Positive Thyrotropin Receptor Antibodies in Patients with Transient Thyrotoxicosis |
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| Institution: | 2. 2;3. 3;2. 2;3. 3;4. 4;5. 5;6. 6;7. 7;8. 8;1. From the Departments of Endocrinology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.;2. Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.;2. 2;3. 3;4. 4;1. Department of Internal Medicine, Division of Endocrinology, Texas Tech University Health Science Center, Lubbock, Texas;2. Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas;3. Department of Internal Medicine, Division of Cardiology, Texas Tech University Health Science Center, Lubbock, Texas;4. Department of Internal Medicine, Division of Pulmonology, Texas Tech University Health Science Center, Lubbock, Texas.;1. Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic, Cleveland, Ohio;2. Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio;3. Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio;4. Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio;5. Department of Endocrinology & Metabolism, Cleveland Clinic, Abu Dhabi, United Arab Emirates. |
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| Abstract: | Objective: Thyrotropin (TSH) receptor antibody (TRAb) testing is considered accurate for the diagnosis of Graves disease (GD) and has been identified rarely in thyrotoxic patients without GD. We describe 4 patients with transient thyrotoxicosis and positive TRAb to highlight this clinical possibility.Methods: Patient demographics, symptoms, laboratory findings, and time to resolution of thyrotoxicosis are summarized. TRAb testing was performed by either a third-generation thyrotropin-binding inhibitory immunoglobulin (TBII) competitive-binding assay or a thyroid-stimulating immunoglobulin (TSI) bioassay from either Mayo Clinic Laboratory or Quest Diagnostics.Results: Four patients with transient thyrotoxicosis and positive TRAb testing were identified. Of these, three were female, and the median age was 44 years (range, 25 to 49 years). Median symptom duration at evaluation was 6.5 weeks (range, 3 to 12 weeks). No patient had any clinical manifestations unique to GD or exposure to biotin, thyroid hormone, supplements, iodine, or relevant medications. The TSH was <0.1 mIU/L in all patients. Three patients had a positive TSI, which was elevated less than twice the upper limit of the reference range in all cases, and 1 patient had a strongly positive TBII. None of the patients were treated with thionamides or radioactive iodine. Spontaneous resolution occurred in all patients at a median of 5.5 weeks (range, 2 to 14.4 weeks).Conclusion: These cases demonstrate that TSI or TBII may be present in thyrotoxic patients with transient thyrotoxicosis. For clinically stable patients presenting without pathognomonic evidence of GD, mildly elevated TRAb results may require cautious interpretation, and alterative diagnostic testing or close monitoring should be considered.Abbreviations: cAMP = cyclic adenosine monophosphate; FT4 = free thyroxine; GD = Graves disease; TBII = thyrotropin-binding inhibitory immunoglobulin (also known as TBI); TRAb = thyrotropin receptor antibody; TSH = thyrotropin; TSHR = thyrotropin receptor; TSI = thyroid-stimulating immunoglobulin; TT3 = total triiodothyronine; TT4 = total thyroxine |
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