Clinical Utility of TSH Receptor Antibodies
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CONTEXT: TSH receptor antibodies (TRAb) cause Graves' disease (GD) hyperthyroidism. Widely available TRAb measurement methods have been significantly improved recently. However, the role of TRAb measurement in the differential diagnosis of hyperthyroidism, the prediction of remission of GD hyperthyroidism, the prediction of fetal/neonatal thyrotoxicosis, and the clinical assessment of Graves' ophthalmopathy (GO) are controversial. EVIDENCE ACQUISITION: We reviewed and analyzed the literature reporting primary data on the clinical use of TRAb. We focused our analyses on clinical studies analyzing third-generation TRAb assays. EVIDENCE SYNTHESIS: The performance of TRAb in the differential diagnosis of overt hyperthyroidism is excellent, with sensitivity and specificity in the upper 90%. TRAb can accurately predict short-term relapses of hyperthyroidism after a course of antithyroid drugs but are less effective in predicting long-term relapses or remissions. Pregnancies in women with GD with negative TRAb are highly unlikely to result in fetal hyperthyroidism, whereas high titers of TRAb in pregnancy require careful fetal monitoring. GD patients with GO frequently have high TRAb levels. However, there are insufficient data to use the test to predict the clinical course of GO and response to treatment. CONCLUSIONS: Third-generation TRAb assays are suitable in the differential diagnosis of hyperthyroidism. In GD, TRAb should be tested before deciding whether methimazole can be stopped. TRAb should be used in pregnant women with GD to assess the risk of fetal thyrotoxicosis. The use of TRAb in GO requires further studies.
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Third generation TSH Binding Inhibition Immunoglobulin assays are unable to distinguish the TSH-R antibody types.
“These TRAb or TBII assays are unable to distinguish the TSH-R antibody types.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [55]
Bioassays for Thyroid Stimulating Immunoglobulin specifically detect stimulating antibodies and can differentiate between the TSH-R antibody types.
“Such assays specifically detect simulating antibodies (TSI) and can differentiate between the TSH-R antibody types.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [55]
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- Authors
- Barbesino, G., & Tomer, Y.
- Affiliations
- Harvard University (US)
- James J. Peters VA Medical Center (US)
- Corresponding author
- Barbesino, Giuseppe
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2013-06-01
- Volume
- 98
- Issue
- 6
- Pages
- 2247-2255
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC3667257
- OpenAlex
- W2021566627
- Cited by
- 237
- References
- 89
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 20 · 2023: 24 · 2022: 32 · 2021: 19 · 2020: 17 · 2019: 16 · 2018: 18 · 2017: 13 · 2016: 23 · 2015: 13 · 2014: 15 · 2013: 4 · 2012: 1
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Massachusetts General Hospital
- National Institute of Diabetes and Digestive and Kidney Diseases (DK061659, DK073681, R01DK061659, DK067555, R01DK073681, R01DK067555)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Keywords
- TSH receptor antibodies, Graves' disease, hyperthyroidism, differential diagnosis of hyperthyroidism, Graves' ophthalmopathy, pregnancy, remission prediction, antithyroid drug withdrawal
- MeSH terms
- Autoantibodies, Female, Graves Disease, Humans, Maternal-Fetal Exchange, Pregnancy, Prognosis, Receptors, Thyrotropin, Graves Ophthalmopathy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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