Wiener J D, van der Gaag R D
Clin Endocrinol (Oxf). 1985 Dec;23(6):635-42. doi: 10.1111/j.1365-2265.1985.tb01124.x.
The pathogenesis of Plummer's disease (localized thyroid autonomy) is incompletely known. It has been shown that a normal thyroid follicle can harbour cells with widely different properties, and hyperactive follicles may arise from cells with both high replicating and hormonogenic potencies under the influence of chronic mild stimulation. We now find thyroid growth-stimulating immunoglobulins (TGI) to be present in low or intermediate titre in the serum of 7 of 9 patients with Plummer's disease. Haemagglutinating antibodies against thyroid microsomal antigen were present in low titre in two of these as well as in three of 21 other patients with this disorder. Two of the patients had a suppressible goitre in addition to the autonomous nodule. One of these is described in more detail. The possibility is discussed that autoimmunity may play a pathogenic role in Plummer's disease. TGI, in relatively low titres as found here, could exert the chronic mild stimulation supposed to be the prime event in the generation of hyperactive follicles. Whether autonomy is intrinsically present in these follicles or triggered by stimulation, remains to be established. Hyperthyroidism supervenes only when the mass of autonomous cells surpasses a certain limit. It appears that these patients with Plummer's disease should be included in the multidimensional spectrum of autoimmune thyroid disease.
普卢默病（局限性甲状腺自主性）的发病机制尚不完全清楚。研究表明，正常甲状腺滤泡可含有具有广泛不同特性的细胞，在慢性轻度刺激的影响下，高活性滤泡可能源自具有高复制和激素生成能力的细胞。我们现在发现，9例普卢默病患者中有7例血清中存在低滴度或中等滴度的甲状腺生长刺激免疫球蛋白（TGI）。其中2例以及另外21例患有该疾病的患者中有3例血清中存在低滴度的抗甲状腺微粒体抗原血凝抗体。2例患者除了有自主性结节外，还有可抑制性甲状腺肿。其中1例将进行更详细的描述。本文讨论了自身免疫可能在普卢默病中起致病作用的可能性。此处发现的相对低滴度的TGI可能会施加慢性轻度刺激，而这种刺激被认为是高活性滤泡产生的主要事件。这些滤泡的自主性是内在存在的还是由刺激引发的，仍有待确定。只有当自主性细胞的数量超过一定限度时，才会出现甲状腺功能亢进。看来，这些普卢默病患者应被纳入自身免疫性甲状腺疾病的多维范畴。
