Computerized axial tomography in the diagnosis and management of thyroid and parathyroid disorders.

Computerized axial tomography (CAT) was used to study 39 patients with known thyroid disease and 14 patients with primary hyperparathyroidism. In all, CAT was performed only when information that was required for diagnosis or therapy was not available from other less expensive techniques. The greatest value was found in the evaluation of cryptic symptoms or structures in the neck after surgery for thyroid cancer, the assessment of the extent of thyroid cancer, the localization of aberrant thyroid tissue, the etiology of unexplained recurrent laryngeal nerve paralysis and the identification and delineation of mediastinal goiter. In six of 14 patients undergoing neck exploration for primary hyperparathyroidism CAT correctly localized the site of the enlarged parathyroid glands including one mediastinal parathyroid adenoma and one patient with two parathyroid adenomas.

Pergolide for the treatment of pituitary tumors secreting prolactin or growth hormone.

We gave pergolide mesylate, a new long-acting ergot derivative with dopaminergic properties, to 47 patients with hypersecretion of prolactin or growth hormone. Single doses produced long-lasting reductions of serum prolactin levels; after 24 hours, the values remained depressed at a mean of 28.8 per cent of the base-line value. Among 41 patients (22 women and 19 men) with hyperprolactinemia who took pergolide for three months or more, prolactin levels fell to normal in 37 and remained slightly elevated in 2. In the two patients in whom the levels fell to only 38 to 52 per cent of base line, treatment was regarded as a failure. The level of growth hormone fell to a mean of 52.8 per cent of base line in patients with acromegaly who were taking 100 micrograms of pergolide per day. Among patients for whom adequate CT scans were available, definite tumor shrinkage occurred in 10 of 13 with macroadenomas and definite or probable shrinkage in 5 of 9 with microadenomas. Menses returned in 76 per cent of treated women and testosterone levels rose in 10 of 14 men. We conclude that pergolide reduces hypersecretion and shrinks most prolactin-secreting macroadenomas. In some patients long-term pergolide therapy may be superior to surgery and x-ray treatment.

Evaluation of euthyroid solitary. Autonomous nodule of the thyroid gland. Importance of scintillation scanning and thyrotropin-releasing hormone testing.

The euthyroid autonomous nodule of the thyroid may escape diagnosis if only the usual criterion of less than 50% suppression of radioactive iodine uptake, (RAIU) after administration of liothyronine sodium is employed. This was the case in four patients who had thyrotoxic response to suppressive therapy, which had been given as a result of the improper conclusion that a nodule was hyperplastic, after the RAIU had fallen. We studied 95 patients with a solitary functioning nodule and found ten euthyroid persons (11 tests) in whom scintiscans showed persistent function in the nodule in spite of suppression of the RAIU by more than 50%. A thyrotropin-releasing hormone test demonstrated lack of thyroid-stimulating hormone responsiveness after administration of liothyronine, proving adequacy of the suppressive dose. Diagnosis of an autonomous nodule should not be excluded unless a scintiscan reveals that its function, in distinction to the rest of the gland, is curtailed by adequate suppression.