[Presence of ophthalmopathy in all cases of Basedow disease?]. / Présence d'une ophtalmopathie dans tous les cas de maladie de Basedow?

In order to evaluate the frequency of ophthalmopathy in Graves' disease, we used a progression criterion, the variation of the eyeball protrusion, in a group of 145 patients initially examined at the time when thyrotoxicosis was diagnosed, before any treatment. By the means of a systematic measure of the protrusion with the Hertel's exophthalmometer at every consultation, we calculated for each patient the variation of protrusion (delta PO) between each annual mean value and the initial value. The mean survey was 6.4 years (range 1-18 years). For the whole group, we observed, after a slight increase (0.3 mm) during the first year, a progressive decrease, which reached about 4 mm at the 12th year and kept an afterwards (p < 0.01 at 3 years; p < 0.001 afterwards). The percentage of cases in which the decrease was significant related to the initial value (> or = 2 mm) rose regularly to reach 100% at the 16th year. These results seem to give evidence of the constant nature of ophthalmopathy at the initial stage of Graves' hyperthyroidism.

[Reliability of needle biopsy of solitary thyroid nodules in view of surgical indications]. / Fiabilité de la cytoponction des nodules thyroïdiens solitaires en vue des indications opératoires.

To evaluate the accuracy of fine-needle biopsy in the management of the solitary thyroid nodules, 320 biopsies without aspiration were performed in 212 patients, iteratively in 91 cases. Among the 212 initial biopsies, 93 smears were found presumably benign (43.9%), 6 malignant (2.8%), 49 benign implying cytologic control (23.1%), 24 suspicious with decision to operate (11.3%), 40 inadequate (18.9%). On 67 surgical indications (malignant or suspicious cytology, or clinical data), 59 operations were performed. The 11 diagnosed cancers (5.2% of the patients; 18.6% of the operations) correspond to six malignant and five suspicious cytologies at the first or second biopsy. On 145 cases without decision to operate, 125 were clinically surveyed, with sometimes another biopsy (mean survey: 27.6 months; range: 6-80 months), and it was never necessary to modify the initial expectancy attitude. Our results, rather similar to those related by most of the previous publications, confirm that the fine-needle biopsy is a reliable and effective means for the etiologic diagnosis of thyroid nodules and the indications for operative intervention. It spares many patients from a useless operation and is worthy to take a leading place in exploring these nodules.

[Late onset hyperandrogenism caused by 3-beta-hydroxysteroid dehydrogenase deficiency]. / Hyperandrogénie par déficit en 3 beta-hydroxystéroïde déshydrogénase à révélation tardive.

OBJECTIVES: Clinical manifestations of hyperandrogenism, including hirsutism and acne with or without dysmenorrhoea are well recognized in late onset hyperandrogenism due to deficiency in 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD), yet the frequency of this deficiency in patients with post-puberty hirsutism is not well established. We therefore evaluated retrospectively this deficiency state in women who consulted our unit for manifestations suggestive of hyperandrogenism from 1990 to 1992. METHODS: We included 32 women with clinical manifestations of hyperandrogenism for whom a partial deficit in 3 beta-HSD could be searched for on the basis of hormone assays. Their mean age was 27.5 years (range 14 to 46) and the clinical manifestation was hirsutism in 21 cases, acne in 13, alopecia in 5 and dysmenorrhoea in 11. Diagnostic tests included adrenal stimulation with 0.25 mg beta 1-24 corticotrophin and immunoradioassay of plasma levels of 17-hydroxypregnenolone (17-OHPreg), 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone (DHA) and cortisol (F). Pang's criteria for the diagnosis of partial deficiency in 3 beta-HSD were retained. We defined deficiency in 3 beta-HSD as certain when the 4 following criteria were present 60 minutes after stimulation: 17-OHPreg > 17.5 ng/ml; DHA > 20 mg/ml; 17-OHPreg/17-OHP > 9; 17-OHPreg/F.10(-3) > 53. Diagnosis was considered probable when only 3 criteria were met and was excluded in all other cases. RESULTS: Positive diagnosis of deficiency in 3 beta-hydroxysteroid dehydrogenase was made in 4 of the 32 patients and probable in 4 others. CONCLUSION: Based on our series of patients, late onset hyperandrogenism due to 3 beta-hydroxysteroid dehydrogenase deficiency would thus appear to be a relative frequent deficiency state. Since therapeutic measures can be taken, this deficiency should be carefully searched for in all young patients presenting with manifestations suggesting hyperandrogenism.

[Improvement of the prognosis of Basedow's disease by using high doses of carbimazole]. / Amélioration du pronostic de la maladie de Basedow par utilisation de fortes doses de carbimazole.

The influence of synthetic antithyroid drug dosage on the course of Graves' disease was evaluated by comparing two groups of matched patients treated with carbimazole. Thirty-seven patients received a rapidly degressive treatment (60 mg/day initially rapidly reduced without replacement thyroid hormone therapy), and 36 patients received a prolonged treatment in high doses (60 mg daily for 6 months with progressive reduction of dosage over 5 months and replacement therapy). There was a highly significant difference in the actuarial curves of patients without relapse during 36 months: 82 per cent in patients with high doses, as against 38 per cent in patients with rapidly degressive treatment (log rank: chi 2 = 7.67, P less than 0.01). The anti-TSH receptor antibody titers decreased more rapidly in patients under prolonged treatment with high doses than in those with the rapidly degressive treatment. It is concluded that carbimazole in high doses is more immunosuppressive than in rapidly degressive doses and that it improves the prognosis of Graves' disease.