Moreover, six GD patients (4.69%) with elevated calsequestrin developed active TAO 12 weeks later. == Conclusion == 99Tcm-octreotide scintigraphy played a critical role in the evaluation of the clinical activity and therapeutic efficacy of TAO. active and inactive TAO was 1.34 (sensitivity, 100% specificity, 89.4%). The level IL8RA of serum calsequestrin antibody was higher in active TAO (P<0.05), showed Evista (Raloxifene HCl) a significant correlation with CAS (r=0.738,P<0.05), and also decreased after treatment (P<0.05). The best serum calsequestrin antibody threshold of the ROC curve was 138 ng/l (sensitivity, 88.4% specificity, 89.2%). The UACA antibody was elevated in both TAO and GD patients (P<0.05), with no significant difference (P>0.05). As to G2s, no significant difference was found between all groups (P>0.05). Moreover, six GD patients (4.69%) with elevated calsequestrin developed active TAO 12 weeks later. == Conclusion == 99Tcm-octreotide scintigraphy played a critical role in the evaluation of the clinical activity and therapeutic efficacy of TAO. Autoimmunity against calsequestrin in the pathogenesis of the eye muscle components may provide further objective evidence of myopathy in active TAO. Furthermore, calsequestrin antibody may predict myopathy in active TAO. == Introduction == Thyroid-associated ophthalmopathy (TAO) is the most common extrathyroidal manifestation of autoimmune thyroid disease occurring in ~50% of patients with Graves’ disease (GD)1and 25% with Hashimoto’s thyroiditis.2Although the pathogenesis of TAO is not clearly understood, most researchers now agree that it is an autoimmune disease with immunological cross-reactivity between the thyroid and the orbital preadipocytes, myoblasts, and fibroblasts.3Generally, the natural history of TAO follows Rundle’s curve with early inflammatory/congestive phase (the active phase) lasting 12 years, followed by stabilization (the plateau phase), and eventually, remission (the inactive phase).1The treatment for TAO varies according to inflammatory activity and severity. Inflammatory suppression therapy with corticosteroids is always suggested to treat moderate-to-severe active TAO to decrease orbital inflammation and congestion, and surgery is indicated for the stable, inactive TAO.4,5Clinical activity score (CAS), based on characteristic ocular signs and symptoms, has been widely used for TAO Evista (Raloxifene HCl) evaluation and as criteria and guideline for therapeutic management.6,7,8Clinically, most of the diagnosed TAO patients have mild TAO (76.9%),9and 1525% of these patients will progress to more severe disease as reflected in a change in CAS.10So, Evista (Raloxifene HCl) it is necessary to find more sensitive and objective criteria to access TAO activity. Nowadays, somatostatin receptor scintigraphy has been used to predict efficacy of immunosuppressive therapy for TAO. Somatostatin, a neuroendocrine peptide hormone, has receptors on many human cells, including fibroblasts, myoblasts, and lymphocytes, which are involved in the pathology of active TAO. Orbital increase of somatostatin analogs has been found to be correlated with CAS and clinical disease severity.11As a result of its clinical associations, octreotide scintigraphy in TAO may Evista (Raloxifene HCl) guide treatment by identifying and grading disease activity.12Previous studies have shown a sensitivity of ~90%, and a specificity of 100%, when octreoscan was used for evaluation of treatment efficacy.13,14 As an autoimmune-related orbital inflammation, TAO comprises two main subtypes (1) congestive ophthalmopathy, which is characterized by swelling of the eyelid and periorbital connective tissues, and (2) ocular myopathy, which Evista (Raloxifene HCl) reflects an autoimmune attack against the extraocular muscle.15The thyroid stimulating hormone-receptor (TSH-R) is the most popular candidate antigen for the development of TAO, but TSH-R cannot explain the development of eye muscle swelling and dysfunction.16Several studies have implicated the role of autoimmunity against eye muscle antigens, including the calcium-binding protein calsequestrin, G2s, and the uveal auto-antigen with coiled-coil domains and ankyrin repeats (UACA). Calsequestrin was expressed 4.8 times higher in eye muscle compared to other skeletal muscle.17As reported, anti-calsequestrin antibodies were detected in 40% of patients with clinically active TAO but only in.
