{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T16:38:46Z","timestamp":1782146326542,"version":"3.54.5"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Subacute thyroiditis (SAT) is a self-limiting thyroiditis with an unclear pathogenesis. Human leukocyte antigen (HLA)-B*35 is considered a predisposing factor, and viral infection is believed to be a trigger. In recent years, elevated levels of thyroid-stimulating hormone receptor antibodies (TRAb) have been observed in some patients with SAT. Typically, these elevated TRAb levels may spontaneously revert to negative as the disease improves. The mechanism of TRAb production may be related to abnormalities in immune surveillance and viral infections. Critically, the presence of TRAb can influence clinical manifestations, complicate diagnosis, and affect recovery in SAT. There are three types of TRAb, yet studies on their changing patterns during SAT remain scarce. Both SAT and Graves\u2019 disease (GD) can cause thyrotoxicosis, leading to difficulties in clinical differential diagnosis, especially when SAT presents with positive TRAb. Currently, studies on TRAb-positive SAT are relatively limited. Therefore, this article reviews the pathogenesis of TRAb-positive SAT and its differential diagnosis from GD, aiming to enhance the understanding of this disease among clinicians.<\/jats:p>","DOI":"10.3389\/fimmu.2025.1727240","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T06:26:37Z","timestamp":1766125597000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The progression of TRAb-positive subacute thyroiditis and its differential diagnosis from Graves\u2019 disease"],"prefix":"10.3389","volume":"16","author":[{"given":"Saiya","family":"Yuan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolu","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinming","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyu","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"456","DOI":"10.4158\/ep.17.3.456","article-title":"Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists","volume":"17","author":"Bahn","year":"2011","journal-title":"Endocr Pract"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-010-1306-4","article-title":"Eponym : de Quervain thyroiditis","volume":"170","author":"Engkakul","year":"2011","journal-title":"Eur J Pediatr"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-021799","article-title":"Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study","volume":"88","author":"Fatourechi","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e26924","DOI":"10.7759\/cureus.26924","article-title":"Painless subacute thyroiditis in a patient with acute COVID-19 infection: A transient event","volume":"14","author":"Dolkar","year":"2022","journal-title":"Cureus"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1674-7151.2023.01.016","article-title":"Diagnostic value of free thyroxine\/free triiodothyronine ratio combined with thyroid hormone antibody for subacute thyroiditis and Graves\u2019 disease","volume":"15","author":"Ma","year":"2023","journal-title":"Chin J Clin Pathol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1674-4721.2021.20.054","article-title":"Application value of thyroid-stimulating hormone receptor antibody in the diagnosis of toxic diffuse goiter disease","volume":"28","author":"Xie","year":"2021","journal-title":"China Mod Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e70525","DOI":"10.1096\/fj.202403264R","article-title":"Advances in subacute thyroiditis: Pathogenesis, diagnosis, and therapies","volume":"39","author":"Li","year":"2025","journal-title":"FASEB J: Off Publ Fed Am Soc Exp Biol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e19448","DOI":"10.7759\/cureus.19448","article-title":"Elevated graves\u2019 disease-specific thyroid-stimulating immunoglobulin and thyroid stimulating hormone receptor antibody in a patient with subacute thyroiditis","volume":"13","author":"Alvin Mathew","year":"2021","journal-title":"Cureus"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.aace.2021.10.001","article-title":"Graves disease following subacute thyroiditis in a chinese man","volume":"8","author":"Al-Bacha","year":"2022","journal-title":"AACE Clin Case Rep"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0039.1975.tb00622.x","article-title":"The HL-a system and subacute thyroiditis. 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