[Thyroid and AIDS]. / Thyroïde et SIDA.

Two types of thyroid biochemical abnormalities (TBA) are observed in AIDS. The unspecific TBA are similar to TBA reported in the Euthyroid Sick Syndrome. An increased serum TBG of unknown origin and a decreased circulating rT3 are the most specific TBA of AIDS. The latter abnormality may be in relation with an elevated level of TNF. The frequency of serum antithyroid antibodies seems higher than in control groups. Opportunistic infections of the thyroid gland or destruction of the thyroid by Kaposi's sarcoma are also reported in AIDS.

Elevated CEA in breast cancer patients with overlooked medullary thyroid carcinoma.

After mastectomy and radiation for breast cancer, two patients were found to have persistent elevated CEA in their serum. This finding was erroneously attributed to occult metastases for the first patient and to local recurrence for the second. Overlooked medullary thyroid carcinoma (MTC) was the causal disease in both patients. A review of the literature stresses the frequency of CEA elevation in serum of MTC patients. A thorough search for any possible cause of elevated levels of CEA is advocated, particularly by thyroid sonogram with a needle aspiration biopsy when a nodule is discovered and by calcitonin assay in the serum.

Age influence on clinical features in hospitalized thyroid patients: dissimilarity between clinical and laboratory findings in adulthood. A retrospective study.

To evaluate the influence of age on clinical findings of thyroid disease, the records of 209 consecutive hospitalized patients with hyperthyroidism (n = 109) or hypothyroidism (n = 100) over a ten year period (1979 to 1988) were retrospectively reviewed. Patients included 51 males and 158 females, aged 21-99 years. Control euthyroid subjects (n = 70) were selected in the same age range and for similar non-thyroid illness as patients. Patients and controls were sorted by age decade of life. For each group a clinical index was calculated on the basis of 10 symptoms and 10 signs most frequently observed in thyroid disease. With increasing age, the occurrence rate of the clinical manifestations of thyroid disease decreased in patients while it increased in controls. This opposite evolution was less marked in hypothyroidism than in hyperthyroidism and was independent of biological parameters which remained stable whatever the age of patients and controls. Specific clinical features were identified for hyper- and hypothyroidism but none of them had sensitivity higher than 60% except goiter in hyperthyroid patients aged 61-80. In conclusion, a clinical diagnosis of thyroid disease is difficult in aged subjects because there are only a few specific features and their frequency is low. Therefore, in subjects over 60 years, we advocate performance of thyroid biochemical screening.

Biochemical thyroid profile in patients infected with the human immunodeficiency virus.

Over a 2-year period, thyroid function was studied in 102 patients infected with the human immunodeficiency virus (HIV) and in 102 age- and sex-matched controls with various infectious diseases. Biochemical abnormalities were observed in 1-20% of the patients, depending on thyroid indices, but thyroid disease (hypothyroidism) was diagnosed in only 1. Compared to controls, patients, especially those with the acquired immunodeficiency syndrome (AIDS), had a significant increase in serum thyroxine-binding globulin, a lower T3 and free thyroxine index, and a higher frequency of thyroglobulin antibodies.

Radioiodine therapy in voluminous multinodular non-toxic goitre.

Large doses of radioiodine were administered since 1969 to 15 euthyroid patients with compressive voluminous goitres. A decrease in goitre size was observed in all patients (between 15 and 63%, average 39%). Maximal effect on goitre size was attained rapidly, partially already after less than one year and was almost maximal after 24 to 30 months. No significant local adverse reactions were observed; no patient required steroid administration. Hypothyroidism followed radioiodine administration in 30% of the patients after 2 years; after 8 years, all those who had survived were hypothyroid, requiring substitution therapy. In all patients there was a marked improvement in compression symptoms. The use of radioactive iodine therapy constitutes an alternative to surgery in selected patients with large compressive goitres in whom surgery is contraindicated because of age or other medical conditions.

Dexamethasone treatment of amiodarone-induced thyrotoxicosis (AIT) with or without persistent administration of the drug.

Treatment of amiodarone-induced thyrotoxicosis (AIT) with thionamide, lithium or radioactive iodine is ineffective. This particular form of hyperthyroidism is long-lasting because of the slow elimination of amiodarone. Therefore, an alternative therapy is necessary, especially for patients who need to continue permanent administration of the drug. We report 2 cases of AIT: in one case, amiodarone was interrupted; in the other case, amiodarone was continued because of recurrent ventricular tachycardia resistant to classical antiarrhythmic drugs. Both patients were successfully treated with propylthiouracil (PTU) and dexamethasone (DXT).

Thyroid hormone reserve in asymptomatic autoimmune thyroiditis.

Basal (B) and peak (P) serum levels of thyroxine (T4), free thyroxine (FT4), triiodothyronine (T3), free triiodothyronine (FT3), and TSH were measured before and after oral TRH (40 mg) administration in 79 subjects affected with asymptomatic autoimmune thyroiditis (AAT) and in 69 normal subjects. The area under the curve (AUC) and peak values of T4, FT4, T3 and FT3 were considered as parameters of thyroid hormone reserve. Intrathyroidal iodine (ITI) was measured by the X-ray fluorescence method. The AAT subjects were divided into three groups on the basis of their basal and peak TSH values. In group I, these parameters were similar to those in the normal controls; in group II, basal TSH remained normal but peak TSH was significantly increased, and in group III both values were significantly increased. Group I differed from the controls by a decrease in P FT4 and AUC FT4, whereas in groups II and III B FT4 was also significantly lowered. T3 levels were similar in all groups except in group III, in whom they dropped. ITI was already lower in group I than in the controls. Its decline went further in groups II and III. An inverse correlation with significant r values was evidenced between log B and P TSH on one hand and log B FT4, P FT4 and AUC FT4 on the other. When group III was excluded, log P TSH was positively correlated with log B T3, P T3, AUC T3, and AUC F T3.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural history of primary myxedema.

It is generally admitted that primary myxedema in adults is the outcome of autoimmune atrophic thyroiditis. The present review traces the natural history of this process from its incipient biologic and genetic anomalies up to its protracted asymptomatic course, clinical development, and eventual lethal complications. The apprehension of preclinical hypothyroidism may change a clinician's outlook on early diagnosis and therapy.

Rapidly fatal bronchiolitis obliterans with circulating antinuclear and rheumatoid factors.

A 57-year-old woman developed severe bronchiolitis obliterans and presented circulating antinuclear and rheumatoid factors without any evidence of connective tissue disease. The evolution was rapidly fatal despite corticosteroid therapy and immunosuppressive treatment. The post-mortem study disclosed no connective tissue disease lesions. We suggest that the serologic abnormalities could be secondary to the inflammation of the bronchioles.

Thyroidal release after oral administration of TRH in normal subjects.

The oral administration of 40 mg TRH to 17 normal volunteers induced a greater TSH response in females than in males, contrasting with an identical pattern of total T3 and T4 (TT3, TT4) and of free T3 and T4 (FT3, FT4). TSH peaked at 180 min while thyroid hormones (total and free) reached their maximum at 360 min. The drop in the T4 to T3 ratio (total and free hormones) observed at 360 min is consistent with an initial preferential T3 secretion. At 360 min the thyroglobulin (Tg) levels were still in the basal range while at 24 h a significant increase was observed, essentially in female subjects. Thus T3, T4 and Tg seem to be sequentially secreted by the thyroid in response to a prolonged TSH stimulus.

Heterogeneity of immunoregulatory T cells in human thyroid autoimmunity: influence of thyroid status.

Monoclonal antibodies of the OKT series were used to identify circulating T lymphocytes (OKT3+), their helper-inducer (OKT4+) and suppressor-cytotoxic (OKT8+) subsets and cells bearing Ia antigen (OKIa+) in 75 patients with thyroid autoimmune disorders, including 14 Graves' disease, 21 myxoedema, 20 asymptomatic thyroiditis, 12 Hashimoto's thyroiditis and eight simple goitre with superimposed thyroiditis. In the whole population of patients, a negative correlation was observed between the percentage of OKT8+ cells and serum free thyroxine levels whatever the type of thyroiditis. The percentage of OKT8+ cells was decreased in Graves' disease and increased in myxoedema while it reversed after adequate treatment of the two diseases. However, a trend to a decrease in the proportion of OKT8+ cells was still observed in treated Graves' disease and in all the other groups of thyroiditis with euthyroidism. The minor modifications observed for OKT3+ and OKT4+ cells were in relation with those of OKT8+ cells. There was an increased percentage of Ia+ cells in Graves' disease and in Hashimoto's thyroiditis partly reflecting the presence of activated lymphocytes. In conclusion, these data suggest first of all a direct influence of serum T4 on the distribution of circulating OKT8+ cells in addition to documenting the heterogeneity of T cell immunoregulatory factors.

Asymptomatic atrophic thyroiditis.

Asymptomatic atrophic thyroiditis (AAT), one of the three variants of autoimmune thyroiditis, is characterized by the presence of serum antithyroid antibodies in good correlation with thyroid lymphoplasmocytic infiltrations. AAT affects 5-15% of the general population and is especially prevalent in elderly women. Patients with AAT have no goitre and are clinically euthyroid. While circulating thyroid hormones are always in the normal range, peak TSH and TRH and basal TSH values are increased in two thirds of the cases. There is a familial aggregation of AAT and a frequent association with other autoimmune diseases. Development of overt hypothyroidism in AAT patients is not rare. Preventive thyroid replacement therapy is indicated in patients with elevated basal TSH levels.

[Thyroid gland and female sexual function. I. Relation outside of pregnancy]. / Glande thyroïde et fonction sexuelle féminine. I. Relations en dehors de la grossesse.

After having reviewed briefly the main characteristics of adult thyroid function, as well as the ways in which this is controlled (the first part), the authors reviewed present day methods of investigating thyroid gland function (the second part). In the third part of the work hormonal interrelationships between the thyroid and the ovary are discussed as well as the influence of gonadal hormones on thyroid function and the influence of the latter on ovarian function and on hypothalamic-pituitary interactions. The effects of thyroid diseases on reproductive function are studied in the last part of the work.