| Objective: Hyperthyroidism is the thyrotoxicosis due to the excessive thyroid hormomes which the thyroid itself composes. And Graves' disease (GD) is the most frequent cause of hyperthyroidism. Currently, it is generally acknowledged that GD is an organ-specific autoimmune disorder with genetic predisposition. Some studies has proved that the serum thyrotropin receptor antibodie(TRAb) plays an important role in the pathogenesis, progression, and relapse of GD. TRAb is a G-protein linked immunoglobulin produced by the lymphocytes of the thyroid glands. In the case of abnormal situations, TRAb binds to the TSH receptors, activates the adenylate cyclases, increases the cAMP, and imitates the biological effects of TSH, such as accelerating the proliferation of the thyroid folliculars, stimulating the synthesis and the release of thyroid hormones, and finally leads to hyperthyroidism. Graves ophthalmo- pathy (infiltrative exophthalmos, GO), often companied with GD, is also an autoimmune disease which indicates that there may exsist common antigen in the two organs. Nowadays the treatment with anti-thyroid drug (ATD) is still the common therapy of GD , but the relapse rate is very high (about 50%) after therapy withdrawal. This study was performed to explore the role of TRAb in the course of the Graves'diease by means of detecting serum TRAb levels in GD petients, then to direct the ATD treatment, improve the cure rate and lower the relapse ratio. In addition, the relationship between TRAb and infiltrative exophthalmos, and the extent of goiter in patents of GD were further investigated.Methods: According to the GD diagnostic criteria of the Guide of Diagnosis and Treatment of Thyroid Diseases in 2008, A total of 276 patients of GD were enrolled. And another 50 healthy subjects without autoimmune disease and matched with GD group in gender and age were also observed. The GD patients were divided into five groups: the newly diagnosed group (Group A), the alleviated group after anti-thyroid treatment (Group B), the non-alleviated group (Group C), the relapsing group in six months after successful treatment (Group D), and the non-relapsing group (Group E). The vein blood specimens of all subjects were sampled and centrifuged. The serums were kept in the -20℃refrigerator and determined in bulk for TRAb, thyrotropin and thyroid hormones. After that, the GD group was divided into several groups on the basis of exophthalmos and the exent of goiter. The TRAb levels and the positive ratio were respectively compared. The data were dealt with SPSS 13.0.Results:1 Thyroid hormone (TT3, TT4, FT3, FT4) and TSH levels ( x±s)1.1 Control:1.86±0.57 nmol/L, 105.61±28.76 nmol/L, 4.12±0.38 pmol/L, 10.13±3.84 pmol/L and 1.41±0.97 mIU/L.1.2 Group A: 4.78±0.84 nmol/L, 399.05±32.16 nmol/L, 21.26±11.01 pmol/L, 50.49±16.06 pmol/L and 0.03±0.02 mIU/L.1.3 Group B:2.15±0.46 nmol/L, 112.34±20.41 nmol/L, 4.97±0.84 pmol/L, 11.02±3.16 pmol/L and 1.92±0.45 mIU/L.1.4 Group C:3.92±1.05 nmol/L, 343.38±29.61 nmol/L, 18.24±9.58 pmol/L, 43.57±14.24 pmol/L and 0.23±0.10 mIU/L.1.5 Group D:5.12±1.79 nmol/L, 401.26±19.73 nmol/L, 27.23±8.64 pmol/L, 57.81±10.28 pmol/L and 0.04±0.02 mIU/L.1.6 Group E:1.79±0.38 nmol/L, 100.87±20.91 nmol/L, 4.25±0.09 pmol/L, 12.58±1.39 pmol/L and 1.13±0.92 mIU/L.2 The TRAb levels and positive rate were 35.02±5.46 IU/L and 54.82% in Group A, and 26.11±3.72 IU/L and 50.71% in Group D, both were significantly higher than 1.51±0.28 IU/L and 0 in normal group(both P<0.01). The TRAb levels and positive rate were 2.47±0.36 IU/L和1.42% in Group E, and no statistical difference was observed between Group E and normal group(P>0.05). 3 The levels and positive rate of TRAb were 7.85±1.29 IU/L and 29.71% in Group B, which significantly lower than 19.28±4.25 IU/L and 36.19% in the Group C (P<0.01).4 TRAb levels and positive rate in GD patients with infiltrative exophthalmos were statistically higher than that in those without infiltrative exophthalmos(29.73±6.19 IU/L and 48.26% vs 12.69±3.42 IU/L and 8.53%, P<0.01).5 Related analysis showed that there was no correlation between TRAb levels and thyroid related hormones in GD patients ( r=0.126, 0.084, 0.262, 0.160 and 0.027, P<0.01).6 The TRAb levels and positive rate of three different exents of goiter in GD group were respectively 15.67±2.78 IU/L and 24.71%, 17.73±4.72 IU/L and 29.86%,25.61±6.53 IU/L and 41.72%(P>0.05).There was no difference among the three groups.Conclusions:1 TRAb played an effective role in the initial course of GD.2 TRAb was an useful predictor of assessing the remiss of GD; and the resume of basic immunological function was a slow process.3 The measurement of TRAb was meaningful for the prediction of relapse after medical treatment of GD.4 TRAb could be used as an useful indicator for the pathogenesis and diagnosis of infiltrative exophthalmos.5 TRAb level was not associated with thyroid related hormone level and the goiter extent in GD patients.
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