The sonographical and functional sequelae of de Quervain's subacute thyroiditis: long-term follow-up.

Fifty-three patients with subacute thyroiditis (SAT) were seen during the acute stage of the disease. HLA-Bw 35 was positive in 33 out of 39 tested patients. At first presentation, all examined patients (N = 23) had ultrasound abnormalities (generalized hypodensity, single or multiple hypodense areas). Serum T4 and/or T3 were increased in 24/52, free T4 in 11/23, and the TSH response to TRH was flat in 8/11 patients. Six of 12 in whom volumetry was performed had goitres. Thirty-seven patients were re-examined after a mean follow-up interval of 46.5 months. At this follow-up, serum T4, free T4 and T3 levels as well as the sonographically determined thyroid volume had decreased, but there was still abnormalities by ultrasound detected in 14/36 patients; 19.4% had focal sonolucent lesions, whereas the prevalence of such lesions was only 3.1% in asymptomatic controls. Three patients were subclinically hypothyroid at the follow-up, whereas all others were euthyroid. Patients with abnormal ultrasound findings were of the same age and had a similar thyroid size, but a slightly higher TSH and a significantly (P less than 0.02) lower free T4 than those with normal ultrasound findings. They also had a higher prevalence of thyroid autoantibodies in low titres. Serum thyroglobulin was elevated in more than half of the patients during the acute phase, but only in 1 out of 11 patients during follow-up. Thyroglobulin at the follow-up was not related to TSH, but there was a correlation with thyroid volume (r = 0.57).(ABSTRACT TRUNCATED AT 250 WORDS)

[Sonographic volumetry of the thyroid gland in the control o thyroxin and iodide treatment of non-toxic goiter]. / Sonographische Volumetrie der Schilddrüse zur Verlaufskontrolle bei der Thyroxin- und Jodidbehandlung der blanden Struma.

In a prospective study 39 patients with diffuse euthyroid goitre were treated for one year with 100 micrograms levothyroxine (n = 19) or 500 micrograms iodide (n = 20). Efficacy of treatment was assessed by sonographic thyroid volumetry . In both forms of treatment maximum volume decrease was already seen within the first six months. After treatment for one year the mean decrease of thyroid volumes was 27.5% in the thyroxine group and 22% in the iodide group. This difference was statistically not significant. There was no difference in the extent of goitre size reduction within the thyroxine group among patients with complete TSH suppression and with still positive TRH test. Significant increases of T4 and of fT4 values within the normal range were observed already after one month with thyroxine treatment and only after 3 months with iodide treatment. There were no changes of the T3 values. In one female patient iodine-induced hyperthyroidism occurred. However, there were no further side effects in both treatment groups. This randomised study documents for the first time that both 500 micrograms of iodide and 100 micrograms of levothyroxine have a comparable efficacy for reduction of goitres.

Thyroid function after bronchography with propyliodone.

Thyroid function was studied in 27 subjects who underwent bronchography with propyliodone (18-70 ml, containing 30% of organic iodine). Sustained elevations of serum non-hormonal iodine were observed, indicating that significant amounts of propyliodone were absorbed from the bronchial tree and also that elimination may take several weeks. During the period of anaesthesia, there was an increase in thyroxine-binding globulin and all thyroid hormones which was transient and probably reflected vascular response to the anaesthetic. T4-T3 conversion was inhibited with a nadir of T3 and a peak of rT3 occurring on the 2nd day after propyliodone exposure. FT4 increased gradually during the 2 weeks after bronchography, but remained within the normal range. 6 out of the 27 patients developed pathologic T4 levels, 3 elevated T3 levels, and 2 an abnormal response to thyrotropin-releasing hormone; these changes might have been confused with hyperthyroidism. None of the patients developed clinical thyrotoxicosis; however, in patients with autonomous thyroid tissue, the same precautions should be taken with propyliodone as with other iodine-containing agents which are known to induce hyperthyroidism in this situation.

[Diagnostic value of FT4 concentration and T4/TBG radio--better discrimination with FT4 in marked TBG anomalies]. / Diagnostische Wertigkeit von FT4-Konzentration und T4/TBG-Quotient--Bessere Trennschärfe des FT4 bei ausgeprägten TBG-Anomalien.

In 211 consecutive patients T4/TBG ratio correlated well with direct FT4 determination over a wide range of TBG concentration. However, there was a tendency to decreasing T4/TBG ratios with an increase of TBG concentration, which in consequence did lead to false results in three patients with very high TBG concentrations. Direct FT4 determination, which is not influenced by the binding protein levels, therefore is superior to T4/TBG ratio in patients with very low or high TBG concentrations.

[The Houssay phenomenon in man (author's transl)]. / Das Houssay-Phänomen beim Menschen.

Marked insulin sensitivity, accompanied by unusual hypoglycaemic symptoms, was observed in three patients with juvenile diabetes mellitus. All three had anterior hypopituitarism, developing post-partum in two, a craniopharyngioma being the cause in the third. These are thus three examples of the Houssay phenomenon of which only 37 cases have previously been described.

[Late manifestation of glycogenosis I in early adulthood]. / Späte Manifestierung einer Glykogenose I im frühen Erwachsenenalter.

Mild forms of glucose-6-phosphatase deficiency (glycogenosis type I) may remain undetected till indirect consequences of the metabolic bloc clarify the diagnosis in early adulthood. Since humoral regulation could play a decisive role in the metabolic adaption to hypoglycemia, caused by the enzyme deficiency, we studied insulin-, glucocorticoid-, catecholamine- and somatotropin-secretion in a 27 year old man with a mild glycogenosis type I. Basal and simulated insulin release was decreased, the glucocorticoid secretion lay in the lowest part of the normal range, whereas catecholamine and somatotropin secretion showed no significant change. Thus, the humoral adaption in glucose-6-phosphate deficiency corresponds to the hormonal regulation in prolonged starvation.

[Late manifestations of glycogenosis 1 in early adulthood]. / Späte Manifestierung einer Glykogenose I im frühen Erwachsenenalter.

Mild forms of glucose-6-phosphatase deficiency (glycogenosis type I) may remain undetected till indirect consequences of the metabolic bloc clarify the diagnosis in early adulthood. Since humoral regulation could play a decisive role in the metabolic adaption to hypoglycemia, caused by the enzyme deficiency, we studied insulin-, glucocorticoid-, catecholamine-and somatotropin-secretion in a 27 year old man with a mild glycogenosis type I. Basal and stimulated insulin release was decreased, the glucocorticoid secretion lay in the lowest part of the normal range, whereas catecholamine and somatotropin secretion showed no significant change. Thus, the humoral adaption in glucose-6-phosphatase deficiency corresponds to the hormonal regulation in prolonged starvation.

Effects of a single high oral dose of thyroxine on the pituitary-thyroid-axis.

Ten euthyroid and 9 hypothyroid volunteers were orally administered 2 mg L-thyroxine (T4) to study the interaction between substitutive and suppressive effects of a single high T4 dose. After a significant rise the serum T4 concentration for 5 days in euthyroid and for 11 days in hypothyroid patients an inhibition of basal and of TRH stimulated TSH release was observed. Maximal inhibition of the TSH response in hypothyroid patients occurred 1 to 7 days after the individual T4 peak. This interval was significantly correlated to the extent of the respective T4 rise. In euthyroid subjects TSH response was significantly inhibited for 8, in hypothyroid patients for 22 days. In all but 3 of the euthyroid patients there was a significant inhibition of the thyroidal 132I uptake on day 8. Normalization of thyroidal 132I uptake and of pituitary TSH secretion generally coincided.

[Effect of a 2 mg thyroxine bolus on the hypophyseal-thyroid axis (author's transl)]. / Auswirkungen eines 2-mg-Thyroxin-Bolus auf die Hypophysen-Schilddrüsen-Achse.

The effect of a single dose of 2 mg L-thyroxine on central and peripheral parameters of the hypophyseal-thyroid axis was studied on ten euthyroid and ten hypothyroid patients, and ten with euthyroid goitre. Without the occurrence of hyperthyroid symptoms, the T4 serum level was raised for five days in the euthyroid group, for 11 days in the hypothyroid ones. During this time the T3 serum level did not alter. Suppression of iodine uptake by the thyroid and TSH secretion of the hypophysis persisted longer, both for basal and TRH-stimulated liberation, than the substitution effect. Even when the T4 bolus has to be at a higher total T4 dose for the same therapeutic effect than with daily small single doses, it is a comparable alternative to present-day forms of treatment. It is of particular advantage where there are medical reasons for widely spaced drug intake or rapid normalisation of the T4 serum level is deemed desirable.

[Combined doxorubicin and bleomycin treatment of metastasising thyroid carcinoma: results in 21 patients (author's transl)]. / Zytostatische Kombinationsbehandlung metastasierender Schilddrüsenkarzinome mit Doxorubicin und Bleomycin. Ergebnisse bei 21 Patienten.

The effectiveness of combined cytostatic treatment with doxorubicin and bleomycin was analysed in 21 patients with metastasising thyroid carcinoma which had progressed despite both surgical and radiotherapy. Tumour histology (anaplastic carcinoma in 50%), age and general condition of all patients pointed to a poor prognosis. Significant success (full or partial remission) occurred in eight patients. It is possible that these results can be improved if chemotherapy is started earlier and other cytostatic drugs are used in case of failure of treatment.

Enzyme activity in kidney, adrenal and gonadal tissue of rats treated neonatally with androgen or oestrogen.

A single injection of 300 mug oestradiol benzoate (OEB) or 1.25 mg testosterone propionate (TP) on day 1 of life led to significant changes in the activity of enzymes involved in steroid hormone metabolism in kidney, adrenal and gonadal tissues of adult rats. In the kidney, the enzyme activities of male rats reacted to OEB, but not TP, by the development of normal female levels. With one exception the enzyme activities of the kidney of female rats did not respond to either steroid. In the adrenal of both sexes 5alpha-reductase reacted to OEB, but not TP treatment, by a fourfold increase in activity. In the ovary all the enzymes investigated responded both to OEB and TP treatment by a fall in activity; 20alpha-hydroxysteroid dehydrogenase activity fell to undetectable levels. In the testis, OEB and TP treatment led to contrasting effects. With the exception of 5alpha-reductase all the enzymes tested in this organ responded to OEB by a rise in activity. Where TP had any effect, it produced a slight decrease in activity.

The role of the gonads and the hypophysis in the regulation of hydroxysteroid dehydrogenase activities in rat kidney.

With the exception of 3beta-hydroxy-steroid dehydrogenase all the hydroxysteroid dehydrogenases of adult male and female rat kidney show significant sex differences in their activities. Interference with the organisms endocrine balance (gonadectomy on day 25 of life, hypophysectomy on day 50, a combination of both these operations, administration of testosterone or oestradiol) demonstrates that the sexually differentiated enzyme activities may be classified as androgen or oestrogen dependent, the respective sex hormone acting either in an inductive or repressive manner. The criteria for androgen dependency (microsomal 3alpha- and 20beta-, cytoplasmic 17beta- and 20alpha- hydroxysteroid dehydrogenase) are the feminization of the enzyme activity in male animals after castration and the masculinization of the activity in male and female castrates as well as in normal female animals after administration of testosterone. This latter effect on normal females cannot be a testosterone mediated inhibition of ovarian function since ovariectomy has no effect. For 3alpha-, 20alpha-, and 20beta-hydroxysteroid dehydrogenase the effects of hypophysectomy parallel those of gonadectomy. However, after hypophysectomy the activity of 17beta-hydroxysteroid dehydrogenase falls significantly below the gonadectomized level. The androgen effect on 3alpha and 20beta-hydroxysteroid dehydrogenase is independent of the hypophysis, whereas that of 17beta- and 20alpha-hydroxysteroid dehydrogenase is mediated by the hypophysis.