A 48-year-old non-goitrous woman, who had undergone cardiac surgery for mitral stenosis under the extracorporeal circulation, showed high levels of serum T
3 and free T
3 in a recent follow-up study, employing antibody coated-bead RIA for T
3 and -Amerlex M particle RIA for free T
3. However, other thyroid function tests (T
4, free T
4, TSH and TBG) were normal. We suspected that thyroid hormone autoantibodies (THAA) in her serum interfered with T
3 and free T
3 analyses.
The presence of THAA was demonstrated by the use of various procedures as follows. Firstly, the patient's serum was directly incubated with
125I-T
3 or -T
4 analog which did not bind to TBG, followed by B/F separation with polyethyleneglycol, counting the precipitates.
Secondly, after the serum was treated with an acid-charcoal solution to remove circulating thyroid hormone, the measurement of THAA was made as stated above. Normal sera were used as controls. Both the non- and acid-charcoal-treated sera showed much higher percentages of
125I-T
3 analog precipitation as compared with controls. In the case of
1251-T
4 analog, there was no difference between them.
In the third study, the presence of IgG antibodies that bound T
3 but not T
4 was investigated. The IgG fraction of the patient's serum was separated employing a Protein A-Sepharose CL-4B column chromatography. Then, the prepared IgG fraction was purified by a technique of gel filtration chromatography (Sephacryl S 200). Non-purified- and purified-IgG fractions both revealed higher binding percentages of
125I-T
3 analog than the control IgG fraction and non-IgG fraction of the patient. Furthermore, a good dose response was observed between the binding percentage of
125I-T
3 analog and each dose of the patient's serum or IgG fraction.
From these observations, it was clarified that this woman had anti-T
3 IgG autoantibodies using a Protein A column chromatography with confirmation of gel filtration chromatography.
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