Joffe B, Gunji K, Panz V, Zouvanis M, Swanson J, Ackrell B A, Wall J R
Carbohydrate and Lipid Metabolism Research Unit, University of the Witwatersrand Medical School, Johannesburg, South Africa.
Thyroid. 1998 Nov;8(11):1023-7. doi: 10.1089/thy.1998.8.1023.
Thyroid-associated ophthalmopathy (TAO) is a progressive eye disorder associated with Graves' hyperthyroidism, which is generally considered to have an autoimmune etiology. Eye muscle membrane proteins of 64 kd are good markers of ophthalmopathy in patients with thyroid autoimmunity. The 64-kd protein is now shown from a partial sequence to be the flavoprotein subunit (Fp) of mitochondrial succinate dehydrogenase. Hyperthyroidism due to Graves' disease is increasing in incidence among urban black female Africans, possibly because of exposure to environmental risk factors such as increased dietary iodine ingestion and stress. Ophthalmopathy is frequently observed in this clinical context, but its association with serum autoantibodies reactive with Fp has not been examined. We studied 19 black South African patients with Graves' disease during the course of prolonged antithyroid drug administration, of whom 10 had congestive ophthalmopathy, but no clinical evidence for eye muscle damage at the onset. Anti-Fp antibodies were detected in 2 of these patients, as well as in 2 of the 9 patients who did not have overt eye disease. Additionally, the antibodies became positive in 3 patients with ophthalmopathy in whom tests were negative initially, remained positive in 1 patient throughout the study period and became negative in 1 patient with positive tests initially. Ophthalmopathy did not develop in any of the 9 patients who lacked this complication on presentation. The reasons why we failed to demonstrate a close relationship between anti-Fp antibodies and the eye muscle component of ophthalmopathy are unclear although one possibility is that ocular myopathy is an uncommon manifestation in African thyrotoxic patients compared with those of Caucasian origin. The relationship between anti-Fp antibodies and eye muscle inflammation in patients with thyroid autoimmunity of different ethnic origins and environmental settings, needs to be addressed in a large prospective study.
甲状腺相关眼病（TAO）是一种与格雷夫斯甲亢相关的进行性眼部疾病，一般认为其病因是自身免疫性的。64kd的眼肌膜蛋白是甲状腺自身免疫患者眼病的良好标志物。现在从部分序列显示，64kd蛋白是线粒体琥珀酸脱氢酶的黄素蛋白亚基（Fp）。格雷夫斯病导致的甲亢在非洲城市黑人女性中的发病率正在上升，可能是因为接触了环境风险因素，如饮食中碘摄入量增加和压力。在这种临床情况下经常观察到眼病，但其与与Fp反应的血清自身抗体的关联尚未得到研究。我们研究了19名长期服用抗甲状腺药物的南非黑人格雷夫斯病患者，其中10名患有充血性眼病，但发病时没有眼肌损伤的临床证据。在这些患者中有2名检测到抗Fp抗体，在9名没有明显眼病的患者中也有2名检测到。此外，3名最初检测为阴性的眼病患者抗体转为阳性，1名患者在整个研究期间抗体保持阳性，1名最初检测为阳性的患者抗体转为阴性。9名就诊时没有这种并发症的患者均未发生眼病。我们未能证明抗Fp抗体与眼病的眼肌成分之间存在密切关系的原因尚不清楚，尽管一种可能性是与白种人起源的患者相比，眼肌病在非洲甲状腺毒症患者中是一种不常见的表现。不同种族和环境背景的甲状腺自身免疫患者中抗Fp抗体与眼肌炎症之间的关系，需要在一项大型前瞻性研究中加以探讨。
