Stimulation of thyroid adenylate cyclase activity by sera from patients with non-thyroidal illness

Hypothalamic thyrotropin-releasing hormone and thyrotropin biological activity

Hypothalamic thyrotropin-releasing hormone (TRH) is the main positive regulator of thyrotropin (TSH) secretion. TRH action and the negative feedback of thyroid hormone are integrated in order to guarantee appropriate thyroid stimulation. TRH action affects various steps of the biosynthetic process within thyrotrophs, with major effects on the posttranslational maturation of TSH oligosaccharide chains, and is necessary for the secretion of the glycoprotein hormone with full biological activity. Since the first description in 1979 of some patients with central hypothyroidism of hypothalamic origin associated with the secretion of TSH molecules with conserved immunoreactivity but decreased bioactivity, a large body of evidence has accumulated in more recent years showing that changes of the oligosaccharide chains have a great impact on the biological properties of circulating TSH and occur in various in vivo situations. These findings have lead to the new concept of a qualitative regulation of TSH secretion. This can be achieved mainly through the transcriptional and posttranscriptional regulation of the complex enzymatic machinery devoted to the processing of the three oligosaccharide chains linked to specific asparagine residues of TSH heterodimer. Data obtained in several physiological and pathological conditions, which are characterized by an increased or diminished TRH action, indicate that both qualitative and quantitative regulations cooperate within thyrotrophs in order to adjust thyroid-stimulating activity to the temporary needs.

Transiently decreased sialylation of thyrotropin (TSH) in a patient with the euthyroid sick syndrome

A 60-year old woman was admitted to the medical intensive care unit with respiratory distress and worsening renal function, and was found to have bilateral renal artery occlusion. Aggressive nutrition per nasogastric tube was begun on day 8 of her illness, and she eventually recovered after bilateral renal artery bypass surgery, which was performed on day 15. She developed the euthyroid sick syndrome. Levels of serum TSH, T3, and T4 fell during the first few days of her illness, then all trended to normal levels by day 28. The TSH level declined from 1.6 microU/mL on day 2 to 0.2 microU/mL on day 5, then rose to 4.5 microU/mL on day 10, and was 3.8 microU/mL on day 14. The ratios of free T4/TSH, a crude measure of the bioactivity of TSH, were 1.4, 8.0, 0.16, 0.32, and 1.14 on days 2, 5, 10, 14 and 28, respectively. TSH was immunoaffinity concentrated from serum collected on four dates. The TSH oligosaccharides were enzymatically released, treated with or without neuraminidase, labeled with a fluorescent probe, and analyzed by gel electrophoresis. The TSH oligosaccharides were found to be transiently less sialylated on day 13 as compared to days 2, 4, and 24. Three gel bands representing poorly sialylated oligosaccharides represented a mean of 20.6% of TSH oligosaccharides on days 2, 4, and 24, but represented 33.7% of TSH oligosaccharides on day 13. This is the first report of altered TSH oligosaccharide sialylation in the euthyroid sick syndrome. If confirmed by studies of additional patients, altered TSH sialylation may, in part, explain the altered TSH bioactivity that has been described in the euthyroid sick syndrome.

Measurement of TSAb directly in serum using FRTL-5 cells

FRTL-5 cells were shown to be suitable for the measurement of thyroid stimulating antibody (TSAb) present in sera of patients with Graves' disease. Current methods for the assay of TSAb require the separation of immunoglobulin G (IgG) from patient sera. In this report the possibility to measure TSAb directly on serum was evaluated using FRTL-5 cells. To this purpose cells were seeded in 96-well plates and cultured for 4 days in medium deprived of TSH. Using this system bovine TSH was able to produce a significant stimulation of cAMP production at 1 microU/ml. Whole normal serum completely inhibited the stimulation of TSH as well as that of TSAb, while diluted serum was devoid of any effect. Heat inactivated sera and IgGs, prepared by DEAE Sephadex separation, were diluted in hypotonic medium and incubated with cells for 1 h at 37 C. After incubation cAMP was measured in the assay medium by RIA. In some experiments the effects of graded dilutions of sera and IgGs with known TSAb activity were compared. Sera as well as IgGs increased the cAMP production, but, at the highest concentrations, an inhibitory effect was evident. For this reason sera were tested after appropriate dilution. Thirteen/27 (48%) sera and 22/27 (81%) IgGs from patients with Graves' disease were TSAb positive. The effect of Graves' sera on adenylate cyclase stimulation was completely inhibited by an anti-human IgG. The results of stimulation produced by Graves' sera and IgGs were highly correlated (r = 0.97, p less than 0.001). In conclusion it is possible to measure TSAb directly in serum using FRTL-5 cells.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of diabetes mellitus on thyrotropin response to thyrotropin-releasing hormone in untreated acromegalic patients

Impairment of thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) has been documented in patients with uncontrolled diabetes mellitus (DM). In acromegalic patients, however, there have been no data regarding TSH secretion studied taking the existence of DM into consideration. Therefore, we investigated the TSH response to TRH [expressed as TSH increment (delta TSH)] in 14 untreated acromegalic patients, who did not show the suprasellar extension of adenoma, divided into two groups on the basis of either presence or absence of uncontrolled DM, and in 28 normal subjects. The mean max delta TSH was significantly reduced (p less than 0.02) in acromegalic patients despite similar mean serum T4 and free T4 index (FT4l) levels. Furthermore, the mean basal and max delta TSH in 7 patients with DM (FBS, 120-300 mg/dl; HbA1, 8.8-15.2%) were significantly lower than those in 7 patients without DM (p less than 0.05 and p less than 0.02, respectively) despite similar the mean serum T3, T4, FT4l, growth hormone (GH) and prolactin (PRL) levels and sellar volume. In 4 patients with DM the TSH response to TRH 6-8 weeks after insulin therapy, when their HbA1 levels were normal, increased compared to that before insulin therapy. The mean max delta TSH after selective adenomectomy in 8 patients (3 in DM group and 5 in non-DM group), whose fasting basal GH fell to less than 5 ng/ml, was almost identical to that in normal subjects. In conclusion, the present study suggests that the abnormality in TSH secretion in acromegalic patients may be increased by the existence of uncontrolled DM.