Clinical and laboratory features of children and adolescents with congenital hypothyroidism due to dyshormonogenesis in southern Brazil / Características clínicas e laboratoriais de crianças e adolescentes com hipotireoidismo congênito devido a disormonogênese no sul do Brasil

OBJECTIVE: To characterize the phenotype of patients with congenital hypothyroidism (CH) due to dyshormonogenesis, and to hypothesize on the degree of genetic defect. SUBJECTS AND METHODS: Patients with dyshormonogenesis were subdivided into G1 (radioactive iodine uptake, RAIU > 15%; n = 62) and G2 (RAIU < 15%; n = 32). Thyroglobulin (TG) was measured in all patients; perchlorate discharge test (PDT) was performed in G1; and saliva-to-plasma radioiodine ratio (I- S/P) in G2. RESULTS: Levels of TSH, TT4, and FT4 before treatment and upon diagnosis confirmation were significantly different in both groups, but not between groups. In G1, 27 patients developed goiter; 17 had positive PDT (14%-71% discharge), 11 had TG < 2.5 ng/dL (one with high TSH), and one developed thyroid carcinoma. In G2, four patients developed goiter, and three had low I- S/P. CONCLUSION: These data suggest an iodide organification defect in 17 cases; an iodide transport defect (NIS defect) in three, probable TSH resistance in 10, and a TG synthesis defect in two cases.

OBJETIVO: Caracterizar o fenótipo de pacientes com hipotireoidismo congênito (HC) por disormonogênese e sugerir o nível do defeito genético. SUJEITOS E MÉTODOS: Pacientes com disormonogênese foram subdivididos em G1 (captação de 131I > 15%; n = 62) e G2 (captação < 15%; n = 32). Tireoglobulina (TG) foi dosada em todos, teste de descarga do perclorato (TDP) foi realizado no G1 e relação iodo salivar/sérico (I- S/P), no G2. RESULTADOS: Os valores de TSH, T4T e T4L pré-tratamento e na confirmação do diagnóstico foram significativamente diferentes em ambos os grupos (p < 0,01), mas não entre eles. No G1, 27 pacientes desenvolveram bócio; TDP foi positivo em 17 (descarga de 14%-71%); 11 tiveram TG < 2,5 ng/dL (um com TSH elevado) e um desenvolveu carcinoma de tireoide. No G2, quatro pacientes desenvolveram bócio e três apresentaram baixa I- S/P. CONCLUSÃO: Esses dados sugerem defeito na organificação do iodeto em 17 casos; defeito no transporte do iodeto (defeito na NIS) em três, provável resistência ao TSH em 10 e defeito na síntese de TG em dois.

The importance of sodium/iodide symporter (NIS) for thyroid cancer management

The thyroid gland has the ability to uptake and concentrate iodide, which is a fundamental step in thyroid hormone biosynthesis. Radioiodine has been used as a diagnostic and therapeutic tool for several years. However, the studies related to the mechanisms of iodide transport were only possible after the cloning of the gene that encodes the sodium/iodide symporter (NIS). The studies about the regulation of NIS expression and the possibility of gene therapy with the aim of transferring NIS gene to cells that normally do not express the symporter have also become possible. In the majority of hypofunctioning thyroid nodules, both benign and malignant, NIS gene expression is maintained, but NIS protein is retained in the intracellular compartment. The expression of NIS in non-thyroid tumoral cells in vivo has been possible through the transfer of NIS gene under the control of tissue-specific promoters. Apart from its therapeutic use, NIS has also been used for the localization of metastases by scintigraphy or PET-scan with 124I. In conclusion, NIS gene cloning led to an important development in the field of thyroid pathophysiology, and has also been fundamental to extend the use of radioiodine for the management of non-thyroid tumors.

A glândula tireóide tem capacidade de captar e concentrar iodeto, etapa fundamental na biossíntese dos hormônios tireóideos. O uso de iodo radioativo para fins de diagnóstico e terapia das doenças da tireóide vem sendo feito há muitos anos. Entretanto, somente após a clonagem do gene que codifica o co-transportador de sódio/iodeto (NIS) houve aumento significativo dos estudos relacionados ao mecanismo de transporte de iodeto. Os estudos sobre a regulação da expressão do NIS e a possibilidade de terapia gênica visando à transferência do gene NIS para células que normalmente não expressam esse transportador, foram também viabilizados. Na maior parte dos nódulos tireóideos hipofuncionantes, tanto benignos quanto malignos, a expressão do gene do NIS está presente, mas a proteína NIS fica retida no compartimento intracelular. A transferência do gene usando-se promotores tecido-específicos possibilitou a expressão do NIS em células tumorais não-tireóideas in vivo. Além do seu uso terapêutico, o NIS também vem sendo usado para a localização de metástases tumorais através da cintilografia ou do PET-scan usando-se 124I. Em conclusão, a clonagem do NIS possibilitou enorme avanço na área de fisiopatologia tireóidea e foi também fundamental para estender o uso do radioiodo para tumores não tireóideos.

Goitrogenic content of Indian cyanogenic plant foods & their in vitro anti-thyroidal activity.

BACKGROUND & OBJECTIVES: Consumption of cyanogenic foods has been considered as one of the etiological factors in certain instances for the persistence of endemic goitre. The present study was undertaken to study the cyanogenic glucosides, glucosinolates and thiocyanate content in edible portion of certain selected plant foods of Indian origin. Further in vitro anti-thyroidal activity using raw, boiled and cooked extracts of these plants with and without excess iodide was also studied. METHODS: Cyanogenic plant foods generally vegetables were collected from different areas of West Bengal and Tripura. Cassava was obtained from Meghalaya and Kerala and their cyanogenic glucosides, glucosinolates and thiocyanate were estimated. Thyroid peroxidase activity (TPO) of human thyroid was assayed from microsomal fraction following I3- from iodide. The anti-TPO activities of the plants were assayed after adding raw, boiled and cooked extracts in the assay medium with and without extra iodide. Relative antithyroidal potency of the plant extracts was also evaluated in terms of the concentration (IC50) necessary to produce 50 per cent inhibition of TPO activity. PTU equivalence of the plant foods was also determined. RESULTS: Cabbage and cauliflower were rich in glucosinolates, bamboo shoot and cassava were rich in cyanogenic glucosides, mustard, turnip and radish were relatively rich in thiocyanate however all the constituents were present in each plant. Boiled extracts showed maximum inhibition of TPO activity followed by cooked and raw extracts. Excess iodide was found relatively effective for raw extract but less effective for boiled and cooked extracts in reversing anti-TPO activity. Inhibition constant (IC50) was found highest with bamboo shoot and least with cabbage. INTERPRETATION & CONCLUSION: Raw, boiled and cooked extracts of the plants showed anti-thyroidal activity in vitro. Excess iodide reversed the anti-TPO activity to same extent but could not neutralise it.

Pendred 's syndrome

This report describes pendred's syndrome in three siblings of a consanguineous marriage, belonging to Rahim Yar Khan. The children presented with deafmutism and goiters. The investigations included scintigram, perchlorate discharge test and audiometery. The perchlorate discharge was positive in index case. Bilateral sensorineural hearing defect was detected on Pure Tone Average [PTA] audiometry. Meticulous clinical and laboratory evaluation is mandatory for the detection of rare disorders like Pendred's syndrome

Estradiol decreases iodide uptake by rat thyroid follicular FRTL-5 cells

Estradiol has well-known indirect effects on the thyroid. A direct effect of estradiol on thyroid follicular cells, increasing cell growth and reducing the expression of the sodium-iodide symporter gene, has been recently reported. The aim of the present investigation was to study the effect of estradiol on iodide uptake by thyroid follicular cells, using FRTL-5 cells as a model. Estradiol decreased basal iodide uptake by FRTL-5 cells from control levels of 2.490 0.370 to 2.085 0.364 pmol I-/æg DNA at 1 ng/ml (P<0.02), to 1.970 0.302 pmol I-/æg DNA at 10 ng/ml (P<0.003), and to 2.038 0.389 pmol I-/æg DNA at 100 ng/ml (P<0.02). In addition, 4 ng/ml estradiol decreased iodide uptake induced by 0.02 mIU/ml thyrotropin from 8.678 0.408 to 7.312 0.506 pmol I-/æg DNA (P<0.02). A decrease in iodide uptake by thyroid cells caused by estradiol has not been described previously and may have a role in goiter pathogenesis

Further studies on iodide uptake autoregulation in calf thyroid slices

La autorregulación tiroídea es mediada por un yodocompuesto orgánico de natureleza desconocida. Trabajos previos de diferentes laboratorios sugieren diversos yodocompuestos como posibles intermediarios, tales como hormonas tiroideas, vodolípidos y una yodoproteína. Recientes estudios propusieron que una yodoproteína estaría iunvolucrada en la autorregulación de la captación de yodo en tiroides de gato. El presente trabajo fue diseñado con el objeto de explorar esta hipótesis en tiroides bovina. La preincubación de cortes de tiroides bovina en presencia de KI 0.01mM produce una inhibición del 36-40% en la captación de I-125 (relación tiroides/medio, T/M). Este efecto no fue modificado por puromicina ni cicloheximida bajo condiciones en las cuales la síntesis proteica fue casi totalmente abolida. Por otra parte, estos dos compuestos no son capaces de alterar significativamente el perfil de incorporación de I-125 a los diferentes yodocompuestos tiroideos analizados por cromatografía en papel. Cuando se exploró la reversibilidad del efecto inhibitorio del yodo sobre la captación de I-125, se observó que después de 60 min de interrumpido el tratamiento con yoduro existió una recuperación parcial, en tanto que a los 90 min se retornó a los valores de captación basales. Estos resultados indican que una yodoproteína no sería el mediador de la autorregulación de yodo, en vaca. Por otra parte el yodocompuesto involucrado tendría una vida media relativamente corta