Pathogenic anti-thyrotropin receptor autoantibody (TRAb)

Pathogenic anti-thyrotropin receptor autoantibodies (TRAbs) are the primary drivers of Graves' disease and its extrathyroidal manifestations, such as Graves' ophthalmopathy. These autoantibodies bind to the thyrotropin receptor (TSHR) on the surface of thyroid follicular cells, mimicking the action of the natural ligand, thyroid-stimulating hormone (TSH). This interaction leads to the chronic overstimulation of the thyroid gland, resulting in hyperthyroidism and goiter. In the orbit, these antibodies activate TSHR on fibroblasts and adipocytes, contributing to inflammation and tissue remodeling. Modern therapeutic strategies aim to directly neutralize these antibodies, block their interaction with the receptor, or reduce their systemic concentration through neonatal Fc receptor (FcRn) inhibition or B-cell depletion.

Other names

Thyroid-stimulating immunoglobulinTSIThyroid-stimulating antibodyTSAbThyrotropin receptor antibodyThyrotropin-binding inhibitory immunoglobulinTBIITSH receptor autoantibody

Neutralization of circulating autoantibodies, competitive inhibition of autoantibody binding to the thyrotropin receptor, or depletion of B-lineage cells producing the autoantibodies.