Summary
37 patients with hyperthyroidism, 23 patients with various forms of thyroiditis and 10 patients with malignomas of the thyroid were examined for humoral thyroid antibodies as well as for lymphocytes sensitized against thyroid antigens. Passive hemagglutination and indirect immunofluorescence were used for the studies of humoral antibodies while circulating lymphocytes were examined with the leukocyte migration test. For this test thyroglobulin and the microsomal fraction of glands with hyperthyroid function served as antigens. Measurement of antinuclear factors was performed with the indirect immunofluorescence method using hemolyzed chicken red cells. In some patients the levels of serum immunoglobulins were measured.
It was shown that in thyroid disorders of the various types, not only humoral antibodies but also sensitized lymphocytes against thyroid antigens are present. There was a marked difference regarding the “distribution-pattern” of the immune reactions. While in patients with thyroiditis a predominance of the humoral immune response was found, patients with hyperthyroidism had a more marked cellular immune response. — In the group of patients with malignant tumours only those able for iodine uptake, i.e. with mature cell types showed sensitized lymphocytes against thyroid antigens. — Antinuclear factors were found in low titers in both groups (thyroiditis, hyperthyroidism).—A correlation was found in patients with hyperthyroidism between the severity of the disease and the extent of the cellular immune response in vitro. Increasing activity of the disease was accompanied by a decrease of cell reactivity of the white blood cells. The results are interpreted as further indications for the important role of autoimmune mechanisms not only in chronic thyroiditis but also in hyperthyroidism.
Zusammenfassung
Bei 37 Patienten mit Hyperthyreose, 23 Patienten mit verschiedenen Formen einer Thyreoiditis und 10 Patienten mit Schilddrüsenmalignomen wurden die humoralen Immunreaktionen mit der passiven Hämagglutination nach Boyden und mit der indirekten Immunfluorescenz untersucht. Gegen Schilddrüsenantigene (Thyreoglobulin sowie mikrosomale Fraktion der Schilddrüse) sensibilisierte weiße Blutzellen wurden mit dem Leukocytenmigrationstest nachgewiesen. Zur Bestimmung der organunspezifischen Antikörper gegen Kernfaktoren (ANF) wurde die indirekte Immunfluorescenz an hämolysierten Hühnererythrocyten verwandt. Bei einem Teil der Patienten wurden gleichzeitig die Immunglobuline mit der Mancini-Technik quantitativ bestimmt.
Die bei diesen Untersuchungen erhobenen Befunde zeigen, daß sich bei den untersuchten Krankheitsbildern sowohl humorale Antikörper als auch sensibilisierte Zellen im in vitro-Test gegen die Schilddrüsenantigene nachweisen ließen. Dabei fand sich ein deutlicher Unterschied im Verteilungsmuster der Immunreaktionen. Bei der Thyreoiditis überwog die humorale, bei der Hyperthyreose die celluläre Immunantwort. Bei den Malignomen fanden sich sensibilisierte Zellen nur bei den speichernden Formen. während die Leukocyten von Patienten mit undifferenzierten Malignomen nicht reagierten. Antinucleäre Faktoren in niedrigen Titern ließen sich sowohl bei einem Teil der Thyreoiditisfälle als auch in etwas höherem Prozentsatz bei der Hyperthyreose nachweisen.
Bei den Hyperthyreosen zeigte sich eine Korrelation zwischen der Schwere der Erkrankung und den cellulären Immunreaktionen gegen das mikrosomale Antigen. Bei zunehmender Schwere der Erkrankung war eine deutliche Abnahme der cellulären Immunreaktionen zu finden, während die Zellen von Patienten mit einer leichteren Verlaufsform der Hyperthyreose deutliche Reaktionen zeigten. Die hier beschriebenen Ergebnisse können als weiterer Hinweis auf die Bedeutung von Autoimmunvorgängen nicht nur bei der Thyreoiditis, sondern auch bei der Hyperthyreose gelten. Die Entstehung unterschiedlicher Krankheitsbilder aus gemeinsamer Disposition wird diskutiert.
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Helmke, K., Federlin, K. Humorale Antikörper und celluläre Immunmechanismen bei verschiedenen Schilddrüsenerkrankungen sowie ihre Beziehungen zum klinischen Erscheinungsbild. Klin Wochenschr 52, 578–588 (1974). https://doi.org/10.1007/BF01468500
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DOI: https://doi.org/10.1007/BF01468500
Key words
- Thyroiditis
- hyperthyroidism
- humoral antibodies
- passive hemagglutination. indirect immunofluorescence
- sensitized lymphocytes
- leukocyte migration test
- thyroid malignomas