Zakarija M, McKenzie J M
Life Sci. 1983;32(1-2):31-44. doi: 10.1016/0024-3205(83)90171-6.
The current knowledge of thyroid-stimulating antibody (TSAb) and its significance in Graves' disease is reviewed under 4 headings. 1) Methods of assay; these are categorized as thyroid-stimulation or thyrotropin-receptor-modulation type methods. The latter are convenient but non-specific and the former are inconvenient but specific. The use of guinea pig fat cell membranes as a source of receptor for thyrotropin may improve the specificity of the thyrotropin-binding inhibition (TBI) system. 2) Immunochemistry of TSAb; evidence for the restricted heterogeneity, or oligoclonality, of the antibody as it occurs in some sera, viz. selected for the very high titer, includes a relatively constant pI on isoelectric focussing, restriction to IgG1 and having only lambda or k as the light chain. 3) Are antibodies other than TSAb pathogenic in hyperthyroidism? data are provided indicating the presence in one serum of an antibody that inhibits the action of TSAb in vitro. Clinically this novel antibody caused delayed onset of neonatal hyperthyroidism in 2 children. The prevalence of the antibody and its general clinical significance are unknown, but ways of testing for its presence are reviewed. 4) Clinical significance of the assay of TSAb; TSAb occurs in at least 90% of patients but should not be necessary for the diagnosis of Graves' disease. Its persistence at the end of a course of antithyroid drugs predicates relapse; a high level on first diagnosis may forecast such persistence and be an indication for ablative therapy for hyperthyroidism. A high level of TSAb in the third trimester of pregnancy is a reliable index of neonatal hyperthyroidism. It should be recognized that there is a marked tendency for TSAb values to fall throughout the course of pregnancy.
本文从四个方面综述了促甲状腺素抗体（TSAb）及其在格雷夫斯病中的意义。1）检测方法；这些方法分为甲状腺刺激型或促甲状腺素受体调节型方法。后者操作简便但缺乏特异性，前者操作不便但具有特异性。使用豚鼠脂肪细胞膜作为促甲状腺素受体来源，可能会提高促甲状腺素结合抑制（TBI）系统的特异性。2）TSAb的免疫化学；在某些血清中出现的抗体具有受限的异质性或寡克隆性，即选择高滴度血清进行研究，其证据包括等电聚焦时相对恒定的pI、局限于IgG1且轻链仅为λ或κ。3）除TSAb外的其他抗体在甲状腺功能亢进症中是否具有致病性？提供的数据表明，在一份血清中存在一种抗体，该抗体在体外可抑制TSAb的作用。临床上，这种新型抗体导致2名儿童出现新生儿甲状腺功能亢进症延迟发作。该抗体的患病率及其一般临床意义尚不清楚，但文中综述了检测其存在的方法。4）TSAb检测的临床意义；至少90%的患者存在TSAb，但它并非格雷夫斯病诊断所必需。抗甲状腺药物疗程结束时TSAb持续存在预示着疾病复发；首次诊断时TSAb水平高可能预示着其持续存在，是甲状腺功能亢进症消融治疗的指征。妊娠晚期TSAb水平高是新生儿甲状腺功能亢进症的可靠指标。应当认识到，在整个妊娠过程中，TSAb值有明显下降的趋势。
