{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:16:40Z","timestamp":1784557000884,"version":"3.55.0"},"reference-count":36,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2015,9,1]]},"abstract":"Summary<\/jats:title>\n \n A 67-year-old man was referred to our department for thyrotoxicosis with intermittent palpitation and 4-kg weight loss during the previous month. At the first visit, the patient was treated with cyclosporine A (CyA) for membranous nephropathy during the last 3 years and 8 months. Laboratory studies revealed that the serum TSH level was <0.005\u200a\u03bcU\/ml, and free thyroxine (fT\n 4<\/jats:sub>\n ) and triiodothyronine (fT\n 3<\/jats:sub>\n ) levels were elevated at 2.76\u200ang\/dl and 5.96\u200apg\/ml respectively. Anti-TSH receptor antibody (TRAb) level was increased at 26.4%. A clinical diagnosis of Graves' hyperthyroidism was given, and then thyrostatic treatment with thiamazole (MMI) at a dose of 10\u200amg daily was initiated after CyA withdrawal. After the initiation of MMI therapy, serum fT\n 4<\/jats:sub>\n and fT\n 3<\/jats:sub>\n attained the normal level within 1.5 months, with relief of symptoms followed by a remarkable decrease in urinary protein excretion from 2.0\u20135.2\u200ag\/day to \u22640.03\u200ag\/day. The patient maintained euthyroid with a low titre of TRAb for the succeeding 2 years and then MMI was finally stopped. Neither a relapse of hyperthyroidism nor a flare-up of nephrotic syndrome was observed for 3 years after MMI discontinuation. CyA has conflicting effects on immunologic self-tolerance by modulation of self-reactive T cells and natural CD4\n +<\/jats:sup>\n CD25\n +<\/jats:sup>\n Foxp3\n +<\/jats:sup>\n regulatory T cell (Treg) functions, and possibly becomes a triggering factor in the development of autoimmune disorders. This case may be interesting when considering the effect of each T cell subset on the development of Graves' disease.\n <\/jats:p>\n \n Learning points<\/jats:title>\n \n \n \n \n The balance between intrathyroidal self-reactive T cell and natural CD4\n +<\/jats:sup>\n CD25\n +<\/jats:sup>\n Foxp3\n +<\/jats:sup>\n Treg functions determine self-tolerance in the thyroid.\n <\/jats:p>\n <\/jats:list-item>\n \n CyA not only halts the expansion of self-reactive T cells but also impairs the function of Treg, which can provoke an unwanted immune response.<\/jats:p>\n <\/jats:list-item>\n \n A change in thyroid autoimmunity during treatment with CyA may result in the development of autoimmune thyroid diseases (AITD).<\/jats:p>\n <\/jats:list-item>\n \n Renal involvement in AITD frequently manifests as nephrotic syndrome, and thyrostatic treatment with thiamazole may be effective for excessive proteinuria.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n 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