IMMUNOPATHOLOGY OF THE THYROID GLAND

There is considerable confusion and disagreement on the criteria required for a disease to be called 'autoimmune.' Part of this confusion is because of the ambiguity of speech usage. Some persons seek to apply the term 'autoimmune' only to those illnesses in which there is reason to believe that immunological mechanisms play a part in the pathogenesis. Others deem it sufficient if an antibody can be demonstrated in the patients' serum or if a substance resembling an antibody is directed toward the ill organ. This antibody formation therefore does not necessarily have anything to do with pathogenesis, which can also represent a secondary phenomenon. The report discusses the following four criteria established by Witebsky: (1) It must be possible to demonstrate directly in the patient's serum free, circulating antibodies efficaceous at body temperature, or to demonstrate indirectly cell-connected antibodies. (2) It must be possible to demonstrate and preferably to characterize closely the specific antigen against which the antibody is directed. (3) It must be possible to produce antibodies against the same antigen in animal research. (4) Finally, pathological changes must occur in the corresponding organs in similarly actively immunized animals, and these changes should in their nature resemble those seen in the sickness in humans. Trans. of Norsk Laegeforening. Tidsskrift, v84 p74-79, 1964.