[Therapy with large doses of methylprednisolone in Basedow's ophthalmopathy]. / Terapia cu doze mari de metilprednisolon în oftalmopatia basedowiana.

Up to now there is no satisfactory therapeutical method in Graves' ophthalmopathy (GO). Recently, several authors have published the results of the so-called "pulse" method of corticotherapy, using intravenous methylprednisolone (MP) 1 g dissolved in 200 ml isotonic NaCl solution. We have treated with this method 4 patients (3 women and 1 man, aged between 35-62 years) with severe GO (III-V class after AMT Classification). Although the number of perfusions varied between 1 (2 patients) and 8, the results are encouraging: 3 improvements, 1 stationary evolution (after a single "pulse"). We have not noticed important side-effects. In conclusion we consider that the "pulse" method have proved its efficiency, recommendable in severe GO.

[The cardiac manifestations in hyperthyroidism. The surgical implications]. / Manifestari cardiace în hipertiroidii. Implicatii chirurgicale.

In a statistics including 954 patients with hyperthyroidism [correction of Huprotoncoses] treated between 1966-1989, the authors found 522 cases (54) with various associated cardiac disorders. Of these cases, 199 presented rhythm disturbances: extrasystolic arrhythmia, auricular fibrillation and flutter to which 34 postoperative arrhythmias are added. Cardiac insufficiency present in 46 cases was the main complication and end point of the various myocardial conditions. Ischemic cardiopathy (181 cases), arterial hypertension (98 cases) and rheumatic valvulopathies (9 cases), either isolated or dominating the clinical picture, complete the nosological spectrum of these disturbances. The frequency of associated conditions and the absence of some specific morphologic lesions suggest that thyrotoxicosis is rather an aggravating factor although in many cases the presence of a previous cardiac disease is excluded. The two objectives in the management of thyrocardiac diseases are the amelioration of cardiac condition and an endocrine balance. In the conditions of a careful selection and preoperative preparation, surgery gave good results consisting, in this series, in over 70% cures and ameliorations.

Association of autonomous thyroid adenoma with chronic thyroiditis.

Coexistence of an autonomous thyroid adenoma (ATA) with chronic thyroiditis suggests a complex pathogeny pointing to the autonomous character of the nodule and to the presence of immunitary disorders. The rarity of this association and the paucity of data prompted us to present 4 cases of a series of 71 thyroidectomized ATA cases. The rarity of ATA associated with chronic thyroiditis, accumulation of radioiodine under the conditions of euthyroidism only at the adenoma level as well as the possibility for the disease to occur in hypopituitarism, all support the hypothesis of an initial thyreotropic deficiency, with subsequent hyperplasia "of necessity". Later on there is an autonomous hyperfunction increasing pituitary depression, with total extinction of the thyroid tissue outside the adenoma. When the two lesions are associated, we consider that initially there was the TSH-dependent thyroiditis that developed during which, by accidental depression of TSH secretion a local hyperplasia occurs which later becomes autonomous.