title: Thyroid stimulating immunoglobulin is often negative in children with Graves' disease.
abstract: BACKGROUND
  The diagnosis of Graves' disease (GD) is typically confirmed with a thyroid stimulating immunoglobulin (TSI) titer. While TSI is reported to be positive in >90% of patients with GD, our anecdotal experience suggests that TSI negative GD may be more common in children.
  
  
  OBJECTIVE
  To investigate the incidence of TSI negative GD in our population and to compare patients with TSI negative vs TSI positive GD.
  
  
  METHODS
  Charts of children with GD seen in our pediatric endocrinology clinic over the past 5 years were reviewed.
  
  
  RESULTS
  Fifty-seven patients with GD were included. TSI was negative in 43% of patients. No significant differences were found in children with TSI negative vs TSI positive GD.
  
  
  CONCLUSIONS
  In patients with GD, the finding of a negative TSI titer usually creates diagnostic uncertainty. However, the fact that nearly half of our patients with GD were TSI negative suggests that this is common in children.
authors.affiliation: Section of Pediatric Endocrinology/Diabetology, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN 46260, USA. sxrahhal@stvincent.org
authors.forename: Samar N
authors.initials: SN
authors.lastname: Rahhal
authors.forename: Erica A
authors.initials: EA
authors.lastname: Eugster
mesh_terms: D000293:Adolescent; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006111:Graves Disease / Q000097:blood* / Q000276:immunology; D050031:Hashimoto Disease / Q000175:diagnosis; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood*; D008297:Male; D011237:Predictive Value of Tests; D012016:Reference Values; D016606:Thyroid Nodule / Q000175:diagnosis; D013971:Thyrotoxicosis / Q000175:diagnosis
chemical_list: D018828:Immunoglobulins, Thyroid-Stimulating