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Accepted on ,

Brief Communications

Intermethod Variability in TSH-Receptor Antibody Measurement: Implication for the Diagnosis of Graves Disease and for the Follow-Up of Graves Ophthalmopathy

¹ Unité Fonctionnelle d'Hormonologie, CHU de Rennes, France, and INSERM 0203 Centre d'Investigation Clinique, Université de Rennes 1, France
² Laboratoire d'Explorations Fonctionnelles par les Isotopes, CHRU de Strasbourg, France, and ULP/CNRS UMR 7191, Faculté de Médecine, Université Louis Pasteur, Strasbourg, France
³ Unité Fonctionnelle d'Hormonologie, CHU de Rennes, France
⁴ Laboratoire de Médecine Nucléaire, Centre de Biologie-Pathologie, CHRU de Lille, France, and Faculté de Médecine, Université Lille 2, France

^* To whom correspondence should be addressed. E-mail: catherine.massart{at}chu-rennes.fr.

BACKGROUND: We compared the analytical and clinical performance of 3 porcine thyroid receptor antibody (TRAb) methods (2 second- and 2 new third-generation systems) with the conventional TRAb assay based on the human recombinant TSH receptor (hTRAK).

PATIENTS AND METHODS: We obtained sera from 86 patients with untreated Graves disease (GD) and 71 healthy controls. We measured TRAb concentrations by radioreceptor assay using the hTRAK (Brahms) or the porcine TSH receptor (pRRA) from Beckman-Coulter, by electrochemiluminescence immunoassay (ECLIA) with the Elecsys/Cobas (Roche), and by ELISA using the Medizym TRAb clone (Medipan).

RESULTS: Between-run assay imprecision was 10% and 7.6% for hTRAK and ECLIA, but reached 14% and 14.9% for ELISA and pRRA, respectively. Maximal specificity and sensitivity close to 100% were obtained for hTRAK, ECLIA, and ELISA. pRRA failed to detect positive TRAbs in 5 GD patients. Although calibrated against the same reference standard 90/672, the assays displayed a high intermethod variability. The results were significantly higher by ECLIA and lower by ELISA and pRRA compared with hTRAK. Patients with ophthalmopathy had higher TRAb results by ELISA and pRRA than those without eye disease.

CONCLUSIONS: Second- and third-generation TRAb assays had similar diagnostic sensitivities in the diagnostic evaluation of GD. Despite the use of the same reference standard for calibration, high intermethod variability in TRAb assay results was seen in untreated GD patients. Assay harmonization is necessary for correct interpretation in the follow-up of Graves ophthalmopathy.