TSH RECEPTOR ANTIBODY (TRAb) TESTING IN NON-PREGNANT ADULTS

AN AUDIT IN HOSPITAL TELUK INTAN

Abstract

INTRODUCTION
Determining the etiology of hyperthyroidism is essential for appropriate management, as different causes, such as Graves’ disease, toxic multinodular goiter (MNG), and toxic adenoma, require distinct treatment approaches. Among these, Graves’ disease is the most common autoimmune cause of hyperthyroidism, and TSH receptor antibody (TRAb) testing plays a crucial role in its diagnosis.

At Hospital Teluk Intan, TRAb testing is not available on-site and must be outsourced to Hospital Kuala Lumpur (HKL), located approximately 160 km away. Samples are sent twice a week, and results typically take up to two weeks. This audit aims to evaluate the number of TRAb tests performed in non-pregnant adults, analyze positive and negative results, and assess the workload and clinical significance of outsourcing this test.

METHODOLOGY
A retrospective audit was conducted from January to December 2024, including all non-pregnant adult patients (≥12 years) who underwent TRAb testing. Pregnant patients, pediatric cases, and those with incomplete data were excluded. Data was retrieved from laboratory records and patient files, focusing on test requests, positivity rates, and processing issues.

RESULT
A total of 111 TRAb tests were sent during the audit period. Of these, 64 (59.8%) were positive, supporting a diagnosis of Graves’ disease, while 43 (40.1%) were negative. Four samples were rejected due to incomplete clinical summaries or the absence of a specialist’s countersignature.

Analysis showed that TRAb levels did not correlate with disease severity when compared with thyroid function test (TFT) results.

CONCLUSION
This audit highlights the high demand for TRAb testing and the significant proportion of positive results. Given its diagnostic importance in differentiating Graves’ disease from other causes of hyperthyroidism, in-house TRAb testing at Hospital Teluk Intan would reduce delays and improve patient management. Establishing local testing capabilities could enhance efficiency, facilitate timely diagnosis, and optimize treatment planning.