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Hyperthyroid Graves' disease without detectable thyrotropin receptor antibodies.

A Ilicki1, A Gamstedt, F A Karlsson

  • 1Department of Clinical Research, University Hospital, Uppsala, Sweden.

The Journal of Clinical Endocrinology and Metabolism
|May 1, 1992
PubMed
Summary

Graves' disease hyperthyroidism can occur without detectable TSH receptor antibodies. In some cases, these antibodies appear after radioiodine treatment, suggesting alternative thyroid-stimulating mechanisms beyond antibodies.

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Area of Science:

  • Endocrinology
  • Immunology
  • Thyroidology

Background:

  • Graves' disease is an autoimmune disorder characterized by hyperthyroidism, typically caused by TSH receptor antibodies stimulating the thyroid.
  • Thyroid-stimulating immunoglobulins (TSI) are the primary drivers of thyroid overactivity in Graves' disease.

Purpose of the Study:

  • To investigate hyperthyroid patients with increased thyroid radioiodine uptake but lacking detectable TSH receptor antibodies.
  • To explore potential alternative mechanisms of thyroid stimulation in Graves' disease.

Main Methods:

  • Radioreceptor assay for TSH receptor antibodies.
  • Bioassay using rat thyroid cell line (FRTL-5) to assess immunoglobulin stimulant activity.
  • Monitoring TSH receptor antibody presence and activity post-radioiodine therapy.

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Main Results:

  • Nine out of 130 hyperthyroid patients lacked detectable TSH receptor antibodies initially.
  • Serum immunoglobulins showed no stimulant activity in the FRTL-5 cell line bioassay.
  • TSH receptor antibodies became detectable in all nine patients after radioiodine treatment, with varying stimulatory and blocking activities observed.

Conclusions:

  • A subset of patients with active hyperthyroid Graves' disease may not have detectable TSH receptor stimulatory antibodies at presentation.
  • Radioiodine therapy may unmask or induce the production of TSH receptor antibodies.
  • Alternative mechanisms, potentially independent of antibodies, might contribute to thyroid activation in Graves' disease.