Werner Langsteger

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.

Ossifying fibromyxoid tumor misdiagnosed as follicular neoplasia. A case report.

BACKGROUND Fine needle aspiration of an ossifying fibromyxoid tumor (OFMT) at a prethyroidal location is initially misinterpreted as follicular neoplasia. Though the histopathologic criteria have been analyzed in detail, no experience with the cytologic features of OFMT is reported in the literature. CASE A 50-year-old male presented clinically with a recurrent goiter. Aspiration cytology (Giemsa stained) was characterized by a predominant fine fibrillary, pink matrix and moderate cellularity. The nuclei were eccentrically located, round to oval and slightly plemorphic, with fine chromatin. Focally, mild nuclear crowding and a few rosettelike structures were present. CONCLUSION The cytologic features were consistent with a soft tissue tumor of probably neurogenic origin, like OFMT. Differential diagnosis in this particular location not only included follicular thyroid neoplasms but also neurofibroma, neuroma, chondroma and, less likely, neuroepithelial tumors. However, since some diagnostic criteria of OFMT, like the nodular growth pattern and mature bone, can be found only histologically, the diagnostic value of aspiration cytology seems to be limited.

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.

Intraoperative radiation therapy in advanced thyroid cancer

An intraoperative radiation therapy (IORT)-protocol was designed for poorly differentiated non-anaplastic thyroid carcinoma. Out of 155 cases of differentiated thyroid tumours, 12 showed marked vascular/capsular invasion. Five entered the study (three primarily local invasive tumours, two local recurring). IORT was administered after tumour surgery (4-10 GY) and combined with post-operative percutaneous irradiation. The tumour control rate in the thyroid bed was achieved in all five patients, 1/5 developed mediastinal nodes and 1/5 with primary mediastinal tumour extension showed tumour progression. No specific complications occurred.

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.

Persistence and recurrence of vesicoureteric reflux in children after endoscopic therapy - implications of a risk-adapted follow-up.

Introduction There is no well-defined follow-up scheme available to reliably detect persistent or recurrent vesicoureteric reflux (VUR) after endoscopic therapy (ET), but also to reduce postoperative invasive diagnostics in these children. Our aim was the evaluation of possible predictors of persistence and recurrence of VUR, in order to elaborate and test a risk-adapted follow-up regimen. Material and methods 92 patients (85/92%f, 7/8%m, age 2.99y) underwent direct isotope cystography (DIC) three months after ET. Persistent or recurrent VUR, scarring on dimercaptosuccinic acid (DMSA) scans and further fUTIs after therapy (follow-up 24.6 m) were documented and analysed. Results VUR persistence 3 months after ET was found in 11 (11.9%) patients; recurrent VUR in 4 (4.3%) patients. Scarring on preoperative DMSA and dilating VUR (°III and °IV) were significantly associated with recurrent VUR. If only children with preoperative positive DMSA scan or dilating VUR would have undergone DIC, only 58/92 DICs (64%) would have been necessary. Only 45.5% of otherwise detected VURs would have been identified using this risk-adapted strategy. Conclusions Limiting invasive follow-up diagnostics (VCUG) and, therewith, the radiation burden in a predefined group of patients at risk for persistence or recurrence of VUR is not recommended, due to the significant chance of missing persistent or new onset contralateral VUR. Therefore, we recommend a routine follow-up VCUG after ET. Further prospective scientific efforts to evaluate new, alternative factors influencing persistence and recurrence of VUR, in order to establish an effective follow-up strategy, are warranted.

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].