title: The Presence of Thyroid-Stimulation Blocking Antibody Prevents High Bone Turnover in Untreated Premenopausal Patients with Graves' Disease.
abstract: Osteoporosis-related fractures are one of the complications of Graves' disease. This study hypothesized that the different actions of thyroid-stimulating hormone receptor (TSHR) antibodies, both stimulating and blocking activities in Graves' disease patients might oppositely impact bone turnover. Newly diagnosed premenopausal Graves' disease patients were enrolled (n = 93) and divided into two groups: patients with TSHR antibodies with thyroid-stimulating activity (stimulating activity group, n = 83) and patients with TSHR antibodies with thyroid-stimulating activity combined with blocking activity (blocking activity group, n = 10). From the stimulating activity group, patients who had matched values for free T4 and TSH binding inhibitor immunoglobulin (TBII) to the blocking activity group were further classified as stimulating activity-matched control (n = 11). Bone turnover markers BS-ALP, Osteocalcin, and C-telopeptide were significantly lower in the blocking activity group than in the stimulating activity or stimulating activity-matched control groups. The TBII level showed positive correlations with BS-ALP and osteocalcin levels in the stimulating activity group, while it had a negative correlation with the osteocalcin level in the blocking activity group. In conclusion, the activation of TSHR antibody-activated TSH signaling contributes to high bone turnover, independent of the actions of thyroid hormone, and thyroid-stimulation blocking antibody has protective effects against bone metabolism in Graves' disease.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Sun Wook
authors.initials: SW
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Bae
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Gyeong Woon
authors.initials: GW
authors.lastname: Noh
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Ye An
authors.initials: YA
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.|Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Min Kyong
authors.initials: MK
authors.lastname: Moon
authors.affiliation: Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Kyoung Un
authors.initials: KU
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Boramae Medical Center, Seoul, South Korea.
authors.forename: Junghan
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.|Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Ka Hee
authors.initials: KH
authors.lastname: Yi
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Do Joon
authors.initials: do J
authors.lastname: Park
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea.
authors.forename: June-Key
authors.initials: JK
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.|Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.
authors.forename: Bo Youn
authors.initials: BY
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Park
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D016723:Bone Remodeling / Q000276:immunology*; D016022:Case-Control Studies; D005260:Female; D006111:Graves Disease / Q000097:blood / Q000276:immunology*; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood* / Q000276:immunology*; D011989:Receptors, Thyrotropin / Q000097:blood; D013960:Thyroid Function Tests; D013963:Thyroid Hormones / Q000097:blood*
chemical_list: D001323:Autoantibodies; D018828:Immunoglobulins, Thyroid-Stimulating; D011989:Receptors, Thyrotropin; D013963:Thyroid Hormones; C118905:thyroid stimulation-blocking antibody; C094372:thyrotropin-binding inhibitory immunoglobulin