THYROID AUTO-IMMUNITY AS A DISORDER OF IMMUNOLOGICAL TOLERANCE.
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The immunological response to thyroid damage has been studied in the 101. thyrotoxic patients treated with radioactive iodine (131I). Patients who had positive titres of thyroid complement-fixing (CF) antibody in the sera before treatment invariably showed a rise in titre of this antibody commencing approximately 6 weeks after treatment but always falling to pre-treatment or lower levels after some months. Only in exceptional cases was there any formation of the thyroid CF antibody in patients who had negative thyroid CF tests before treatment; this was so even when the 131I treatment was repeated on two, three or four occasions. In general, the change in thyroid CF titre was more pronounced than the change in titre of antibody to thyroglobulin.
Although the epithelial cells of the human fectal thyroid are rich in thyroid cytoplasmic antigen, the basement membrane is even more delicate than that noted in Hashimoto thyroiditis affecting the adult gland.
A preliminary study has been made of the thymus in Hashimoto thyroiditis. Numerous germinal centres were observed in a thymic biopsy in one case and the radiological appearances of an enlarged thymus were noted in two others.
These several findings are considered in terms of the possible meclhanisms of auto-immunity and the view is taken that formation of thyroid auto-antibodies is a result of a genetically determined disorder of immunological tolerance.