Graves’ orbitopathy (GO) is an inflammatory disease associated with autoimmune thyroid diseases, mainly Graves’ disease. The target of the immune reaction seems to be the TSH receptor, leading to the production of specific autoantibodies. The autoimmune process triggers a cascade of inflammatory changes, production of glycosaminoglicans and adipose tissue expansion. The clinical presentation is characterized by soft tissue inflammation around and behind the eyes, ranging from mild edema and chemosis to sight-threatening corneal ulcers and ischemic optic neuropathy. The evaluation relies on the assessment of severity (NOSPECS) stages and clinical activity score (CAS). We examined the relationship between TSH receptor antibodies (TRAb) and severity stages, clinical activity score, smoking habit and serum interleukins in 35 GO patients. We found a positive, statistically significant relationship between TRAb and CAS (r2=0.339, p=0.003). Smokers had higher TRAb levels than non-smokers, but without statistical significance (20.493±3.128, vs. 12.593±3.409, p= 0,145). There was no difference in serum TRAb levels between the specific NOSPECS stages but we noticed a tendency to higher antibody levels in more severe stages. Statistically significant, negative correlation was found between IL-1, IL-4 and TRAb levels, and significant positive correlation between MCP-1, TNF-α and TRAb (p<0.05). We suggest that all patients with Graves’ disease and GO should be carefully and correctly evaluated, focusing on TRAb. Cytokine profiling could be helpful in choosing the most appropriate treatment.
Keywords: Graves’ orbitopathy, interleukins, TSH-receptor antibodies