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Thyroid-stimulating immunoglobulins indicate the onset of dysthyroid optic neuropathy

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Abstract

Purpose

Recognition of dysthyroid optic neuropathy (DON) requires sensitive diagnostic tools. Clinical assessment may fail to reliably evaluate the acuteness of DON especially if signs for inflammation are missing. Aim of this cross-sectional study was to assess the relationship between thyroid-stimulating immunoglobulins (TSI) and onset of DON.

Methods

At a multidisciplinary orbital center, serum TSI levels were measured in 180 consecutive patients with thyroid eye disease (TED) and 302 healthy controls with a FDA-cleared cell-based bioassay using a chimeric TSH receptor and a CRE-dependent luciferase.

Results

Thirty of 180 (16.7 %) patients with TED had DON of recent onset or a past history of DON (post-DON). Optic disk swelling was present and visual-evoked potentials were pathologic in all eyes with DON of recent onset, but in one of 13 (7.7 %) with post-DON, only (p = 0.005). 19/20 (96 %) patients with DON of recent onset were TSI-positive. TSI was associated with DON of recent onset (OR: 20.96; 95 % CI 1.064–412.85, p = 0.045). All controls were TSI negative. TSI correlated with the clinical activity score (R = 0.70, p < 0.001) and higher TSI-levels were noted in active vs. inactive TED (485.1 ± 132.3 vs. 277.7 ± 143.7 %, cut-off < 140 %; p < 0.001). Six of seven (85.7 %) patients with inactive TED with recent onset DON versus one of four (25 %) with active post-DON were TSI-positive (p = 0.006). A discriminatory cut-point of 377 SRR % for TSI was determined based on a ROC analysis (sensitivity: 0.95, specificity: 0.8).

Conclusions

Serum TSI levels identify patients with DON of recent onset requiring urgent therapy.

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Abbreviations

TED:

Thyroid eye disease

TSI:

Thyroid stimulating immunoglobulins

DON:

Dysthyroid optic neuropathy

TSH:

Thyroid stimulating hormone

TSHR:

TSH-receptor

EUGOGO:

European Group on Graves Orbitopathy

CAS:

Clinical activity score

TBII:

Thyroid binding inhibitory immunoglobulin

SRR %:

Percentage of specimen-to-reference ratio

RLU:

Relative light units

CV %:

Coefficient of variation

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Acknowledgments

Katharina A Ponto is funded by the Federal Ministry of Education and Research (BMBF 01EO1003). The authors are grateful to Paul D. Olivo, MD, PhD and to Jeff Houtz for the critical evaluation of the manuscript.

Conflict of interest

Katharina A. Ponto, Tanja Diana, Harald Binder, Nina Matheis, Susanne Pitz, and Norbert Pfeiffer have nothing to disclose; George J. Kahaly consults for and has received research funding from Quidel, CA, USA. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Department of Ophthalmology, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany

    K. A. Ponto, S. Pitz & N. Pfeiffer

  2. Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Langenbeckstreet 1, 55131, Mainz, Germany

    T. Diana, N. Matheis & G. J. Kahaly

  3. Department of Biomedical Statistics, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany

    H. Binder

  4. Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany

    K. A. Ponto

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  1. K. A. Ponto
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Ponto, K.A., Diana, T., Binder, H. et al. Thyroid-stimulating immunoglobulins indicate the onset of dysthyroid optic neuropathy. J Endocrinol Invest 38, 769–777 (2015). https://doi.org/10.1007/s40618-015-0254-2

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