Effects of low-level laser therapy on the serum TGF-ß1 concentrations in individuals with autoimmune thyroiditis.

OBJECTIVE: The objective of this study was to evaluate the serum concentration of transforming growth factor-ß1 (TGF-ß1) after low-level laser therapy (LLLT) in patients with hypothyroidism resulting from chronic autoimmune thyroiditis (CAT). BACKGROUND DATA: Certain data indicate that LLLT is effective in patients with hypothyroidism caused by CAT; however, the mechanisms of action of LLLT in thyroid tissue are unknown. Cytokines could play a role in the response to LLLT. METHODS: A randomized, placebo-controlled trial included 43 patients with a history of levothyroxine therapy for CAT-induced hypothyroidism. The patients were randomly assigned to receive either 10 sessions of LLLT (830 nm, 50 mW output power, and 707 J/cm(2) fluence; L group, n=23) or 10 sessions of a placebo treatment (P group, n=20) twice a week. Levothyroxine was maintained at the same dose during the entire study period. TGF-ß1 was measured both pre-intervention and 30 days post-intervention in both groups. The differences were calculated between the TGF-ß1 values observed 30 days post-intervention and the pre-intervention TGF-ß1 values for each group (intragroup). RESULTS: Comparing the differences in TGF-ß1 levels between the L group (874.9±541.7 pg/mL) and the P group (-128.4±832.8 pg/mL) revealed that there was a statistically significant increase in TGF-ß1 levels 30 days post-intervention in group L compared with the placebo group (p=0.0379). CONCLUSIONS: This finding suggested that the significant increase in serum TGF-ß1 levels in patients with CAT-induced hypothyroidism was associated with the thyroid LLLT procedure. Future studies of the effect of LLLT on TGF-ß1 gene expression in thyroid tissue are necessary to confirm these findings.

F-18-FDG-PET in a patient with Hashimoto's thyroiditis and MALT lymphoma recurrence of the thyroid.

We report on the case of a 86-year-old male patient with a rapidly growing nodule within the right lobe of the thyroid gland, which after hemithyroidectomy, turned out to be a mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid gland. In addition, Hashimoto's thyroiditis was reported in the thyroid tissue adjacent to the MALT lymphoma. During follow-up a second nodule emerged within the left lobe and, because of evidence of MALT lymphoma recurrence, F-18-FDG-PET was performed. F-18-FDG-PET imaged a clearly increased accumulation within the whole left lobe and isthmus. Thus, no differences in the degree of hypermetabolism could be imaged between the nodule and the adjacent thyroid tissue. To our knowledge, this is the first report about F-18-FDG-PET in a patient with MALT lymphoma of the thyroid. Literature search revealed only a few cases of MALT lymphomas in locations other than the thyroid gland that were studied with F-18-FDG-PET. In no case was F-18 FDG accumulation seen in the MALT lesions. However, clear F-18 FDG accumulation was reported in some patients with Hashimoto's thyroiditis. It is concluded that the intensive F-18-FDG accumulation within the whole left lobe and isthmus of the presented case was due to the coexisting Hashimoto's thyroiditis. Consequently, F-18-FDG-PET imaging does not seem to be indicated in a patient with MALT lymphoma and known Hashimoto's thyroiditis in order to evaluate the status of the MALT lymphoma.

[Exhalation of I-131 after radioiodine therapy (RIT): time dependence and chemical form]. / Exhalation von I-131 nach Radioiodtherapie (RIT): Zeitabhängigkeit und chemische Form.

AIM: The change of both amount and chemical forms of radioiodine exhaled in the air of rooms with patients on the therapy ward should be investigated depending on radioactivity applied, time after application, and kind of thyroid disease. METHODS: The air of ward-rooms of 62 patients with thyroid carcinoma, Graves' Disease, and autonomy which received different therapy doses, was investigated with an portable constant air flow sampler. Different chemical iodine species (organic, elemental, aerosol bound) were collected during 8 hr in various filters until 3 days after application of the radioiodine capsule, according to their chemical form. The radioactivity in the filters was measured with a well counter on defined time points after application. RESULTS: The radioactivity exhaled was between 0.008 and 0.03% related to activity of radioiodine applied. The percentage of radioiodine exhaled related to the activity applied, differed significantly depending on disease and changed as follows: Grave's Disease > autonomy > carcinoma. The exhalation of radioiodine became stronger with increasing applied activities and showed an exponential decrease with time. The most part of radioiodine was present in organic bound form. This organic portion decreased with time in favour of the other iodine species. CONCLUSION: The degree of accumulation of radioiodine orally applied within thyroid seems to be in direct proportion to the extend of its exhalation. Further measurements directly in the breathing air of RIT-patients are necessary, in order to clarify the relationship between degree of thyroid uptake and quantity as well as chemical form of radioiodine exhaled.

Detecting TSH-receptor antibodies with the recombinant TBII assay: technical and clinical evaluation.

We evaluated the technical robustness of the new commercial TBII assay using human recombinant TSH-R, and describe its use for the clinician in the routine laboratory. The human recombinant TSH-R assay (DYNOtest TRAK human) was compared to a conventional TBII assay (TSH-REZAK). Specificity was adjusted at 99.1% for both assays by ROC plot analysis including 113 healthy individuals. Sensitivity in 115 patients with active Graves' Disease (GD) was 98.2% for the DYNOtest TRAK human compared to 68.4% for the TSH-REZAK (p<0.0001). Comparison of the ROC-calculated cut off confirmed the recommended cut-off for the DYNOtest TRAK human, since 11% inhibition of tracer equals 1 IU/L, which is recommended as the grey zone. At the recommended cut-off (2 IU/L, 22% inhibition), the sensitivity is still 93.9% with 100% specificity. The ROC plot-derived cut-off of the TSH-REZAK (4.4%, 2 to 10 U/L) is below the grey zone of 10-15 U/L. At the recommended cut off of 15 U/L, the sensitivity is 43.0% with a specificity of 100%. Both assays showed a good correlation (r = 0.82, p < 0.0001); however, assay comparison revealed a constant bias in favour of the DYNOtest TRAK human. Applying the ROC plot-derived cut-off of 11 % inhibition (1 IU/L) for the DYNOtest TRAK human, we found 15 of 50 patients with autoimmune thyroiditis (AIT) and 6 of 23 patients with goitre (all < 1.5 IU/L). These patients would have been missed using the recommended 2 IU/L. The difference in sensitivity between the DYNOtest TRAK human and the TSH-REZAK was highly significant in the GD group, but not in other groups, indicating that the DYNOtest TRAK human has a higher sensitivity for GD without compromising specificity. In summary, the proposed high sensitivity of the new TBII assay using human recombinant TSH-R could be confirmed with the commercial product. This method offers a clear advantage over conventional TBII assays to confirm or exclude the diagnosis of GD. The recommended cut-off is very stringent, and until we have more information on the clinical relevance of low-level TBII between 1 and 1.5 IU/L, those patients should be monitored for the development of autoimmune thyroid disease.

[Early changes in thyroid hormones following radioiodine therapy of hyperthyroidism with reference to etiology and accompanying medication]. / Frühveränderungen der Schilddrüsenhormone nach Radiojodtherapie der Hyperthyreose unter Berücksichtigung von Atiologie und begleitender Medikation.

Radioiodine therapy (RITh) is an effective mode of treatment of different types of hyperthyroidism (immunogenic, IH; nonimmunogenic, NIH). The aim of this study was to evaluate the risk of thyroid storm after RITh. For this purpose a systematic determination of thyroid hormones (TT3, TT4) 5 and if possible 12 days after RITh was performed in 416 patients with borderline or overt hyperthyroidism. Additional antithyroid medication after RITh was necessary in 20 patients. Among the remaining 396 patients 48% had been pretreated with antithyroid drugs because of more severe clinical symptoms. This medication was canceled 10 to 5 days before RITh in all cases. After RITh the mean TT3 and TT4 levels of the subgroups, with and without antithyroid premedication, decreased nearly in parallel course. The whole group of 396 patients presented a significant decrease in TT3 levels with a mean from 1.9 to 1.4 ng/ml. In 18 cases (5%) an increase in TT3 level (greater than or equal to 0.5 ng/ml) was detected without requiring antithyroid therapy. No case of thyroid storm was observed in the entire patient group. TT3 decrease appeared to be more pronounced in patients with higher pretreatment levels. TT4 showed a significant decrease only in case of elevated levels. Post-therapeutic hormone levels were not dependent on the etiology of hyperthyroidism (IH, NIH). The decrease of TT3 levels in the IH group was more pronounced after application of 150 Gy compared with 60 Gy. The additional medication with propranolol (greater than or equal to 60 mg/day) enforced the TT3 decrease. Accompanying glucocorticoid medication had no influence on the hormone levels.(ABSTRACT TRUNCATED AT 250 WORDS)