Changes in Thyrotropin Binding Inhibitor Immunoglobulin (TBII) Concentration before and after Various Treatments in a Patient with Infiltrative Graves Ophthalmopathy
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In a patient with active Graves disease an infiltrative ophthalmopathy developed during antithyroid drug therapy. Her eye symptoms were effectively treated with a large dose of prednisolone (PD), plasma exchanges (PE), cyclophosphamide, orbital irradiation, antithyroid drug and a supplemental dose of triiodothyronine.<BR>Before, during and after these treatments thyrotropin binding inhibitor immunoglobulin (TBII) activities in a unit serum immun.oglobulin (IgG) were measured after adjusting the IgG concentration by adding normal IgG. Relative T811 concentrations were calculated by extrapolating individual data on a standard curve constructed from serial dilutions of the most potent IgG. Approximately a 5 fold increase in the TBII concentration was observed during 2 months of progression of the ophthalmopathy, while TBII activity revealed only a 13.3% increase. After treatment TBII concentrations decreased gradually showing a close relation with the severity of the eye symptoms. Every PE was found to remove 48.5±7.9 (s.e.m.)% of TBII. After PE TBII returned to the preexchange level very rapidly and then overshot it in 2 to 3 weeks. Sixty mg of PD failed to prevent the overshoot but a 100mg initial of PD after 5 PEs inhibited it to some extent.<BR>The effectiveness of combined therapy with PE, PD and cyclophosphamide appeared to confirm a role of hurnoral factors in the pathogenesis of Graves ophthalmopathy. Serial determinations of TBII in a relative concentration were considered quite useful in analyzing the effectiveness of treatment in Graves ophthalmopathy.
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