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Tumor necrosis factor-alpha regulation of thyroid transcription factor-1 and Pax-8 in rat thyroid FRTL-5 cells.

Tumor necrosis factor-alpha (TNF-alpha) is known to modulate the expression of thyroid-specific genes, such as thyroglobulin (TG), contributing to the pathogenesis of autoimmune thyroid disease. In the present study, we show that TNF-alpha suppresses DNA-binding activity of thyroid transcription factors, Pax-8 and thyroid transcription factor-1 (TTF-1), which is, in part, involved in TNF-alpha-induced decrease in TG gene expression. Transfected into rat thyroid FRTL-5 cells, the activity of reporter plasmid containing the rat TG promoter ligated to a luciferase gene was significantly suppressed in the presence of TNF-alpha. In gel mobility shift analyses, protein-DNA complexes formed by TTF-1 and Pax-8 were reduced when the nuclear extracts prepared from TNF-alpha-treated FRTL-5 cells were used. The suppressive effect of TNF-alpha on TTF-1-DNA complex formation is, in part, caused by suppression of TTF-1 gene transcription by TNF-alpha. Expressions of TTF-1 messenger RNA and protein, which were assessed by Northern blot and Western blot analyses, respectively, were decreased by TNF-alpha treatment of FRTL-5 cells. In contrast, TNF-alpha did not affect the expression of Pax-8 messenger RNA. Treatment of FRTL-5 cells with TNF-alpha caused a decrease in Pax-8 protein in nuclear extracts and accumulation of the protein in the cytoplasm, as assessed by Western blot analyses. Mutation of the TTF-1/Pax-8-binding site lost the TNF-alpha-induced decrease in TG promoter activity in a transfection experiment. These results indicate that TNF-alpha suppresses the activity of TTF-1 and Pax-8 by different mechanisms, which, in part, seem to be involved in TNF-alpha-induced decrease in TG gene expression.

Animals↗

Mosaicism of a thyroid hormone receptor-beta gene mutation in resistance to thyroid hormone.

CONTEXT: Heterozygous mutations in thyroid hormone receptor-beta (TRbeta) gene are the cause of resistance to thyroid hormone (RTH) in more than 85% of families having the syndrome. In 23% of the families, TRbeta gene mutations occur de novo. Of the 141 families with RTH investigated by us, 21 (15%) had no TRbeta gene mutations detectable by sequencing from genomic DNA (gDNA) or cDNA (non-TR RTH). OBJECTIVE: The objective of the study was to investigate the genotype of a family with RTH and correlate it to the phenotype. DESIGN: The DNA was isolated from different tissues, and the sequence of the TRbeta gene was determined. Clinical studies involved the administration of incremental doses of T(3). SETTING: The study was conducted at a referral pediatric endocrinology clinic in Turkey and an academic medical center in the United States. MAIN OUTCOME AND MEASURES: Measurement included markers of thyroid hormone action and sequencing of TRbeta revealing a R338W mutation. Patients and Family: We studied two siblings with short stature, panic disorder, psychosis, and high free iodothyronine concentrations with nonsuppressed TSH and their father with similar thyroid function tests without growth or psychiatric abnormalities. RESULTS: Direct sequencing of gDNA obtained from the father's leukocytes, buccal mucosa cells, and prostate tissue showed less amplification of the mutant allele (R338W) than the normal allele as confirmed by PCR/restriction fragment length polymorphism analysis. No sequence abnormalities were detected in gDNA from fibroblasts. Similar results were found in mRNA from the leukocytes and fibroblasts. The sensitivity of various tissues to thyroid hormone was not uniform. The progeny had equal amounts of mutant and wild-type gDNA in leukocytes and skin. CONCLUSIONS: The father has a mosaicism for the R338W mutation as it was present in some cell lineages, including his germline, because it was transferred to his children but not in fibroblasts. This indicates that the mutation occurred de novo in early embryonic life. Here is the first report of mosaicism in RTH. The possibility of mosaicism should be considered in subjects with RTH without apparent mutations in the TRbeta gene.

Adult↗

Adenylate cyclase activity and the accumulation and release of adenosine 3',5'-monophosphate in normal human thyroid tissue slice preparations: responses to thyrotropin and thyroid-stimulating antibodies.

The cAMP response to TSH was investigated in slice preparations of normal human thyroid tissue maintained under in vitro conditions. In particular, dose-response relationships for tissue obtained from different thyroid glands were assessed, and the sensitivity and precision of this system were compared with the adenylate cyclase response to TSH in plasma membrane preparations derived from similar tissue. The effect of thyroid-stimulating antibodies (TSAb) on the thyroid slice cAMP response was investigated. After an incubation period of 120 min, 58% of a series of 43 immunoglobulin G (IgG) fractions prepared from the sera of Graves' disease patients significantly elevated the slice level of cAMP when assayed in triplicate at a level of 5 mg/ml. From a total of 22 preparations of IgG from untreated thyrotoxic patients, 11 (50%) stimulated the accumulation of cAMP in thyroid slices. Six out of a group of 8 patients with Graves' ophthalmopathy had demonstrable TSAb activity. After the initiation of antithyroid therapy with carbimazole, IgG preparations from 5 out of a group of 8 patients were without detectable TSAb activity. However, cAMP accumulation was stimulated by all 5 of a group of IgG preparations from previously thyrotoxic patients who had relapsed upon cessation of antithyroid therapy. The elevated cAMP levels in tissue slices in response to either TSH or TSAb were accompanied by an increase in cAMP in the incubation medium. The magnitude and significance of this extracellular cAMP accumulation were similar to those observed in the tissue and, accordingly, may form the basis of a simplified bioassay procedure for TSAb.

Adenylyl Cyclases↗

The stimulation of thyroid hormone secretion in vitro by thyroid-stimulating antibodies.

A new simple technique is described for the in vitro assay of thyroid-stimulating antibody (TSAb) in serum. Thyroid slices are incubated with serum in two-compartmental dialysis pot, followed by measurement of the thyroid hormone concentration in the dialysis fluid by RIA. Heat-inactivated normal serum applied directly to the tissue has no effect on the basal level of response. A dose-dependent relationship is demonstrated for both TSH and TSAb. Serum from patients with untreated Graves' hyperthyroidism is clearly shown to stimulate thyroid hormone secretion. Porcine thyroid tissue has been used and responds well to TSAb. This technique not only has the advantage of simple methodology, but also reflects the biological activity of TSAb. Therefore it will prove useful for further studies of the significance of TSAb and the pathogenesis of Graves' disease.

Animals↗

A new in vitro assay for human thyroid stimulator using cultured thyroid cells: effect of sodium chloride on adenosine 3',5'-monophosphate increase.

A new sensitive in vitro assay for human thyroid stimulator (HTS) was developed using human thyroid adenoma cells in monolayer culture. After being cultured for 2 days, the cells were incubated in 0.3 ml Hank's solution without 0.8% NaCl (medium 1) and with thyroid stimulator (bovine TSH or 3 mg patient serum immunoglobulin G) at 37 C for 2 h. The cAMP generated in the cells and the medium during the incubation was measured by RIA. The assay was sensitive enough to elicit a 1.7- to 7.9-fold increase in cAMP at a TSH concentration of 10 microU/ml. HTS was detected in 33 (82.5%) of the 40 patients with untreated graves' disease using this assay system. In Hank's solution (medium 2), however, HTS was detected in only 5 (23.8%) of the 21 patients with untreated GRaves' disease. cAMP increment upon stimulation by either TSH or HTS in medium 1 was larger than that in medium 2, and the difference in the response to HTS using the two media was much greater than that in the response to TSH. Therefore, all HTS-immunoglobulin G studies showed higher activity using medium 1 than using medium 2 when expressed as bovine TSH equivalent. Analysis by the Lineweaver-Burk plot of dose-response curves of the effect of TSH and HTS stimulation on cAMP increment showed an increase in the Km upon the addition of NaCl to the medium. A similar inhibitory effect of NaCl (150 mM) was also observed in the assay system of human thyroid adenylate cyclase stimulator using crude plasma membrane fractions. In summary: 1) an assay for HTS measuring cAMP production in cultured thyroid adenoma cells was developed and the assay using low NaCL medium was found to be the most sensitive, and 2) the inhibitory effect of NaCl on the response to HTS was much greater than that on the response to TSH. These data suggest different behaviors of these two stimulators at their receptor sites.

Adenoma↗

Defective thyroid hormone action in fibroblasts cultured from subjects with the syndrome of resistance to thyroid hormones.

Two preadolescent girls and their mother with the syndrome of central and peripheral resistance to thyroid hormones are reported. The sisters had goiters, high radioiodine uptakes, high plasma levels of thyroid hormones, normal TSH levels, and brisk increases in TSH after TRH administration, but had no clinical evidence of thyrotoxicosis. The mother, who had undergone partial thyroidectomy and radioiodine therapy, presented with mild hypothyroid symptoms, normal thyroid hormone levels, and a high TSH level. On T4 treatment, her TSH fell toward normal, and thyroid levels became elevated without thyrotoxic symptoms. Special studies were performed with cultured skin fibroblasts. T3 stimulated low density lipoprotein receptor activity in cells from normal subjects, but failed to do so in fibroblasts form the three patients, indicating that their fibroblasts had a defective response to T3. However, after incubation of fibroblasts with labeled T3, no abnormalities in the binding capacity or affinity of nuclei were observed. These findings suggest that in this family, the thyroid hormone resistance demonstrable in vivo and in vitro results from a cellular defect at a site other than at the nuclear binding site.

Adult↗

T lymphocyte subsets in autoimmune thyroid diseases and subacute thyroiditis detected with monoclonal antibodies.

Peripheral T lymphocyte subsets were analysed with monoclonal antibodies, by highly standardized fluorescence-activated cell sorter analysis instead of manual counting by the indirect immunofluorescence method, in autoimmune thyroid diseases and subacute thyroiditis. Total lymphocyte counts were increased in patients with thyrotoxic Graves' disease and subacute thyroiditis. The percentage of total T (Leu 1) cells was significantly lower in patients with thyrotoxic Graves' disease and Hashimoto's disease with destructive thyrotoxicosis than in normal subjects. No significant changes were observed in the percentages of suppressor-cytotoxic T (Leu 2a) cells or helper-inducer T (Leu 3a) cells or in the Leu 3a-Leu 2a ratio in different groups of patients. There were no correlations between the percentages of E rosette-forming cells and Leu 1 cells and between the percentages of T gamma cells and Leu 2a cells in normal subjects and patients. The peak position of fluorescence intensity of Leu 2a cells showed a significant sex difference even in normal controls. The most important finding was a significant decrease in the peak position of Leu 2a cells in patients with thyrotoxic Graves' disease and with hypothyroid or thyrotoxic Hashimoto's disease. These findings indicate the significant association of qualitative, but not quantitative, abnormality of suppressor-cytotoxic T (Leu 2a) cells with thyroid dysfunction in autoimmune thyroid diseases.

Adult↗

Thyroid-infiltrating T lymphocyte subsets in Hashimoto's thyroiditis.

In Hashimoto's thyroiditis, the thyroid gland is infiltrated with immunocompetent lymphocytes. In this study we have used the fine needle aspiration technique to obtain thyroid-infiltrating lymphocytes from 11 HT patients for surface marker studies. The cells were characterized using conventional T and B cell markers as well as monoclonal antibodies (OKT) to different T cell subsets in a microscale immunofluorescence assay. We observed a relative decrease in intrathyroidal suppressor phenotype T (OKT 8+) cell numbers compared with peripheral blood (13% vs. 26%; P less than 0.01 by Wilcoxon signed rank test). This resulted in an increased helper to suppressor T (OKT 4+/OKT 8+) cell ratio (4.7 vs. 2.1; P less than 0.01). Within the gland, a significant local accumulation of B cells was also registered (27% vs. 12%; P less than 0.01). As to circulating lymphocyte subsets, no differences were found between 18 Hashimoto's thyroiditis patients and 26 normal subjects. Our results are compatible with a local synthesis of thyroid-directed antibodies and emphasize the importance of studying the local immunity in organ-specific autoimmune disease.

Adult↗

Anti-thyroid peroxidase antibody in patients with autoimmune thyroid disease: possible identity with anti-microsomal antibody.

Thyroid microsomal antigen and peroxidase (TPO) have a close intracellular anatomical relationship, especially in exocytotic vesicles. We considered that antibodies to microsomal antigen might react with TPO and therefore looked for the presence of antibodies against TPO in the serum of patients with autoimmune thyroid disease (AITD). TPO was prepared from Graves' thyroid glands, solubilized by n-octyl glucoside, and its activity was assayed by the guaiacol method. Control sera and sera with a positive microsomal hemagglutination test (MCHA(+) ) were assayed for their ability to precipitate TPO activity by incubation of sera with TPO and protein A. We identified MCHA(+) sera which caused precipitation of TPO activity, and the extent of precipitation was related to the amount of serum added. A significant correlation was present between this anti-peroxidase activity and microsomal antibodies titers, measured by a micro-ELISA method. Affinity columns prepared from immunoglobulins of MCHA(+) sera, coupled to Reacti-Gel (6X), bound TPO activity, whereas using control IgG the recovery in the unbound fraction was high. These data provide evidence of antibodies against thyroid peroxidase in the serum of patients with AITD and suggest a close link between microsomal antigen and thyroid peroxidase.

Antibodies↗

Unusual antagonistic actions of mixtures of vasoactive intestinal peptide, thyroid-stimulating antibodies, and cholera toxin on adenosine 3',5'-monophosphate accumulation in normal human thyroid cell cultures.

When individually tested, vasoactive intestinal peptide (VIP), cholera toxin, and monoclonal thyroid-stimulating antibodies (TSAbs), but not TSH binding-inhibiting antibodies (TBIAbs), elevate cAMP levels in cultured human thyroid cells. In this study, we tested the effect on cAMP levels in human thyroid cells of the simultaneous presence of VIP and the other ligands noted. Monoclonal TBIAbs (11E8 and 122G3), which interact with a membrane glycoprotein containing the high affinity binding site of the TSH receptor, did not alter VIP-induced cAMP accumulation in the thyroid cells. These data indicate that VIP and TSH bind to distinct sites on the cell membrane. In contrast, monoclonal TSAbs 208F7 and 307H6, which interact with a portion of the TSH receptor other than its high affinity binding site, not only did not have their usual agonist activity, but, instead, caused a marked inhibition of human thyroid cAMP accumulation when VIP was also present. Mutual antagonism by two agonists, i.e. inhibition evident when TSAbs and VIP were mixed, was also found when cholera toxin was coincubated with VIP. The inhibitory effect of mixing cholera toxin and VIP was nearly immediate and was duplicated with mixtures of the beta-subunit of cholera toxin and VIP. The inhibition evident in mixing VIP and the TSAbs or cholera toxin was not duplicated in mixtures of isoproterenol and VIP or in mixtures of forskolin and VIP. These results suggest that the mutual inhibition of VIP and either TSAbs or cholera toxin is at a step that couples the TSH and VIP high affinity receptor-binding sites to the adenylate cyclase complex.

Antibodies, Monoclonal↗

Antibodies against denatured and reduced thyroid microsomal antigen in autoimmune thyroid disease.

Different antigenic determinants on thyroid microsomal antigen (MAg) could induce different antibodies, which, in turn, could have differing importance in the pathogenesis of autoimmune thyroid disease. In this study we demonstrated three types of microsomal antibodies (MAbs) present in serum of patients with autoimmune thyroid disease by Western blot analysis. These MAbs reacted with native, denatured, and denatured and reduced MAg. Methods for detecting the MAbs were developed, and the clinical significance of these Abs was analyzed in 197 patients with thyroid disorders. For measurement of Ab against native and denatured MAg, an enzyme-linked immunosorbent assay, in which wells were coated with untreated or sodium dodecyl sulfate-denatured MAg, was used. For measurement of Ab against denatured and reduced MAg, 6% SDS-polyacrylamide gel electrophoresis followed by Western blot analysis was used. Native MAb enzyme-linked immunosorbent assay values correlated highly with microsomal hemagglutination titers, but patients with high titers of Ab against native MAg did not necessarily have Ab against denatured MAg or reduced MAg. Abs against denatured MAg or denatured and reduced MAg were found in patients with Hashimoto's disease (28.8% and 13.6%) and Graves' disease (22.4% and 11.2%). The percentage of patients with positive denatured and reduced MAb was higher in Graves' disease patients who had a longer sick interval or who developed hypothyroidism after radioiodine treatment. This study provides the first clear demonstration that MAbs are heterogeneous. The data suggest that antibodies against denatured or denatured and reduced MAg may be related to destruction of the thyroid gland.

Autoantibodies↗

Nontoxic nodular goiter and papillary thyroid carcinoma are not associated with peripheral blood lymphocyte sensitization to thyroid cells.

We tested the claim that uni- and multinodular goiter (UNG and MNG) and papillary carcinoma (PC) of the thyroid are autoimmune thyroid diseases (AITD) similar to Graves' disease (GD) and Hashimoto's thyroiditis (HT). The expression of HLA-DR on cultured thyroid epithelial cells (thyrocytes) from UNG, MNG, and PC after coculture with autologous peripheral blood mononuclear cells (PBMC) was compared with that on GD and HT cells. The thyrocytes also were cultured with interferon-gamma (IFN gamma) alone. A cytotoxicity assay involving 51Cr-labeled thyrocytes, anti-HLA-DR, and complement was used to determine HLA-DR expression. Stimulation of thyrocytes with 200 U/mL IFN gamma induced HLA-DR (expressed as a cytotoxicity index) equally well on all thyrocytes [AITD (n = 6): IFN gamma, 23.8 +/- 7.7 (+/- SD); unstimulated, 3.6 +/- 2.0; UNG (n = 6), MNG (n = 9), and PC (n = 5): IFN gamma, 22.5 +/- 4.7; unstimulated, 4.0 +/- 3.0]. When cocultured with autologous PBMC, the values were: AITD, 24.9 +/- 10.1; UNG, MNG, and PC, 3.8 +/- 3.7 (P less than 0.001). The supernatants from the AITD cocultures had higher IFN gamma concentrations (by RIA) than those from the other cocultures. We conclude that in UNG, MNG, and PC, the peripheral blood helper T-lymphocytes are not sensitized to thyrocyte membrane antigen(s); consequently, little if any IFN gamma is produced in cocultures, and hence, there is no increase in thyrocyte HLA-DR expression, unlike the situation in AITD (GD and HT). Thus, UNG, MNG, and PC are not primarily autoimmune in nature, as defined by a lack of sensitization of the PBMC of such patients to thyroid antigen(s).

Antigens, Surface↗

The biological activity of bovine and human thyrotropin is differently affected by trypsin treatment of human thyroid cells: thyroid-stimulating antibody is related to human thyrotropin.

Pretreatment of cultured human thyroid cells with trypsin decreased the cAMP response to bovine TSH (bTSH) (by 50-60%). In striking contrast, in trypsin treated cells the cAMP stimulation by both human TSH (hTSH) and thyroid-stimulating antibodies (TSab) was unimpaired, indicating a similar behavior for these two stimulators. The effect of trypsin on inhibiting cAMP stimulation by bTSH was: 1) dose dependent; 2) present at a trypsin concentration as low as 3.3 mg/L; 3) fully reversible within 24 h after removal of the enzyme. In accordance with the altered biological activity in human thyroid cells exposed to trypsin the binding of labeled bTSH was reduced (about 40%). On the contrary, in the same cells, the binding of labeled human TSH was enhanced (about 3-fold). The cAMP response to cholera toxin and forskolin was unaffected in trypsin treated cells, indicating that the tryptic treatment did not alter any other component of the adenylate cyclase complex. The medium obtained from trypsin-treated human thyroid cells was able to neutralize the biological activity of bTSH but not that of hTSH or TSab. Our study demonstrates that in human thyroid cells: 1) trypsin impaires bovine, but not human TSH or TSab biological activity; 2) bovine and human TSH may bind to different components of the TSH receptor.

Animals↗

Recessive inheritance of thyroid hormone resistance caused by complete deletion of the protein-coding region of the thyroid hormone receptor-beta gene.

Generalized resistance to thyroid hormone is a syndrome of reduced responsiveness of target tissues to thyroid hormone. The determination of amino acid sequences of the human thyroid receptor-beta (hTR beta), deduced from cDNA sequencing, has enabled evaluation of the genetic basis for this syndrome. Distinct point mutations in the ligand-binding domain of hTR beta have been identified in affected members of unrelated families, producing single amino acid substitutions that result in products with decreased or no hormone-binding activity. Inheritance in these families was autosomal dominant. We now report the molecular basis of generalized resistance to thyroid hormone in a consanguineous family unique for its autosomal recessive mode of inheritance. Deletion of the entire coding region of both hTR beta alleles in homozygous affected members of the family was demonstrated by the failure to amplify the coding exons 3-8 by the polymerase chain reaction using primers specific for flanking intronic sequences and by the demonstration of the presence of only two noncoding exons in Southern blots hybridized with exon-specific probes. As expected, obligate heterozygotes were phenotypically normal, since, in contrast to alleles with point mutations, the deleted allele could not act in a dominant negative fashion. Survival and maintenance of a euthyroid state are presumably mediated through expression of the hTR alpha gene, present in affected subjects, and the maintenance of high thyroid hormone levels. Furthermore, the clinical manifestations were relatively more mild that those observed in a homozygous patient with a single amino acid deletion in the hTR beta gene.

Amino Acid Sequence↗

Correlations of language abnormalities with localization of mutations in the beta-thyroid hormone receptor in 13 kindreds with generalized resistance to thyroid hormone: identification of four new mutations.

Generalized resistance to thyroid hormone is an inherited disease characterized by unresponsiveness of pituitary and peripheral tissues to thyroid hormone. Genetic analysis of several kindreds linked this syndrome to the gene for the beta-form of the thyroid hormone receptor, and this led to the subsequent identification of various mutations in the ligand-binding domain of this receptor. In this region we now have found 4 new point mutations with reduced T3-binding affinities from separate kindreds by direct sequencing of polymerase chain reaction products. Similar to previously studied kindreds, the reduction in T3 binding of these four kindreds ranged from 2.5- to 5-fold, indicating that these are not neutral polymorphisms. Furthermore, the pattern of inheritance of these 4 kindreds is familial in 2, sporadic in 1, and unknown in 1. To date, 20 distinct mutations have been identified, of which 18 are clustered in 2 distinct topographical regions: 11 are within the tau i/dimerization subdomains of exon 9, and 7 are within the L2 subdomain of exon 10. The 4 newly identified mutations coupled to the 9 mutations our laboratory has previously identified provide new insights into the clinical aspects of generalized resistance to thyroid hormone. Kindreds with mutations in exon 9 compared with those in exon 10 have significantly more problems in language development, as manifested by articulation problems and/or wide discrepancies in verbal and performance IQs. Interestingly, marked variability in language deficiency as well as other clinical patterns were seen not only between kindreds but also within a kindred. Further identification and clinical correlations of new mutations will continue to enhance our understanding of the structure/function relationships and physiological role of the human thyroid hormone receptor.

Adolescent↗

Reversible inhibition by interferons alpha and beta of 125I incorporation and thyroid hormone release by human thyroid follicles in vitro.

When interferons (IFN-alpha-2a, IFN-alpha-2b, natural IFN-alpha and IFN-beta) were cultured with human thyroid follicles, each IFN inhibited TSH-induced thyroid function (125I incorporation and release of 125I-T4) in a concentration-dependent manner. The minimal inhibitory effect was exerted at 1-10 U/ml. However, the inhibitory effect was reversible, and no inhibitory effect was detected when IFNs were removed from the medium within 12 h. These in vitro findings suggest that each IFN directly inhibits human thyroid function at clinically attainable levels. However, since the inhibitory effect was reversible, IFN therapy would provoke only subtle thyroid dysfunction in a majority of patients without preexisting thyroid autoimmunity.

Culture Techniques↗

Resistance to thyroid hormone caused by two mutant thyroid hormone receptors beta, R243Q and R243W, with marked impairment of function that cannot be explained by altered in vitro 3,5,3'-triiodothyroinine binding affinity.

Resistance to thyroid hormone (RTH) is a syndrome of reduced responsiveness to thyroid hormone caused by mutations in the thyroid hormone receptor beta (TRbeta) gene. Mutant TRbetas exhibit variable degrees of impaired T3 binding resulting in reduced T3-mediated function. The dominant mode of inheritance is attributed to the ability of mutant TRbetas to interfere with the function of the wild-type (WT) TR, a phenomenon known as dominant negative effect (DNE). We recently identified two families with RTH having mutations in amino acid 243 (R243Q and R243W) in whom the mechanism of RTH appears to be distinct from that of other natural TRbeta mutations. These mutations, which are located in the hinge domain of the TRbeta, do not significantly alter the binding affinity for T3, measured in vitro. The present study was undertaken to characterize the properties of these mutant TRbetas to understand the molecular basis of the RTH phenotype. Two other mutant TRbeta producing RTH with mild (320H) and severe (345R) impairment of T3 binding were studied in parallel. The results demonstrate that TRbetas 243Q and 243W could be translocated into the nucleus where they exerted normal ligand-independent repression of positively regulated thyroid hormone response elements. Yet, the addition of 10 nmol/L T3 failed to normalize the transactivation (16-13% of WT) and revert the DNE exerted by the two TRbeta mutants. In contrast, at this T3 concentration, the transactivation function of 320H was significantly higher (50% of WT), and the DNE was completely abolished, in keeping with the mild clinical form of RTH. Formation of 243Q and 243W homodimers on thyroid hormone response elements could not be as readily prevented by T3 as those formed by the WT and 320H TRbetas. These results suggest that the substitution of R243 in TRbeta produces RTH by increasing the propensity for the formation of tightly bound homodimers or by reduction of the receptor affinity for T3 only after it binds to DNA.

Animals↗

Maltoma of the thyroid in a man with Hashimoto's thyroiditis.

We report the case of a 42-yr-old man with primary thyroid lymphoma arising from mucosa-associated lymphoid tissue (MALT-lymphoma, maltoma). The patient underwent a hemithyroidectomy for a growing mass in the right lobe of the thyroid while being treated with 1-thyroxine for Hashimoto's thyroiditis. The clinical diagnosis of Hashimoto's disease was confirmed by aspiration biopsy of the mass during the course of L-thyroxine treatment. Postoperatively, histology showed atypical lymphoproliferative infiltrates suspicious of low-grade non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue-type, coexisting with a reactive process typical of chronic lymphocytic thyroiditis. Immunophenotyping showed a mixed B- and T-lymphocyte population, which was nondiagnostic. However, Southern blot analysis revealed a clonal rearrangement of the Ig heavy chain gene. This case demonstrates that cytology or histology may not distinguish between reactive or low-grade lymphomatous thyroid processes. The use of molecular technique was essential to prove clonality and the presence of lymphoma.

Adult↗