A makro-TSH diagnosztikus és terápiás jelentősége Hashimoto-thyreoiditises betegekben

Abstract

INTRODUCTION: Structure, importance and incidence and clinical role of macro-TSH not clarified in thyroid diseases. AIM: This study was undertaken to determine the incidence and biological role of macro-TSH in patients with Hashimoto's thyroiditis. METHOD: Blood samples taken from patients with Hashimoto's thyroiditis were screened for the presence of macro-TSH with the polyethylene glycol method and confirmed with protein G agarose absorption test and gel filtration chromatography. Stimulatory capacity of macro-TSH was measured by CHO cells bio-assay. Patients were treated with L-thyroxine (mean 66.5 microg/day) and half of them with selenium (mean 60 microg/day), respectively. RESULTS: 880 patients (728 female, aged 44.8 yr) with Hashimoto's thyroiditis was involved in the study. Macro-TSH was found in the serum of 41 patients (4.6%), the mean TSH 185.4 +/- 35 IU/l was before PEG precipitations and after 5.55 +/- 1.8 IU/l. Titre of anti-TPO proved to be 445 +/- 51 IU/l and gradulally decreased to 212 +/- 51 IU/l after one year therapy. Both the precipitation, protein G absorption and gel chromatography supported the presence of anti-TSH antibody in the macro-TSH complex. Stimulatory capacity of macro-TSH on CHO bio-assay was not proved. The macro-TSH was detected in the selenium not treated group for 18 +/- 3.2 months, selenium-treated for 12 +/- 1.9 months. CONCLUSION: It is concluded that anti-human TSH autoantibodies are a major components of macro-TSH and may cause diagnostic and therapeutical difficulties. The PEG precipitation is a suitable screening method for detection of macro-TSH. Selenium is able to decrease of anti-TPO antibodies and macro-TSH, respectively. When the TSH level is greater than 40.0 IU/l, without the signs of hypothyroidism, the presence of macro-TSH is to be considered. Orv Hetil. 2017; 158(34): 1346-1350.