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S.B. Marshall, J.B. Kerrison, D.E. Holck, S.M. Blaydon; Thyroid Antibodies in Association with Thyroid Ophthalmopathy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4610.
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Purpose: In some cases, thyroid ophthalmopathy (TO) is a clinically challenging diagnosis. Some patients meet minimal criteria for TO according to the clinical NOSPECS classification, yet they have normal thyroid function testing (TFT) and unremarkable computed tomography (CT) scans. Conventional TFTs and CT scanning lack sensitivity for TO. The aim of this study is to assess the sensitivity and specificity of a variety of thyroid autoantibodies in the diagnosis of TO. Such antibodies may be useful in establishing a diagnosis of TO when clinical diagnosis is uncertain. Methods: This project was designed as an age-matched case control study. Cases were all patients who had been seen at Wilford Hall Medical Center (WHMC) or Brooke Army Medical Center (BAMC) ophthalmology for treatment of TO. Controls were age-matched subjects seen by ophthalmology at WHMC/BAMC for an eye exam, who have a history of thyroid dysfunction, but have no evidence of TO (e.g. no lid retraction, proptosis, diplopia, dysmotility, or optic neuropathy). The following laboratory values were performed: Thyroglobulin Antibody, Thyroid Microsomal Antibody, Thyroid Peroxidase Antibodies, Thyrotropin Binding Inhibitor Immunoglobulin, Thyroid Stimulating Immunoglobulin, and Thyroxine Binding Globulin. Data was analyzed using a two-tailed t-test assuming unequal variances. Results: Nineteen cases with TO and twenty-one controls without TO who had thyroid dysfunction were recruited. Five of six antibodies tested were not significantly different. However, cases had elevated Thyrotropin Binding Inhibitor Immunoglobulin (TBI Ig) values (28.11±11.30 [95% Confidence Interval (CI)]) while controls were within normal (6.40±1.28 [95% CI]) (p=0.0009). Sensitivity of TBI Ig for TO was 0.78 and specificity was 0.90. Conclusions: Testing for elevated levels of Thyrotropin Binding Inhibitor Immunoglobulin may assist in the diagnosis of TO.
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