PURPOSE Thyrotropin receptor autoantibodies (TSH-R-Ab) are heterogeneous in their biological function and play a significant role in the pathophysiology of both Graves' disease and Graves' orbitopathy (GO). The clinical significance and utility of determining functional TSH-R-Ab in a Serbian collective were evaluated. METHODS 91 consecutive patients with GO were included in this study. Total TSH-R-Ab concentration, referred to as TSH-R binding inhibitory immunoglobulins (TBII) was detected using a competitive-binding immunoassay. Stimulating and blocking TSH-R-Ab (TSAb and TBAb) were measured with cell-based bioassays. RESULTS Stimulating TSAb activity and TBII positivity were detected in 85 of 91 (93.4%) and 65 of 91 (71.4%) patients with GO (P < 0.001). Blocking TBAb activity was observed in only one patient who expressed dual stimulating and blocking TSH-R-Ab activity. The sensitivity rates for differentiating between clinically active versus inactive and mild versus moderate-to-severe GO were 100% and 100% for TSAb, respectively. In contrast, these were 82% and 87% only for TBII. Seven of eight (87.5%) and one of eight (12.5%) euthyroid patients with GO were TSAb and TBII positive, respectively (P < 0.031). TSAb serum levels significantly predicted GO activity compared to TBII (odds ratio, OR, 95%CI: 3.908, 95%CI 1.615-9.457, P = 0.003; versus 2.133, 0.904-5.032, P = 0.084, univariate analysis; and OR 4.341, 95%CI 1.609-11.707, P = 0.004; versus 2.337, 0.889-6.145, P = 0.085 multivariate analysis). CONCLUSION Stimulating TSAb are highly prevalent in patients with GO and show superior clinical characteristics and predictive potential compared to the traditionally used TBII.

中文翻译：

---

功能性促甲状腺激素受体抗体在塞尔维亚 Graves 眼眶病患者中的临床价值。

目的 促甲状腺激素受体自身抗体 (TSH-R-Ab) 在其生物学功能上具有异质性，并且在 Graves 病和 Graves 眼眶病 (GO) 的病理生理学中发挥重要作用。评估了在塞尔维亚集体中确定功能性 TSH-R-Ab 的临床意义和效用。方法 91 例 GO 患者被纳入本研究。使用竞争性结合免疫测定法检测总 TSH-R-Ab 浓度，称为 TSH-R 结合抑制性免疫球蛋白 (TBII)。使用基于细胞的生物测定法测量刺激和阻断 TSH-R-Ab（TSAb 和 TBAb）。结果 91 名 GO 患者中有 85 名 (93.4%) 和 91 名 (71.4%) 患者中检测到刺激 TSAb 活性和 TBII 阳性 (P < 0.001)。仅在一名表达双重刺激和阻断 TSH-R-Ab 活性的患者中观察到阻断 TBAb 活性。对于 TSAb，区分临床活动与非活动以及轻度与中度至重度 GO 的敏感性分别为 100% 和 100%。相比之下，仅 TBII 为 82% 和 87%。8 名甲状腺功能正常的 GO 患者中有 7 名（87.5%）和 1 名（12.5%）分别为 TSAb 和 TBII 阳性（P < 0.031）。与 TBII 相比，TSAb 血清水平显着预测 GO 活性（比值比，OR，95%CI：3.908，95%CI 1.615-9.457，P = 0.003；对比 2.133，0.904-5.032，P = 0.084，单变量分析；和 OR 4.341 , 95%CI 1.609-11.707, P = 0.004；与 2.337, 0.889-6.145, P = 0.085 多变量分析相比）。