PMID: 8590966Jan 1, 1996Paper

Patient with monoclonal gammopathy, thyrotoxicosis, pretibial myxedema and thyroid-associated ophthalmopathy; demonstration of direct binding of autoantibodies to the thyrotropin receptor

European Journal of Endocrinology
M TonaccheraM Ludgate

Abstract

We describe a patient with monoclonal gammopathy who subsequently developed thyrotoxicosis, pretibial myxedema and thyroid-associated ophthalmopathy. The pathogenesis of thyrotoxicosis in Graves' disease is due to the presence of autoantibodies that mimic the action of thyrotropin (TSH), called thyroid-stimulating antibodies (TS-ab); these antibodies may or may not inhibit the binding of TSH to the receptor (thyroid-binding inhibiting immunoglobulin, TBII). The patient's immunoglobulins were TS-ab positive and TBII negative when measured on CHO cells expressing the human TSH receptor. The pathogenetic link between the thyroid, orbit and skin is yet to be established but several candidate shared antigens have been proposed, including the TSH receptor itself. The monoclonal immunoglobulins were in evidence before the symptoms of pretibial myxedema, thyrotoxicosis and ophthalmopathy. In addition, the patient had no autoantibodies to thyroglobulin or thyroperoxidase, which are classic markers of thyroid autoimmunity. This combination led us to postulate that the monoclonal gammopathy could be the cause of all the observed pathology. One method to test this hypothesis would be to show that the monoclonal immunoglobulin is a TS-ab. V...Continue Reading

Citations

Apr 14, 2005·Best Practice & Research. Clinical Endocrinology & Metabolism·Takao AndoTerry F Davies
Apr 9, 1998·Baillière's Clinical Endocrinology and Metabolism·A E Heufelder
Aug 21, 2002·Thyroid : Official Journal of the American Thyroid Association·T Akamizu
Sep 29, 2007·Thyroid : Official Journal of the American Thyroid Association·Bernard Rees SmithJadwiga Furmaniak
Aug 23, 2008·Endocrinology·Syed A MorshedTerry F Davies
Jul 30, 2005·Clinical & Developmental Immunology·Takao Ando, Terry F Davies
Dec 16, 2011·Journal of Cutaneous Pathology·Silvia Gómez-BernalManuel Ángel Rodríguez-Prieto
Apr 5, 2002·The Journal of Clinical Endocrinology and Metabolism·Russell MetcalfeMarian Ludgate
Dec 23, 1998·Endocrine Reviews·B RapoportS M McLachlan
Jan 23, 2019·Frontiers in Endocrinology·Simeng SunTerry F Davies

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