General Medicine

» Elaine Moore - Autoimmune Disease

In response to Autoimmune Disease posted by lolly47:

Hi Lorraine,
TSH receptor antibodies are considered the primary autoantibodies that contribute to TED. Older studies that described collagen stimulating immunoglobulins haven't panned out. However, immune system chemicals known as cytokines, particularly tumor necrosis factor alpha and interleukin 6 also play an important role in promoting inflammation in TED.
Some experts consider these chemicals, which occur at the same time the autoantibodies are produced, even more destructive, and they're known to perpetuate the autoimmune process.

Both the autoantibodies and these immune system chemicals are produced by white blood cells, primarily lymphocytes. These cells are found in the blood circulation and lymph nodes. They also cluster in organs where there is tissue destruction or an ongoing autoimmune process. They contribute to inflammation by rushing to the area and inducing a fullblown immune response.

In thyroidectomy, when most of the thyroid tissue is removed, these clusters of white blood cells, thyroid antibodies and immune system chemicals are removed with the tissue. But surgery itself causes more white blood cells to cluster to the surgical site. If the autoimmune process is still active, these white blood cells will continue producing TSH receptor antibodies and immune system chemicals. In most cases, the autoimmune process will slow down because the thyroid tissue proteins that triggered the reaction are markedly reduced.
And, usually, shortly after surgery thyroid antibody levels will fall. And in most cases TED improves and thyroid autoantibody levels continue to fall.

However, in a small number of people, thyroid antibody production continues. And over time these antibodies react with orbital tissue because TSH receptor protein is present on orbital cells and there is very little thyroid tissue left for the antibodies to react with.

These specific antibodies, the TSH receptor antibodies, won't cause other autoimmune diseases. And the immune system isn't stimulated for a long time after surgery the way it is when people have RAI.

However, if the immune system is still being stimulated by the original triggers that caused the Graves' disease like continual exosure to allergens or chemicals or estrogens... and the immune system has never healed, other autoimmune diseases can develop.

This is why addressing the autoimmune problem when treating Graves' disease has the most efficacy. You're addressing the cause of the problem, promoting immune system healing and allowing the disease process to resolve. By just treating the symptoms, for instance with surgery or RAI, you end up resolving the hyperthyroidism but still having the autoimmune process to deal with.

I know of some people from the UK who have had tests for total TSH receptor antibodies so they're probably available but not always relied on. Best, Elaine