Mizuno E, Sugenoya A, Haniuda M, Sakai R, Kameko M, Kato M, Iida F
Department of Surgery, Shinshu University School of Medicine.
Nihon Naibunpi Gakkai Zasshi. 1988 Aug 20;64(8):677-86. doi: 10.1507/endocrine1927.64.8_677.
A 48-year-old non-goitrous woman, who had undergone cardiac surgery for mitral stenosis under the extracorporeal circulation, showed high levels of serum T3 and free T3 in a recent follow-up study, employing antibody coated-bead RIA for T3 and -Amerlex M particle RIA for free T3. However, other thyroid function tests (T4, free T4, TSH and TBG) were normal. We suspected that thyroid hormone autoantibodies (THAA) in her serum interfered with T3 and free T3 analyses. The presence of THAA was demonstrated by the use of various procedures as follows. Firstly, the patient's serum was directly incubated with 125I-T3 or -T4 analog which did not bind to TBG, followed by B/F separation with polyethyleneglycol, counting the precipitates. Secondly, after the serum was treated with an acid-charcoal solution to remove circulating thyroid hormone, the measurement of THAA was made as stated above. Normal sera were used as controls. Both the non- and acid-charcoal-treated sera showed much higher percentages of 125I-T3 analog precipitation as compared with controls. In the case of 125I-T4 analog, there was no difference between them. In the third study, the presence of IgG antibodies that bound T3 but not T4 was investigated. The IgG fraction of the patient's serum was separated employing a Protein A-Sepharose CL-4B column chromatography. Then, the prepared IgG fraction was purified by a technique of gel filtration chromatography (Sephacryl S 200). Non-purified and purified-IgG fractions both revealed higher binding percentages of 125I-T3 analog than the control IgG fraction and non-IgG fraction of the patient. Furthermore, a good dose response was observed between the binding percentage of 125I-T3 analog and each dose of the patient's serum or IgG fraction. From these observations, it was clarified that this woman had anti-T3 IgG autoantibodies using a Protein A column chromatography with confirmation of gel filtration chromatography.
一名48岁无甲状腺肿的女性，曾在体外循环下接受二尖瓣狭窄心脏手术，在最近的一项随访研究中，采用T3抗体包被珠RIA法和游离T3 - Amerlex M颗粒RIA法检测，发现其血清T3和游离T3水平升高。然而，其他甲状腺功能检查（T4、游离T4、TSH和TBG）均正常。我们怀疑她血清中的甲状腺激素自身抗体（THAA）干扰了T3和游离T3分析。通过以下各种方法证实了THAA的存在。首先，将患者血清直接与不与TBG结合的125I - T3或 - T4类似物孵育，然后用聚乙二醇进行B/F分离，对沉淀物进行计数。其次，用酸 - 活性炭溶液处理血清以去除循环甲状腺激素后，按上述方法检测THAA。以正常血清作为对照。未处理和经酸 - 活性炭处理的血清与对照相比，125I - T3类似物沉淀百分比均高得多。对于125I - T4类似物，它们之间没有差异。在第三项研究中，研究了结合T3但不结合T4的IgG抗体的存在。采用蛋白A - Sepharose CL - 4B柱色谱法分离患者血清的IgG组分。然后，通过凝胶过滤色谱法（Sephacryl S 200）对制备的IgG组分进行纯化。未纯化和纯化的IgG组分与患者的对照IgG组分和非IgG组分相比，125I - T3类似物的结合百分比均更高。此外，在125I - T3类似物的结合百分比与患者血清或IgG组分的各剂量之间观察到良好的剂量反应。从这些观察结果可以明确，通过蛋白A柱色谱法并经凝胶过滤色谱法确认，该女性患有抗T3 IgG自身抗体。
