Epidemiology of thyroid-stimulating immunoglobulin in recent-onset symptomatic thyroid eye disease

• Published in: European thyroid journal Vol. 13; no. 4; pp. 1 - 7
• Main Authors: Lai, Kenneth Ka Hei, Aljufairi, Fatema Mohamed Ali Abdulla, Sebastian, Jake Uy, Wei, Yingying, Jia, Ruofan, Chan, Karen Kar Wun, Au, Elaine Yuen Ling, Lee, Alan Chun Hong, Ng, Chiu Ming, Yuen, Hunter Kwok Lai, Yip, Wilson Wai Kuen, Young, Alvin Lerrmann, Cheng, George Pak Man, Tham, Clement Chee Yung, Pang, Chi Pui, Chong, Kelvin Kam Lung
• Format: Journal Article
• Language: English
• Published: England Bioscientifica Ltd 01-08-2024; Bioscientifica
• Subjects: Adult; Aged; Diplopia - epidemiology; Exophthalmos - blood; Exophthalmos - epidemiology; Female; Graves Ophthalmopathy - blood; Graves Ophthalmopathy - drug therapy; Graves Ophthalmopathy - epidemiology; Hong Kong - epidemiology; Humans; Immunoglobulins, Thyroid-Stimulating - blood; Magnetic Resonance Imaging; Male; Middle Aged; Oculomotor Muscles - diagnostic imaging; Prospective Studies; thyroid eye disease; thyroid-stimulating immunoglobulin; Hong Kong; thyroid eye disease; thyroid-stimulating immunoglobulin
• ISSN: 2235-0802; 2235-0640; 2235-0802
• DOI: 10.1530/ETJ-23-0129

This study aims to report correlations between thyroid-stimulating immunoglobulin (TSI) and both clinical and radiological parameters in recent-onset symptomatic thyroid eye disease (TED) patients.
A prospective cohort study of TED patients managed at the Chinese University of Hong Kong from January 2014 to May 2022. Serum TSI levels were determined with the functional assay. Outcomes included the Clinical Activity Score (CAS), marginal reflex distance1 (MRD1), extraocular muscle motility restriction (EOMy), exophthalmos, and diplopia. The radiological assessment included cross-sectional areas and signal of extraocular muscles on STIR-sequence MRI.
A total of 255 (197 female) treatment-naive patients, with an average onset age of 50 ± 14 years (mean ± s.d.), were included. Elevated pre-treatment TSI level was observed in 223 (88%) patients. There was a weak positive correlation between TSI and CAS (r = 0.28, P = 0.000031), MRD1 (r = 0.17, P = 0.0080), and the size of the levator palpebrae superioris/superior rectus complex (r = 0.25, P = 0.018). No significant correlation existed between TSI and STIR signals. The AUC and optimal cut-off value for clinical active TED were 0.67 (95% CI: 0.60-0.75) and 284% (specificity: 50%, sensitivity: 85%). In total, 64 patients received intravenous methylprednisolone (IVMP) during the study interval, and they had a higher baseline TSI level than those who did not have IVMP (P = 0.000044). Serial post-IVMP TSI among the 62 patients showed a significant reduction compared to the baseline level (P < 0.001). Both the baseline and post-IVMP TSI levels, and percentages of TSI changes were comparable between patients who responded and did not respond to the first course of IVMP.
TSI can be a serum biomarker for the diagnosis, prognosis, and treatment response of TED. Further validation should be warranted.