갑상선기능항진증에서 갑상선 자가항체의 해석
Interpretation of Thyroid Autoantibodies in Hyperthyroidism
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Thyrotoxicosis is a clinical state with a variety of various etiologies that results from excess thyroid hormones, including hyperthyroidism and thyroiditis. Graves' disease (GD) is a well-known autoimmune thyroid disease that causes hyperthyroidism, and its pathogenesis is mainly driven by the thyroid-stimulating hormone receptor antibody (TSHRAb), which is highly specific for GD. Measuring the TSHRAb is a fast and accurate diagnostic tool for GD and has been used to monitor disease activity and the treatment response. However, conventional TSH-binding inhibitory immunoglobulin (TBII) does not differentiate between stimulating, blocking, or neutral antibodies. In contrast, thyroid stimulatory immunoglobulin bioassays differentiate between stimulating and blocking antibodies and have comparably high sensitivity and specificity to TBII for GD. We also discuss the role of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) in thyrotoxicosis, although they are less specific than TSHRAb for GD. TPOAb is associated with autoimmune thyroiditis, while TgAb appears with TPOAb in patients with autoimmune thyroid disease. In addition, TPOAb or TgAb may be associated with a low recurrence of GD after discontinuing anti-thyroid drugs. Clinicians should interpret thyroid autoantibodies in the context of the patient's clinical presentation and consider their implications to manage and monitor thyrotoxicosis.
Abstract
Thyrotoxicosis is a clinical state with a variety of various etiologies that results from excess thyroid hormones, including hyperthyroidism and thyroiditis. Graves' disease (GD) is a well-known autoimmune thyroid disease that causes hyperthyroidism, and its pathogenesis is mainly driven by the thyroid-stimulating hormone receptor antibody (TSHRAb), which is highly specific for GD. Measuring the TSHRAb is a fast and accurate diagnostic tool for GD and has been used to monitor disease activity and the treatment response. However, conventional TSH-binding inhibitory immunoglobulin (TBII) does not differentiate between stimulating, blocking, or neutral antibodies. In contrast, thyroid stimulatory immunoglobulin bioassays differentiate between stimulating and blocking antibodies and have comparably high sensitivity and specificity to TBII for GD. We also discuss the role of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) in thyrotoxicosis, although they are less specific than TSHRAb for GD. TPOAb is associated with autoimmune thyroiditis, while TgAb appears with TPOAb in patients with autoimmune thyroid disease. In addition, TPOAb or TgAb may be associated with a low recurrence of GD after discontinuing anti-thyroid drugs. Clinicians should interpret thyroid autoantibodies in the context of the patient's clinical presentation and consider their implications to manage and monitor thyrotoxicosis.
참고문헌 (14)
- Ross DS, "2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis", Thyroid, 26, pp.1343~1421 (2016)
- Badiu C, "Williams textbook of endocrinology", Acta Endocrinol(Buchar), 15, pp.416~ (2019)
- Baek HS, "The prediction model using thyroid-stimulating immunoglobulin bioassay for relapse of Graves' disease", J Endocr Soc, 6, pp.bvac023~ (2022)
- Lytton SD, "Bioassays for TSH-receptor autoantibodies : an update", Autoimmun Rev, 10, pp.116~122 (2010)
- Tozzoli R, "TSH receptor autoantibody immunoassay in patients with Graves' disease : improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis", Autoimmun Rev, 12, pp.107~113 (2012)
- 우영재, "Clinical Association of Thyroid Stimulating Hormone Receptor Antibody Levels with Disease Severity in the Chronic Inactive Stage of Graves’ Orbitopathy", Korean Journal of Ophthalmology, 29(4), pp.213~219 (2015), 대한안과학회
- 이지인, "Diagnostic Value of a Chimeric TSH Receptor (Mc4)-Based Bioassay for Graves’ Disease", The Korean Journal of Internal Medicine, 26(2), pp.179~186 (2011), 대한내과학회
- Kahaly GJ, "Management of Graves thyroidal and extrathyroidal disease : an update", J Clin Endocrinol Metab, 105, pp.3704~3720 (2020)
- Jeon H, "Clinical relevance of thyroid-stimulating immunoglobulin as a biomarker of the activity of thyroid eye disease", Eye(Lond), 37, pp.543~547 (2023)
- 권혜미, "Usefulness of Measuring Thyroid Stimulating Antibody at the Time of Antithyroid Drug Withdrawal for Predicting Relapse of Graves Disease", Endocrinology and Metabolism, 31(2), pp.300~310 (2016), 대한내분비학회
- "Health insurance benefit expenses" (2022)[URL]
- Cho BY., "Clinical Thyroidology" (2014), Korea Medical Book Publishing Company
- Muir CA, "Thyroid peroxidase antibody positivity is associated with relapse-free survival following antithyroid drug treatment for Graves disease", Endocr Pract, 26, pp.1026~1030 (2020)
- 최윤미, "Changes in Thyroid Peroxidase and Thyroglobulin Antibodies Might Be Associated with Graves’ Disease Relapse after Antithyroid Drug Therapy", Endocrinology and Metabolism, 34(3), pp.268~274 (2019), 대한내분비학회[DOI]