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  • Author: Clement Chee Yung Tham x
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Kenneth Ka Hei Lai K Lai, Department of Ophthalmology and Visual Sciences, PWH, Hong Kong, Hong Kong

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Fatema Mohamed Ali Abdulla Aljufairi F Aljufairi , Hong Kong, Hong Kong

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Jake Uy Sebastian J Sebastian , Department of Ophthalmology and Visual Sciences, PWH, Hong Kong, Hong Kong

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Yingying Wei Y Wei, Statistics, CUHK, Hong Kong, Hong Kong

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Ruofan Jia R Jia, Statistics, CUHK, Hong Kong, Hong Kong

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Karen Kar Wun Chan K Chan, Hong Kong, Hong Kong

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Elaine Yuen Ling Au E Au , Pathology, Queen Mary Hospital, Hong Kong, Hong Kong

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Alan Chun Hong Lee A Lee, Medicine , The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong

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Chiu Ming Ng C Ng, Medicine , Queen Elizabeth Hospital, Hong Kong, Hong Kong, Hong Kong

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Hunter Kwok Lai Yuen H Yuen , Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, Hong Kong, Hong Kong

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Wilson Wai Kuen Yip W Yip, Department of Ophthalmology and Visual Sciences, PWH, Hong Kong, Hong Kong

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Alvin Lerrmann Young A Young, Department of Ophthalmology and Visual Sciences, PWH, Hong Kong, Hong Kong

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George Pak Man Cheng G Cheng, Department of Ophthalmology and Visual Sciences, CUHK, Hong Kong, Hong Kong

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Clement Chee Yung Tham C Tham, Department of Ophthalmology and Visual Sciences, CUHK, Hong Kong, Hong Kong

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Chi Pui Pang C Pang, Department of Ophthalmology and Visual Sciences, CUHK, Hong Kong, Hong Kong

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Kelvin Kam Lung Chong K Chong, Department of Ophthalmology and Visual Sciences, CUHK, Hong Kong, Hong Kong

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Purpose:

This study aims to report correlations between thyroid-stimulating immunoglobulin(TSI) and both clinical and radiological parameters in recent-onset symptomatic thyroid eye disease(TED) patients.

Methods:

A prospective cohort study of TED patients managed at the Chinese University of Hong Kong from January 2014 to May 2022. Serum TSI levels were determined with the functional assay. Outcomes included the clinical activity score(CAS), marginal reflex distance1(MRD1), extraocular muscle motility restriction(EOMy), exophthalmos, and diplopia. The radiological assessment included cross-sectional areas and signal of extraocular muscles on STIR-sequence MRI.

Results:

A total of 255(197female) treatment-naïve patients, with an average onset age of 50±14 years, were included. Elevated pre-treatment TSI level was observed in 223(88%) patients. There was a weak positive correlation between TSI and CAS(r=0.28, P=0.000031), MRD1(r=0.17, P=0.0080), and the size of the levator palpebrae superioris/superior rectus complex(r=0.25, P=0.018). No significant correlation existed between TSI and STIR signals. The AUC and optimal cut-off value for clinical active TED were 0.67(95% confidence interval:0.60-0.75) and 284%(Specificity:50%, sensitivity:85%). 64 patients received intravenous methylprednisolone (IVMP) during the study interval, and they had a higher baseline TSI level than those who did not have IVMP(P=0.000044). Serial post-IVMP TSI among the 62 patients showed a significant reduction compared to the baseline level(P<0.001). Both the baseline and post-IVMP TSI levels, and percentages of TSI changes were comparable between patients who responded and non-responded to the first course of IVMP.

Conclusion:

TSI can be a serum biomarker for the diagnosis, prognosis, and treatment response of TED. Further validation should be further warranted.

Open access