Otto Eber

The incidence of hyperthyroidism in Austria from 1987 to 1995 before and after an increase in salt iodization in 1990

Abstract. Between 1963 and 1990, Austria had iodized salt prophylaxis of endemic goitre with 10xa0mg KI (7.5xa0mg I) per kg. This was obviously insufficient, as urinary iodine excretion ranged from 42 to 78xa0μg I per g of creatinine and goitre in adults remained in the endemic range of 15%–30%. Therefore salt iodization was doubled in 1990. The aim of this study was to assess the annual incidence of different types of hyperthyroidism (HT) before and after this increase in salt iodization. The incidence of HT was recorded in 14 nuclear medicine centres from 1987 to 1995. In five additional centres data were available from 1992 onwards. Data prior to 1992 were documented retrospectively, while those after 1992 were recorded prospectively. The 14 centres drew patients from an area with a population of approximately 4.23 million while all 19 institutes were estimated to cover an area with a population of 5.4 million (the total population of Austria is 7.86 million). A total of 414232 persons were examined for the first time in the participating centres. HT and the type of HT were defined by clinical examination, serum TSH, thyroid hormone levels in blood, ultrasonography, scintigraphy and serum autoantibody titres. HT was classified into immunogenic HT (Graves’ or Basedow’s disease, GD) and HT with intrinsic thyroid autonomy (uni-, multinodular or disseminated Plummers’ disease, PD). HT was also divided into overt (o) or subclinical (sc) disease. The following data were calculated: annual incidence per 100000 and the relative risk (RR) for HT with 95% confidence intervals (CI). In addition, linear trends were calculated for each type of HT by means of logistic regressions. In the 19 centres a total of 47834 patients with HT were registered from 1987 to 1995. PD accounted for 75% of all cases of HT and GD for 19%, while other types of HT were present in 6%. From 1987 to 1989 (time period T0), the annual incidence of oPD was 30.5 (95% CI 29.6-31.5) per 100000. The RR compared to the baseline period T0 was highest in 1992 (1.37; 1.3-1.45) and decreased to 1.17 (1.1-1.24) in 1995. The annual incidence of scPD in T0 was 27.4 (26.5–28.3) per 100000. The RR was highest in 1991 (1.64; 1.56-1.73) and was 1.60 (1.51–1.69) in 1995. In oPD and scPD a higher RR was observed in persons older than 50 years of age, particularly in men. The incidence of oGD in T0 was 10.4 (9.8–10.9) per 100000; the maximum RR increased to 2.19 (2.01-2.38) in 1993 and decreased to 1.95 (1.78–2.13) in 1995. The incidence of scGD was 1.9 (1.6-2.1) in T0. The maximum RR was observed in 1994 (2.47; 2.04-3.0) and it was still 2.26 (1.85–2.77) in 1995. The increased incidence of oGD and scGD was evenly distributed in all ages and both sexes. The time course of different types of HT following the increase in salt iodization could be divided into two phases: an increase in the incidences of HT with peaks after 1–4 years and a subsequent decrease, the only exception being scGD. The effect was more pronounced in GD than in PD. PD showed an age and gender dependency over time, while GD did not.

Changes in thyroid hormone parameters after acute myocardial infarction

Abnormalities in circulating thyroid hormone levels are very common in systemic nonthyroidal illnesses, such as acute myocardial infarction. In this study, thyroid parameters were determined in a series of 16 consecutive infarction patients treated by thrombolysis. Blood samples were taken before therapy as well as 2, 4, 6, 8, 12 and 72 h following admission. Total and free serum thyroxin and triiodothyronine decreased and reverse T3 increased significantly showing no major variations up to 72 h, whereas thyroid-stimulating hormone values remained almost unchanged during the observation period. Subjects with CK-MB levels of more than 150 ng/ml (n = 10) revealed similar changes in thyroid parameters in comparison to those with lower values (n = 6; NS). Thus, although hormone modifications very often occur following acute infarction, thyroid status may not serve as a marker for the extent of left ventricular dysfunction in the early phase of myocardial infarction.

The impact of geographical, clinical, dietary and radiation-induced features in epidemiology of thyroid cancer

Cancer of the thyroid accounts for less than 1% of all cancers recognised each year, but the incidence is rising. Much of the early work of the epidemiology and aetiology of thyroid cancer was based on the assumption that thyroid cancer can be treated as an entity. The recognition that two distinct types of endocrine cell occur within the thyroid has made it clear that any discussion of the aetiology and epidemiology of thyroid malignancies must take into account the histological classification of these tumours. Moreover, there are difficult problems to be considered when comparing thyroid cancer incidence across tumour registries, because of a lack of standardisation or morbidity data collection, difficulties in histological diagnosis, varying rates of diagnosis of occult papillary carcinoma, and prevalence and techniques of autopsies. So far only a relatively small proportion of thyroid cancer cases can be explained with adequate certainty as regards epidemiology and aetiology. As in cancer in general, the aetiology and epidemiology of thyroid cancer in detail remains unknown in the majority of cases.

THE EFFECT OF D‐ VERSUS L‐ PROPRANOLOL IN THE TREATMENT OF HYPERTHYROIDISM

The purpose of this study is to determine whether there is a difference in treatment of hyperthyroidism using either the D‐ or L‐isomer of propranolol. Two groups of 20 patients with overt hyperthyroidism received either 120 mg L‐or D‐propranolol each for a period of 5 days. In the D‐propranolol administered group there was a significant decrease in TT3 and f T3 plasma levels and in the ratio of TT3 to TT4; however, a significant increase occurred in rT3 values up to day 5. On the other hand, L‐propranolol treatment resulted in a less pronounced decrease in TT4 and TT3 values, while all other thyroid hormone levels remained unchanged as, above all, did the T3/T4 ratio. The well known effect of D,L‐propranolol upon peripheral conversion of T4 to T3 is thus not due to the beta‐blocking action of L‐propranolol but is mainly conditioned by the D‐isomer which has no beta‐blocking action itself.

Misinterpretation of iodine uptake in papillary thyroid carcinoma and primary lung adenocarcinoma

SummaryThis is the first case report of an iodine-storing metastasising carcinoma of extrathyroidal origin and the simultaneous presence of a papillary thyroid carcinoma. In the course of the disease, an increase in pathological iodine uptake was observed after repeated iodine-131 ablation, so that the original tentative diagnosis of a metastasising, differentiated thyroid carcinoma appeared to be confirmed; moreover, the histological work-up of a femur metastasis — without adequate immunohistochemical assessment — was misinterpreted. What is also remarkable about this case report is a pathological iodine-131 uptake both in the extrathyroidal primary tumor and the metastases.

99mTc-DTPA aerosol for same-day post-perfusion ventilation imaging: Results of a multicentre study

A multicentre study was performed in an attempt to evaluate a submicronic technetium-99m diethylene triamine penta-acetic acid aerosol generated by a newly developed delivery system, the aerosol production equipment (APE nebulizer), for same-day post-perfusion ventilation imaging in patients with clinically suspected pulmonary embolism. Quantitative comparison between the DTPA aerosol and krypton gas demonstrated a close correlation with respect to regional pulmonary distribution of activity and peripheral lung penetration (n=14,r=0.94,P<0.001 andr=0.75,P<0.0025, respectively). In 169 consecutive patients, DTPA aerosol images performed immediately following perfusion (inhalation scan I) were compared to those carried out on the next day (inhalation scan 11) with respect to image quality and assessment of perfusion-ventilation matches or mismatches. Agreement between inhalation scans I and II with respect to perfusion defects matched or mismatched to ventilation was found in 166/169 (98%) studies. The image quality of inhalation scan I was equal to that of scan II in 72%; inhalation scan I was superior in 11% of cases, while scan 11 was superior in 17%. This submicronic99mTc-labelled DTPA aerosol is well suited for fast same-day post-perfusion ventilation imaging in patients with clinical suspicion of pulmonary embolism.

Familial dysalbuminaemic hyperthyroxinaemia and inherited partial TBG deficiency: first report

BACKGROUND Abnormalities of the serum thyroid hormone binding proteins are not uncommon but, when properly asessed, they do not present diagnostic difficulties. In contrast, the presence of two inherited defects of thyroid hormone transport, of the type presented in the family described here, may cause a major problem in diagnosis and has not been described previously.

Localization of mediastinal parathyroid adenoma by Tl-201 scintiscan and SPECT

SummaryA 64-year-old female patient was admitted to our department for fatigue, pain in the right upper abdomen, obstipation, and meteorism. The laboratory findings showed total calcium and ionized calcium elevated, phosphate close to lower limit, and parathyroid hormone increased. Tl-201/Tc-99m subtraction scintiscan of the neck and upper mediastinal region did not give any evidence of isolated enhanced uptake suggesting the presence of parathyroid adenoma. After further increases in calcium and parathyroid hormone level Tl-201 whole-body scan and single photon emission computed tomography of the thoracic region were performed. These revealed a circumscribed Tl-201 uptake in the mediastinum immediately cranial ventral to the heart base. The postcontrast transmission computed tomography of this area confirmed the finding of the Tl-201 scintigraphy with a 4×3×2 cm tumor. After sternotomy and surgical removal of the mediastinal parathyroid adenoma (chief cell adenoma), calcium and parathyroid hormone levels returned to normal values.

Epidemiological and Etiological Aspects in Thyroid Carcinoma

Epidemiology of thyroid cancer contains mostly findings and data of frequency and can also help to define the cause and pathogenesis as well as therapy and prevention of thyroid carcinomas. With an incidence of 1–3/100,000 and a frequency of < 1% out of the total rate of malignant tumors in the population, clinically relevant thyroid malignancies are equally rare in almost all countries [9].

Metastasierendes Schilddrüsenkarzinom: Plötzlicher Herztod nach Aclarubicin-Therapie

SummaryWe report on a 62-year-old patient with a metastasising, only poorly differentiated follicular thyroid carcinoma, who was subjected postoperatively to chemotherapy with Aclarubicin. Aclarubicin (Aclaplastin) is a new cytostatic agent, from the group of anthracyclines, with fewer side effects and clearly diminished cardiotoxicity. The patient died suddenly after two treatment cycles with clinical symptoms of cardiac insufficiency; the postmortem examination, however, revealed that two metastases in the myocardium might have been the cause of death; toxic myocardial damage could be excluded histologically. Upon occurrence of cardial symptoms and signs during therapy with cytostatic agents of thyroid carcinoma with Aclarubicin, whose cardiotoxic side effects are known, the possibility of metastatic spread in the myocardium should, nevertheless, also always be considered in the differential diagnosis.