Kraiem Z, Baron E, Kahana L, Sadeh O, Sheinfeld M
Institute of Endocrinology, Carmel Hospital-Kupat Holim, Haifa, Israel.
Clin Endocrinol (Oxf). 1992 Feb;36(2):211-4. doi: 10.1111/j.1365-2265.1992.tb00960.x.
We report a patient who underwent, over a mere 3-year period, three successive cycles of oscillation from hypo to hyper-thyroidism and back to hypothyroidism. This unusual sequence of events originated in a rare passage of primary hypothyroidism to hyper-thyroidism. The hyperthyroidism seemed typical of the autoimmune subgroup of toxic multinodular goitre. Stimulating and blocking TSH receptor antibody activities were measured (by cAMP functional bioassays using cultured human thyrocytes) during the course of the fluctuating phases of hypo and hyper-thyroidism. Measurement of such antibody activities revealed the coexistence of both stimulatory and blocking types of antibody in several serum samples from the patient. Throughout the whole course of alterations in thyroid function, thyroid stimulating antibodies were present. This was not the case with thyrotrophin receptor antibodies exhibiting TSH antagonist activity which seemed to appear and disappear. Monitoring such activity indicated that the emergence of blocking antibody seems to herald the onset of hypothyroidism.
我们报告了一名患者，在仅仅3年的时间里经历了从甲状腺功能减退到甲状腺功能亢进再回到甲状腺功能减退的三个连续周期的振荡。这一不寻常的事件序列起源于原发性甲状腺功能减退罕见地转变为甲状腺功能亢进。甲状腺功能亢进似乎是毒性多结节性甲状腺肿自身免疫亚组的典型表现。在甲状腺功能减退和甲状腺功能亢进的波动阶段，通过使用培养的人甲状腺细胞的cAMP功能生物测定法测量了刺激和阻断促甲状腺激素（TSH）受体抗体的活性。对这些抗体活性的测量显示，在该患者的几个血清样本中同时存在刺激型和阻断型抗体。在甲状腺功能改变的整个过程中，均存在甲状腺刺激抗体。而表现出TSH拮抗活性的促甲状腺激素受体抗体似乎有出现和消失的情况，并非如此。对这种活性的监测表明，阻断抗体的出现似乎预示着甲状腺功能减退的开始。
