Thyroid controversy - Stimulating antibodies

Many physicians would pay dearly to obtain a marker for the disease that interests them most. Those of us interested in caring for patients with Graves' disease have such a marker. Knowing the titer of TSHR-Abs in patients is useful in the prediction of thyrotoxic recurrence after antithyroid drugs. A careful review of the literature shows strong evidence for the observation that their accurately measured presence predicts hyperthyroidism in more than 90% of cases in iodine-sufficient areas. The assay of TSHR-Abs, therefore, remains a most useful addition to the clinical armamentarium and a low-cost help in treatment planning. Assays to distinguish blocking from stimulating antibodies remain expensive but are only clinically important in patients with pregnancy (40). The major hurdle remains one of increasing the sensitivity of the available assays for TSHR-Ab so that their usefulness can be applied successfully to an even greater proportion of patients with Graves' disease.