title: TSBAb (TSH-stimulation blocking antibody) and TSAb (thyroid stimulating antibody) in TSBAb-positive patients with hypothyroidism and Graves' patients with hyperthyroidism.
abstract: There are two types of TSH receptor antibodies (TRAb); thyroid stimulating antibody (TSAb) and TSH-stimulation blocking antibody (TSBAb). TSAb causes Graves' hyperthyroidism. TSBAb causes hypothyroidism. Both TSAb and TSBAb block TSH-binding to thyroid cells as TSH receptor antibodies (TRAb). TSBAb-positive patients with hypothyroidism and Graves' patients with hyperthyroidism may have both TSBAb and TSAb. We studied TSBAb and TSAb in 43 TSBAb-positive patients with hypothyroidism and in 55 untreated Graves' patients with hyperthyroidism. TSBAb-activities were expressed as percentage inhibition of bovine (b) TSH-stimulated cAMP production by test IgG. Two formulas were used to calculate TSBAb-activities; TSBAb-A (%) = [1 - (c - b)/(a - b)] x 100 and TSBAb-B (%) = [1 - (c - d)/(a - b)] x 100, where a: cAMP generated in the presence of normal IgG and bTSH, b: cAMP generated in the presence of normal IgG, c: cAMP generated in the presence of test IgG and bTSH, and d: cAMP generated in the presence of test IgG. TSAb (%) = [d/b] x 100. All of the 43 TSBAb-positive patients with hypothyroidism had strongly positive TSBAb-A and -B. Some of them had weakly positive TSAb (<240%). All 55 untreated Graves' patients had positive TSAb (205-2509%). Some of them had both TSAb and TSBAb. TSBAb-positive patients with hypothyroidism had a limited distribution of TSBAb- and TSAb-activities (TSBAb-A + 75 - + 103%, TSBAb-B + 87 - + 106%, TSAb 92-240%), but Graves' patients with hyperthyroidsim had a wide distribution of TSAb- and TSBAb-activities (TSAb 205-2509%, TSBAb-A - 158 - + 43%, TSBAb-B - 14 - + 164%). TSBAb-A ignores TSAb activity in serum, and might give low TSBAb activity. However, TSBAb-A clearly differentiates TSBAb-positive patients with hypothyroidism from Graves' patients with hyperthyroidism; thus, we favor TSBAb-A over TSBAb-B. Some of TSBAb-positive patients with hypothyroidism and Graves' patients with hyperthyroidism have both TSBAb and TSAb.
authors.affiliation: Department of Internal Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Takasu
authors.forename: K
authors.initials: K
authors.lastname: Yamashiro
authors.forename: Y
authors.initials: Y
authors.lastname: Ochi
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: A
authors.initials: A
authors.lastname: Nagata
authors.forename: I
authors.initials: I
authors.lastname: Komiya
authors.forename: H
authors.initials: H
authors.lastname: Yoshimura
mesh_terms: D000328:Adult; D003627:Data Interpretation, Statistical; D005260:Female; D006111:Graves Disease / Q000276:immunology*; D006801:Humans; D007037:Hypothyroidism / Q000276:immunology*; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood*; D008297:Male; D008875:Middle Aged
chemical_list: D018828:Immunoglobulins, Thyroid-Stimulating; C118905:thyroid stimulation-blocking antibody