長期間治療中に甲状腺ホルモン自己抗体の消長を認めた甲状腺疾患の三例  [in Japanese] Three Thyroid Patients Showing Fluctuation of Thyroid Hormone Autoantibody Titers during Long-term Treatment  [in Japanese]

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Abstract

Development and fluctuation of thyroid hormone autoantibody (THAA) titers were observed during long-term treatment of thyroid diseases in three patients.<BR>The presence of THAA was noticed by spuriously high serum free thyroid hormone levels measured with an analog tracer RIA (Amerlex-M FT<SUB>3</SUB>, FT<SUB>4</SUB>) in all three patients. Amerlex-M FT<SUB>3</SUB> or FT<SUB>4</SUB> levels gradually decreased to appropriate values for the clinical status according to the decreasing titers of THAA.<BR>Free thyroid hormone levels with radiolabeled antibody radioassay (Amerlex-MAB FT<SUB>3</SUB>, FT<SUB>4</SUB>) were not affected by the THAA and always reflected actual thyroid function.<BR>Case <I>1</I> was a 46-year-old man with untreated primary hypothyroidism. Auti-T<SUB>4</SUB> autoantibody was detected in his serum. The <SUP>125</SUP>I-T<SUB>4</SUB> analog binding to the autoantibody (<SUP>125</SUP>I-T<SUB>4</SUB> analog binding ratio) gradually declined after L-T<SUB>4</SUB> therapy and finally almost disappeared two years and four months later. Amerlex-MAB FT4 level rose to the normal range two months after T<SUB>4</SUB> therapy, but TSH level remained slightly elevated (5.4-13μU/ml) for five months during T<SUB>4</SUB> therapy. The <SUP>125</SUP>I-T<SUB>4</SUB> analog binding ratio and anti-Tg autoantibody (TgAb) titer were inversely correlated.<BR>Case 2 was a 72-year-old woman had received desiccated thyroid for a long time. Sequential changes of <SUP>125</SUP>I-T<SUB>4</SUB> analog binding ratio were very similar to those of TgAb titer.<BR>Case 3 was a 74-year-old woman with Graves' disease. She had been treated with methimazole (MMI) and desiccated thyroid for three years and five months. Ten months after stopping both drugs, anti-T<SUB>3</SUB> autoantibody was detected. The <SUP>125</SUP>I-T<SUB>3</SUB> analog binding ratio was transiently elevated and gradually declined to reference range for four years during L-T<SUB>4</SUB> therapy. <SUP>125</SUP>I-T<SUB>3</SUB> analog binding ratio and TgAb titer changed in a similar way.<BR>These results suggest that desiccated thyroid hormone therapy and TgAb formation are related to the development of THAA and that L-T<SUB>4</SUB> therapy reduces the THAA titer.

Journal

  • Folia Endocrinologica Japonica

    Folia Endocrinologica Japonica 71(5), 695-708, 1995-05-01

    The Japan Endocrine Society

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