Subpopulations of intrathyroidal lymphocytes in Graves' disease

Subsets of T- and B-lymphocytes were immunophenotyped in frozen thyroid tissues from 20 patients with Graves' disease by using the avidin-biotin-complex peroxidase method. A panel of B- and T-cell monoclonal antibodies were employed to detect the subsets of T cells, activated T cells, natural killer cells and B cells. Serum thyroglobulin and microsomal antibodies were also measured simultaneously from both the thyroid vein and the peripheral vein in 9 patients. The quantitative results found that an almost equal ratio of lymphocytes stained positively for Leu 3a (CD4) and T8 (CD8) in almost all specimens. Activated lymphocytes expressing T9, T10, and Tac (CD25) were sporadically noted in the interstitial areas. The lymphoid aggregates and follicles were B cell clusters. Natural killer cells appear to play an insignificant role in Graves' disease. The thyroid epithelial cells expressed HLA-DR (Ia+) and HLA-ABC, suggesting a possible localized immune reaction between antigen-presenting thyroid epithelial cells and lymphocytes. The titers of serum thyroglobulin and microsomal antibodies from either the thyroid vein or the peripheral vein showed no definite correlation with the lymphoid distribution of the thyroid tissues, implying that the in situ or local immunologic reaction may not reflect the status of systemic antibody production. The immunologic mechanism and pathogenesis of Graves' disease is reviewed and discussed.