PATIENTS AND METHODS
Forty-eight patients with Graves’ disease (29 females and 19 males aged 14 to 60 years) and twenty age and sex matched control subjects were included in the study. They were divided into four groups: group A included newly diagnosed GD patients (15), group B were hyperthyroid GD patients undergoing methamizole therapy (15), group C were patients who had been rendered euthyroid after methamizole treatment (18) and group D included 20 controls who had neither systemic disease nor endocrine disorder. All patients were selected from thyroid clinic, Mayo Hospital, Lahore. The diagnosis of Graves’ disease was made on Wayne’s clinical diagnostic index13, thyroid function tests, radioactive iodine (131J) uptake, thyroid scans, serum T4. T3 and TSH using T4 RIA, T3 RIA and TSH RIA kits (Amersham International Ltd., Amersham Buckinghamshire, England). All sera were stored at -4°C till required. Thyroid microsomal antibody (MSAb) was estimated using the Serodia-AMC kit (Fujcribio Inc., Tokyo, Japan). The test was based on indirect agglutination/microtitration technique14. Statistical analysis was done using students \\\'t\\\' test.
1. Larsen, l’.R. The thyroid, in Cecil’s textbook of medicine. 19th ed. Philadelphia, Saunders, 1992 pp. 1248-71.
2. Stewart, AG. Pot- debate: drifting continents and endemic goiter in northern Pakistan. Br.MedJ., 1990:300:1507-12.
3. Ashraf, S.W.K. and Tavyab. M. Long acting thyroid stimulator in Graves’ disease. Pakistan. .1.Med. Res., 1989:28;131-34.
4. Bjoro. T., Gaardcr, P.1., Smeland, CIt. and Kornstad, L. Thyroid antibodies in blood donors; prevalence and clinical significance. Acta Endocrinol., 198.1: 105:324-29.
5. 1lawkins, BR., Cheah, P.S., Dawkins. R.L, Wbittingham, S.. Burger, H.G., Patel, Y., Mackay, L.R. and Welborn, T.A. Diagnostic significance of thyroid microsomal antibodies in randomly selected population. Lancct, 1980:2:1057-59.
6. Amino, N. Antithyroid antibodies, in Werner’s the thyroid. 5th ed. Philadelphia, Lippincot, 1986: pp. 546-59.
7. Hamada, N., Grimm, C.. Mori. H. and DeGrool, L.J. Identification of a thyroid microsomal antigen by western blot and immunoprecipitation. J.Clin. Endocrinol. Metab., 1985;61:120-28
8. Mariotti, S., Chiovato, P.. Vitti, P. etal. Recentadvancesin theunderstandingof humoral and cellular mechanisms implicated in thyroid autoimmune disorders. Clin. Immunol. Immunopath. 1989:50:S73-S84.
9. Kboury, E.L., Hammond. L., Bottazzo, G.F. and Doniach. D. Presence of the oi’gan.speciflc "microsomal" autoantigen on the surface of human thyroid cells in culture; its involvement in complement mediated cytyxicity. Clin.Exp. Immunol., 1987;45:316-28.
10. Pinchera, A., Mariotti, S., Chiovato, L, Vitti. P., Lopez, G., Lombardi, A., Anelli, S., Bechi, R. and Carayon, P. Cellular localizationof the microsomal antigen and the thyroid peroxidase antigen. Ada Endocrinol. Suppl. (Copcnh), 1987;281:57-62.
11. Mariotti. S., Anelli. S., Ruf, J., Bechi, R.. Czarnocka. B., Lambardi, A., Carayon, P. and Pinchera, A. Comparison of serum thyroid microsomal and thyroid peroxidase auto-antibodies in thyroid diseases. J.Clin.Endocrinol. Metab., 1987:65:987-93.
12. Mariotti, S., Caturgeli, P., Piccolo, P., Barbesino, 0. and Pinchera, A. Antithyroid peroxidase autoantibodies in thyroid disease. J.Clin. Endocrinol. Metab., 1900;71:66169.
13. Raing, A.J. I. and Capper, W.M. Bailey and Love’s short practice of surgery. 15th ed. London, Levis. 1971, P. 572.
14. Roitt, TM., Brostoff, .1. and Mole, D.K. ed. Immunology, London, Gower Medical PubI..1985, p.25.2
15. Laurent. E., Van-Sande, 3,1., Ludgate, M., Corvilian. B., Rocman’s, P., Dumont, J.E, and Moekell, J. Unlike thyrodropin, thyroid-stimulating antibodies do not activate phospholipase C in human thyroid slices. J.Clin.Invest., 1991;87:1634-42.
16. Belcher, M. and Bar, R.S. Autoimminity in thyroid disorders: Graves’ disease, in receptors and human disease. Baltimore, Williams and Wilkins, 1981, pp.219-35.
17. Real, G.N. and Solomon. D.H. Hashimoto’s disease and Graves’ disease, Immunological disease. Samter MAx.(ed) 3rd ed. Boston, Little Brown, 1978, vol.2 pp. 1261-77.
18. Ingbar, S.H. The thyroid gland, William’s textbook of endocrinology. 7th ed Philadelphia, Saunders, 1985, pp.682-815.
19. Lucas-Martin. A.. Foz-Sala, M., ‘l’odd, I., Bottazzo, G.F. and Pujol-Boreell, R. Occurrence of thyrocyte HLA class II expression in a wide variety of thyroid diseases. Relationship with lymphocytic infiltration and thyroid autoantibodies. J.Clin.Endocrinol. Metab., 1988,66:367-75.
20. Volpe, R. Pathogenesis of autoimmune thyroid disease, in Werner’s the thyroid. Philadelphia, Lippincott, 1986, pp. 747-67.
21. Hamada, N., Jaeduck, N., Portmann, L., Ito, K. and DeGroot, Li. Antibodies against denatured and reduced thyroid microsomal antigen in autoimmune thyroid disease. 3. Clin. Endocrinol. Metab., 1987:64:230-38
22. Sherbaum, W.A. On the clinical importance of thyroid microsomal and thyroglobulin antibody determination. Acts Endocrinol. (Copenh), 1987;281:325.29.
23. Karlsso, F.A. and Totterman, TN. Immunomodulation by methimazote therapy in Graves’ disease: rapid changes in activation stageof circulating regulatory T cell subsets, Btellsand NKcells. Clin. Exp. Immunol., 1988:74:258-63.
24. Mashio. Y., Beniko, M., lkota. A., Mizumoto, H. and Kunita, H. ‘rrcatmcnt of hyperthyroidism with a small single daily dose of methimazole. Acta Endocrinol. (Copenh), 1988:119:139-44.
25. Romaldini, 3.1 I., Werner, M.C., Rodrigues. H.F., Teixeria. V.1,., Warner, R.S., Farah, CS. and Bromberg. N. Graves’ diseaseand Hashimoto\\\'s thyroiditis: cffectsofhighdoses ofantithyroi drugs on thyroid autoantibody levels. J.Endocrinol., Invest., 1986;9:233-38
26. codacioni, J.L., Orgiazzi, J., Blanc, P., Pugeat. M., Router, R. and Carayon, P. Lasting remiaaion in patienta treated for Gravea’ hyperthyroidism with propranolol alone; a pattern of apontaneoua evolution of the disease. J.Clin.Endocrinol. Metab., 1988;67:656- 62.
27. Kandall-Taylor,P. Arc antithyroid drugt immuno-auppreasive? Br.MedJ., 1984;288:509-10.
28. Solomon, B.L., Evaul, I.E., Burman, K.D. and Wartofsky, L. Remission rates with antithyroid drug therapy; continuing influence of iodine intake? Ann.Intern.Med., 1987;107:5 10-12.
29. Muratami, M., Koizumi, Y., Aizawa, T., Yamada, T., Takahaahi, Y., Watanabe, T. and Kamol, K. Studiea of thyroid function and immune parameters in Graves’ disease in remission J.Clin.EndoerinoL Metab., 1988;66:103-8.