Immunological aspects of Graves' disease

Assuming an autoimmune interested to know whether apart from restoring the immunologic parameters. Freshly diagnosed hyperthyroid patients with Graves' disease were all similarly treated with MMI 10 mg t.i.d. and when euthyroidism was achieved, with substitution of thyroid hormone. At regular intervals measurement of thyroid status and immunologic parameters was done (chapter III). We were interested to know whether thyroid stimulating immunoglobulins (TSI) would change during treatment and whether values of TSI would allow us to determine the prognosis of the disease after a one year course of MMI. In order to measure these TSI, a bioassay was developed measuring cAMP in cultured human thyroid cells in vitro. Assuming an influence of T lymphocytes on autoantibody production, we were also interested to know whether these patients would have abnormal numbers of T helper- and/or T suppressor lymphocytes, which would explain the abnormal immune status. In order to measure these T lymphocyte subpopulations we used monoclonal antibodies specific for these subpopulations and counted the cells with a fluorescenceactivated cell sorter (FACS). A parallel study in the same patients was performed to investigate the sensitivity of two different methods for the measurement of thyroid stimulating immunoglobulins (chapter IV). The cAMP bioassay was compared with two commercially available kits measuring inhibition of binding of TSH to thyroid cell membranes. Also conventional thyroid autoantibodies (anti-thyroglobulin antibodies and anti-microsomal antibodies) were measured as another expression of autoimmunity in this disease. Finally two studies were performed concerning OGD. One (chapter V) was on two patients with unusual clinical presentation of OGD. The other study (chapter VI) was performed in patients with severe ophthalmic Graves' disease (OGD) in order to determine the impact of several therapeutic approaches on the ocular signs with emphasis on irradiation of retrobulbar tissue of these patients.