hashimoto’s disease was initially recognized by characteristic histopathological abnormalities in...
TRANSCRIPT
Hashimoto’s disease was initially recognized by characteristic histopathological abnormalities in the thyroid gland, different from thyroid cancer but concept has been expanded on the basis of autoimmune thyroiditis
Assay development for detection of anti –thyroid antibodies
1957 USA Witebsky UK Roitt,
Doniach
1958 UK Roitt, Doniach
1959 UK Holborow , Doniach
1976 Japan Amino, Yamada
1985 USA Portmann,
DeGroot
: Anti-thyroglobulin antibody ( Tanned red cell hemagglutination )( TRC ) → ( TGHA ): Anti-microsomal antibody ( Complement fixation )( MCF )
: Immunofluorescent antibody (Cytoplasmic antibody) ( Fab ): Anti-microsomal antibody ( Tanned red cell hemagglutination )( TRC ) ( MCHA ): Anti-peroxidase antibody ( TPOAb )
Assay for anti-microsomal antiboby using hemagglutination method
Solubilized microsomal antigen by sonication
Tanned sheep red cell
+
Antibody(MCHA)
Agglutinationgatin
( Yamada N, Amino N )
Anti-microsamal antibody(MCHA) and -thyroglobulin antibody(TGHA) in thyroid diseases
Negative
204080
160320640
128025605120
10240204804096081920
163840
Euthyroid Hypothyroid
Hashimoto’s thyroiditis
MCHA
TGHA
Amino N et al. Clinical Endocrinology 5: 115 , 1976
Graves’ disease
Subacute thyroidits
(Amino, The Thyroid 5th ed, Chapter 24, 1986.)
Prevalence of anti-thyroid microsomal antibodies in healthy adults
18 ~ 29 30 ~ 49 50 ~ 69 70 ~ 89 Age(years)
20
15
10
5
%: Female
: Male
Examination into specificity of anti-microsamal hema gg lutination antibody
1) Thyroid specificity : Comparison with immunofluresence antibody
2)Autoimmune change in thyroid gland :
Relation to lymphocytic infiltration
3) Relation to thyroid dysfunction
Intensity of immunofluorescence
Negative
16000080000400002048010240
512025601280
64032016080
4020
Negative + ++ +++
Examination of anti-microsomal antibodies :Comparison between hemagglutination and
immunofluorescence testsTi
ter o
f MCH
A
(Amino N et al. Clin Endocrinol 5: 115 , 1976 )
Presence of anti-thyroid antibodies and lymphocytic infiltration in thyroid gland
Autopsy study in 70 cases without thyroid disease
Serum antibodies
lymphocytic infiltration
No Yes
Negative 57 2
Positive* 1 10* MCHA 9 cases, TGHA 2 cases
Yoshida H, Amino N et al. J Clin Endocrinol Metab 46: 859 , 1978
MCHA titer 1000
Association of serum antithyroid antibodies with lymphocytic infiltration of the thyroid gland: Studies of seventy autopsied cases
Yoshida H, Amino N, Yagawa K, Uemura K, Satoh M, Miyai K, Kumahara Y
J Clin Endocrinol Metab 46: 859 – 862, 1978
These data suggest that positive serum antithyroid antibodies in subjects without overt thyroid disease may indicate the existence of lymphocytic infiltration in the thyroid gland, that is presumably subclinical autoimmune thyroiditis.
Significance of thyroid microsomal antibodies
Nobuyuki Amino, Hidemitsu Mori, Yoshinori Iwatani, Minoru Kawashima, Kiyoshi Miyai
Lancet 2: 1369, 1980
High TSH cases in positive MCHAtotal 9.1 %
Less than 50 years old 2.2 %
50 years old and more 16.2 %
Health examination 1024 adult cases
Positive MCHA :
Adult female 10.2 %
Adult male 6.0 %
Start of autoimmune abnormality
Aggravating factorsActivating event
in immunity
NormalSubclinical
autoimmune state
Clinical autoimmune disease
Reversible Irreversible
Activ
ity o
f aut
oim
mun
ity
Time
Time course of autoimmune abnormality
(Amino et al. Thyroid 9:705, 1999)
Subclinical Autoimmune Thyroiditis(10% in adult females)
Delivery
Aggravation
Postpartum Thyroid Dysfunction
Systemic Immune Reaction in PregnancyImmune Rebound After Delivery
Activation
Supression
Non pregnant
Pregnant
Parturition
Postpartum (months)
3 6 9 12
Cellularimmunity
(Th1)
Humoral immunity (Th2)
Th1predominant
Th2predemonant
Imm
une
activ
ity
( Amino et al. Endocr J 47: 645,2000 )
2 4 6
Delivery
Postpartum Thyroid Dysfunction(5-10 % of postparum momen)
Incr
ease
Dec
reas
e
months
( II) Transient thyrotoxicosis
( I) Persistent thyrotoxicosis (4.5%)
( III) Destructive thyrotoxicosis (52.1%)( IV) Transient hypothyroidism (20.5%)
( V) Persistent hypothyroidism (0.1%)
PostpartumGraves’ disease
Postpartumexacerbation
of autoimmune thyroiditis
elevated RAIU (6.8%)
Seru
m th
yroi
d ho
rmon
e
low RAIU (16.0%)
Amino N et al. New Engl J Med 306:849,1982Amino et al. Thyroid 9: 705,1999
The classical concept of Hashimoto’s disease has been expanded on the basis of the concept of autoimmune thyroiditis, and subclinical or mild cases of Hashimoto’s disease are thought to exist in one of 10-30 adult women in the general population.
Alumni meeting of the first department of surgery, Kyushu University in 1928
Dr Hakaru Hashimoto Dr Shizuo Kuma,The first president of Kuma Hospital
Founded in 1932
Kobe, Japan
We are very happy to continue the traditional thyroid clinic and research in Kuma Hospital
Thank you very much for your attention