Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea (the Republic of).
Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea (the Republic of).
BMJ Open. 2022 Jun 21;12(6):e050337. doi: 10.1136/bmjopen-2021-050337.
The clinical course of thyroid eye disease (TED) is heterogeneous and predicting patients who may develop the severe sequelae of the disease is difficult. In this study, we evaluated the longitudinal association between changes in serum thyroid-stimulating hormone (TSH) receptor antibody (TRAb) levels and course of disease activity and severity over time.
This was a multicentre, prospective, observational study.
Fifteen tertiary care oculoplastic service centres in Korea.
Seventy-six patients with newly diagnosed TED were included and followed up for 12 months.
We evaluated clinical characteristics and serum TRAb levels at baseline, 6 and 12 months of TED diagnosis. Additionally, we analysed longitudinal associations between the serum TRAb levels and clinical activity score (CAS), no signs or symptoms, only signs, soft tissue involvement, proptosis, extraocular muscle involvement, corneal involvement, sight loss (NOSPECS) score and proptosis.
Thyroid-stimulating immunoglobulin (TSI) and TSH-binding inhibitory immunoglobulin (TBII) levels decreased during the 1-year follow-up, whereas disease activity measured using CAS decreased mainly in the first 6 months. Disease severity measured using NOSPECS score and proptosis remained unchanged. Moreover, inter-person differences in TBII levels were associated with CAS, NOSPECS score and proptosis over time, whereas inter-person differences in TSI levels were associated with NOSPECS score. Subgroup analysis of patients with a baseline CAS≥4 demonstrated that within-person changes in TSI levels affected the CAS and NOSPECS score.
Follow-up measurement of serum TSI and TBII levels may help evaluate TED prognosis and enable accurate clinical decision-making.
甲状腺眼病（TED）的临床病程存在异质性，预测可能发生疾病严重后遗症的患者较为困难。本研究旨在评估血清促甲状腺激素受体抗体（TRAb）水平变化与疾病活动度和严重程度随时间推移的纵向关联。
这是一项多中心、前瞻性、观察性研究。
韩国 15 个三级眼科整形服务中心。
纳入了 76 例新诊断的 TED 患者，并进行了 12 个月的随访。
我们在 TED 诊断时、6 个月和 12 个月评估了临床特征和血清 TRAb 水平。此外，我们还分析了血清 TRAb 水平与临床活动评分（CAS）、无症状或仅有体征、软组织受累、眼球突出、眼外肌受累、角膜受累、视力丧失（NOSPECS）评分和眼球突出之间的纵向关联。
在 1 年的随访期间，甲状腺刺激免疫球蛋白（TSI）和促甲状腺激素结合抑制免疫球蛋白（TBII）水平下降，而使用 CAS 测量的疾病活动度主要在最初的 6 个月下降。使用 NOSPECS 评分和眼球突出度测量的疾病严重程度保持不变。此外，TBII 水平的个体间差异与 CAS、NOSPECS 评分和眼球突出度随时间变化相关，而 TSI 水平的个体间差异与 NOSPECS 评分相关。在基线 CAS≥4 的患者亚组分析中，TSI 水平的个体内变化影响了 CAS 和 NOSPECS 评分。
对血清 TSI 和 TBII 水平进行随访测量可能有助于评估 TED 的预后，并为准确的临床决策提供依据。
