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The article reports that autoimmune thyroid disorders are associated with the presence of antibodies to thyroid antigens such as the thyroid peroxidase, the thyroglobulin and the thyroid stimulating hormone receptor. It notes that these antibodies can be obtained using either a competitive binding immunoassay or a cell-based one bioassays. It states that patients with Hashimoto's thyroiditis (HT) can also develop thyroid-associated orbitopathy.

Background: Endocrine orbitopathy (EO) encompasses functional and cosmetic limitations. The aim of this study was to assess the health services situation of patients with EO treated at a multidisciplinary specialized center., Methods: The medical records pertaining to the clinical spectrum, access route, and medical specialty of the referring physician of patients who were treated within a period of 5 years at a tertiary referral orbit center were systematically assessed., Results: A total of 431 subjects with EO (female n =354, 82%; median age 40 years, range 5-79 years) were included in the study. Of the patients 148 (35%) and 123 (29%) were referred by family physicians and ophthalmologists, respectively. A sight-threatening optic nerve neuropathy was present in 11 (14.3%) men and 21 (5.9%) women (p =0.011). At least 2 other autoimmune diseases were found in 8 (10.4%) men and in 15 (4.3%) women (p =0.079). Psychotherapeutic support was utilized by 2 (2.6%) men and 92 (26%) women (p <0.001). An access route of 50 km or more was accepted by 14 (28%) men and 83 (43%) women (p =0.054). There was also an association between an access route ≥100 km and a prior medical treatment (odds ratio 3.78, 95% confidence interval 1.18-12.05, p =0.025)., Conclusion: Men were more severely affected by EO than women and often had complex autoimmune diseases; however, male patients were less frequently willing to accept long access routes and barely used psychosocial support. Especially patients with further autoimmune diseases travelled long distances to be treated at a specialized center.

Graves' disease (GD) is the only autoimmune disease where autoantibodies stimulate the target organs. Among the most common clinical manifestations are hyperthyroidism and orbitopathy (GO). To ensure the diagnosis of autoimmune hyperthyroidism, activity of TSH receptor autoantibodies (TRAb) should be determined. Because of their significantly improved sensitivity and equal specificity, second-generation TRAb assays (activity given in IU/l) should be preferred over first-generation assays (activity given in U/l). During follow-up of antithyroid drug therapy it is possible to predict outcome for some patients with high chances if TRAb levels are high. On this basis, thyreoablative treatment (operation or radioiodine) can already be indicated before the 1st year of antithyroid drug treatment has passed. If TRAb antibody titers are > 10 IU/l, it is possible to predict outcome as early as 6 months after initiation of antithyroid drug therapy. Below a certain threshold, depending on the time point of measurement, no representative risk analyses are available for TRAbs. TRAb measurement is also helpful to determine the course of GO. This may guide the physician through crucial treatment decisions, especially if the patient is at risk of deterioration.

Inflammatory orbitopathy is the most common extrathyroidal manifestation of Graves' disease and is characterised by a lymphocyte infiltration into the peribulbar space. Interdisciplinary management is recommended for rapid diagnosis and effective therapy of patients with thyroid orbitopathy. Immunosuppressive treatment is often used initially, and by suppressing inflammatory changes, it may result in both subjective and objective improvement. On the long run, though, decompression surgery is actually regarded as the most effective treatment of thyroid eye disease.