{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:24:11Z","timestamp":1793157851355,"version":"4.5.0"},"reference-count":166,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2022,9,24]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>Thyroid-stimulating hormone (TSH) receptor antibody (TSH-R-Ab or TRAb) testing plays a pivotal role in arriving at the aetiological diagnosis in patients with thyrotoxicosis. A positive test establishes the diagnosis of Graves\u2019 disease (GD) while a negative result in conjunction with imaging studies supports other possible aetiologies. In patients with GD, TRAb levels at diagnosis and at the time of withdrawal of antithyroid drugs can identify patients who are unlikely to achieve remission and guide clinical management decisions. We provide an algorithm that incorporates TRAb in the decision-making process for the management of thyrotoxicosis. The utility of TRAb in predicting the risk of fetal and neonatal thyroid dysfunction is established and widely accepted in guidelines. TRAb may also help in the diagnosis of Graves\u2019 orbitopathy, especially in euthyroid or hypothyroid patients and its role in guiding its management is evolving as a useful adjunct to the clinical parameters used in making therapeutic decisions.<\/jats:p>\n                  <jats:p>Anti-thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibodies (TgAb) indicate thyroid autoimmunity. The most common use of TPOAb is to identify patients at a higher risk of progression to treatment-requiring hypothyroidism. They also aid the diagnosis of immune thyroiditis and Hashimoto\u2019s encephalopathy. Thyroglobulin measurement is used to help guide differentiated thyroid cancer treatment. TgAb is used as an accompanying test with thyroglobulin measurement as its presence can interfere with the thyroglobulin assay. A negative TgAb result reduces the likelihood of, but does not exclude, interference with thyroglobulin assay.<\/jats:p>","DOI":"10.1136\/jcp-2022-208290","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T08:30:15Z","timestamp":1667205015000},"page":"19-28","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":75,"title":["Thyroid autoantibodies"],"prefix":"10.1136","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1215-765X","authenticated-orcid":false,"given":"Shivangi Nikhil","family":"Dwivedi","sequence":"first","affiliation":[{"name":"Endocrinology and Diabetes, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1306-8832","authenticated-orcid":false,"given":"Tejas","family":"Kalaria","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry, New Cross Hospital, Black Country Pathology Services, Wolverhampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harit","family":"Buch","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetes, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,10,21]]},"reference":[{"key":"2025112109552736000_76.1.19.1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-012-9703-2"},{"key":"2025112109552736000_76.1.19.2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.00521"},{"key":"2025112109552736000_76.1.19.3","first-page":"11","article-title":"Abnormal responses in the assay of thyrotropin","volume":"34","author":"Adams","year":"1956","journal-title":"Proc Univ Otago Med Sch"},{"key":"2025112109552736000_76.1.19.4","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1097\/IOP.0000000000001052","article-title":"Thyrotropin receptor antibodies-an overview","volume":"34","author":"Kotwal","year":"2018","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"2025112109552736000_76.1.19.5","doi-asserted-by":"publisher","DOI":"10.1210\/en.2010-0424"},{"key":"2025112109552736000_76.1.19.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2008.03512.x"},{"key":"2025112109552736000_76.1.19.7","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/S0140-6736(74)91815-7","article-title":"Thyroid-stimulating immunoglobulins in Graves\u2019 disease","volume":"304","author":"Smith","year":"1974","journal-title":"Lancet Lond Engl"},{"key":"2025112109552736000_76.1.19.8","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1055\/s-0030-1267171","article-title":"Continuously increasing sensitivity over three generations of TSH receptor autoantibody assays","volume":"42","author":"Z\u00f6phel","year":"2010","journal-title":"Horm Metab Res"},{"key":"2025112109552736000_76.1.19.9","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.2741\/4687","article-title":"Functional diagnostics for thyrotropin hormone receptor autoantibodies: bioassays prevail over binding assays","volume":"23","author":"Lytton","year":"2018","journal-title":"Front Biosci"},{"key":"2025112109552736000_76.1.19.10","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1515\/cclm-2016-0197","article-title":"Evaluation of the first fully automated immunoassay method for the measurement of stimulating TSH receptor autoantibodies in Graves' disease","volume":"55","author":"Tozzoli","year":"2017","journal-title":"Clin Chem Lab Med"},{"key":"2025112109552736000_76.1.19.11","doi-asserted-by":"publisher","DOI":"10.1373\/jalm.2017.024067"},{"key":"2025112109552736000_76.1.19.12","doi-asserted-by":"crossref","DOI":"10.1002\/jcla.23950","article-title":"Evaluation of analytic and clinical performance of two immunoassays for detecting thyroid-stimulating receptor antibody in the diagnosis of Graves' disease","volume":"35","author":"Hu","year":"2021","journal-title":"J Clin Lab Anal"},{"key":"2025112109552736000_76.1.19.13","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1159\/000478522","article-title":"Performance and specificity of 6 immunoassays for TSH receptor antibodies: a multicenter study","volume":"6","author":"Diana","year":"2017","journal-title":"Eur Thyroid J"},{"key":"2025112109552736000_76.1.19.14","unstructured":"Instructions for use\/ package insert: COBAS Elecsys Anti-TSHR. 08496609501V1.0, 2020"},{"key":"2025112109552736000_76.1.19.15","unstructured":"Instructions for use\/ package insert: Immulite 2000 thyroid stimulating immunoglobulins (TSI). 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