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Prevalence and functional significance of thyrotropin receptor blocking antibodies in children and adolescents with chronic lymphocytic thyroiditis.

AbstractCONTEXT:
TSH receptor (TSHR) blocking antibodies (Abs) inhibit TSH-induced thyroid growth and function in some adults with chronic lymphocytic thyroiditis (CLT), but their role in the pediatric age range is unknown.
OBJECTIVES:
Our objectives were: 1) to determine the prevalence of TSHR blocking Abs in children and adolescents with CLT and 2) assess their functional significance both in vivo and in vitro.
DESIGN AND SETTING:
This was a retrospective study in a referral outpatient setting.
PATIENTS:
Sera from a total of 87 CLT patients and 33 controls were studied.
MAIN OUTCOME MEASURES:
TSHR Abs were measured by both ELISA and bioassay.
RESULTS:
Eight of 87 children and adolescents with CLT (9.2%), including one as young as 4 yr of age, had TSHR Abs in serum as measured by ELISA. The prevalence was significantly higher in individuals whose serum TSH concentration was 20 mU/liter or greater within 3 months of study than in less hypothyroid patients (eight of 45 vs. none of 42, P < 0.005). Conversely, TSHR Ab-positive patients were significantly more hypothyroid at diagnosis but only when the analysis was restricted to those with severe hypothyroidism was a decreased prevalence of goiter observed. IgG purified from TSHR Ab sera retained the TSH binding-inhibitory activity and TSHR Ab-positive sera inhibited TSH-induced stimulation of cAMP significantly more than normal.
CONCLUSIONS:
TSHR-blocking Abs contribute significantly to the severity of the hypothyroidism in some children with CLT, but as compared with adults, they appear to play less of a role in determining the presence or absence of a goiter.
AuthorsShiri B Feingold, Jessica Smith, Jeff Houtz, Erica Popovsky, Rosalind S Brown
JournalThe Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 94 Issue 12 Pg. 4742-8 (Dec 2009) ISSN: 1945-7197 [Electronic] United States
PMID19850692 (Publication Type: Journal Article)
Chemical References
  • Antibodies, Blocking
  • Immunoglobulin G
  • Receptors, Thyrotropin
  • Thyroid Hormones
  • Thyrotropin
Topics
  • Adolescent
  • Adult
  • Antibodies, Blocking (analysis)
  • Child
  • Child, Preschool
  • Chronic Disease
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Humans
  • Immunoglobulin G (analysis, biosynthesis)
  • Longitudinal Studies
  • Male
  • Receptors, Thyrotropin (antagonists & inhibitors, immunology)
  • Thyroid Function Tests
  • Thyroid Hormones (blood)
  • Thyroiditis, Autoimmune (immunology)
  • Thyrotropin (antagonists & inhibitors)

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