Changes in thyrotropin binding inhibitor immunoglobulin (TBII) concentration before and after various treatments in a patient with infiltrative Graves' ophthalmopathy.
In a patient with active Graves' disease an infiltrative ophthalmopathy developed during antithyroid drug therapy. Her eye symptoms were effectively treated with a large dose of prednisolone (PD), plasma exchanges (PE), cyclophosphamide, orbital irradiation, antithyroid drug and a supplemental dose of triiodothyronine. Before, during and after these treatments thyrotropin binding inhibitor immunoglobulin (TBII) activities in a unit serum immunoglobulin (IgG) were measured after adjusting the IgG concentration by adding normal IgG. Relative TBII concentrations were calculated by extrapolating individual data on a standard curve constructed from serial dilutions of the most potent IgG. Approximately a 5 fold increase in the TBII concentration was observed during the 2 months of progression of the ophthalmopathy, while TBII activity revealed only a 13.3% increase. After treatment TBII concentrations decreased gradually showing a close relation with the severity of the eye symptoms. Every PE was found to remove 48.5 +/- 7.9 (s.e.m.) % of TBII. After PE TBII returned to the preexchange level very rapidly and then overshot it in 2 to 3 weeks. Sixty mg of PD failed to prevent the overshoot but a 100 mg initial dose of PD after 5 PEs inhibited it to some extent. The effectiveness of combined therapy with PE, PD and cyclophosphamide appeared to confirm a role of humoral factors in the pathogenesis of Graves' ophthalmopathy. Serial determinations of TBII in a relative concentration were considered quite useful in analyzing the effectiveness of treatment in Graves' ophthalmopathy.
Mori
T
T
Tanaka
K
K
Akamizu
T
T
Yokota
T
T
Ishii
H
H
Nakamura
H
H
Imura
H
H
D005128:Eye Diseases / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism*; D018828:Immunoglobulins, Thyroid-Stimulating; D008713:Methimazole / Q000627:therapeutic use; D008875:Middle Aged; D010956:Plasmapheresis; D011441:Propylthiouracil / Q000627:therapeutic use; D011859:Radiography; D012886:Skull / Q000000981:diagnostic imaging
D007074:Immunoglobulin G; D018828:Immunoglobulins, Thyroid-Stimulating; D008713:Methimazole; D011441:Propylthiouracil