Thyroid storm complicated by bicytopenia and disseminated intravascular coagulation.

PATIENT: Male, 23. FINAL DIAGNOSIS: Thyroid storm. SYMPTOMS: Delirium • diarrhea • fever • hypertension • hyperventilation • tachycardia • weight loss. MEDICATION: -. CLINICAL PROCEDURE: -. SPECIALTY: Endocrinology and Metabolic. OBJECTIVE: Unusual clinical course. BACKGROUND: The clinical presentation of thyroid storm includes fever, tachycardia, hypertension, and neurological abnormalities. It is a serious condition with a high mortality rate. Furthermore, some other complications affect the clinical course of thyroid storm. Although it is reported that prognosis is poor when thyroid storm is complicated by disseminated intravascular coagulation syndrome (DIC) and leukopenia, reports of such cases are rare. CASE REPORT: A 23-year-old man presented with delirium, high pyrexia, diarrhea, and weight loss of 18 kg over 2 months. According to the criteria of Burch and Wartofsky, he was diagnosed with thyroid storm on the basis of his symptom-complex and laboratory data that confirmed the presence of hyperthyroidism. Investigations also found leukopenia, thrombocytopenia, and disseminated intravascular coagulation, all of which are very rare complications of thyroid storm. We successfully treated him with combined therapy including anti-thyroid medication, despite leukopenia. CONCLUSIONS: Early diagnosis and treatment are essential in ensuring a good outcome for patients with this rare combination of medical problems.

Effect of iodine source and dose on growth and iodine content in tissue and plasma thyroid hormones in fattening pigs.

PURPOSE: The aim of the present feeding trial with iodine was to assess pigs' growth performance and carcass characteristics, the iodine accumulation in tissues, and their influences on the thyroid hormones in plasma. METHODS: Eighty pigs (33-115 kg body weight) were allotted to 5 dietary treatments: a control group (150 µg I/kg), two potassium iodide [KI] groups (4,000 and 10,000 µg I/kg), and two potassium iodate [KIO3] groups (4,000 and 10,000 µg I/kg). Iodine concentration was determined in thyroid gland, liver, kidney, muscle, fat, and skin by ICP-MS. Furthermore, thyroxine (T4) and triiodothyronine (T3) in plasma were evaluated. RESULTS: High dietary iodine tended to have a negative effect on younger animals' growth (average daily gain, ADG). However, during the entire growth period, the growth performance and carcass characteristics were not influenced by iodine dosages or sources. Irrespective of iodine source, higher iodine doses of diets affected higher iodine stores in all tested tissues except for abdominal fat. Thus, iodine supplementation with 10,000 µg I/kg feed significantly increased iodine content in thyroid gland (+122%), liver (+260%), kidney (+522%), muscle (+131%), and skin (+321%) compared to the control group. However, there was no significance of thyroid hormones in plasma. CONCLUSIONS: As a result, pork and fat of pigs showed only low iodine accumulation even in the high-iodine groups. Thus, there should be no risk of an iodine excess in human nutrition and animal health, and the EU-upper level for iodine in pig feed can be maintained.

INCAP studies of endemic goiter and its prevention.

The high prevalence of goiter among adults in its member countries of Central America and Panama was observed as soon as INCAP began field studies. This led to systematic studies of goiter in schoolchildren in all of the countries as described, beginning with Guatemala where the rate was 38% nationally. However, efforts to eliminate the consequences of iodine with iodized salt using the water soluble potassium iodate and a process that had proved successful in Switzerland and the United States could not be used with the crude moist salt of the region. INCAP identified potassium iodate that is insoluble in water, and in four schools (two each in El Salvador and Guatemala) proved that the iodine in this compound was as available as that in potassium iodate. It remained evenly distributed in moist salt. When added to salt in Guatemala, goiter rate dropped to 15% in four years and less than 5% in eight years. Compulsory iodation of salt in other developing countries followed with comparable results. This method is now used in worldwide campaigns against iodine deficiency in developing countries.

An unusual cause of neonatal coagulopathy and liver disease.

Congenital thyrotoxicosis is a rare and potentially fatal illness. We report a case in a preterm infant delivered to a mother known to have autoimmune endocrine disease. Diagnosis was difficult because the infant's presenting symptoms and signs closely resembled congenital viral infection with co-existent hepatic dysfunction and coagulopathy. The associated hepatic dysfunction was so severe that liver biopsy was scheduled before the diagnosis emerged. A high degree of clinical suspicion coupled with prenatal identification of pregnancies at risk of complication by congenital thyrotoxicosis is imperative to facilitate prompt diagnosis and treatment.

Comparison of radiohaloanalogues of meta-iodobenzylguanidine (MIBG) for a combined gene- and targeted radiotherapy approach to bladder carcinoma.

Targeted radiotherapy using radiolabelled meta-iodobenzylguanidine (MIBG) is a promising treatment option for bladder cancer, restricting the effects of radiotherapy to malignant cells thereby increasing efficacy and decreasing morbidity of radiotherapy. We investigated the efficacy of a combined gene therapy and targeted radiotherapy approach for bladder cancer using radiolabelled MIBG. The effectiveness of alternative radiohalogens and alternative preparations of radiolabelled MIBG for this therapeutic strategy were compared. Bladder cancer cells, EJ138, were transfected with a gene encoding the noradrenaline transporter (NAT) under the control of a tumour specific telomerase promoter, enabling them to actively take up radiolabelled MIBG. This resulted in tumour-specific cell kill. Uptake and retention of radioactivity in cells transfected with the NAT gene were compared with that obtained in cells transfected with the sodium iodide symporter (NIS) gene. Substantially greater uptake and longer retention of radioactivity in NAT-transfected cells was observed. Carrier-added (c.a.) [131I]MIBG, no-carrier added (n.c.a.) [131I]MIBG, and [211At]-labelled benzylguanidine (i.e. [211At] meta-astatobenzylguanidine (MABG)) were compared with respect to efficiency of induction of cell kill. N.c.a[(131)I]MIBG was more cytotoxic than c.a.[131I]MIBG. However, the alpha-emitter [211At]MABG was, by three orders of magnitude, more effective in causing tumour cell kill than the beta-emitter [131I]MIBG. We conclude that NAT gene transfer combined with the administration of n.c.a.[131I]MIBG or [211At]MABG, is a promising novel treatment approach for bladder cancer therapy.

Quantitative evaluation for blood-retinal barrier breakdown in experimental retinal vein occlusion produced by photodynamic thrombosis using a new photosensitizer.

Purpose. To establish a rat model of retinal vein occlusion (RVO), we applied photodynamic thrombosis using a new photosensitizer. By measuring the breakdown of the blood-retinal barrier (BRB), we evaluated the model quantitatively. We also investigated how hypertension and retinal pigment epithelium (RPE) influence the breakdown of BRB after RVO. Methods. We modified a slit lamp biomicroscope for photodynamic thrombosis. The light source was changed from white light to argon laser, which made it possible to perform fluorescein angiography (FAG) simultaneously during photodynamic thrombosis. We irradiated with a continuous diode laser to occlude three retinal veins in a rat after PAD-S31 injection. The breakdown of BRB was quantitated by measuring extravasated Evans blue dye in albino and pigmented rats. We compared hypertensive rats (SHR) to normotensive rats (WKY) and sodium iodate-treated rats to normal rats. Results. High photosensitivity of PAD-S31 made it possible to occlude any retinal veins within 120 seconds at a low dose of 10 mg/kg without retinal thermal burn at the occlusion site. Simultaneous FAG enabled us to observe the formation of thrombus during diode laser irradiation. Our measured value of intraretinal Evans blue correlated with the range of serous retinal detachment. Both albino and pigmented rats demonstrated stable and constant values of Evans blue. SHR recovered from the breakdown of BRB after venous occlusion more slowly than WKY. Sodium iodate-treated rats had smaller breakdowns of BRB and recovered earlier than normal rats. Conclusions. In this study, we established the stable and constant rat model of RVO efficiently by using a new photosensitizer. Our simultaneous FAG method was considered to have an advantage of several potential clinical applications. Our rat model of RVO allows us to study factors associated with the recovery from damage by RVO.

Preparación preoperatoria abreviada en enfermedad de Basedow Graves / Abreviated presurgical preparation in Basedow Graves disease

Con el propósito de determinar la factibilidad de realizar una preparación preoperatoria abreviada mediante el uso de dexametasona(Dex) e iodato de sodio(IS) en pacientes con EBG, se analizan prospectivamente 11 casos tratados entre febrero de 1985 y abril de 1987. Su hipertiroidismo se determinó por hallazgos clínicos y de laboratorio y se sometieron a tiroidectomía subtotal bilateral, una vez obtenido el eutiroidismo, al 4o día de iniciada la preparación. Durante la intervención se evaluó el comportamiento hemodinámico y las características de la glándula, con el fin de establecer los efectos de agresión anestésico quirúrgica, observándose estabilidad hemodinámica y moderada disminución de la hipervascularización glandular. Mediante microscopia óptica y electrónica de las glándulas extirpadas se evaluaron las alteraciones histológicas producidas por la Dex e IS. No se registró mortalidad y sólo 2 ,pacientes presentaron seroma de herida operatoria

[Surgical treatment of Basedow's disease]. / Die operative behandlung der basedowschen krankehit

Specific surgery of Graves' disease in the patient prepared by prior medication is a low-risk method of treatment. Subtotal thyroidectomy can be regarded as a specific therapeutic procedure which brings about a prompt euthyroid status. Mandatory and circumspect exposure of the recurrent nerves affords greater certainty of avoiding damage to them.

Prevention of endemic goitre with iodized salt.

The paper describes a study, carried out over 16 years, of the use of iodized salt for the control of endemic goitre in a valley of the Himalayan foothills. From 1956, salt was fortified with either potassium iodide or potassium iodate to provide an estimated daily intake of 200 mug per head. There was a progressive and significant decline in goitre prevalence, together with a return of the pattern of iodine metabolism to within normal limits. It is concluded that endemic goitre can be successfully controlled by iodization of domestic salt.