[Correlation of ultrasound and radioisotope studies in subacute de Quervain thyroiditis]. / Korelacija ultrazvucnog i radioizotopskih ispitivanja tokom subakutnog de Quervainovog tireoiditisa.

INTRODUCTION: The first report on ultrasonic findings in subacute thyroiditis was published in 1975 (1). More detailed studies combining ultrasonographic and clinical findings are still missing. The present paper compares echostructure of the thyroid gland with the level of hormones--triiodthyronine (T3), thyroxine (T4), thyroidstimulating hormone (TSH) and thyroglobulin (tg) and thyroglobulin autoantibodies (tg-ab). MATERIAL AND METHODS: This study included 30 patients with subacute thyroiditis de Quervain. The diagnosis was based on typical clinical symptoms, ultrasonic findings, metabolic test with J-131 uptake with thyroid scintiscan, level of hormones--T3, T4, TSH then tg and tg-ab and fine-needle aspiration biopsy of thyroid gland. The patients were followed-up for 6 months, i.e. from the onset of the disease until treatment. Every month the following tests were done: ultrasound of the thyroid gland ("real time" ultrasound with a 5 MHz linear transducer), hormones T3, T4, TSH, then tg and tg-at (original radioimunoassay "Vinca" and "Inep" Zemun). RESULTS: During the acute phase of subacute thyroiditis pathological findings were detected by ultrasound in every patient. The gland increased in volume (p 0.05), unclear contours, nonhomogenous echostructure demonstrates in three ways: as hypodense with "pseudocysts", as hypodense, and multiple hypodense area, 6 months later, all patients had normal echostructure of the thyroid gland. In acute phase all patients had low J-131 uptake by the thyroid. Cytological findings of all patients refer to subacute thyroiditis. In the first 6 months the difference between hormone levels and echostructure of the gland is significant (p 0.05). The difference between tg-ab and echostructure of the gland is also significant. Only in the 6th month, there is no difference between these values (p 0.05). In acute phase, after 1 month and 6 months tg levels are not related to echostructure (p 0.05). The difference is significant in the period from the 2th to 6th month. DISCUSSION: Changed ultrasonic findings in subacute thyroiditis have been described in literature. Although sonographic characteristics of the acute phase are well known, reports of long-term ultrasonic findings in subacute thyroiditis are rare (4,5). Ultrasonic findings are not uniform (6,10). They are in correlation with the form and phase of the disease. They may be related to the intensity of inflammation and edema seen in this disorder (11,12). Subacute thyroiditis is followed by hormonal dysbalance, increase of tg level and tg-ab occurrence (3). Recovery is associated with a return to normal functional and ultrasonic characteristics of the thyroid gland (2). By comparing levels of hormones, tg and tg-ab with the ultrasonic findings it can be noted that the thyroid gland has been recovering functionally more than morphologically. Subacute thyroiditis does not cause ultrasonically visible changes in parenchyma of the thyroid gland. CONCLUSION: In serial examinations no correlation was found between sonographic findings and hormone levels (T3, T4, TSH) as in sonographic findings and tg-in acute phase of disease, only in convalescence period. Correlation was found between sonographic findings and tg in acute phase and convalescence period of disease. Ultrasonography provides useful information for follow-up of the course of disease.

[Cytologic diagnosis of Hashimoto's thyroiditis]. / Citoloska dijagnostika Hashimotovog tireoiditisa.

Cytologic findings and thyroglobulin antibodies were analyzed in 46 patients with chronic Hashimoto's thyroiditis. Only one patient underwent surgery because of Hurthle adenoma, while the histopathologic diagnosis was identical to the cytologic. In all patients the cytologic findings revealed chronic thyroiditis, and in 39 patients the titer of thyroglobulin antibodies was positive or highly positive. In 7 patients the antibodies were slightly positive. In 11 patients a control punction of the thyroid gland nodule was performed as well as the control of antibodies. There were no changes in the cytologic findings, not even in cases where the titer of thyroglobulin antibodies decreased. During the four year period of study there was not a single case where the clinical findings pointed to aggravation of the disease.

[Correlation of cytology and scintigraphic findings in thyroid gland diseases pathohistologically diagnosed]. / Korelacija citoloskih i scintigrafskih nalaza s patohistoloskom dijagnozom oboljenja stitaste zlijezde.

We compared cytologic and scintigraphic findings with pathohistologic diagnosis in 60 patients (11 males and 49 females) with nodular goiter. In the preoperative period, apart from clinical examination, all patients underwet thyroid gland scyntigraphy, puncture, T3, T4, TSH hormon test, and if clinically relevant, thyroglobulin. On the basis of pathohistologic diagnosis, two groups were formed: nontumour and tumour lesions. The nontumour lesion gruop consisted of 24 colloid and 8 cystic noduli. Cytologic diagnosis was confirmed in 29 cases. All cystic and 6 colloid noduli were scintigraphically "cold", while the rest were "relatively cold". In the tumour lesion group there were 14 follicular and 3 Hürthle's adenomas, 5 papillary, 1 follicular, 3 anaplastic and 2 metastatic carcinomas. Cytologic diagnosis was confirmed in 22 cases. All noduli were "cold". Cytologic diagnosis was compatible with pathohistologic diagnosis in 85% of cases. The difference between cytologic and pathohistologic diagnosis was not statistically significant.

Autoantibodies to triiodothyronine and thyroxine in primary hypothyreosis.

The role of autoantibodies to triiodothyronine and thyroxine hormones is still obscure. Our investigation of autoantibodies in primary hypothyreosis gave controversial results. We have investigated 40 patients with primary hypothyreosis caused by chronic atrophic thyroiditis and lymphocytic Hashimoto thyroiditis. We have examined autoantibodies to triiodothyronine (T3) and thyroxine (T4) in patients prior to and during substitution therapy. The control group of 50 subjects with no signs of thyroid gland disease were also examined. Positive antibodies to their own T3 or T4 hormones were not found in this group. Out of 40 patients with primary hypothyreosis, autoantibodies to their own hormones were found in 11 patients (27.5%). At the same time, antibodies to T3 and T4 were found in 3 patients, antibodies to T3 in 7 and antibodies to T4 were found in only 1 patient. In the course of substitution therapy (L-thyroxine) there was an increase in number of patients with antibodies to T4, thus having no statistical significance in comparison with the total number of patients with positive antibodies to T3 and T4.

The frequency of thyrotoxicosis in war time period.

The frequency of thyrotoxicosis in peace and war time periods was compared in the same region with the same population. In one year peace and war time periods 54 and 87 cases of thyrotoxicosis were found, respectively, which indicates the increase for 62%. The results point to the conclusion that psychic trauma increases the number of patients affected by thyrotoxicosis.