Kraiem Z, Glaser B, Yigla M, Pauker J, Sadeh O, Sheinfeld M
Endocrine Research Unit, Carmel Hospital, Haifa, Israel.
J Clin Endocrinol Metab. 1987 Oct;65(4):659-64. doi: 10.1210/jcem-65-4-659.
The aim of this study was to examine whether at least a subgroup of patients with toxic multinodular goiter may have autoimmune thyroid disease. Thyroid-stimulating immunoglobulin (TSI) activity, measured by a sensitive bioassay employing cultured human thyroid cells, was determined in patients with toxic multinodular goiter and other thyroid disorders. All patients with active Graves' disease (n = 47) had detectable serum TSI activity, whereas TSI was undetectable in patients with thyroid disease not believed to be of autoimmune origin: toxic adenoma (n = 13), cold nodule (n = 5), and nontoxic goiter (n = 19), with a single exception in the latter group. Toxic multinodular goiter (n = 26) was diagnosed based on clinical and laboratory evidence of hyperthyroidism associated with a multinodular goiter on palpation and scintiscan. The toxic multinodular goiter group was then subclassified according to scintiscan pattern (type A, diffuse but uneven distribution of technetium uptake; type B, multiple discrete nodules of varying size and function). All but 1 of the 11 TSI-positive toxic multinodular goiter patients had a type A scintiscan pattern. The patients with the type A scintiscan pattern were younger and more often had elevated antithyroid antibody titers, ophthalmopathy, and concurrent development of goiter and hyperthyroidism (rather than long-standing goiter preceding hyperthyroidism) compared to the type B patients. Thus, a subgroup of patients with clinically defined toxic multinodular goiter (type A) probably have autoimmune hyperthyroidism (a variant of Graves' disease), while in another subgroup (type B) hyperthyroidism is not related to an autoimmune etiology (a variant of toxic adenoma).
本研究的目的是检验毒性多结节性甲状腺肿患者中是否至少有一个亚组可能患有自身免疫性甲状腺疾病。通过采用培养的人甲状腺细胞的灵敏生物测定法测量的促甲状腺素免疫球蛋白（TSI）活性，在毒性多结节性甲状腺肿患者和其他甲状腺疾病患者中进行了测定。所有活动性格雷夫斯病患者（n = 47）血清TSI活性均可检测到，而在被认为非自身免疫性起源的甲状腺疾病患者中TSI检测不到：毒性腺瘤（n = 13）、冷结节（n = 5）和非毒性甲状腺肿（n = 19），后一组中有一个例外。毒性多结节性甲状腺肿（n = 26）根据甲状腺功能亢进的临床和实验室证据诊断，触诊和闪烁扫描显示为多结节性甲状腺肿。然后根据闪烁扫描模式将毒性多结节性甲状腺肿组进行亚分类（A 型，锝摄取弥漫但分布不均匀；B 型，多个大小和功能各异的离散结节）。11 例 TSI 阳性的毒性多结节性甲状腺肿患者中除 1 例之外均为 A 型闪烁扫描模式。与 B 型患者相比，A 型闪烁扫描模式的患者更年轻，抗甲状腺抗体滴度升高、眼病以及甲状腺肿和甲状腺功能亢进同时发生（而非甲状腺功能亢进之前有长期存在的甲状腺肿）的情况更常见。因此，临床定义的毒性多结节性甲状腺肿患者亚组（A 型）可能患有自身免疫性甲状腺功能亢进（格雷夫斯病的一种变体），而在另一个亚组（B 型）中，甲状腺功能亢进与自身免疫病因无关（毒性腺瘤的一种变体）。
