Wilson R, McKillop J H, Jenkins C, Thomson J A
University Department of Medicine, Glasgow Royal Infirmary, UK.
Eur J Nucl Med. 1991;18(4):265-8. doi: 10.1007/BF00186651.
Radio-iodine therapy for Graves' disease is followed by immunological changes in addition to effects on thyroid hormone production. The present study examined these changes and the mechanisms responsible for them. Of the 15 patients enrolled in the study, 10 became hypothyroid in the first year after iodine 131 therapy. Patients who became hypothyroid had a tendency to show a rise in serum thyrotropin receptor antibody levels (30 +/- 14 to 40 +/- 9 units; NS) and a significant rise in immunoglobulin production (324 +/- 153 to 740 +/- 200 ng/ml; P less than 0.0005) from mitogen-stimulated peripheral blood lymphocytes (a measure of B-cell activity) 2 months after iodine 131 therapy. The increases were not seen in the patients who remained euthyroid at 1 year. In vitro studies suggested that the rise in B-cell activity is due to a fall in suppressor T cell numbers, a change shown to occur following iodine 131 therapy in previous studies. Our results indicate that immunological changes do arise after iodine 131 therapy for Graves' disease but appear to be confined to patients who subsequently became hypothyroid. It is not possible from this study to determine whether the immunological changes appear as a consequence of thyroidal destruction leading to hypothyroidism or whether they contribute directly to it.
放射性碘治疗格雷夫斯病后，除了对甲状腺激素产生影响外，还会伴随免疫变化。本研究对这些变化及其发生机制进行了检测。在纳入该研究的15名患者中，10名在接受碘131治疗后的第一年出现了甲状腺功能减退。出现甲状腺功能减退的患者血清促甲状腺素受体抗体水平有升高趋势（从30±14升至40±9单位；无显著差异），并且在碘131治疗2个月后，来自丝裂原刺激的外周血淋巴细胞（衡量B细胞活性的指标）的免疫球蛋白产生显著增加（从324±153升至740±200 ng/ml；P<0.0005）。在1年后仍保持甲状腺功能正常的患者中未观察到这些升高情况。体外研究表明，B细胞活性的升高是由于抑制性T细胞数量减少，先前的研究已表明这种变化在碘131治疗后会发生。我们的结果表明，碘131治疗格雷夫斯病后确实会出现免疫变化，但似乎仅限于随后出现甲状腺功能减退的患者。从本研究中无法确定免疫变化是甲状腺破坏导致甲状腺功能减退的结果，还是它们直接导致了甲状腺功能减退。
