The diagnostic criteria of Graves' disease and especially the thyrotropin receptor antibody; our own experience.

It is generally accepted that the thyrotropin receptor antibody (TRAb) has a stimulating activity and is the major pathogenic factor in Graves' disease (GD). In spite of that, TRAb is not routinely examined in clinical practice. The aim of this article is to briefly review the subject and suggest protocols for the diagnosis, treatment and follow-up of patients with GD based on our own studies and referring especially to TRAb. Clinical symptoms and signs and thyroid hormones may have poor sensitivity or specificity, especially in cases of endocrine ophthalmopathy and subclinical hyperthyroidism. In these cases the TRAb test is 98% sensitive and specific with a diagnostic accuracy of almost 99%. By this test it is possible to differentiate between autoimmune and other forms of thyrotoxicosis such as autonomous hyperthyroidism, destructive thyroiditis, iodine induced hyperthyroidism etc. Antithyroid drugs decrease serum TRAb levels and also induce immune remission. If after treatment TRAb remains increased as in about 30%of our cases, patients will relapse. In pregnant women with GD the follow-up of serum TRAb levels is also important as predictive of immune thyroid disease in the newborn. Data presented in this article confirm that the determination of serum TRAb levels in some rare hyperthyroid disorders, such as associated autoimmune and autonomous forms and in epidemiological studies, is also justified.