PREDICTION OF REMISSION IN CHILDREN AND ADOLESCENTS WITH GRAVES' DISEASE: UTILIT

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。假设和具体目标：本提案的目标将是：1)前瞻性随访一组新诊断为Graves病的儿童和青少年2)在诊断后6个月检测甲状腺功能（T4、游离T4、总T3和TSH）、TSH受体抗体（ELISA和生物测定）和TSH受体抗体寡克隆性（以lambda/kappa比值评估）；3)确定甲状腺功能亢进的初始严重程度（由临床和激素参数确定）是否与初始TSH受体Ab效价和/或寡克隆性或两者相关4)确定6个月和12个月时TSH受体Ab效价是否与：a)甲亢的初始严重程度（由临床和激素参数确定）b) TSH受体Ab的初始效价（通过ELISA和生物测定）c) TSH受体Ab在6个月和12个月时的初始寡克隆性，以及TSH受体Ab在6个月和12个月时的寡克隆性5)表征个体患者在诊断时、6个月和12个月时TSH受体Ab异质性的过程；我们假设：在患有格雷夫斯病的儿童中，75%会TSH受体多克隆作为评估的Absλ/ kappa比率和25%会寡克隆Abs 2)寡克隆Abs更强有力的和影响患者更严重的疾病和不太可能汇3)患者最严重的疾病诊断将Ab TSH受体浓度最高和职权范围将不太可能在药物治疗4)25%的患者将会改变与疾病进展单克隆。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. HYPOTHESES AND SPECIFIC OBJECTIVES: The objectives of this proposal will be to: 1) Prospectively follow a group of children and adolescents with newly diagnosed Graves' disease 2) Measure thyroid function tests (T4, Free T4, Total T3, and TSH), TSH receptor antibodies (by both ELISA and bioassay), and TSH receptor antibody oligoclonality (as assessed by lambda/kappa ratio) at diagnosis, 6 months, and 12 months 3) Determine whether initial severity of hyperthyroidism (as determined by both clinical and hormonal parameters) is related to initial TSH receptor Ab potency and/or oligloclonality or both 4) Determine whether TSH receptor Ab titer at 6 months and at 12 months is related to: a) initial severity of hyperthyroidism (as determined by both clinical and hormonal parameters) b) initial TSH receptor Ab potency (by both ELISA and bioassay) c) initial TSH receptor Ab oligoclonality, as well as TSH receptor Ab oligoclonality at 6 months and 12 months 5) Characterize the course of TSH receptor Ab heterogeneity at diagnosis, 6 months and 12 months in individual patients; We hypothesize that: 1) Amongst children with Graves' disease, 75% will have TSH receptor Abs that are polyclonal as assessed by lambda/kappa ratio and 25% will have oligoclonal Abs 2) Oligoclonal Abs are more potent and affected patients have more severe disease and are less likely to remit 3) Those patients who have the most severe disease at diagnosis will have the highest TSH receptor Ab titers and will be less likely to remit on medical therapy 4) 25% of patients will have a change in clonality with disease progression.