Aversano M, Caiazzo P, Iorio G, Ponticiello L, Laganá B, Leccese F
Endocrinology Unit ASL NA3, Naples, Italy.
Allergy. 2005 Apr;60(4):489-93. doi: 10.1111/j.1398-9995.2005.00723.x.
The association between chronic idiopathic urticaria (CIU) and autoimmune thyroiditis (AT) is known, as well as major prevalence of antithyroid antibodies in the allergical subjects and other autoimmune diseases. We have evaluated the effects of l-thyroxine on clinical symptoms of CIU in AT patients suggesting the hypothesis of a new thyroid-stimulating hormone (TSH) role in immune system.
In 20 female patients with CIU + AT, both hypothyroid and euthyroid, we have investigated the therapeutic effects of l-thyroxine dosed to suppress the TSH. Free-T3, Free-T4, TSH, antithyroperoxidase and antithyroglobulin antibodies, total immunoglobulin (Ig)E, Rheuma test and eritro-sedimentation rate were monitored during treatment.
In 16 patients a strong decrease of urticaria symptoms has happened after 12 weeks. The TPO Ab and HTG Ab clearly decreased in 14 patients. Furthermore, in two patients with rheumatoid arthritis and in two patients with pollen allergy a strong decrease of rheuma test titer and total IgE has happened.
The reason of AT is associated to CIU and others allergical and autoimmune diseases is poorly known. The exclusive hormonal therapy reduces the symptoms of CIU and inflammatory response in many chronic diseases associated to AT. We suggest a stimulatory effect of TSH able to produce considerable changes of the immune response and immune tolerance in patients with AT causing target organs damage. The causal mechanism involves immune, nervous and endocrine system, sharing a common set of hormones, cytokines and receptors, in a unique totally integrated loop (the neuro-immuno-endocrine axis).
慢性特发性荨麻疹（CIU）与自身免疫性甲状腺炎（AT）之间的关联是已知的，以及在过敏受试者和其他自身免疫性疾病中抗甲状腺抗体的主要患病率。我们评估了左甲状腺素对AT患者CIU临床症状的影响，提出了促甲状腺激素（TSH）在免疫系统中发挥新作用的假设。
在20名患有CIU + AT的女性患者中，包括甲状腺功能减退和甲状腺功能正常的患者，我们研究了用于抑制TSH的左甲状腺素的治疗效果。在治疗期间监测游离T3、游离T4、TSH、抗甲状腺过氧化物酶和抗甲状腺球蛋白抗体、总免疫球蛋白（Ig）E、类风湿因子检测和红细胞沉降率。
16名患者在12周后荨麻疹症状明显减轻。14名患者的TPO Ab和HTG Ab明显下降。此外，两名类风湿性关节炎患者和两名花粉过敏患者的类风湿因子检测滴度和总IgE明显下降。
AT与CIU以及其他过敏性和自身免疫性疾病相关的原因尚不清楚。单纯的激素治疗可减轻CIU的症状以及与AT相关的许多慢性疾病中的炎症反应。我们认为TSH具有刺激作用，能够在导致靶器官损伤的AT患者中引起免疫反应和免疫耐受的显著变化。因果机制涉及免疫、神经和内分泌系统，它们共享一组共同的激素、细胞因子和受体，形成一个独特的完全整合的环路（神经免疫内分泌轴）。
