[TPO immunostaining of the solitary, cold thyroid nodules]. / TPO-immunfarvning af den solitaere, kolde thyreoideaknude.

INTRODUCTION: The chance of malignancy in scintigraphically cold thyroid nodules is 2-24%. Differentiation between malignant and benign cytology is difficult. The aim of this study was to evaluate the ability of immunostaining (MoAB47--raised against thyroid peroxidase (TPO)) to differentiate between malignant and benign cells taken from cold thyroid nodules by fine needle aspiration biopsy (FNAB) in order to reduce the number of unnecessary thyroid operations. MATERIALS AND METHODS: One hundred and eighty-one patients (150 female) with a scintigraphically cold, solitary thyroid nodule were entered between 1993 and 1996. Fifty-seven were excluded for various reasons. Material removed by FNAB was stained with MoAB47 and routine staining. Staining of 80% or more of the cells was considered benign, less than 80% was considered malignant. Routine staining of operatively removed material was used as the final diagnosis. RESULTS: A pattern with negative TPO staining was found in all lesions that were subsequently proved to be malignant. In all but one, the lesions subsequently diagnosed as being benign stained positive for TPO. The sensitivity and specificity were respectively 1.0 and 0.99. CONCLUSION: TPO immunostaining of material removed by FNAB is a powerful tool in the differentiation between benign and malignant tumours.

[Diagnosis of ACTH-producing tumors. Can sinus petrosus catheterization be avoided?]. / Diagnostik af ACTH-producerende tumorer. Kan sinus petrosus-kateterisation undvoeres?

A 38-year-old woman with Cushing stigmata and an MRI confirmed pituitary tumour was referred for pituitary surgery. High-dose dexamethasone test had indicated ectopic focus. An additional peripheral CRH test was performed, indicating ectopic focus. To secure the diagnosis inferior petrosal sinus sampling (IPSS) was performed, also indicating ectopic tumour. Operation revealed an ACTH-producing tumour in the thorax. We conclude that IPSS is necessary when diagnosing Cushing syndrome.

[Serum thyroglobulin compared with ultrasonically detected recurrent goiter]. / Serumtyreoglobulin sammenholdt med UL-påvist strumarecidiv.

Thirty-nine patients were studied for 13 years following resection of non-toxic goitre in order to correlate changes in serum thyroglobulin (Tg) to relapse. Preoperative serum Tg was elevated. After operation, mean serum Tg declined to 43 micrograms/L at one year and increased to 90 micrograms/L at 10 years. Thyroid hormones showed evidence of compensated hypothyroidism at one month which normalised within one year. 13 years after resection thyroid volume was determined by ultrasonography in 30 patients. In 10 patients the thyroid volume was enlarged (> or = 28 ml). In this group delta Tg after resection was 133 micrograms/L, compared to 26 micrograms/L in the 20 patients without relapse (volume < 28 ml). Thus, repeated serum Tg determinations may provide biochemical evidence of increased growth of thyroid remnants following goitre resection.

[Preoperative scintigraphic localization of hyperfunctioning parathyroid glands]. / Praeoperativ scintigrafisk lokalisation af hyperfungerende parathyreoideakirtler.

Preoperative identification of hyperfunctioning parathyroid glands was performed by 99m-Tc-sestamibi scintigrams in 29 patients with hyperparathyroidism. Out of 30 histopathologically proven diseased parathyroid glands 21 were identified by scintigraphy. The diagnostic specificity (PVpos) was 88%. All diseased glands weighing more than 1200 mg were identified by scintigraphy including four glands in the mediastinum. 99m-Tc-sestamibi scintigraphy can identify the larger hyperfunctioning parathyroid glands with high reliability. The method was of great value in situations with ectopic abnormal parathyroid glands.

[Indication for thyrotoxine therapy after surgery of non-endemic non-toxic goiter]. / Indikation for tyroxinbehandling efter operation for ikkeendemisk atoksisk struma.

Levo-thyroxine has for many years been used after operation for non-toxic goitre to prevent recurrence and postoperative thyroid hypofunction. The philosophy behind prevention was to suppress production of the thyroid stimulating hormone (TSH), which was assumed to be the main growth factor for the thyroid gland. Suppression of the serum-TSH concentration by thyroxine therefore seemed logical. No scientific documentation verifying this assumption has been found in non-endemic goitre areas. Treatment with levo-thyroxine subsequent to goitre surgery is thus only indicated in situations with risk of hypofunction, viz. when only a small thyroid remnant is left.

[Reevaluation of antithyroid drug therapy in Graves disease]. / Revurdering af antityreoid medicinsk behandling af Graves' sygdom.

Though antithyroid medical therapy has been used for several decades in the medical treatment of hyperthyroidism, only recently has attention been drawn towards prospective controlled trials concerning the effect in relation to dosage as well as the dosage related to side effects. A review is given in relation to recent investigations on treatment strategies in various parts of the world as well as the most frequently used strategies in Europe. Special attention is given to treatment principles in relation to pregnancy, children and adolescents as well as patients with eye symptoms. Antithyroid drug therapy of hyperthyroidism is a frequent and successful treatment strategy in Europe. Globally, there are still large discrepancies in the treatment strategies, related rather to conventions than to a rational attitude.

[Invasive fibrous thyroiditis--Riedel's goiter. A review of the literature and a case report]. / Invasiv fibrøs thyreoiditis--Riedel's struma. En gennemgang af litteraturen og diskussion af en sygehistorie.

Invasive fibrous thyroiditis (Riedel's goitre) is a rare condition of an unknown aetiology. The condition was first described by Riedel in 1883. In 1904 Hashimoto described another condition of invasive fibrous thyroiditis. Since then it has been discussed if Hashimoto's thyroiditis and Riedel's goitre were one disease in different states or two different diseases. Hashimoto's thyroiditis is known to have an autoimmune aetiology and it can be seen together with pernicious anaemia. Co-existence of Riedel's goitre and pernicious anaemia has never been reported. The patient mentioned had both Riedel's goitre and pernicious anaemia, and was first treated with subtotal thyroidectomy, relapsed after one year and consequently received steroids. Such coexistence and the very good effect of steroids could be explained on the basis of Hashimoto's and Riedel's thyroiditis being one condition in different states and with an autoimmune aetiology. It is recommended that patients with Riedel's goitre are postoperatively treated with steroids.

[Primary hyperparathyroidism. An underdiagnosed disease in Denmark?]. / Primaer hyperparatyreoidisme. En underdiagnosticeret sygdom i Danmark?

Population-based investigations measuring serum calcium levels seem to indicate a prevalence of primary hyperparathyroidism (pHPT) of 0.4-1% in adults with a figure of about 3% in women over 60 years of age. Annual incidence rate varies and is found to be about 25-30 new cases per 100,000 adults with routine use of serum calcium measurements in diagnostic work-up. In women over 60 years of age the incidence approaches 200 instances per 100,000 individuals. Autopsy studies have demonstrated parathyroid disease in about 10%, one third as solitary adenomas and two thirds as hyperplasia. Annual incidence of surgical interventions, however, is currently found to be low with a frequency of about 2 instances per 100,000 inhabitants in Denmark, but with somewhat higher figures in Sweden and Finland. Recently, the preoperative diagnosis of pHPT has been considerably simplified and requires in most cases solely the demonstration of sustained raised serum calcium levels associated with elevated serum concentration of intact PTH. Investigations indicate that pHPT is underdiagnosed in Denmark, and indications for surgical treatment appear to be restrictive. Compared with Swedish operation series the weight of parathyroid adenomas in Danish series is found to be 3 times higher and the mass of hyperplasia 9 times higher consistent with significantly more elevated serum calcium concentrations. Arguments are presented in favour of an increased interest in diagnosing pHPT and a more liberal approach in the selection of patients for surgical treatment of mild or even asymptomatic disease. Routine measurement of serum calcium concentration in blood samples from patients might be considered in order to increase the incidence rate.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pernicious anemia. A study of initial forms of the disease and diagnostic significance of determination of the intrinsic factor antibody and parietal cell antibody]. / Anaemia perniciosa. En undersøgelse af sygdommens debutformer, samt den diagnostiske betydning af påvist indre faktor antistof og parietalcelleantistof.

In a prospective study of thirty five consecutive patients with decreased plasma cobalamine (P-Cbl), twenty-two (63%) were diagnosed as having pernicious anaemia (PA) (no age or sex differences) on basis of the B12-absorption test and/or megaloblastic changes in the bone marrow. In this group ten patients were anaemic (six of whom were characterized as macrocytic), sixteen of nineteen examined had megaloblastic changes in the bone marrow, and all of thirteen examined had achlorhydria with positive correlation to Parietal Cell Antibodies (PCA). Two patients with PA had normal Cbl-absorption and two had malabsorption at the time of diagnosis. Twenty-one patients (95%) had PCA and thirteen (59%) were Intrinsic Factor Antibody (IFAb) positive. Three patients IFAb-seroconverted within a year. Among the remaining thirteen patients (37%), one had PCA but not IFAb and three were IFAb-positive all of whom had normal Cbl-absorption. Of the three patients with IFAb one had also PCA, one IFAb-seroconverted within three months, and one had microcytic anaemia with iron depleted bone marrow due to coecal cancer. Among twenty two healthy adult controls four (18%) had PCA while none had IFAb. This investigation shows that at the debut half of PA patients (55%) do not have anaemia, some have normal Cbl-absorption and some have malabsorption. 95% have PCA and 59% have IFAb. So, IFAb-negative PA is often seen (41%) and seroconversion can take place. Diagnosis is even more reliable, when achlorhydria is present in PCA-positive persons. Healthy PCA-positive persons are probably predisposed to develop PA. Patients with cbl-deficiency, IFAb and/or PCA must be considered as having latent PA even if they have normal haemoglobin and normal Cbl-absorption. These patients should be followed and, in case of anaemia or signs of neuropathia, treated.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute iridocyclitis with fever and liver involvement during quinidine therapy]. / Akut iridocyclitis med feber og leverpåvirkning ved kinidinbehandling.

Acute iridocyclitis is a rare hypersensitive reaction to quinidine treatment. The third case in the literature is reported here. A woman aged 80 years developed pyrexia, anorexia, nausea, skin rash and hepatic dysfunction after treatment with quinidine for two weeks. Four weeks later, while still receiving quinidine, she developed acute iridocyclitis. Quinidine treatment was withdrawn, the eye symptoms were treated and the patient recovered rapidly without complications. This case report draws attention to quinidine as a possible cause of iridocyclitis of unknown origin.