Cho B Y, Kim W B, Chung J H, Yi K H, Shong Y K, Lee H K, Koh C S
Department of Internal Medicine, Seoul National University College of Medicine, Korea.
Clin Endocrinol (Oxf). 1995 Oct;43(4):465-71. doi: 10.1111/j.1365-2265.1995.tb02619.x.
We have reevaluated the prevalence and pathogenetic importance of TSH receptor blocking antibodies (TRBAb) in autoimmune hypothyroidism, and investigated the changes in TRBAb activities during thyroxine and antithyroid drug treatment.
Serum TSH binding inhibitor immunoglobulin (TBII) and thyroid stimulation blocking antibody (TSBAb) were measured serially in all patients with non-goitrous autoimmune thyroiditis (AT) and measured monthly during methimazole treatment in 6 patients.
Ninety patients with non-goitrous AT and 95 patients with goitrous AT were entered consecutively into this study. All patients with non-goitrous AT were treated with thyroxine and followed at intervals of 6 months for 2 years initially and then yearly intervals. The duration of follow-up was 1-8 years. Six patients from the TRBAb-positive non-goitrous AT group who were treated with thyroxine were randomly selected and given additional treatments with methimazole (40 mg per day) for 6 months.
Serum TBII was measured by a radioreceptor assay, TSBAb by using FRTL-5 cells, and antithyroid peroxidase and antithyroglobulin antibodies by radioimmunoassay.
The prevalences of TBII and TSBAb is non-goitrous AT were 47.8 and 58.9%, respectively, which were significantly higher than those in goitrous AT (6.3% for TBII, 10.5% for TSBAb). All but one patient showed persistent TBII and TSBAb activities during the thyroxine treatment for up to 8 years. A high dose of methimazole (40 mg per day) did not affect the titres of TBII and TSBAb in 5 out of 6 patients with non-goitrous AT tested. However, antithyroid peroxidase and antithyroglobulin antibodies activities were significantly decreased during the methimazole treatment.
The high prevalence of TSH receptor blocking antibodies (TRBAb) suggests that TRBAb may play a major role in the development of hypothyroidism and thyroid atrophy in the vast majority of patients with non-goitrous autoimmune thyroiditis. Most TRBAb activities are stable for at least 8 years and are now affected by thyroxine and antithyroid drug treatment.
我们重新评估了促甲状腺激素受体阻断抗体（TRBAb）在自身免疫性甲状腺功能减退症中的患病率及其致病重要性，并研究了甲状腺素和抗甲状腺药物治疗期间TRBAb活性的变化。
对所有非结节性自身免疫性甲状腺炎（AT）患者连续测定血清促甲状腺激素结合抑制免疫球蛋白（TBII）和甲状腺刺激阻断抗体（TSBAb），并对6例患者在甲巯咪唑治疗期间每月进行测定。
90例非结节性AT患者和95例结节性AT患者连续纳入本研究。所有非结节性AT患者均接受甲状腺素治疗，最初每6个月随访1次，持续2年，之后每年随访1次。随访时间为1 - 8年。从TRBAb阳性的非结节性AT组中随机选取6例接受甲状腺素治疗的患者，加用甲巯咪唑（每日40 mg）治疗6个月。
采用放射受体分析法测定血清TBII，利用FRTL - 5细胞测定TSBAb，采用放射免疫分析法测定抗甲状腺过氧化物酶和抗甲状腺球蛋白抗体。
非结节性AT患者中TBII和TSBAb的患病率分别为47.8%和58.9%，显著高于结节性AT患者（TBII为6.3%，TSBAb为10.5%）。除1例患者外，所有患者在长达8年的甲状腺素治疗期间均表现出持续的TBII和TSBAb活性。在接受检测的6例非结节性AT患者中，5例患者使用高剂量甲巯咪唑（每日40 mg）并未影响TBII和TSBAb的滴度。然而，在甲巯咪唑治疗期间，抗甲状腺过氧化物酶和抗甲状腺球蛋白抗体活性显著降低。
促甲状腺激素受体阻断抗体（TRBAb）的高患病率表明，TRBAb可能在绝大多数非结节性自身免疫性甲状腺炎患者的甲状腺功能减退和甲状腺萎缩的发生中起主要作用。大多数TRBAb活性至少8年保持稳定，且不受甲状腺素和抗甲状腺药物治疗的影响。
