Role of Thyroid Stimulating Immunoglobulins (TSI) in Early Diagnosis of Patients with Euthyroid Graves’ Ophthalmopathy

Sep 27, 2026

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Descriptive cross-sectional research evaluated the role of thyroid stimulating immunoglobulin (TSI) for early diagnosis in patients presenting with euthyroid Graves’ ophthalmopathy at an oculoplastics outpatient clinic of a tertiary care center. Participants of all ages and genders had signs and symptoms consistent with Graves’ ophthalmopathy while maintaining normal thyroid function. TSI was assessed and analyzed for associations with age and gender using statistical comparison methods. The study found TSI positivity in most cases and emphasized timely referral to prevent ocular complications.

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CategoryHealthcare

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ORIGINAL ARTICLE Role of Thyroid Stimulating Immunoglobulins (TSI) in Early Diagnosis of Patients with Euthyroid Graves’ Ophthalmopathy Mohammad Idris 1 , Muhammad Zubair Umer2 , Eemaz Nathaniel3 , Muhammad Iqbal4 , Adnan Zar5 1,5Lady Reading Hospital, 3Rehman Medical Teaching Institute (MTI), Peshawar, 2Mardan Medical Complex, Mardan, Medical College, Peshawar, 4PINUM cancer Hospital, Faisalabad ABSTRACT Purpose: To determine the role of thyroid stimulating immunoglobulin (TSI) in early diagnosis of patients with euthyroid Graves’ ophthalmopathy visiting Oculoplastic service of a tertiary care centre. Study Design: Descriptive cross sectional study. Place and Duration of Study: Oculoplastic service , outpatient department of ophthalmology, Lady Reading Hospital, Peshawar, Pakistan, from August 2015 to August 2016. Methods: Patients of both gender, and all ages with any one of the signs and symptoms of Grave’s Ophthalmopathy at any stage and of any severity of disease, but normal thyroid functions, were included in the study. Patients were selected by non-probability purposive sampling technique. One-way ANOVA test was done to find out relationship of TSI with age and gender. Results: Among 90 patients included in the study there were 68.9% females and 31.1% males. Maximum number of patients were between 41 and 55 years (37 .8%) . Thyroid stimulating immunoglobulin (TSI) test was positive in 84% patients out of which 55.6% were females and 28.9% were males. Age group of 41 – 55 years had maximum number of positive TSI (32 .2%) and > 56 years age group had 2nd most positive TSI (26 .7%) with the overall significance of 0.969. The association of TSI with gender showed higher significance than age with p values of 0.142 and 0.908 respectively. Conclusion: TSI is positive in majority of female Euthyroid Graves’ ophthalmopathy patients in age between 41 and 55 years. Early diagnosis with the help of TSI in euthyroid Graves’ disease can prevent ocular complications by timely referral to the endocrinologist. Key Words: Euthyroid Graves’ ophthalmopathy, Thyroid Stimulating Immunoglobulin , Thyroid Function Tests. How to Cite this Article: Idris M, Umer MZ, Nathaniel E, Iqbal M, Zar A. Role of Thyroid Stimulating Immunoglobulins (TSI) in Early Diagnosis of Patients with Euthyroid Graves’ Ophthalmopathy. Pak J Ophthalmol. 2020, 36 (4): 418-422. Doi: [https://doi.org/10.36351/pjo.v36i4.1113](https://doi.org/10.36351/pjo.v36i4.1113) Correspondence: Mohammad Idris Lady Reading Hospital, Medical Teaching Institute (MTI), Peshawar Email: [idrisdaud80@gmail.com](idrisdaud80@gmail.com) Received: July 29, 2020 Accepted: September 6, 2020 INTRODUCTION Thyroid eye disease is a common reason for many patients visiting Oculoplastic clinics because of its cosmetic and vision related problems. Graves’ disease is by far the most common cause of hyperthyroidism, with more than 1% prevalence in the general population.1 Thyroid related disorders are more common in females than males and increase with increasing age.2 The peak incidence of Graves’ disease (GD) occurs among patients of 30 – 60 years age, with an increased incidence among African Americans.3 The euthyroid Graves’ Ophthalmopathy occurs in 5- 10% of patients, which is mostly bilateral.4 Thyroid Associated Ophthalmopathy (TAO) is an organ specific, autoimmune process, in which the thyroid gland is over stimulated, causing hyperthyroidism. The extra ocular muscles (EOM) and thyroid gland have same antigenic nature that is recognized by the antibodies. Antibodies bind to the EOM and cause swelling behind the eyeball. The orbital and periorbital tissues are involved leading to swelling which has also been reported to be the result of mucopolysaccharide deposition posterior to the eyes, a symptom indirectly associated with Graves’disease. The “orange peel” skin has been attributed to the infiltration of antibodies beneath the skin, causing an inflammat

FAQs

What is the study designed to determine about TSI?

The study aims to determine the role of thyroid stimulating immunoglobulin (TSI) in the early diagnosis of patients with euthyroid Graves’ ophthalmopathy.

Who were included in the study?

Patients of both genders and all ages were included if they had signs and symptoms of Graves’ ophthalmopathy at any stage and severity, while showing normal thyroid function tests.

How does the study use TSI results for clinical decision-making?

The study reports that TSI is positive in a majority of patients and supports early diagnosis using TSI, enabling timely referral to an endocrinologist to help prevent ocular complications.

Sep 27, 2026

Uploaded by iuabcfuw