[L-thyroxine therapy in differentiated thyroid carcinoma: criteria for evaluation of TSH suppression]. / Leczenie L-tyroksyna zróznicowanego raka tarczycy: kryteria supresji wzglednej.

UNLABELLED: Life-time L-thyroxine therapy is obligatory in patients treated for differentiated thyroid carcinoma (DTC) in order to suppress serum TSH. The rationale for that is the TSH stimulation of follicular cells' growth and the presence of TSH receptors on DTC cells. Nevertheless, the exact criteria for TSH suppression in DTC are not specified and are a matter of discussion, stimulated by the recent progress in the evaluation of thyroxine side effects on bone and heart. The aim of the study was the optimalization of the reference range for TSH suppression in DTC patients in order to minimalize the risk of iatrogenic thyrotoxicosis. One hundred and twenty nine patients were randomly chosen among patients treated radically for DTC (116 females and 13 males). Basal and TRH stimulated TSH level, FT4 and FT3 serum level were estimated by microimmunoenzymatic method, while SHBG was estimated by immunofluorimetry. Full suppression (basal TSH < 0.05) was obtained in 64 patients (49%), submaximal suppression (TSH between 0.1 and 0.3 mU/l) was observed in 21 patients (16%). In 29 patients (22%) no suppression was obtained by the applied dose of thyroxine. The risk of iatrogenic hyperthyreosis, as judged by the increase of FT3 or SHBG, was found to be 38% in patients with full suppression and only 5% in patients with submaximal suppression (p < 0.05). CONCLUSION: 1. Suppression of TSH secretion was achieved in 80% of patients with differentiated thyroid carcinoma. The control of TSH level must be controlled every 3 months in 5 first years of therapy. 2. The optimal serum TSH level for L-thyroxine therapy in asymptomatic patients after radical treatment of differentiated thyroid carcinoma ranges between 0.1 to 0.3 mU/L. This range ensures the expected suppression of TSH with only minimal risk of iatrogenic hyperthyreosis.

[Early evaluation of treatment effectiveness using 131I iodine radiotherapy in patients with differentiated thyroid cancer]. / Ocena wczesnej skutecznosci leczenia uzupelniajacego jodem promieniotwórczym 131I chorych na zróznicowane raki tarczycy.

UNLABELLED: This paper presents the preliminary results of a prospective randomized trial on early effectiveness of 30 mCi versus 60 mCi for ablation of thyroid remnants in patients with WDTC after total thyroidectomy. Since April 1998 to January 2000, 220 patients with papillary thyroid cancer in stage T1b-3, N0-x, M0 had entered the study. 106 patients received 60 mCi and 114 received 30 mCi as the first ablation dose. The subject for the analysis was the uptake over the neck, post-therapeutic whole body scintigraphy and Tg level 6 months after ablation. The early effectiveness of ablation was estimated using a 5-degree scale: 0--very good effect, 1--good effect, 2--dubious effect-required repetition of WBS and Tg assessment in 6-12 months, 3--insufficient ablation--required repetition of radioiodine treatment, 4--for evident dissemination or local recurrence. RESULTS: Grades 0 were obtained in 29 (53%) after 30 mCi (group I) and in 38 patients (86%) after 60 mCi (group II). Grades 1 were obtained in group I in 15 patients (28%) and in 4 patients (9%) of group II. Grades 2 were obtained in group I in 9 patients (17%) and in group II in 1 (2.3%). Grade 3 was obtained only in 1 (2%) patient after 30 mCi. Grade 4 was obtained in one patient after 60 mCi (2.3%). The difference in uptake over the neck in the two groups was statistically significant (p < 0.05), although the differences in early effectiveness between the both groups according to the 5-degree scale were on the borderline of significance (p = 0.075). There was a correlation between uptake before and after ablation in 30 mCi group, which was not seen present in 60 mCi group. CONCLUSION: For the ablation of thyroid remnants 60 mCi should be considered as a standard dose.

[Use of recombinant human TSH for stimulation of iodine radioisotope uptake in metastases of thyroid cancer during therapy with 131I]. / Zastosowanie rekombinowanego ludzkiego TSH do stymulacji jodochwytnosci przerzutów raka tarczycy w czasie terapii jodem promieniotwórczym 131I.

The diagnostics with the use of recombinant human TSH for the follow-up of differentiated thyroid carcinoma (DTC) has been already approved. In more than 400 diagnostic scans, rhTSH proved to be effective in promoting 131I uptake in thyroid remnants and DTC metastases in patients receiving suppressive doses of thyroxine. However, information about its application in radioiodine treatment of DTC are scarce, especially with respect to patients with metastatic disease. In this review we have described our own results obtained during rhTSH aided radioiodine treatment of 42 patients with advanced DTC with reference to current literature data about diagnostic and therapeutic application of rhTSH.

[Evaluation of effects of L-thyroxine therapy in differentiated thyroid carcinoma on the cardiovascular system --prospective study]. / Ocena wplywu leczenia supresyjnego L-tyroksyna w raku tarczycy na uklad krazenia--badanie prospektywne.

Patients with differentiated thyroid carcinoma are treated by thyreoidectomy, followed by radioiodine treatment. A life-time suppressive therapy with L-thyroxine is also indicated. However, it may cause cardiovascular side effects. The aim of the study was a prospective evaluation of the left ventricle hypertrophy in patients treated with suppressive doses of thyroxine. A significant rise in left ventricular mass and mass index was noted during the first year of therapy and could be prevented by a simultaneous treatment with low doses of bisoprolol.

[Evaluation of bone density in women after thyroid cancer surgery and treatment with suppressive doses of L-thyroxine]. / Ocena gestosci kosci u kobiet po operacji raka tarczycy, leczonych supresyjnie L-tyroksyna.

The aim of this work was to evaluate the degree of bone resorption and incidence of osteoporosis in female postmenopausal patients with differentiated thyroid cancer treated with suppressive doses of thyroxine. During the regular follow-up of women with differentiated thyroid cancer, densitometry of lumbar spine (L2-L4) and femoral head were performed. urine concentration of deoxypyridinoline and calcium-phosphate metabolism were also evaluated. Osteoporosis was diagnosed in 11% of patients, all without hormone replacement therapy (HRT). Mean bone density was significantly higher in patients treated with HRT. A decrease in bone mass was related to the duration of thyroxine therapy. The best results of bone mass density were obtained in patients on HRT and with short duration of thyroxine therapy. Deoxypiridinoline estimation did not exhibit significant differences between groups, however it was useful in the individual evaluation of bone resorption.

Association of polymorphism of LTalpha and TNF genes with Graves' disease.

Graves' disease (GD) is an autoimmune disease, which develops on the basis of an interaction between genetic, environmental and endogenous factors. GD is associated with some HLA genes. Closely linked with them are TNF genes (TNF and LTalpha). Their role in the pathogenesis of GD is still unclear. Two functional polymorphisms within TNF genes include a substitution of G with A in intron I of LTalpha gene and the same one at position -308 in the TNF gene promoter. We carried out a case-control study for the analysis of the contribution of TNF genes to GD in Polish patients. 156 patients with GD diagnosed by clinical data were investigated and compared to 80 healthy persons with negative familial anamnesis. Both TNF and LTalpha were analysed by PCR/Nco I RFLP. The allelic frequency of the rarer TNF2 (A) allele, was 24.7% in GD patients, significantly higher than in healthy persons (9.3%; p<0.0001). The OR was 4.38 for this allele. The frequency of heterozygotes was 41.8% in GD, as compared to 13.6% in the control group. The allelic frequency of the rarer LTB*1 (G) allele was also significantly increased: from 21.9% in the control group to 37.2% in GD patients (p<0.01; OR 2.81). The frequency of heterozygotes was 48.7% in GD, and 28.8% in the control group. The results indicate that TNF genes may contribute to GD in the Polish population.

Markers of tissue response to thyroid hormones in patients with hyperthyroidism or hypothyroidism.

Changes in serum cholesterol and aminoterminal type III procollagen propeptide (PIIIPN) were compared in 33 patients with hyperthyroidism, 16 patients with hypothyroidism, and 23 healthy individuals. An increase in PIIIPN was found in patients with hyperthyroidism and an increase in serum cholesterol level was associated with hypothyroidism. There was no correlation between investigated indices. It is suggested that PIIIPN changes were a result of altered connective tissue metabolism, while serum cholesterol was related to the intensity of body metabolism.

Serum amino-terminal propeptide of type III procollagen in patients with hyperthyroidism or hypothyroidism during therapy.

Changes in serum amino-terminal type III procollagen propeptide (PIIIPN) and hydroxyproline were compared with indices of thyroid function in 33 patients with hyperthyroidism and 16 patients with hypothyroidism before and after treatment. Control values were obtained from 26 healthy individuals. Hyperthyroidism was shown to be associated with an increased level of PIIIPN and hypothyroidism with a decreased PIIIPN level. An increase in PIIIPN was found in 100% of hyperthyroid patients and a decrease in 31% of those with hypothyroidism, while hydroxyproline increased in only 54% of patients with hyperthyroidism and its level was decreased in only 6% of patients with hypothyroidism. Correlation between PIIIPN and thyroxine and triiodothyronine levels was shown. The results obtained suggest that PIIIPN is a valuable index of tissue response to thyroid hormones.

[Usefulness of determining the blood protein synthesis index in the evaluation of liver damage]. / Przydatnosc oznaczania wskaznika syntezy bialek osocza krwi w ocenie uszkodzenia watroby.

UNLABELLED: The purpose of report was the presentation of the variability range of the plasma protein synthesis index (PSI) in dependence on the chronic character of the liver parenchyma lesion in man or the extent of parallel indices of PSI with other biochemical parameters usually determined in the diagnostics of the liver parenchyma diseases. The studies have been performed in 20 patients with viral hepatitis (VH ), 20 patients with balanced liver cirrhosis (BLC), 20 patients with unbalanced liver cirrhosis and in 43 healthy volunteers. The PSI, total protein, albumin, gamma-globulin, bilirubin, prothrombin index and the alanine aminotransferase and the choline esterase activity has been determined. The most important lowering of the PSI values has been observed in patients with BLC. In those with VH the prolonged depression of the protein synthesis may indicate the chronic character of the inflammatory process. The extent of correlation of PSI with other parameters was statistically not significant. CONCLUSIONS: 1. PSI is a result of the liver lesion and its values are lowest in patients with MWN. 2. The WSB value does not depend on the age of subjects studied. 3. The diagnostic usefulness of WSB for evaluation of the liver parenchyma lesion is greater than of the albumin, choline esterase or prothrombin index determination. 4. The WSB determination is of value in the complex evaluation of the liver function in patients with lesions of that organ.