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Der Nuklearmediziner 2005; 28(1): 11-17
DOI: 10.1055/s-2005-836340
Labor, Radiochemie und (Radio-)Immunologie

© Georg Thieme Verlag Stuttgart · New York

TRAK-Bestimmung: Aktuelles für die klinische Praxis

Determination of TSH Receptor Autoantibodies: Current Recommendations for the Clinical PracticeE. Scheiffele1 , J. Fröhlich2 , N. G. Morgenthaler2
  • 1Rottweiler Str. 14, 12247 Berlin
  • 2B.R.A.H.M.S Aktiengesellschaft, Hennigsdorf, Germany
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Publication History

Publication Date:
17 March 2005 (online)

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Zusammenfassung

Beim Morbus Basedow stimulieren Autoantikörper (Ak) den TSH-Rezeptor (TSH-R) und verursachen so die Hyperthyreose. Der Nachweis der Ak ist daher ein wichtiges Hilfsmittel für Nachweis bzw. Ausschluss eines Morbus Basedow. Die Bestimmung der TSH-R-Ak hat verbreitet Anwendung gefunden und wird in der klinischen Diagnostik meist mittels Radio-Rezeptor-Assays durchgeführt, die TSH-binding-inhibition-Aktivität messen, wobei Schweine-Schilddrüsen-Rezeptoren (für die pTBII-Assay) Verwendung finden. Mit einer neueren Methode, die humane rekombinante TSH-Rezeptoren verwendet, konnte in mehreren Studien, eine signifikant höhere Sensitivität bei gleich bleibend hoher Spezifität zur Diagnose des Morbus Basedow demonstriert werden. Weitere Hauptindikationen sind die Vorhersage eines Rezidivs nach thyreostatischer Therapie und die Bestimmung von Krankheitsaktivität und Schweregrad der endokrinen Orbitopathie. Die vorliegende Arbeit gibt einen Überblick über die wichtigsten methodischen Aspekte mit Darstellung der Konsequenzen für die klinische Praxis.

Abstract

Graves' disease is characterized by autoantibodies (Ab) that stimulate the TSH-Receptor (TSH-R) thereby causing hyperthyroidism. Detection of these Ab is therefore an important tool for confirmation or exclusion of Graves' disease. Determination of TSH-R-Ab has found wide spread use and is mostly performed in clinical routine by radio receptor assays measuring TSH binding inhibitory activity using porcine (pTBII assay). Using a more recent method, applying human recombinant TSH-receptors, many studies revealed a significantly higher sensitivity - without loss of specificity - in diagnosing Graves' disease. Further important indications are prediction of relapse after antithyroid drug therapy and evaluation of disease activity and severity in Graves' ophthalmopathy. This review provides an overview over the most relevant methodological aspects and demonstrates the consequences for clinical practice.

Schlüsselwörter

TSH-R-Ak-Assay - Indikationen - Sensitivität - Spezifität

Key words

TSH-R-Ab assays - indications - sensitivity - specificity

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Dr. Eckehard Scheiffele

Rottweiler Str. 14

12247 Berlin

Phone: +49/30/7 74/22 26

Fax: +49/30/7 74/22 26

Email: j.froehlich@brahms.de