Chemistry, toxicology & urinalysis

Organ specific

Thyroid

Thyroglobulin, TSH receptor and thyroperoxidase antibodies



Topic Completed: 1 March 2011

Minor changes: 4 October 2021

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PubMed Search: Thyroglobulin antibody [title]

Nat Pernick, M.D.
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Cite this page: Pernick N. Thyroglobulin, TSH receptor and thyroperoxidase antibodies. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/chemistrythyroglobulnab.html. Accessed December 3rd, 2021.
Thyroglobulin antibody
  • See Stains - Thyroglobulin topic for immunohistochemistry
  • Marker of autoimmune thyroid disease (note: other thyroid antibodies are to TSH and thyroperoxidase)
  • Also ordered with serum thyroglobulin, since it may interfere with thyroglobulin assay
  • Modest correlation with presence of anti-thyroperoxidase antibodies (Autoimmunity 2006;39:497)
  • Immunoassays now most common methodology
    • Quantitative passive hemagglutination:
      • Formerly most common, uses chromic chloride hemagglutination or tanned red blood cells, 80% with Hashimoto's thyroiditis have titers > 1:1000
      • Also present, at lower titers, in Graves disease (60%), thyroid carcinoma (30%), pernicious anemia, Sjogren's syndrome, normals (3 - 18%)
    • Indirect immunofluorescence microscopy (uncommon):
      • Uses monkey thyroid gland tissue
      • Patterns are floccular, dull colloid spaces but bright peripheral fluorescence or diffuse bright uniform colloid staining in ground-glass pattern
      • 5 - 8% are false positives with positive immunofluorescence attributed to CA2 (second colloid antigen) but are negative for anti-thyroglobulin or anti-thyroperoxidase by other methods
    • Concordance between automated methods needs improvement (Clin Chim Acta 2007;376:88)
  • Interpretation
    • Present in patients with Hashimoto's thyroiditis, other autoimmune disease, also women with no clinical disease
    • Values < 4 .0 IU/ml are unlikely to interfere with thyroglobulin assay
TSH receptor antibody
  • Also called TRAb (TSH Receptor Antibody)
  • Previously called thyroid stimulating immunoglobulin or long acting thyroid stimulators (LATS)
  • Present in 85 - 95% with Graves disease
  • Either stimulating (causing hyperthyroidism), blocking (usually no clinical impact) or no effect
  • Antibodies cross placenta and may cause thyroid dysfunction in newborns
  • Indications: not for routine clinical testing, but to confirm Graves disease in difficult cases, monitor hormone replacement therapy, diagnose neonatal thyrotoxicosis
  • Methodology: thyrotropin binding inhibiting immunoglobulin technique, RIA
  • Reference ranges: negative: 0 - 9%, indeterminate: 10 - 15%, positive: 16% or more
  • Intrepretation
    • Positive results are consistent with autoimmune disease
    • Low antibody titer before drug therapy for Graves disease is a good prognostic factor for remission after drug therapy (Horm Metab Res 2004;36:92) or relapse (Horm Metab Res 2007;39:56), predicts risk of thyroid dysfunction in newborns of mothers with Graves disease
  • References: J Clin Invest 2005;115:1972
Thyroperoxidase antibody
  • Associated with Hashimoto's thyroiditis (90%) and Graves disease (75%), although also present in women with no clinical disease
  • Antibody is directed against antigen within microsomal fraction of thyroid epithelial cells
  • Methodology
    • ELISA, RIA, IRMA
    • Previously indirect immunofluorescence microscopy with substrate of air dried human or cryostat monkey tissue, looking for cytoplasmic but not nuclear staining of thyroid follicular cells
    • Concordance between automated methods needs improvement (Clin Chim Acta 2007;376:88)
  • Interpretation: Does not predict relapse of Graves disease after carbimazole treatment withdrawal (Thyroid 2006;16:1041); elevated in MELAS syndrome (Pediatr Neurol 2007;36:414)
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