title: Clinical features of thyroid-associated ophthalmopathy in clinically euthyroid Korean patients.
abstract: OBJECTIVE
  To compare clinical characteristics and thyroid-stimulating hormone receptor antibodies (TRAbs) in thyroid-associated ophthalmopathy (TAO) in euthyroid Korean patients with those in hyperthyroid patients.
  
  
  METHODS
  Clinical activity scores (CASs), modified NOSPECS scores, exophthalmometry values, prevalence of optic neuropathy, restrictive myopathy and lid retraction, and the positivity and levels of TRAb (thyrotropin-binding inhibitor immunoglobulin (TBII) and thyroid-stimulating immunoglobulin (TSI)) were compared in 24 euthyroid (group A) and 139 clinical/subclinical hyperthyroid TAO patients (group B).
  
  
  RESULTS
  Group A presented more clinically unilateral involvement than group B (79.2% vs 27.3%, P<0.001), less active (CAS 1.50 vs 2.26, P=0.014) and less severe clinical course (NOSPECS 3.38 vs 4.13, P=0.037). Lid retraction was more prevalent in group A than group B (91.7% vs 66.2%, P=0.014). Prevalence of optic neuropathy and restrictive myopathy, and the mean value of exophthalmometry were not different. Mean TBII levels were lower (7.20 IU/l) in group A than in group B (44.58 IU/l, P<0.001). A similar difference was found in the TSI bioassay (201.40% vs 425.19%, P=0.001). The positive rate of TBII in group A (34.8%) was significantly lower than in group B (90.8%, P<0.001). The positive rate of TSI was high in both group A (83.3%) and B (91.7%), with no significant difference (P=0.337).
  
  
  CONCLUSIONS
  Patients with euthyroid TAO showed a less active and severe clinical course, more unilateral involvement, and lower levels of TRAb than those in patients with hyperthyroid TAO. These distinct clinical and biochemical characteristics might be useful in assessment of euthyroid TAO, and the TSI might be more sensitive for diagnosing these patients.
authors: Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
authors: S Y
authors: SY
authors: Jang
authors: S Y
authors: SY
authors: Lee
authors: E J
authors: EJ
authors: Lee
authors: J S
authors: JS
authors: Yoon
mesh_terms: D000328:Adult; D005067:Euthyroid Sick Syndromes / Q000175:diagnosis* / Q000276:immunology; D005141:Eyelid Diseases / Q000175:diagnosis / Q000276:immunology; D005260:Female; D049970:Graves Ophthalmopathy / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis / Q000276:immunology; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D007723:Korea; D008297:Male; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000276:immunology; D011989:Receptors, Thyrotropin / Q000276:immunology; D012189:Retrospective Studies; D013974:Thyroxine / Q000097:blood; D014057:Tomography, X-Ray Computed; D014284:Triiodothyronine / Q000097:blood; D014792:Visual Acuity
chemical_list: D018828:Immunoglobulins, Thyroid-Stimulating; D011989:Receptors, Thyrotropin; C094372:thyrotropin-binding inhibitory immunoglobulin; D014284:Triiodothyronine; D013974:Thyroxine