Endocrine Abstracts

Background: In Graves’ disease, immune cellular mechanisms and cytokine release, as well as auto-antibody production found in the serum, most likely contribute to the development of thyroid eye disease (TED). Biosynthesis of neopterin is closely associated with activation of the cellular immune system and could be a valuable marker of the severity of the disease.

Objectives: To assess whether serum neopterin concentrations in patients with TED are a reliable measure of the severity of the disease, to be used to monitor the effectiveness of treatment.

Methods: In a prospective study of 30 patients with TED (ophthalmopathy index, IO>3) of mean age 57±12 years, levels of hTRAB, neopterin, CRP, sTNFαRII and IO were studied prior to and after anti-inflammatory glucocorticoid treatment and consecutive radiotheraphy.

Results: The median values before and after treatment were: hTRAb 12.2 vs. 1.7 IU/L; neopterin 8.6 vs. 7.3 nmol/l; CRP 1.6 vs. 0.7 mg/l; sTNFαRII 2228.3 vs. 2109.4 ng/L and IO 7 vs. 4 respectively. The differences between these levels (Wilcoxon’s test) were statistically significant for IO, CRP and hTRAb, but not for neopterin. Statistically significant correlations (r Spearman’s factor) were found between the levels of CRP and sTNFαRII (r=0.85; P<0.05) prior to treatment, and IO and hTRAb levels (r=0.55; P<0.01) after treatment.

Conclusions: Serum neopterin concentrations were not markedly elevated initially and did not decrease significantly after the treatment. The clinical relevance of neopterin for evaluating and monitoring TED severity is therefore questionable. Other markers studied appear to be more useful in evaluating TED treatment: CRP – prior to treatment, and hTRAb post-treatment, as they correlate with sTNFαRII and IO, respectively.