Evidence of intrathyroidal accumulation of TSH receptor antibody in Graves' disease.
To clarify the intrathyroidal accumulation of TSH receptor antibody (TR-ab) produced in the thyroid, adrenalin was injected directly into the thyroid artery of patients with Graves' disease during surgery, allowing serial determination of the TR-ab levels in the thyroidal venous blood. Nine surgical patients (3M and 6F) with Graves' disease and receiving anti-thyroid drugs preoperatively for a period of one to four years were enrolled in this study. Comparison between pre- and posttreatment TR-ab levels revealed continuous increments from the pretreatment levels within 15 min of the injection in five (55.6%) of the nine patients. In three of the five patients, TR-ab levels that had been negative before adrenalin injection became positive 1 min after injection. It is assumed that the increase in the TR-ab level is due to adrenalin-induced constriction of the capillaries in the thyroid tissues, resulting in a voluminous flow of the TR-ab retained in the thyroid into the vein. These findings indicate that the TR-ab level in the peripheral blood does not necessarily reflect precisely the abnormal immunological condition in the Graves' thyroid.
Sugenoya
A
A
Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Kobayashi
S
S
Kasuga
Y
Y
Masuda
H
H
Fujimori
M
M
Komatsu
M
M
Takahashi
S
S
Yokoyama
S
S
Shimizu
T
T
Yamada
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000032:analysis*; D002319:Cardiovascular System / Q000187:drug effects; D004837:Epinephrine / Q000009:adverse effects / Q000494:pharmacology; D005260:Female; D006111:Graves Disease / Q000097:blood / Q000276:immunology* / Q000601:surgery; D006801:Humans; D007267:Injections; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011989:Receptors, Thyrotropin / Q000276:immunology*; D013961:Thyroid Gland / Q000187:drug effects / Q000276:immunology*; D014680:Veins
D000906:Antibodies; D011989:Receptors, Thyrotropin; D004837:Epinephrine