Endocrine Abstracts

Background: Graves’ disease (GD) is an autoimmune condition accounting for up to 80% of thyrotoxicosis cases.1 90% of these patients have TSH receptor antibodies (TRAbs).2 Current NICE guidance recommends testing for TRAbs in adults with confirmed thyrotoxicosis to differentiate between thyrotoxicosis with hyperthyroidism (e.g GD and toxic multinodular goitre) and thyrotoxicosis without hyperthyroidism (e.g thyroiditis).2

Objective: To evaluate the necessity of the TRAb blood test to confirm a diagnosis of Graves’ disease in patients presenting with a clinical diagnosis of thyrotoxicosis.

Methodology: We chronologically selected the first 102 patients with TRAb tests performed between January 2020 and September 2021 at UHB. Patients pregnant at the time of testing were excluded. We recorded group demographics, initial diagnosis at clinical assessment, TRAb result and post-TRAb diagnosis.

Results: Of our 102 patients, 57 (56%) had a pre-TRAb diagnosis of GD. Of this group, 49 (86%) of the patients with an initial diagnosis of GD did not have their diagnosis altered post-TRAb. For those without an initial diagnosis of GD (n=45), 28 (63%) did not have their diagnosis altered post-TRAb. In the group as a whole, 77 (75%) did not have their diagnosis altered once TRAb results were available.

Conclusions: Our audit suggests that for patients with a clinical diagnosis of GD, from an endocrinologist, TRAb testing added little benefit as it did not alter diagnosis in the majority of cases. In those without an initial diagnosis of GD, the TRAb was more useful.

Recommendations: Our audit supports the British Thyroid Association’s recommendation that TRAb testing is ‘not essential where there is a strong clinical picture of GD.3 Clinical diagnosis appears highly reliable and due to similar initial management of GD and toxic nodular goitre, not confirming a diagnosis of GD poses minimal risk to the patient.