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Improvement of infiltrative ophthalmopathy in parallel with decrease of thyroid-stimulating antibody (TSAb) activity
1Department of Laboratory Medicine, Osaka University Medical School, Japan.
Journal of Endocrinological Investigation
|January 1, 1989
Summary
This study presents two cases of primary hypothyroidism with eye disease, revealing thyroid-stimulating antibodies (TSAb) instead of blocking antibodies. Treatment with levothyroxine reduced these antibodies and improved eye symptoms, suggesting a link to Graves' disease.
Area of Science:
- Endocrinology
- Immunology
- Ophthalmology
Background:
- Primary hypothyroidism typically presents with blocking TSH receptor antibodies (TRAb).
- Infiltrative ophthalmopathy is commonly associated with hyperthyroidism in Graves' disease.
Observation:
- Two patients with primary hypothyroidism and infiltrative ophthalmopathy were identified.
- Unexpectedly, both patients had thyroid-stimulating antibodies (TSAb) rather than blocking antibodies.
- Levothyroxine therapy led to decreased TRAb and TSAb levels, alongside normalized TSH.
Findings:
- TRAb in primary hypothyroidism can exhibit thyroid-stimulating (TSAb) activity.
- Levothyroxine therapy correlated with reduced TRAb/TSAb and improved ophthalmopathy.
- These cases support a diagnosis of "hypothyroid Graves' disease".
Implications:
- TSAb may play a role in the pathogenesis of ophthalmopathy in autoimmune thyroid disease.
- This challenges the traditional association of ophthalmopathy solely with hyperthyroid Graves' disease.
- Further research into the role of TSAb in autoimmune thyroid eye disease is warranted.