Document Detail

Differences in the levels of TSH-binding inhibitor immunoglobulins in goitrous and agoitrous autoimmune thyroiditis after twelve months of L-thyroxine therapy.
MedLine Citation:
PMID:  10468968     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The aims were to study the prevalence of TSH binding inhibitor immunoglobulins (TBII) in newly diagnosed patients with autoimmune hypo-thyroidism, to determine if clinical and biochemical parameters in these patients differed, and to study the course of these antibodies after 12 months of L-thyroxine (LT4) therapy. SUBJECTS AND DESIGN: In a prospective study, 111 consecutive patients with newly diagnosed auto-immune hypothyroidism were enrolled. Patients were divided into groups according to the presence or absence of a goitre and TBII levels. Clinical and biochemical differences in these patients were analysed. Patients were then treated with L-thyroxine (LT4) for 12 months and changes in their TBII monitored. MEASUREMENTS: Free T4 and TSH levels were measured at baseline and then 6-weekly during the titration of LT4 doses. Once TSH levels had normalized, these measurements were performed 3 monthly. TBII levels were measured in patients at baseline and 12 months. Thyroid stimulating blocking antibody (TSBAb) levels were measured 12-18 months after initiation of LT4 therapy. RESULTS: Twenty patients were TBII-positive, 10 goitrous and 10 agoitrous. Agoitrous TBII-positive patients were found to have similar characteristics: these included TBII levels > 100 U/l, potent thyroid stimulating blocking antibody (TSBAb) activity and a tendency for TBII levels to remain unchanged or to rise after LT4 therapy. The degree of hypothyroidism seen in these cases was significantly greater than in all other groups. In contrast, goitrous TBII-positive patients were heterogenous, most did not have significant TSBAb activity and TBII disappeared in 5 out of 10 cases after a year of LT4 treatment. While TBII disappeared in 6 of the 20 patients after a year, remission of hypothyroidism occurred in only 3 cases. CONCLUSIONS: The degree of hypothyroidism in agoitrous TSH-binding inhibitor immunoglobulins-positive patients appears to be more severe than that seen in other forms of AIT. The differences in thyroid stimulating blocking antiboby activity and response to LT4 therapy in agoitrous and goitrous autoimmune thyroiditis suggest that the TSH-binding inhibitor immunoglobulins in these patients are fundamentally different. The disappearance of TSH-binding inhibitor immunoglobulins in hypothyroid patients was not accompanied by the reversal of hypothyroidism in 50% of patients.
D H Khoo; P H Eng; S C Ho; A C Fok
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical endocrinology     Volume:  51     ISSN:  0300-0664     ISO Abbreviation:  Clin. Endocrinol. (Oxf)     Publication Date:  1999 Jul 
Date Detail:
Created Date:  2000-05-09     Completed Date:  2000-05-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  73-9     Citation Subset:  IM    
Thyroid Unit, Department of Endocrinology, Singapore General Hospital, Singapore.
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MeSH Terms
Autoantibodies / analysis*
Goiter / drug therapy,  immunology*,  physiopathology
Immunoglobulins, Thyroid-Stimulating / analysis
Middle Aged
Prospective Studies
Receptors, Thyrotropin / analysis*
Statistics, Nonparametric
Thyroid Function Tests
Thyroid Gland / physiopathology
Thyroiditis, Autoimmune / drug therapy,  immunology*,  physiopathology
Thyrotropin / blood
Thyroxine / blood,  therapeutic use*
Time Factors
Reg. No./Substance:
0/Autoantibodies; 0/Immunoglobulins, Thyroid-Stimulating; 0/Receptors, Thyrotropin; 0/thyrotropin-binding inhibitory immunoglobulin; 7488-70-2/Thyroxine; 9002-71-5/Thyrotropin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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