Thyroid stimulating and thyrotrophin binding-inhibitory immunoglobulin activity in patients with systemic lupus erythematosus having thyroid function abnormalities.

In order to determine whether thyroid function abnormalities seen in patients with systemic lupus erythematosus (SLE) are associated with autoantibodies directed against the TSH receptor, 28 patients with SLE who demonstrated abnormal thyroid function tests were evaluated for the presence of anti-TSH receptor antibodies. Anti-TSH receptor antibody activity was evaluated by assessing cAMP production in vitro in FRTL-5 (rat thyroid) cells (TSI) and the ability of the subjects' IgG to block the binding of thyrotrophin to its receptor in vitro (TBII). Complete thyroid function tests, including TRH testing, also were performed. Ten of the 28 patients demonstrated TSI activity, ranging from 133% to 183% of control. Five patients also had evidence of TBII activity, ranging from 22% to 90% inhibition (of control TSH binding levels), with 2 patients having evidence of both types of antibodies. Neither the TSI nor TBII activity in these patients was associated with the abnormal thyroid function tests. However, there were significantly more patients with TBII activity who had elevated TSH levels (3 of 4 vs 1 of 24, p less than 0.05), suggesting a potential physiologic response to TSH receptor blockade. These results indicate that patients with SLE and thyroid function abnormalities can demonstrate TBII and TSI activity in their serum. However, these antibodies do not necessarily correlate with specific abnormalities of thyroid function.