The Prevalence of Thyroid-Stimulating Antibodies in Goitrous Disease Assessed by Cytochemical Section Bioassay*

Abstract

Thyroid-stimulating antibodies (TSAb) were detectable using a highly sensitive cytochemical section bioassay in plasma from all 56 hyperthyroid patients studied, including those who had either diffuse hyperplasia or nodular goiters. The maximum dilution at which TSAb was detectable ranged from 10(-2) - 10(-6). Six of these patients had scintigraphic evidence of single functioning nodules, and, surprisingly, TSAb was present in all. Of 27 patients who had nontoxic goiter, 14 (52%) had positive titers for TSAb ranging from 10(-2) - 10(-4). The mean serum T3 value in nontoxic goitrous patients who had TSAb was significantly higher than that in subjects in whom TSAb was absent; in contrast, mean serum T4 values were not significantly different in those two groups. It is concluded that idiopathic nontoxic goiter, toxic nodular goiter with functioning nodules (Plummer's disease), and toxic diffuse goiter (Graves' disease) share, in part, a common pathogenesis.

Clinical Experience with a Human Thyroid Cell Bioassary for Thyroid-Stimulating Immunoglobin *

“…Those few patients with Hashimoto's disease who were TSI positive all had the ophthalmopathy of Graves' disease, suggesting that they had coexisting Graves' disease and cannot, therefore, be considered as false positives. The present data do not support recent reports of the detection of TSI in nontoxic goiter and toxic nodular patients (6,17,19). The few patients with untreated hyperthyroid Graves' disease that were TSI negative (7%) are of interest.…”

The implications of “thyroid-growth-immunoglobulins” (TGI) for the understanding of sporadic nontoxic nodular goitre

“…The sensitive Bitensky CBA was found positive in 70% of our euthyroid patients with demonstrable TGI (Ealy and Marshall, personal communication) and this did not correlate with whether or not they had a "flat" TRH response. Similar findings were reported by Smyth et al [33]. However, the shape of the dose response curves often suggested coexisting "blocking" antibodies in these sera.…”

Grave’s Eye Ophthalmopathy Developing Following Radioiodine Therapy for Toxic Adenoma

“…Van Leussen reported a case similar to our patient, who developed severe Graves' ophthalmopathy, post radioiodine therapy, given for toxic multinodular goiter, necessitating treatment with oral steroids and orbital radiotherapy [18]. It was previously postulated that radioiodine therapy could be inducing the release of TSH receptor antigens into the circulation which in turn would trigger the development of TSH receptor antibody (TRAb) [11][12][13][14][15][16][17].…”

“…The development of Graves' ophthalmopathy post radioiodine treatment for multi-nodular goiter (toxic or nontoxic) has been rarely described [11][12][13]. Presence of TRAb has been described in 15% -52% of patients with toxic and non-toxic nodular goiter [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. It is possible that such patients may be harboring sub-clinical Grave's disease which may be uncovered after radio-iodine therapy.…”