Thyrotropin receptor antibodies in hypothyroid Graves' disease.
Thyrotropin receptor antibodies in hypothyroid Graves' disease.
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甲状腺功能减退格雷夫斯病中的促甲状腺素受体抗体。
DOI：
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发表时间：
1993
影响因子：
5.8
通讯作者：
J. Konishi
中科院分区：
文献类型：
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作者：
K. Kasagi;A. Hidaka;Hirotoshi Nakamura;R. Takeuchi;T. Misaki;Y. Iida;J. Konishi
为明确TSH受体抗体（TRAb）与Graves眼病及甲状腺功能的关系，我们检测了5例甲状腺功能减退Graves病患者TSH结合抑制剂免疫球蛋白、促甲状腺抗体、促甲状腺阻断抗体的活性。诊断基于Graves眼病和永久性或短暂性甲状腺功能减退，无甲状腺功能亢进Graves病的治疗史。5例患者均检测到TSH结合抑制剂免疫球蛋白和促甲状腺抗体。甲状腺刺激阻断抗体结果表明，阻断型TRAb不是甲状腺功能减退的原因。甲状腺的破坏性改变可能是甲状腺功能减退的原因，因为1)针对甲状腺球蛋白和甲状腺微粒体抗原的高抗体滴度，2)超声检查甲状腺弥漫性低回声，3)TRH或TSH刺激后血清T3反应缺失或受损，4)观察到与桥本甲状腺炎相似的组织学表现。除1例患者外，所有患者的甲状腺功能都是可变的，在病程中出现甲状腺功能正常甚至亚临床甲状腺功能亢进。可以想象，这种不稳定的甲状腺功能可能是由于甲状腺的破坏性变化和TRAb的刺激作用之间的平衡发生了微妙的变化。综上所述，所有患者均有TRAb，提示此类抗体可能与Graves眼病有关。患者在病程中出现甲状腺功能亢进或亚临床甲状腺功能亢进的频率高。
To clarify the relation of TSH receptor antibody (TRAb) to Graves' ophthalmopathy and thyroid function, the activities of TSH binding inhibitor immunoglobulins, thyroid-stimulating antibodies, and thyroid stimulation-blocking antibodies were measured in five patients with hypothyroid Graves' disease. The diagnosis was based on the presence of Graves' ophthalmopathy and either permanent or transient hypothyroidism without a history of treatment for hyperthyroid Graves' disease. TSH binding inhibitor immunoglobulins and thyroid-stimulating antibodies were detected in all five patients. Thyroid stimulation-blocking antibodies results indicated that a blocking type of TRAb was not a cause of hypothyroidism. Destructive changes in the thyroid were probably responsible for hypothyroidism, since 1) high antibody titers against thyroglobulin and thyroid microsomal antigen, 2) diffuse hypoechogenicity of the thyroid on ultrasonography, 3) absent or impaired responses of serum T3 after TRH or TSH stimulation, and 4) histological findings similar to those in Hashimoto's thyroiditis were observed. In all patients except one, thyroid function was changeable, with euthyroid and even subclinical hyperthyroid episodes occurring during the course of the illness. It is conceivable that such unstable thyroid function may be attributable to subtle changes in the balance between the effects of destructive changes in the thyroid and the stimulatory effects of TRAb. In conclusion, all patients had TRAb, suggesting a possible relationship between such antibodies and Graves' ophthalmopathy. Patients develop euthyroidism or subclinical hyperthyroidism during the course of the illness with high frequency.