[Inapparent primary hypothyroidism]. / [In Process Citation]

Some 12 years ago a 56-year-old man was observed for Epipharyngitis. All the tests, including cytology of the epipharynx, were normal. Thyroid tests, including free thyroxine and triiodthyronine, were normal, only the hypophysial thyroid stimulating hormone was elevated. In a second IGR TSH test it was again elevated. The patient was seen again: he was adynamic. Thyroxine was prescribed in a small initial dose of 25 mgr. daily and after several weeks he was consuming 125 mgr thyroxine daily. TSH was normalised. This inapparent expression of primary hypothyreosis with elevated TSH only was the trigger for many cases of hyporthyreosis without laboratory or clinical signs of thyroid hypofunction. In this paper 27 cases are presented with the sign of elevated TSH only.

Reevaluation of the results of iodine prophylaxis in eradication of endemic goiter in Macedonia.

In order to reevaluate effectiveness of iodine prophylaxis in Macedonia, epidemiological, ultrasonographic studies and estimation of urine excretion were performed. The results from the epidemiological survey in nongoitrogenic regions demonstrated goiter between 12.8% and 18%. Much higher prevalence of goiter was found in goitrogenic regions, between 20.8% and 60.8%. The incidence of goiter increased with age, and its prevalence is higher in girls when compared with the boys of the same age group. The thyroid volume estimated by ultrasonography was higher in children from goitrogenic regions when compared to nongoitrogenic. There was a good correlation between ultrasonographic volumetry data and size of the thyroid estimated by palpation. Urinary iodine excretion demonstrated low values in children from goitrogenic regions as indicator of iodine deficiency.

Synthesis of p-aminohippuric acid analog and its labeling by technetium-99m.

A procedure is described for the synthesis of p-[(bisacarboxymethyl)aminomethyl carbamino] hippuric acid (PAHIDA). The compound was identified by i.r. and NMR spectroscopy. A lyophilized complex was prepared and labeled with 99mTc. The purity of the preparation is better than 98%. The stability of the 99mTc-PAHIDA complex is achieved 8 h after labeling. Biodistribution tested on white rats shows a maximum accumulation in kidneys of 6-10% within 2 min after injection, while the accumulation in the liver is 2-4% of the administrated dose. Preliminary clinical studies of 99mTc-PAHIDA on patients and its comparison with 131I-hippuran showed that the 99Tc-PAHIDA preparation has excellent characteristics for visualization of kidneys. However, it has slightly slower urinary elimination compared to hippuran, which it makes possible to use PAHIDA as a replacement of hippuran to a certain extent.

Extended long-term drug monotherapy of Graves' disease.

The results are presented of a 3-17 years' prolongation of the usual one-year "long-term" drug treatment applied to patients with Graves' disease. Most of the 87 patients with an average age of 34.3 years were on the maintenance dose of 10 mg methimazole daily. This mono-drug therapy was well tolerated and accepted by the patients, the toxic state disappeared, glandular consistency and the size remained almost unchanged. Thirty-six patients of this group (41.4%) were in a "permanent" remission lasting over three years. The remaining 51 patients continued their maintenance dose which kept a balanced euthyroid state. The authors support the convenience of a considerable extension of the traditional long-term methimazole treatment of Graves' disease. This extended scheme of the drug suppression of euthyroid functions is reversible in contrast to radical surgical or radioiodine treatments which increase the cumulative rate of irreversible hypothyroidism over decades.

Synthesis and quality control of 99mTc-p-butyl IDA.

A procedure is described for synthesis of p-butyl IDA and for identification of the product by i.r. and NMR spectroscopy and by chemical analysis. A method for preparing this compound by "instant" technique and for its labelling with 99mTc is also given, as well as a procedure for control of the chemical and biological properties of the radiopharmaceutical. Radiochemical study shows a high labelling yield of 95%. Investigation of the biodistribution proves that this preparation is a good hepatobiliary reagent, suitable for use in investigation of the liver functions and for quantitative visualization of the hepatobiliary system.

Preparation and quality control of 99mTc-calciumgluconate.

A procedure for the labelling of lyophilised Sn-Ca-Gluconate by a 99mTc instant technique was developed. Paper and TLC chromatography and low-voltage electrophoresis were used for the determination of the labelling yield which reached between 95 to 98%. The biodistribution was followed in white (albino) rats. About 25 to 35% of the total activity of the compound was retained in the kidneys one hour after its i.v. injection.

Detection of acute myocardial infarction in spontaneously hypertensive rats by 99mTc-pyrrolidino methyl tetracycline.

The myocardial infarct induced by isoproterenol in spontaneously hypertensive rats accumulates higher activities of 99mTc-PM tetracycline compared with the cardiac infarct in normotensive rats caused by the same method. The isoproterenol model of the myocardial necrosis was induced in intact rats without opening the thorax and is a convenient method for experimental radioisotope studies.