Thyroid sonomorphology, thyroid peroxidase antibodies and thyroid function: new epidemiological data in unselected German employees.

AIM: Employees of Sanofi-Aventis Deutschland GmbH underwent thyroid screening in 2006 to assess new data about the prevalence of irregular sonomorphological pattern, elevated thyroid peroxidase antibodies (TPO AB) and thyroid function in an unselected adult German population. PARTICIPANTS, METHODS: The examination included 700 unselected employees. Blood samples were analyzed for serum TSH and TPO AB, and ultrasound of the thyroid was performed. RESULTS: In 40.7% of the participants (n = 285) an irregular sonomorphological pattern was detected: goiter in 13.7%, nodules in 35.6%, nodular goiter in 8.6% and a hypoechogenic pattern of the thyroid gland in 20.4%. Serum TSH was increased in 3.9% and decreased in 0.6%. Elevated TPO AB values were observed in 13%. Only 1.4% (n = 10) showed elevated TPO AB combined with a TSH increase. Sonomorphological abnormalities were associated with increased TPO AB in 7.1%. Elevated TPO AB was observed significantly more often in combination with sonomorphological pathology (54.9%) than without (45.1%) (p = 0.003). CONCLUSIONS: Sonomorphological disorders are still very common in Germany and our results are comparable with previous screening examinations. Elevated TPO AB correlated significantly with the sonomorphological pattern of nodules and goiter. This may reflect an improved iodine supply or a hypertrophic stage of autoimmune thyroiditis in some cases.

Survey of management of solitary thyroid nodules in Germany.

AIM: To compare the opinions of practitioners in primary care with those of thyroid specialists in Germany on the management of solitary thyroid nodules (Papillon 2005). METHODS: Questionnaires were filled in by 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The test cases and their modifications described a solitary thyroid nodule of 2-3 cm with different levels of thyroid function and a hypoechogenic nodule of 1 cm in diameter. RESULTS: TSH determination and sonography were found to be standard procedures, followed by scintigraphy (selected by 84.7% of practitioners and 95.1% of specialists, p < 0.001) and fine needle aspiration cytology (54.5% of practitioners, 57.4% of specialists). For a hypoechogenic nodule calcitonin determination was advocated by 54.0% of endocrinologists and by 32.2% of nuclear medicine physicians (p < 0.001). A euthyroid solitary thyroid nodule would be treated medically by 77.8% of practitioners and by 85.7% of specialists, the combination of levothyroxine and iodine being clearly preferred (60.9% of practitioners and 67.1% of specialists). For a hyperfunctioning nodule the preference of radioiodine therapy was significantly higher in the specialist group (88.8%) than among the practitioners (52.2%). CONCLUSIONS: The main differences of opinion between practitioners and specialists focused on calcitonin screening and referral to radioiodine therapy.

Management of multinodular goiter in Germany (Papillon 2005): do the approaches of thyroid specialists and primary care practitioners differ?

AIM: Large-scale survey to focus on management of multinodular goiter and to compare the approaches of practitioners in primary care and thyroid specialists in Germany. METHODS: Replies to a questionnaire were received from 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The hypothetical cases and their modifications described multinodular goiters of different sizes with and without toxic nodules. RESULTS: In the workup, TSH determination and thyroid sonography were found to be standard procedures. Scintigraphy was selected by 80.2% of practitioners and 92.9% of specialists (p < 0.001), in preference to fine needle aspiration cytology (17.9% of practitioners and 34.5% of the specialists, p < 0.001). Only 6.1% of practitioners and 24.4% of specialists (p < 0.001) advocated calcitonin screening. Euthyroid multinodular goiter (50-80 ml) was treated medically by 67.1% of practitioners and 65.6% of specialists, the combination of levothyroxine with iodine being clearly preferred (54.5% of practitioners, 52.3% of specialists). For toxic nodular goiter the preference for radioiodine therapy was significantly higher (p < 0.001) among specialists (67.7%) than among practitioners (47.5%). Referral to surgery was recommended for cold nodules with negative cytology by 64.9% of practitioners and 73.5% of specialists (p = 0.004). CONCLUSIONS: Treatment and diagnostic procedures are used to nearly the same extent in primary care and specialist institutions, but the opinions diverge over the issues of calcitonin screening and referral for radioiodine therapy.

Differential response of substance P-containing subtypes of adrenomedullary cells to different stressors.

Adrenal medullary cells produce not only the catecholamines norepinephrine and epinephrine but also a number of peptides; hence, they can be subclassified according to their peptide quality. The present study was an attempt to test whether different stressors address different subclasses of adrenal medullary cells. The adrenal gland of intact male rats was implanted with a dialysis system, and the jugular vein was catheterized. One day after surgery, the adrenal dialysis system was connected to a perfusion pump, and Ringer solution was used for dialysis; dialysate fractions were collected at 15-min intervals, and blood was withdrawn at the end of each fraction period after a 2-h equilibration period. The basal release rates of pituitary PRL and adrenal corticosterone, measured in plasma, and of epinephrine, norepinephrine, and substance P (SP) measured in the adrenal dialysates, were constant during the preshock period. SP concentrations in the blood were below the detection limit of the RIA. Application of mild electric foot shock stress resulted in a marked increase in adrenal catecholamine and SP release. Plasma PRL and corticosterone levels also rose during the time of exposure to foot shock, but plasma SP concentrations remained at undetectable values. In contrast, a metabolic stress i.e. insulin-induced hypoglycemia, did not affect adrenal SP release, although adrenal catecholamine release increased to a larger degree than after foot shock stress. Plasma PRL and corticosterone levels also increased during insulin-induced hypoglycemia. It is concluded that an exogenous stressor (electric foot shock) activates adrenomedullary cells containing catecholamines and SP, whereas these cells are not activated by the stress of insulin-induced hypoglycemia.

Light and electron microscopic studies of diet-induced hepatic changes in mice.

Adult mice were fed a choline-deficient ethionine enriched (CDE) diet for 24, 48 or 72 h. They were then fasted for 24 or 48 h prior to sacrifice. All tissues were studied by light and electron microscopy. Animals fed the CDE diet for 24 h exhibited cells with vacuolated cytoplasm, and the accumulation of lipid in these cells was clearly abnormal. Animals fed the CDE diet for 24 h and subsequently a regular diet for 48 h displayed normal hepatocytes, suggesting that the alterations at 24 h were reversible. Following 48 or 72 h of feeding the CDE diet, abundant lipid-laden cells were observed in the hepatic lobules, and at the electron microscope level these cells were undergoing frank degeneration. Evidence indicated that changes after 48 or 72 h were irreversible.