title: Third-generation ELISA thyrotropin-receptor antibody levels as an adjuvant tool to guide management of patients with Graves orbitopathy.
abstract: OBJECTIVE
  When assessing patients with Graves orbitopathy (GO) in an endocrinology outpatient setting, it is desirable to have a diagnostic laboratory tool to complement the clinical activity score (CAS) in distinguishing patients with moderate-severe active GO requiring high-priority ophthalmological care from those with mild or inactive GO who can be electively scheduled and to asses response to treatment.
  
  
  METHODS
  A retrospective study was conducted to evaluate the correlation between thyrotropin-receptor antibody (TRAb)-Fast-enzyme-linked immunosorbent assay (ELISA) results and CAS in patients with GO seen at a tertiary referral center between 2000 and 2009. TRAb levels were quantified using a commercial third-generation TRAb-specific ELISA. Other variables analyzed included smoking status, gender, age, and thyroid-stimulating hormone level.
  
  
  RESULTS
  Fifty-five patients with GO had a documented CAS within a mean of 22 days from the recorded TRAb level determined by TRAb-Fast-ELISA. An increase in TRAb-Fast-ELISA of 1 unit was associated with a 15% (95% confidence interval, 7-24%) increase in the odds ratio of elevated CAS. A TRAb-Fast-ELISA result ≥10 as a diagnostic tool to predict a CAS ≥3 was assessed and was found to have a specificity of 86.7% and a sensitivity of 87.2% for moderately severe GO.
  
  
  CONCLUSIONS
  Our results demonstrate the ability to predict a patient's GO activity level by antibody titer. A TRAb-Fast-ELISA result ≥10 can be used as a complementary diagnostic tool to predict a CAS ≥3.
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Ravit
authors.initials: R
authors.lastname: Tvito-Green
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Israel Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Reich
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Israel Endocrinology and Metabolism Institute, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Robenshtok
authors.affiliation: Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chodick
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Israel Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel Schneider's Children's Medical Center, Petah Tikva, Israel.
authors.forename: Yonina
authors.initials: Y
authors.lastname: Ron-Kella
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Israel Unit of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Hadas
authors.initials: H
authors.lastname: Stiebel-Kalish
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D005260:Female; D049970:Graves Ophthalmopathy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011989:Receptors, Thyrotropin / Q000276:immunology*; D012189:Retrospective Studies
chemical_list: D001323:Autoantibodies; D011989:Receptors, Thyrotropin