HASHIMOTO S DISEASE 



mesenchymal cells. The exact pathogenesis is unknown; it 

 may be a sequel of thyroiditis due to mumps virus or some 

 other infective agent but in any case thyroglobulin becomes 

 accessible to lymphoid cells, some clones of which have 

 normal ' sites ' corresponding to one or more of the deter- 

 minants which distinguish thyroglobulin from any of the 

 normally accessible components of the body. The lympho- 

 cytes and plasma cells found in the gland substance in the 

 fully developed disease are no doubt mainly representatives 

 of such clones. 



A point of special interest from our point of view was 

 made at a recent discussion of this topic in England {Lancet, 

 1957). A considerable proportion of cases of typical Hashi- 

 moto's disease does not show circulating antibody ; some pro- 

 duce large amounts giving easily demonstrable precipitation 

 with thyroglobulin, others give antibody only detected 

 satisfactorily by Boyden's tanned-cell technique. The sugges- 

 tion here is strong that the essential feature is the reaction of 

 immunologically modified mesenchymal cells with the 

 normally inaccessible antigen in the thyroid. It is of only 

 secondary significance whether circulating antibody is 

 liberated. 



In the same report, White is quoted as interpreting the 

 pathogenesis of the condition in terms of an initial leak of 

 thyroglobulin which attracts a collection of lymphocytes and 

 plasma cells into the substance of the thyroid where they 

 make antibody locally. Cellular destruction resulting from 

 the antigen-antibody reaction causes the release of more 

 thyroglobulin, thus initiating what might be called a chain 

 reaction. 



The possibility of other auto-immune conditions of basi- 

 cally similar pathogenesis cannot be eliminated but none 

 has been established. Lupoid hepatitis, in which liver 

 biopsy often shows mononuclear cell infiltration, is one which 

 we have considered as a possible example and in fact 

 Gajdusek's AIGF test (Gajdusek, 1958; Gajdusek and 



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