Thyroid-Stimulating Antibody/Thyroid-Stimulating Hormone Receptor Antibody Ratio as a Sensitive Screening Test for Active Graves' Orbitopathy
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Updated: Sep 3, 2025
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Published on: March 17, 2023
Masayoshi Nakano1, Hiroe Konishi1, Masahiro Koshiba1
1Department of Clinical Laboratory Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan.
Objective:
Graves' orbitopathy (GO), an extrathyroidal manifestation of Graves' disease, can seriously threaten a patient's quality of life. Given that immunosuppressive treatment during the early active phase of GO has been found to reduce both disease activity and severity, sensitive screening tests are needed.
Methods:
The present study included 86 patients with GO, in whom serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine, thyroid-stimulating antibody, TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin, and thyroglobulin antibody were measured within 2 months before magnetic resonance imaging (MRI) for orbit assessment.
Results:
The thyroid-stimulating antibody/TSH receptor antibody ratio was able to distinguish MRI results with a correct classification rate of 81%. When focusing on patients without T3 predominant Graves' diseases, the ratio distinguished MRI results at a rate of 92%. Receiver operating characteristic curve analysis revealed a cutoff antibody ratio of 87, which yielded a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 91%, 95%, 18.2, and 0.0957, respectively, for distinguished MRI results.
Conclusions:
The thyroid-stimulating antibody/TSH receptor antibody ratio is a highly sensitive and specific indicator for active GO, especially in patients without T3 predominance, and serves as a good screening test for active GO in primary care settings.
Insights
The thyroid-stimulating antibody/TSH receptor antibody ratio effectively screens for active Graves' orbitopathy (GO). This ratio is a sensitive and specific indicator, particularly in patients without T3 predominance, aiding early diagnosis.
Area of Science:
- Endocrinology
- Ophthalmology
- Immunology
Background:
- Graves' orbitopathy (GO) is a severe extrathyroidal manifestation of Graves' disease impacting quality of life.
- Early immunosuppressive treatment for active GO can reduce disease activity and severity.
- Sensitive screening tests are crucial for timely intervention in active GO.
Purpose of the Study:
- To evaluate the diagnostic utility of the thyroid-stimulating antibody (TSAb) to TSH receptor antibody (TRAb) ratio for active Graves' orbitopathy.
- To determine the sensitivity and specificity of this ratio in identifying active GO, especially in specific patient subgroups.
Main Methods:
- Serum levels of various thyroid-related antibodies and hormones were measured in 86 GO patients.
- Magnetic resonance imaging (MRI) was used for orbit assessment.
- The ratio of TSAb/TRAb was analyzed for its ability to correlate with MRI findings.
Main Results:
- The TSAb/TRAb ratio correctly classified MRI results in 81% of patients.
- This classification rate improved to 92% in patients without T3-predominant Graves' disease.
- A cutoff ratio of 87 demonstrated high sensitivity (91%) and specificity (95%) for distinguishing active GO.
Conclusions:
- The TSAb/TRAb ratio is a highly sensitive and specific biomarker for active GO.
- This ratio is particularly effective in patients without T3 predominance.
- It serves as a valuable screening tool for active GO in primary care settings.
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