title: 99Tcm-octreotide scintigraphy and serum eye muscle antibodies in evaluation of active thyroid-associated ophthalmopathy.
abstract: PurposeAs an autoimmune inflammatory disorder, active thyroid-associated ophthalmopathy (TAO) is managed optimally by immunosuppression. In this study, we aimed to evaluate octreotide scintigraphy and the level of serum extraocular muscle antibodies in TAO activity.Patients and methodsThis prospective study comprised 304 patients with active TAO (the clinical activity score; CAS≥3), 73 with inactive TAO (CAS<3), 128 with Graves' disease (GD) without ophthalmopathy, and 100 healthy subjects. Moderate-to-severe active TAO patients (CAS≥5) received intravenous injection of methylprednisolone; mild active patients (3≤CAS≤4) received periocular injection of triamcinolone acetonide.99Tcm-octreotide scintigraphy and serum levels of calsequestrin, uveal auto-antigen with coiled-coil domains and ankyrin repeats (UACA) and G2s antibodies were detected before and after treatment.Results99Tcm-octreotide scintigraphy was positive in active TAO patients (97%) with elevated uptake ratio (UR) (P<0.05), and showed a significant correlation with CAS (r=0.816, P<0.01). After treatment both UR and CAS decreased significantly (P<0.05). The receiving operator characteristic curve (ROC) showed that the best UR threshold for discriminating active and inactive TAO was 1.34 (sensitivity, 100%; specificity, 89.4%). The level of serum calsequestrin antibody was higher in active TAO (P<0.05), showed a significant correlation with CAS (r=0.738, P<0.05), and also decreased after treatment (P<0.05). The best serum calsequestrin antibody threshold of the ROC curve was 138 ng/l (sensitivity, 88.4%; specificity, 89.2%). The UACA antibody was elevated in both TAO and GD patients (P<0.05), with no significant difference (P>0.05). As to G2s, no significant difference was found between all groups (P>0.05). Moreover, six GD patients (4.69%) with elevated calsequestrin developed active TAO 12 weeks later.Conclusion99Tcm-octreotide scintigraphy played a critical role in the evaluation of the clinical activity and therapeutic efficacy of TAO. Autoimmunity against calsequestrin in the pathogenesis of the eye muscle components may provide further objective evidence of myopathy in active TAO. Furthermore, calsequestrin antibody may predict myopathy in active TAO.
authors.affiliation: The Key Laboratory of National Ministry of Health for Forensic Science, College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China.|The Department of Ophthalmology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
authors.forename: B
authors.initials: B
authors.lastname: Sun
authors.affiliation: The Department of Ophthalmology, Shanxi Dayi Hospital, Taiyuan, Shanxi, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: The Department of Ophthalmology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
authors.forename: C
authors.initials: C
authors.lastname: Dong
authors.affiliation: The Department of Ophthalmology, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: The Key Laboratory of National Ministry of Health for Forensic Science, College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
authors.forename: C
authors.initials: C
authors.lastname: Yan
authors.affiliation: The Key Laboratory of National Ministry of Health for Forensic Science, College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
authors.forename: S
authors.initials: S
authors.lastname: Li
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D015551:Autoimmunity; D015415:Biomarkers / Q000097:blood; D002155:Calsequestrin / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D008297:Male; D015282:Octreotide / Q000494:pharmacology*; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging / Q000276:immunology / Q000378:metabolism*; D011446:Prospective Studies; D012372:ROC Curve; D011877:Radionuclide Imaging / Q000379:methods*; D012720:Severity of Illness Index; D013667:Technetium / Q000494:pharmacology*
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D002155:Calsequestrin; D013667:Technetium; D015282:Octreotide