[Evaluation of results of iodine prophylaxis in Czech Republic]. / Hodnocení výsledku jodové profylaxe v ceské republice.

BACKGROUND: Improvement of system of iodine prophylaxis in Czech Republic resulted in compensation of iodine deficiency. Effects of increased iodine intake on the status of thyroid gland (volume, function, autoimmune disorders) should be determined. The aim of the study was to evaluate those effects in an epidemiological survey. METHODS AND RESULTS: A randomly selected sample of adult population (18-65 years old) from 3 regions was investigated using the same methods at the interval of 5 years. A significant increase of ioduria was proved with the marked increase of prevalence of high category (over 300 ug of I per 100 mL of urine). Volume of the thyroid gland decreased significantly in women, not in men. No significant changes of TSH were observed, however FT4 level slightly, but significantly increased. CONCLUSIONS: Repeated epidemiological survey of the randomly selected sample of adult population in 3 regions verified the effectiveness of improved iodine prophylaxis with not unequivocally positive increase of high (supraphysiological) category of ioduria. Decrease of thyroid volume was proved in women only, a tendency of mild (clinically not important) increase of thyroid function was also observed.

[The volumes of the thyroid gland in adults aged 18-65 years in the Czech Republic--determination of the norms]. / Volumy stítné zlázy u dospelé populace ve veku 18-65 let v Ceské republice--stanovení norem.

OBJECTIVE: In the areas with moderate iodine deficit the sonographic examination of thyroid gland is a precious method of precise determination of its volume. The objective of the work was the sonographic examination of males and females aged 18-65 years and to determine the norms of the volumes of thyroid gland. METHODS AND RESULTS: In total, by random sampling, there were sonographically examined 3 416 adults in 11 areas of the Czech Republic; there was chosen a set of 971 females and 681 males whose iodinuria level in first morning urine sample was equal or higher than 100 microg/l. This set was divided according to sex and into the age categories in 5-year interval. The measurement of 3 dimensions of the thyroid gland was determined by Medison-Kretz SA 600 sonographic device with the use of 7.5 MHz linear probe for the depth and width measurement and 3.5 MHz probe was used for the lengths measurement. The volume was determined for each lobe individually using Brunn's formula: V (ml) = 0.479 x length x depth x width. Our results imply the age-related increase of the volume of thyroid gland at both sexes (F-ratio = 1.99, p < 0.0001). At men and women the volume of thyroid gland fluently increases to the 30th year equally, from 30 years to 55 years it increases more rapidly in men while in women there is observed a moderate plateau. Further increase of the volume of thyroid gland is equally fluent from the age of 55 years. CONCLUSION: We managed to determine first own norms of the volumes of thyroid gland for men and women aged 18-65 years in the Czech Republic in five-year age categories. In terms of practical use we recommend 90th percentile as a limit for the evaluation of upper limit of thyroid gland and the 10th percentile for the evaluation of lower limit of the volume of thyroid gland.

[Thyroid, ovarian and adrenal antibodies in female patients with autoimmune thyroiditis]. / Výskyt protilátek proti stítné zláze, ovariím a nadledvine u pacientek s autoimunitní tyroiditidou.

BACKGROUND: In patients with autoimmune thyroiditis confirmed by clinical and laboratory tests frequently complaints associated with ovarian disorders are encountered. In order to verify the polyclonal activation of the autoimmune response of patients with autoimmune thyroid disease the authors investigated the presence of autoantibodies against the thyroid and adrenals. METHODS AND RESULTS: 696 patients were selected (mean age 47.9 years) with autoimmune thyroiditis from a group of 1939 patients examined for the presence of antibodies against thyroid peroxidase (TPO). In these patients also the presence of antibodies against ovaries was assessed (in 183 women, i.e. 26.3%), the adrenals (zona glomerulosa in 136 women, i.e. 19.5%, zona fasciculata in 10 women, i.e. 1.4%, zona reticularis in 114 women, i.e. 16.4%) and the adrenal medulla in 46 women, i.e. 6.6%. The basic group was divided into two sub-groups depending on the presence of ovarian antibodies. In the group of 183 women with positive antibodies against the ovaries and TPO positivity against the zona glomerulosa was found in 93 women, i.e. 50.8%, the zona fasciculata in 7 women, i.e. 3.8%, the zona reticularis in 70 women, i.e. 38.3%, the adrenal medulla in 37% i.e. 20.2%. In the second group of 513 patients with positive TPO and negative antiovarian antibodies against the zona glomerulosa were found in 43 women, i.e. 8.4%, zona fasciculata in 3 women, i.e. 0.6%, zona reticularis in 44 women, i.e. 8.6% and against the adrenal medulla in 9 women, i.e. 1.8%. CONCLUSIONS: These results confirmed that in organ specific autoimmune thyroid disease also other autoantibodies against endocrine organs may be present, i.e. against the ovaries and adrenals. The relative frequency of a common finding of autoantibodies against organs which comprise steroid producing cells can be explained by the fact that for the ovaries and the adrenals a common antigen of steroid producing cells is typical.

[Extra-thyroid autoantibodies in autoimmune thyroiditis]. / Extratyroideální autoprotilátky u autoimunitní tyroiditidy.

Organ specific autoimmune diseases do not occur isolated. In the authors group of 4509 patients with confirmed autoimmune thyroiditis the authors investigated the frequency of extrathyroid organ specific and non-specific autoantibodies. The objective was to draw attention to other autoimmune diseases which may not yet be clinically manifest. The mutual positivity of antibodies against thyroid peroxidase (TPO) and antibodies against the adrenals was: in the zona glomerulosa 21.1%, in the zona fasciculata 3.0%, in the zona reticularis 19.5%, in the adrenal medulla 9.0%. The mutual positivity of antibodies against TPO and ovaries was 28.5%, testes 12.5%, parathyroid 10.2%, islets of Langerhans 8.2%, hair follicles 45.0%, cell nuclei 26.1%, mitochondria 3.1%, smooth muscles 2.4%, striated muscle 0.2%, and gastroparietal cells of the stomach 12.3%. These results draw attention to the importance of polyclonal activation of the autoimmune process in endocrinopathies and the necessity to assess extrathyroid autoantibodies in autoimmune thyroiditis.

[Increased levels of noradrenaline in hypothyroidism and its association with cardiovascular system function]. / Zvýsení hladiny noradrenalinu pri hypotyreóze a jeho souvislosti s cinností kardiovaskulárního systému.

In a group of 10 athyroid subjects treated with thyroxine and triiodothyronine discontinuation of both hormones induced hypothyroidism. During its development on the 7th, 14th, 21st and 28th day systolic time intervals, the heart rate, blood pressure and noradrenaline and adrenaline plasma level were assessed. On the 7th day of hypothyroidism an increased index of the preejection time was recorded, and its value continued to rise throughout the investigation period. A reduction of the index value of the ejection time was also observed on the 7th day and during the subsequent period the value did not change any more. A decline of the heart rate was observed on the 7th day and subsequently the frequency was stable. The index of electromechanical systole was protracted on the 28th day. The systolic blood pressure declined on the 14th day and did not change afterwards. The diastolic pressure rose on the 28th day. The noradrenaline plasma level was elevated from the 21st day of hypothyroidism, the adrenaline level did not change during the decline of thyroid function. The authors discuss the mutual relationship of changes and evaluate the impact of the rise of the noradrenaline level in hypothyroid subjects.

Epidermal growth factor (EGF) in serum of patients with differentiated carcinoma of thyroids.

Serum levels of epidermal growth factor (EGF) were investigated in 31 patients with differentiated carcinoma of thyroid. Patients with carcinoma had significantly decreased basal levels of serum EGF, however this decrease in serum EGF occurred only in the group of patients which had been evaluated at an interval of six weeks after ablation of residues of normal thyroid with radioiodine. In patients that had been treated with radioiodine for cancer this decrease was not observed. The change in serum EGF was not dependent on thyroidal function and did not correlate with the serum thyreoglobulin level. It is presumed that decreased serum EGF is a consequence of functional changes of platelets after whole body irradiation at ablative dose of radioiodine.

[Cardiac function and adrenergic regulation in incipient hypothyroidism]. / Srdecní cinnost a adrenergní regulace u pocínající hypotyreózy.

In patients with thyroid carcinoma who after thyroid elimination took thyroxine and triiodothyronine both hormones were discontinued and after 7 days a complex of peripheral and laboratory parameters was evaluated. Discontinuation of thyroid hormones led to a drop of their serum level and concurrent rise of the TSH level and serum cholesterol. The duration of the pre-ejection period of the systole, the Q-Kd interval and Achilles tendon reflex was protracted. The value of the index of the preejection time increased and that of the index of the expulsion time declined. The heart rate and systolic pressure declined and the body eight increased. Seven-day discontinuation of thyroid hormones did not affect the plasma level of noradrenaline, adrenaline and cyclic adenosine monophosphate. The diastolic pressure and index of electromechanical systole did not change.

[Beta-adrenergic receptors and cAMP production in the lymphocytes of patients with differentiated carcinoma of the thyroid gland during hypothyroidism and euthyroidism]. / Beta adrenergní receptory a produkce cAMP v lymfocytech nemocných s diferencovaným karcinomem stítné zlázy v hypotyreóze a eutyreóze.

Beta-adrenergic receptors and production of cyclic adenosine monophosphate (cAMP) was investigated in peripheral lymphocytes of patients with differentiated thyroid carcinoma in hypothyroidism and euthyroidism, following therapy with 131I and suppression with thyroid hormones. After 131I therapy of patients with differentiated thyroid carcinoma and suppression by means of thyroid hormones, when the patients became euthyroid, the authors found a significantly lower maximal binding capacity Bmax on lymphocytes, as compared with the same patients before radiotherapy when the patients were hypothyroid. The basic cAMP content in patients with euthyroidism was higher, as compared with hypothyroid patients, the difference being at the borderline of significance (p less than 0.06). In vitro stimulation of cAMP formation by lymphocytes using the beta-adrenergic agonist isoprenaline was similar in hypo- and euthyroid patients and did not change in the course of treatment. When expressed in per cent, the stimulation of cAMP formation during euthyroidism was rather lower. Stimulation of cAMP formation by forskoline, an activator of adenylate cyclase was significantly higher in euthyroidism. Simultaneous addition of isoprenaline and forskoline to the incubation medium with lymphocytes produced an additive effect with markedly higher stimulation in euthyroidism. The reduced maximum binding capacity for 3H-dihydroalprenolol (3H-DHA) in euthyroid patients is discussed with regard to the probable influence of the basic disease, participation of radiation and the possible influencing of the immune system on changes in the number and activity of the patients' receptor system.

[Selected anthropometric findings in women with disorders of glucose tolerance with hypertension]. / Vybrané antropometrické nálezy u zen s porusenou glukózovou tolerancí a s hypertenzí.

In a group of 26 women with an impaired glucose tolerance anthropometric measurements of basic somatometric characteristics were made with special attention to the subcutaneous fat distribution and compared the findings with the healthy Czech population. Changes in body build, BMI, subcutaneous body fat distribution were evaluated and the causality of the relationship between blood pressure and gluteofemoral and abdominal obesity was investigated. From the author's observations ensues that in the group of women with impaired glucose tolerance overweight was recorded, as compared with the normal population, disproportions in the circumferences of the trunk and extremities, an excessive percentage of body fat, well developed muscles. In abdominal obesity a significant increase of the blood pressure and BMI was found.

[Cardiac function and adrenergic regulation in incipient hyperthyroidism]. / Srdecní cinnost a adrenergní regulace u pocínající hypertyreózy.

The authors investigated in 14 euthyroid women the action of triiodothyronine administered for 7 days, 100 micrograms per day. It was revealed that after the administration of triiodothyronine the duration of the preejection period of the systole was reduced as well as the index of the preejection period and the index of the electromechanical systole, and the weight declined. At the same time the authors recorded a drop of the plasma noradrenaline and adrenaline level, of the serum cholesterol and thyroxine concentration. The serum triiodothyronine level increased and correlated inversely with the duration of the preejection period. Triiodothyronine administration had no effect on the heart rate, Q-Kd interval, blood pressure and plasma concentration of cyclic adenosine monophosphate. The authors conclude from the findings that in triiodothyronine-induced hyperthyroidism the first cardiac effect of the administered hormone is enhanced contractility of the heart, this change being due to the direct effect of triiodothyronine not mediated by catecholamines.

Prevalence of thyroid diseases in two samples of Czech population. A preliminary study.

Two preliminary pilot studies of prevalence of thyroid disorders in Central Bohemia (with mild endemy before the onset of iodine prophylaxis in 1948) were made: 1. Questionary survey of adult persons in Praha (1559 persons); 2. Clinical and laboratory investigation of 2015 employees of SKODA automobile works in Mladá Boleslav. Prevalence of thyroid disorders in Praha was 11.99%. In randomly selected subjects from Mladá Boleslav (evaluated in two periods after 10 years) the prevalence of clinically manifested thyroid disorders was 0.35% in men and 2.32% in women, respectively, the presence of positive titres of antithyroglobulin antibodies, varied from 2.43-6.11% of high titres and from 2.35 to 17.33% of low titres. However, the prevalence of goiter was markedly higher than expected, since diffuse goitre was found in 8.36% of men and in 11.34% of women. Even more striking was the prevalence of nodular goitre which was 5.59% in men and 22.96% in women thus making the total goitre prevalence of 13.95% in men and 34.30% in women. In addition, an unfavourable increase of prevalence of nodular goitre was found in younger women in comparison with older group. These results, although preliminary, pointed out the necessity of further more extensive and intensive studies of prevalence of thyroid disorders and of methodology of iodine prophylaxis.