THYROID-STIMULATING ANTIBODY IN SERA OF GRAVES OPHTHALMOPATHY PATIENTS AS A POSSIBLE MARKER FOR PREDICTING THE EFFICACY OF METHYLPREDNISOLONE PULSE THERAPY

Nine patients with Graves' ophthalmopathy (GO) were treated with intra venous methylprednisolone pulse therapy and followed up by ophthalmolo gical assessment, magnetic resonance imaging, and thyroid-associated a utoantibody (thyroid stimulating antibody (TSAb), TSH binding inhibito r immunoglobulins (TBII), and anti-eye muscle antibody(EMAb)). Ophthal mological assessment was performed by the ophthalmopathy index (OI) wh ich was made on the basis of the system recommended by the American Th yroid Association Committee. EMAb was expressed as the ratio of densit y of the 64 kDa band of eye muscle membrane to that of 92 kDa non-spec ific band found with all normal sera when assessed by western blotting . Five patients with mild ophthalmopathy (OI<4) did not show progressi ve improvement in OI. Three of 4 patients with severe eye disease (OI> 4) showed a progressive and distinct improvement in OI. These 3 patien ts had high TSAb levels before methylprednisolone pulse therapy. One p atient with severe ophthalmopathy did not respond to this pulse therap y; this patient's TSAb was negative. A significant positive correlatio n was observed between the activity of TSAb before treatment and the i mprovement in OI (Delta OI) (r=0.86, P<0.01, n=9). The relationship be tween Delta OI and EMAb did not reach significance. These results sugg est that TSAb in sera of GO patients can be a useful marker for predic ting the efficacy of methylprednisolone pulse therapy.