Recent advances in the understanding of humoral and cellular mechanisms implicated in thyroid autoimmune disorders.

In this review new data are reported indicating that the thyroid microsomal-microvillar antigen can be identified with thyroid peroxidase (TPO). This concept derives from binding studies of monoclonal and polyclonal microsomal antibodies to TPO purified by affinity chromatography or obtained by recombinant DNA technology. Furthermore, immunofluorescence studies performed on cultured thyroid cells have shown the presence of a TPO-related antigen on the surface of the cells. The expression of the TPO antigen is modulated by TSH through the cAMP pathway. The functional activities of TSH receptor autoantibodies have also been characterized. From these studies the following conclusions can be drawn: (i) TSH receptor antibodies possess multiple biological activities, interfering or mimicking TSH actions; (ii) a good correlation is observed between stimulation of adenylate cyclase and of iodide uptake by Graves' IgG. In these IgG preparations, adenylate cyclase- and growth-stimulating activities cannot be separated; (iii) antibodies blocking the TSH-dependent AC are present in patients with autoimmune hypothyroidism; (iv) a mixture of stimulating and blocking antibodies may coexist in the same patient, whose clinical status may result from the sum of the biological activities of these antibodies. Finally, new data are reported on the identification and characterization of T cell clones infiltrating the thyroid tissue of subjects with thyroid autoimmune disorders. The majority of these clones were CD8+ cytolytic T cells with natural killer activity. These latter data may be of importance in the mechanisms of thyroid damage observed in Hashimoto's glands.