Suzuki Nami, Kawaguchi Akiko, Yoshimura Noh Jaeduk, Yoshimura Ran, Mikura Kentaro, Kinoshita Aya, Suzuki Ai, Mitsumatsu Takako, Hoshiyama Ayako, Fukushita Miho, Matsumoto Masako, Yoshihara Ai, Watanabe Natsuko, Sugino Kiminori, Ito Koichi
Department of Internal medicine, Ito Hospital, Tokyo, 150-0001, Japan.
Department of Surgery, Ito Hospital, Tokyo, 150-0001, Japan.
J Endocr Soc. 2021 Mar 15;5(6):bvab042. doi: 10.1210/jendso/bvab042. eCollection 2021 Jun 1.
Thyroid stimulating hormone receptor antibody (TRAb) is detected in the serum of patients with Graves' disease (GD). This study aims to investigate the prevalence of euthyroid individuals showing positive results for TRAb and to clarify the clinical course of thyroid function and TRAb levels in these subjects.
Subjects were female patients who newly visited our hospital for a screening test prior to fertility treatment and showed normal thyroid function and volume without nodules between 2014 and 2017. After excluding subjects with a history of thyroid disease, 5,622 subjects were analyzed.
Forty-seven of the 5,622 subjects showed positive results for TRAb (reference range, <2.0 IU/L) at the initial visit. Median initial TRAb was 2.9 IU/L (range, 2.0-14.7 IU/L) and median follow-up was 18.3 months (range, 0-66.5 months). Six of the 47 subjects (12.8%) developed GD and median duration until development was 6.6 months (range, 1.2-13.2 months). Median TRAb values initially and at diagnosis of GD for those 6 patients were 3.7 IU/L (range, 2.7-5.1 IU/L) and 7.2 IU/L (range 3.6-21.4 IU/L), respectively. TRAb results turned negative for 20 of the 47 subjects but remained positive despite normal thyroid function in 13 of the 47 subjects.
GD developed over time in 12.8% of euthyroid young female patients showing positive TRAb within a median of 6.6 months. A positive result for TRAb itself did not mean development of GD, so other factors must be essential for the pathogenesis of GD.
在格雷夫斯病（GD）患者的血清中可检测到促甲状腺激素受体抗体（TRAb）。本研究旨在调查TRAb检测结果呈阳性的甲状腺功能正常个体的患病率，并阐明这些受试者的甲状腺功能和TRAb水平的临床病程。
研究对象为2014年至2017年间因生育治疗前筛查而首次就诊于我院、甲状腺功能和体积正常且无结节的女性患者。排除有甲状腺疾病史的受试者后，对5622名受试者进行了分析。
5622名受试者中，47名在初次就诊时TRAb检测结果呈阳性（参考范围，<2.0 IU/L）。初次就诊时TRAb的中位数为2.9 IU/L（范围为2.0 - 14.7 IU/L），随访中位数为18.3个月（范围为0 - 66.5个月）。47名受试者中有6名（12.8%）发生了GD，发生GD的中位时间为6.6个月（范围为1.2 - 13.2个月）。这6名患者初次就诊时和诊断为GD时的TRAb中位数分别为3.7 IU/L（范围为2.7 - 5.1 IU/L）和7.2 IU/L（范围为3.6 - 21.4 IU/L）。47名受试者中有20名TRAb检测结果转为阴性，但47名受试者中有13名尽管甲状腺功能正常但TRAb仍为阳性。
在TRAb呈阳性的甲状腺功能正常的年轻女性患者中，12.8%在中位时间6.6个月内随时间推移发生了GD。TRAb检测结果呈阳性本身并不意味着会发生GD，则其他因素对于GD的发病机制必定至关重要。
