HUBUNGAN KADAR THYROID STIMULATING HORMONE RECEPTOR ANTIBODY (TRAb) TERHADAP AKTIVITAS DAN DERAJAT KEPARAHAN KLINIS OFTALMOPATI GRAVES DI RSUP DR. SARDJITO

KHARISMA WIBAWA N P, dr. M. Robikhul Ikhsan, M.Kes, Sp.PD, KEMD.; dr. Vina Yanti Susanti, M.Sc, Ph.D, Sp.PD, KEMD

2021 | Tesis-Spesialis | ILMU PENYAKIT DALAM

Latar Belakang: Penyakit Graves (PG) merupakan penyakit autoimun penyebab tersering hipertiroid. Thyroid stimulating hormone receptor antibody (TRAb) biomarker spesifik untuk mendiagnosis PG. Oftalmopati Graves (OG) manifestasi tersering ekstratiroid pada Graves . Setiap OG dinilai aktivitas dan derajat keparahan klinis untuk tatalaksana. Tujuan Penelitian: Mengetahui hubungan kadar TRAb terhadap aktivitas klinis OG klasifikasi Clinical Activity Score (CAS) dan derajat keparahan klinis The European Group on Graves Orbitopathy (EUGOGO). Metode Penelitian: : Penelitian cross sectional, berlangsung pada bulan Januari sampai dengan Agustus 2021 di RSUP Dr. Sardjito Yogyakarta. Subyek penelitian PG baru atau dalam pengobatan anti-tiroid yang memiliki gejala hipertiroid. OG menurut kriteria Bartley dan Gorman serta belum mendapatkan injeksi steroid. Pemeriksaan serum TRAb dengan metode electrochemiluminescence immunoassay (ECLIA). Penilaian aktivitas klinis CAS dan derajat keparahan EUGOGO. Uji analisis dengan korelasi spearman. Analisis multivariat dengan regresi linier dan regresi logistic. Hasil Penelitian: 30 subyek dengan usia rerata 35.43 tahun, dominan wanita (80%), median durasi PG 13 bulan. Median TRAb 8.15 IU/L, skor median CAS 2 dengan 46.3% kondisi aktif. Derajat keparahan ringan 40% dan sedang-berat 60%. Korelasi TRAb dengan CAS (r=0.576, p=0,001), EUGOGO (r=0.535, p=0,002). Multivariat analisis TRAb dengan CAS (B= 0.076, p=0,01) sedangkan EUGOGO (OR=1.198, p=0.045). Kesimpulan: TRAb berkorelasi positif terhadap aktivitas dan derajat keparahan klinis OG.

Background: Graves disease (GD) is an autoimmune disease that is the most common cause of hyperthyroidism. Thyroid stimulating hormone receptor antibody (TRAb) is specific biomarker for diagnosing PG. Graves ophthalmopathy (GO) is the most common extrathyroid manifestation in Graves . Each GO was assessed activity and clinical severity for treatment. Objectives: To determine the relationship between TRAb levels and GO clinical activity in Clinical Activity Score (CAS) classification and clinical severity of The European Group on Graves Orbitopathy (EUGOGO). Methods: This is a cross sectional study, taking from January to August 2021 at RSUP Dr. Sardjito Yogyakarta. New GD subjects or on anti-thyroid medication who have symptoms of hyperthyroidism. GO according to Bartley and Gorman criteria and has not received steroid injections. Serum TRAb examination by electrochemiluminescence immunoassay (ECLIA) method. Assessment clinical activity CAS and severity EUGOGO. Test analysis with Spearman correlation. Multivariate analysis with linear regression and logistic regression Results: 30 study subjects mean age 35.43 years, female dominant (80%), median GD duration of 13 months. Median TRAb 8.15 IU/L, median CAS score 2 with 46.3% active. Mild severity 40% and moderate-severe 60%. Correlation of TRAb with CAS (r=0.576, p=0.001), EUGOGO (r=0.535, p=0.002). Multivariate analysis of TRAb with CAS (B= 0.076, p=0.01) while EUGOGO (OR=1.198, p=0.045) Conclusion: TRAb is positively correlated with activity and clinical severity of OG.

Kata Kunci : Thyroid stimulating hormone receptor antibody (TRAb), Oftalmopati Graves , Clinical Activity Score (CAS), The European Group on Graves Orbitopathy (EUGOGO).