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2011, vol. 17, br. 1-2, str. 43-48
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Značaj određivanja tireoidnih antitela u dijagnostici auto-imunih oboljenja štitaste žlezde
Importance of thyroid autoantibodies estimation in autoimmune thyroid disease diagnostics
Univerzitet u Novom Sadu, Medicinski fakultet, Katedra za patološku fiziologiju, Srbija
e-adresa: sofim@ptt.rs
Sažetak
Autoimuna bolest štitaste žlezde je organ-specifična autoimuna bolest, koja je posledica ćelijskog i humoralnog imunog odgovora na vlastito tkivo štitaste žlezde sa posledičnim oštećenjem njene funkcije. Klinički se ispoljava kao Grejvs-Bazedovljeva bolest, imunogena hipertireoza i Hašimoto tireoiditis, zapaljenjski proces u tkivu štitaste žlezde. Glavni tireoidni antigeni su tireoglobulin (Tg), tireoidna peroksidaza (TPO) i tireostimulišući receptor (TSHR). Laboratorijska dijagnostika ovih oboljenja podrazumeva određivanje nivoa tireoidnih hormona i TSH i, prema potrebi, određenih tireoidnih antitela. Pošto se ona sporo razvijaju, veoma je važno dijagnostikovati ih na vreme, jer to vodi lečenju i smanjenju posledica bolesti, što je značajno sa medicinskog i socioekonomskog aspekta. Još uvek se postavlja pitanje koji su dijagnostički parametri kojima možemo tačno i na vreme postaviti dijagnozu autoimunog oboljenja štitaste žlezde. Svakako je u dijagnostičkom procesu nezaobilazno merenje nivoa tireoidnih antitela. Prilikom određivanja tireoidnih antitela potrebno je dobro poznavati njihove karakteristike, laboratorijsku metodologiju određivanja i kliničku primenu dobijenih rezultata. Na osnovu svih sprovedenih istraživanja i mnogobrojnih iskustava iz kliničke prakse, smatra se da postoji velika opravdanost široke upotrebe tireoidnih antitela u diferencijalnoj dijagnostici autoimunih oboljenja štitaste žlezde. U prvom stepenu dijagnostike trebalo bi odrediti nivo antitela na tireoidnu peroksidazu, TPOAt, specifična za autoimuni proces u štitastoj žlezdi, koja su visoko pozitivna u Hašimoto tireoiditisu i Grejvs-Bazedovljevoj bolesti. Antitela na TSHR, TSHR-At određujemo u diferencijalnoj dijagnostici Grejvs-Bazedovljeve bolesti, te ih pratimo u toku terapije oboljenja. Sama tireoglobulinska antitela, TgAt, ne mogu biti jedini dijagnostički pokazatelj autoimunog procesa u štitastoj žlezdi.
Abstract
Autoimmune thyroid disease is an organ specific autoimmune disease. It is a consequence of cell-mediated and humoral immune response toward the own thyroid tissue which leads to alteration of thyroid function. Clinical forms of autoimmune thyroid disease are Graves disease and Hashimoto thyroiditis. Main thyroid antigens are thyroglobulin (Tg), thyroid peroxidase (TPO), and thyrotropin receptor. Laboratory diagnostics of autoimmune thyroid disease consider estimation of thyroid hormones and TSH levels and autoantibodies to thyroid antigens. From medical and socioeconomic aspects, it is very important to estimate the diagnosis of these diseases on time. It is still a question, which are the appropriate diagnostic parameters for their estimation. Estimation of thyroid autoantibodies is inevitable during this diagnostic process. We must know the characteristics of thyroid autoantibodies itself , laboratory methodology and clinical application of obtained results. First step should be estimation of autoantibodies to thyroid peroxidase (TPOAb), highly specific for autoimmune process in thyroid gland and highly positive in Hashimoto thyroiditis and Graves disease. Autoantibodies to thyrotropin receptors (TRAb) are highly specific diagnostic marker for Graves disease and should be followed up during the course of disease. TgAb itself, can't be unique diagnostic parameter in autoimmune thyroid disease diagnosis.
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