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March 1986, Vol 140, No. 3 >
Article | March 1986

Thyrotropin-Receptor Autoantibodies in Children and Young Adults With Graves' Disease FREE

Rosalind S. Brown, MD, CM; Louis P. Kertiles, MS; Cathy Rosenfield, MD; Richard E. Kleinmann, MD; John F. Crigler, MD
[+] Author Affiliations

Accepted for publication Nov 5, 1985.

Presented in part at the Annual Meeting of the American Thyroid Association, San Diego, Nov 5-8, 1980.

Reprints not available.


Am J Dis Child. 1986;140(3):238-241. doi:10.1001/archpedi.1986.02140170064029.
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• Thyrotropin (TSH)-receptor autoantibodies were assessed by measurement of125l-bTSH binding inhibition in 32 patients with juvenile-onset Graves' disease (one of whom was studied twice) and 16 normal control subjects. Thirteen (76.5%) of 17 thyrotoxic patients had significantly elevated TSH binding-inhibitory immunoglobulin (TBII) activity compared with eight (50%) of 16 patients who were in clinical remission and none of the control subjects. Mean TBII activity was significantly greater in thyrotoxic patients than in individuals in remission, except in one unusual patient in whom there was a discordance between TBII activity and in vitro thyroid-stimulatory activity. In eight euthyroid patients who were followed up for at least five months while not receiving treatment, assessment of TBII activity did not predict who would or would not suffer relapse at a later date. Thus, TBIIs are secreted in excess in juvenile Graves' disease, the titer decreasing as the disease remits. The TBII assay cannot be used as the sole predictor of when antithyroid medication can be withdrawn safely, however.

(AJDC 1986;140:238-241)

REFERENCES

1 +
Fisher DA:  Hyperthyroidism: Pediatric aspects , in Werner SC, Ingbar SH (eds): The Thyroid . New York, Harper & Row, 1978;, pp 805-813.
2 +
Saxena KM, Crawford JD, Talbot NB:  Childhood thyrotoxicosis: A longer-term prospective . Br Med J 1964;;2:1153-1158.
3 +
Barnes HV, Blizzard RM:  Antithyroid drug therapy for toxic diffuse goiter (Graves' disease): Thirty years experience in children and adolescents . J Pediatr 1977;;91:313-320.
4 +
Collen RJ, Landaw MD, Kaplan SA, et al:  Remission rates of children and adolescents with thyrotoxicosis treated with antithyroid drugs . Pediatrics 1980;;65:550-556.
5 +
Smith BR, Hall R:  Thyroid-stimulating immunoglobulins in Graves' disease . Lancet 1974;;2: 427-430.
6 +
Mukhtar ED, Smith BR, Pyle GA, et al:  Relation of thyroid-stimulating immunoglobulins to thyroid function and effects of surgery, radioiodine, and antithyroid drugs . Lancet 1975;;1: 713-715.
7 +
Rickards C, Buckland P, Smith BR, et al:  The interaction of Graves' IgG with the thyrotrophin receptor . FEBS Lett 1978;;127:17-21.
8 +
Valente WA, Vitti P, Yavin Z, et al:  Monoclonal antibodies to the thyrotropin receptor: Stimulating and blocking antibodies derived from the lymphocytes of patients with Graves' disease . Proc Nati Acad Sci USA 1982;;79:6680-6684.
9 +
Solomon DH:  The nature of Graves' hyperthyroidism, pp 379-382 in Brown J (moderator): Autoimmune thyroid diseases—Graves' and Hashimoto's . Ann Intern Med 1978;;88:379-391.
10 +
Strakosch CR, Wenzel BE, Row VV, et al:  Immunology of autoimmune thyroid diseases . N Engl J Med 1982;;307:1499-1507.
11 +
Davies TF, Yeo PPB, Evered DC, et al:  Value of thyroid-stimulating-antibody determinations in predicting short-term thyrotoxic relapse in Graves' disease . Lancet 1977;;1:1181-1182.
12 +
McKenzie JM, Zakarija M, Sato A:  Humoral immunity in Graves' disease . Clin Endocrinol Metabol 1978;;7:31-45.
13 +
Teng CS, Yeung RT:  Changes in thyroidstimulating antibody activity in Graves' disease with antithyroid drug and its relationship to relapse: A prospective study . J Clin Endocrinol Metabol 1980;;50:144-147.
14 +
McGregor AM, Smith BR, Hall R, et al:  Prediction of relapse in hyperthyroid Graves' disease . Lancet 1980;;1:1101-1103.
15 +
Schleusener H, Schernthaner G, Mayr WR, et al:  HLA-DR3 and HLA-DR5 associated thyrotoxicosis: Two different types of toxic diffuse goiter . J Clin Endocrinol Metabol 1983;;56: 781-785.
16 +
Farid NR, Stone E, Johnston G:  Graves' disease and HLA: Clinical and epidemiological associations . Clin Endocrinol 1980;;13:535-544.
17 +
Brown RS, Kertiles LP, Reichlin S:  Partial purification and characterization of thyrotropin binding inhibitory immunoglobulins from normal human plasma . J Clin Endocrinol Metabol 1983;; 56:156-163.
18 +
Kleinmann RE, Braverman LE, Vagenakis AG, et al:  A new method for measurement of human thyroid-stimulating immunoglobulins . J Lab Clin Med 1980;;95:581-589.
19 +
Brown RS, Jackson IMD, Pohl SL, et al:  Do thyroid-stimulating immunoglobulins cause nontoxic and toxic multinodular goitre? Lancet 1978;; 1:904-906.
20 +
Zakarija M, McKenzie JM, Banovac K:  Clinical significance of thyroid-stimulating antibody in Graves' disease . Ann Intern Med 1980;;93: 28-32.
21 +
Valente WA, Vitti P, Rotella CM, et al:  Antibodies that promote thyroid growth: A distinct population of thyroid-stimulating autoantibodies . N Engl J Med 1983;;309:1028-1034.
22 +
Drexhage HA, Botazzo GF, Doniach D, et al:  Evidence for thyroid growth-stimulating immunoglobulins in some goitrous thyroid diseases . Lancet 1980;;2:287-292.
23 +
Sugenoya A, Kidd A, Row VV:  Correlation between thyrotropin-displacing activity and human thyroid-stimulatory activity by immunoglobulins from patients with Graves' disease and other thyroid disorders . J Clin Endocrinol Metabol 1979;;48:398-402.
24 +
Kuzuya N, Chiu SC, Ikeda H, et al:  Correlation between thyroid stimulators and 3,5,3'iodothyronine suppressibility in patients during treatment for hyperthyroidism with thionamide drugs: Comparison of assays by thyroid-stimulating and thyrotropin-displacing activities . J Clin Endocrinol Metabol 1979;;48:706-711.
25 +
Toft AD, Irvine WJ, Seth J, et al:  Thyroid function in the long-term follow-up of patients treated with iodine-131 for thyrotoxicosis . Lancet 1975;;2:576-578.
26 +
Buerklin EM, Schimmel M, Utiger RD:  Pituitary-thyroid regulation in euthyroid patients with Graves' disease previously treated with antithyroid drugs . J Clin Endocrinol Metabol 1976;;43:419-427.
27 +
Orgiazzi J, Williams DE, Chopra IJ, et al:  Human thyroid adenyl cyclase–stimulating activity in immunoglobulin G of patients with Graves' disease . J Clin Endocrinol Metabol 1976;;42: 341-354.
28 +
Shewring G, Smith BR:  An improved radioreceptor assay for TSH receptor antibodies . Clin Endocrinol 1982;;17:409-417.
29 +
Southgate K, Creagh F, Teece M, et al:  A receptor assay for the measurement of TSH receptor antibodies in unextracted serum . Clin Endocrinol 1984;;20:539-543.

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References

1 +
Fisher DA:  Hyperthyroidism: Pediatric aspects , in Werner SC, Ingbar SH (eds): The Thyroid . New York, Harper & Row, 1978;, pp 805-813.
2 +
Saxena KM, Crawford JD, Talbot NB:  Childhood thyrotoxicosis: A longer-term prospective . Br Med J 1964;;2:1153-1158.
3 +
Barnes HV, Blizzard RM:  Antithyroid drug therapy for toxic diffuse goiter (Graves' disease): Thirty years experience in children and adolescents . J Pediatr 1977;;91:313-320.
4 +
Collen RJ, Landaw MD, Kaplan SA, et al:  Remission rates of children and adolescents with thyrotoxicosis treated with antithyroid drugs . Pediatrics 1980;;65:550-556.
5 +
Smith BR, Hall R:  Thyroid-stimulating immunoglobulins in Graves' disease . Lancet 1974;;2: 427-430.
6 +
Mukhtar ED, Smith BR, Pyle GA, et al:  Relation of thyroid-stimulating immunoglobulins to thyroid function and effects of surgery, radioiodine, and antithyroid drugs . Lancet 1975;;1: 713-715.
7 +
Rickards C, Buckland P, Smith BR, et al:  The interaction of Graves' IgG with the thyrotrophin receptor . FEBS Lett 1978;;127:17-21.
8 +
Valente WA, Vitti P, Yavin Z, et al:  Monoclonal antibodies to the thyrotropin receptor: Stimulating and blocking antibodies derived from the lymphocytes of patients with Graves' disease . Proc Nati Acad Sci USA 1982;;79:6680-6684.
9 +
Solomon DH:  The nature of Graves' hyperthyroidism, pp 379-382 in Brown J (moderator): Autoimmune thyroid diseases—Graves' and Hashimoto's . Ann Intern Med 1978;;88:379-391.
10 +
Strakosch CR, Wenzel BE, Row VV, et al:  Immunology of autoimmune thyroid diseases . N Engl J Med 1982;;307:1499-1507.
11 +
Davies TF, Yeo PPB, Evered DC, et al:  Value of thyroid-stimulating-antibody determinations in predicting short-term thyrotoxic relapse in Graves' disease . Lancet 1977;;1:1181-1182.
12 +
McKenzie JM, Zakarija M, Sato A:  Humoral immunity in Graves' disease . Clin Endocrinol Metabol 1978;;7:31-45.
13 +
Teng CS, Yeung RT:  Changes in thyroidstimulating antibody activity in Graves' disease with antithyroid drug and its relationship to relapse: A prospective study . J Clin Endocrinol Metabol 1980;;50:144-147.
14 +
McGregor AM, Smith BR, Hall R, et al:  Prediction of relapse in hyperthyroid Graves' disease . Lancet 1980;;1:1101-1103.
15 +
Schleusener H, Schernthaner G, Mayr WR, et al:  HLA-DR3 and HLA-DR5 associated thyrotoxicosis: Two different types of toxic diffuse goiter . J Clin Endocrinol Metabol 1983;;56: 781-785.
16 +
Farid NR, Stone E, Johnston G:  Graves' disease and HLA: Clinical and epidemiological associations . Clin Endocrinol 1980;;13:535-544.
17 +
Brown RS, Kertiles LP, Reichlin S:  Partial purification and characterization of thyrotropin binding inhibitory immunoglobulins from normal human plasma . J Clin Endocrinol Metabol 1983;; 56:156-163.
18 +
Kleinmann RE, Braverman LE, Vagenakis AG, et al:  A new method for measurement of human thyroid-stimulating immunoglobulins . J Lab Clin Med 1980;;95:581-589.
19 +
Brown RS, Jackson IMD, Pohl SL, et al:  Do thyroid-stimulating immunoglobulins cause nontoxic and toxic multinodular goitre? Lancet 1978;; 1:904-906.
20 +
Zakarija M, McKenzie JM, Banovac K:  Clinical significance of thyroid-stimulating antibody in Graves' disease . Ann Intern Med 1980;;93: 28-32.
21 +
Valente WA, Vitti P, Rotella CM, et al:  Antibodies that promote thyroid growth: A distinct population of thyroid-stimulating autoantibodies . N Engl J Med 1983;;309:1028-1034.
22 +
Drexhage HA, Botazzo GF, Doniach D, et al:  Evidence for thyroid growth-stimulating immunoglobulins in some goitrous thyroid diseases . Lancet 1980;;2:287-292.
23 +
Sugenoya A, Kidd A, Row VV:  Correlation between thyrotropin-displacing activity and human thyroid-stimulatory activity by immunoglobulins from patients with Graves' disease and other thyroid disorders . J Clin Endocrinol Metabol 1979;;48:398-402.
24 +
Kuzuya N, Chiu SC, Ikeda H, et al:  Correlation between thyroid stimulators and 3,5,3'iodothyronine suppressibility in patients during treatment for hyperthyroidism with thionamide drugs: Comparison of assays by thyroid-stimulating and thyrotropin-displacing activities . J Clin Endocrinol Metabol 1979;;48:706-711.
25 +
Toft AD, Irvine WJ, Seth J, et al:  Thyroid function in the long-term follow-up of patients treated with iodine-131 for thyrotoxicosis . Lancet 1975;;2:576-578.
26 +
Buerklin EM, Schimmel M, Utiger RD:  Pituitary-thyroid regulation in euthyroid patients with Graves' disease previously treated with antithyroid drugs . J Clin Endocrinol Metabol 1976;;43:419-427.
27 +
Orgiazzi J, Williams DE, Chopra IJ, et al:  Human thyroid adenyl cyclase–stimulating activity in immunoglobulin G of patients with Graves' disease . J Clin Endocrinol Metabol 1976;;42: 341-354.
28 +
Shewring G, Smith BR:  An improved radioreceptor assay for TSH receptor antibodies . Clin Endocrinol 1982;;17:409-417.
29 +
Southgate K, Creagh F, Teece M, et al:  A receptor assay for the measurement of TSH receptor antibodies in unextracted serum . Clin Endocrinol 1984;;20:539-543.

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