Hypersensitivity: Stimulatory (Type V)


Type V hypersensitivity is the final type of hypersensitivity in which antibodies are produced with the property of stimulating specific cell targets. The clearest example is Graves disease caused by antibodies that stimulate the thyroid‐stimulating hormone receptor, leading to overactivity of the thyroid gland.

Keywords: stimulatory hyper sensitivity; type V hypersensitivity; graves disease; stimulatory antibodies

Figure 1.

Graves disease. There is a moderate diffuse goitre, evidence of weight loss due to thyrotoxicosis, and changes of thyroid‐associated ophthalmopathy (eyelid retraction, proptosis due to the eyeball being pushed forward by swollen extraocular muscles, and periorbital oedema).

Figure 2.

(a) Normal feedback control of thyroid hormone synthesis; (b) situation in Graves disease. T4, thyroxine; T3, triiodothyronine; TSH, thyroid‐stimulating hormone.

Figure 3.

Regulatory cascades controlled by the thyroid‐stimulating hormone (TSH) receptor (TSH‐R). TBAb, thyroid‐blocking antibodies; TSAb, thyroid‐stimulating antibodies; PLC, phospholipase C; IP, inositol phosphate; DAG, diacylglycerol; ATP, adenosine triphosphate; cAMP, cyclic adenosine monophosphate. With permission from Van Sande J, Parma J, Tonacehera M, Swillen S, Dumont J and Vassart G (1995) Somatic and germline mutations of the TSH receptor gene in thyroid disease. Journal of Clinical Endocrinology and Metabolism80: 2577–2585. ©The Endocrine Society.



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Further Reading

Davies TF (ed.) (1998) Newer aspects of Graves' disease. Baillière's Clinical Endocrinology and Metabolism 11: 431–601.

Greaves MW (1995) Chronic urticaria. New England Journal of Medicine 332: 1767–1772.

Heufelder AE (1995) Involvement of the orbital fibroblast and TSH receptor in the pathogenesis of Graves' ophthalmopathy. Thyroid 5: 331–340.

Ludgate ME and Vassart G (1995) The thyrotropin receptor as a model to illustrate receptor and receptor antibody diseases. Baillière's Clinical Endocrinology and Metabolism 9: 95–113.

Prabhakar BS, Fan J‐L and Seetharamaiah G (1997) Thyrotropin‐receptor‐mediated diseases: a paradigm for receptor autoimmunity. Immunology Today 18: 437–442.

Rapoport B, Chazenbalk GD, Jaume JC and McLachlan SM (1998) The thyrotropin (TSH)‐releasing hormone receptor: interaction with TSH and autoantibodies. Endocrine Reviews 19: 673–716.

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Weetman, Anthony P(Apr 2001) Hypersensitivity: Stimulatory (Type V). In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1038/npg.els.0001435]