 
      disease activity or to guide treatment. Here we demonstrate, through a 
      retrospective review of 105 patients with TED, that serial TRAb levels vary with 
      time, correlate with disease activity and are affected by smoking and endocrine 
      control. Such serial measurements can guide the modern management of thyroid eye 
      disease, helping to prevent the more serious manifestations. We show that 
      surgical thyroidectomy is associated with a reduction in antibody levels and a 
      reduced rate of TED reactivation when compared to radio-iodine ablation where the 
      stimulating antigen is not removed. This provides a molecular explanation for 
      epidemiological studies showing radio-ablation being associated with an increased 
      risk of orbitopathy. To demonstrate the effect of our clinical approach on a 
      patient population, we then compared the incidence and severity of TED in a 
      clinic in a period before and after the introduction of serial TRAb measurements. 
      Despite an increase in disease incidence and severity at presentation over the 
      two-decade study period, our approach saw a significant reduction in the need for 
      surgical intervention for this orbital disorder.
FAU - Roos, Jonathan C P
AU  - Roos JCP
AD  - Ipswich Hospital NHS Trust, Ipswich, UK.
FAU - Paulpandian, Vignesh
AU  - Paulpandian V
AD  - Ipswich Hospital NHS Trust, Ipswich, UK.
FAU - Murthy, Rachna
AU  - Murthy R
AD  - Ipswich Hospital NHS Trust, Ipswich, UK. rachna.murthy@ipswichhospital.nhs.uk.
AD  - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 
      rachna.murthy@ipswichhospital.nhs.uk.
LA  - eng
PT  - Congress
DEP - 20181106
PL  - England
TA  - Eye (Lond)
JT  - Eye (London, England)
JID - 8703986
RN  - 0 (Autoantibodies)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Iodine Radioisotopes)
RN  - 0 (Receptors, Thyrotropin)
RN  - 83HN0GTJ6D (Cyclosporine)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Autoantibodies/*blood
MH  - Cyclosporine/therapeutic use
MH  - Female
MH  - Graves Ophthalmopathy/etiology/immunology/*therapy
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Iodine Radioisotopes/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Receptors, Thyrotropin/*immunology
MH  - Retrospective Studies
MH  - Smoking/*adverse effects
MH  - *Thyroidectomy
PMC - PMC6367398
COIS- CONFLICT OF INTEREST: All authors are oculoplastic surgeons who manage patients 
      with Thyroid Eye disease. GUARANTOR: Dr Murthy serves as guarantor of this work. 
      It is an honest, accurate, and transparent account of the study being reported; 
      no important aspects of the study have been omitted.
EDAT- 2018/11/08 06:00
MHDA- 2019/07/05 06:00
PMCR- 2020/02/01
CRDT- 2018/11/08 06:00
PHST- 2018/10/03 00:00 [received]
PHST- 2018/10/04 00:00 [accepted]
PHST- 2018/11/08 06:00 [pubmed]
PHST- 2019/07/05 06:00 [medline]
PHST- 2018/11/08 06:00 [entrez]
PHST- 2020/02/01 00:00 [pmc-release]
AID - 10.1038/s41433-018-0242-9 [pii]
AID - 242 [pii]
AID - 10.1038/s41433-018-0242-9 [doi]
PST - ppublish
SO  - Eye (Lond). 2019 Feb;33(2):212-217. doi: 10.1038/s41433-018-0242-9. Epub 2018 Nov 
      6.