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Autoimmunity and thyroid growth. Where do we stand?

This issue of European Journal of Endocrinology contains two articles which have in common the study in humans of the involvement of TSH receptor antibodies (TSH-R-ab) and T cells in goitrous conditions such as Graves' disease and sporadic goitre.

Aust et al. (1) describe activated, i.e. HLA-DR⁺, T cells not only in Graves goitres but also—and in the same proportions–in goitrous conditions such as non-toxic multinodular goitre (NTG) and thyroid autonomy (TA). Forty per cent of these activated T cells show an intracellular staining for IFN-, whereas half of them co-express another activation marker, i.e. CD69. Both NTG and TA are generally regarded as conditions in which the immune system is not activated ("nonautoimmune"), and hence the presence of activated T cells—although clearly in lower numbers as compared to Graves goitres—was surprising to the authors. Because the activation marker CD69 has also been implicated in tolerance induction in the thymus,

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