Is calculation of the dose in radioiodine therapy of hyperthyroidism worth while?

Objective: The persistent controversy as to the best approach to radioiodine dose selection in the treatment of hyperthyroidism led us to perform a study in order to compare a fixed dose regime comprising doses of 185 370 or 555 MBq based on gland size assessment by palpation only, with a calculated 131I dose based on type of thyroid gland (diffuse, multinodular, solitary adenoma), an accurate thyroid volume measurement, and a 24-hour 131I uptake determination.

Design: Prospective randomized study.

Patients: Two hundred and twenty-one consecutive hyperthyroid patients referred for 131I treatment.

Clinical pharmacokinetics of physostigmine in patients with Alzheimer's disease.

Objective: To study the pharmacokinetic and pharmacodynamic properties of physostigmine in subjects with Alzheimer's disease.

Methods: Plasma physostigmine concentration and butyrylcholinesterase inhibition were measured in blood samples collected during and after a single high-dose (1 to 1.5 mg for 45 to 60 minutes) and a sustained low-dose steady-state intravenous infusion in nine subjects with Alzheimer's disease.

[Pregnancy and the thyroid gland].

A review of pregnancy associated normal physiological changes is thyroid function is given as well as guidelines for treatment of thyroid dysfunction in pregnancy. Maternal, foetal and neonatal thyroid dysfunction can be difficult to diagnose, but the treatment is well established and should be provided by a team involving thyroidologists, obstetricians and paediatricians.

Thyroid cytotoxic antibodies in atrophic and goitrous autoimmune thyroiditis.

It is unknown whether in chronic lymphocytic thyroiditis the goitrous (Hashimoto's thyroiditis) and atrophic forms (primary myxedema) are variants of the same disease or different pathogenic entities. Conventional thyroid-related autoimmune parameters are unable to separate both diseases serologically. It is assumed that cellular and humoral cytotoxic events induce gland atrophy and thus should be detectable more often in non-goitrous than goitrous autoimmune thyroiditis.

Apolipoprotein(a) phenotypes and lipoprotein(a) concentrations in patients with hyperthyroidism.

Lipoprotein(a) [Lp(a)] is a low-density lipoprotein (LDL) particle in which apolipoprotein B-100 (apoB) is attached to a glycoprotein called apolipoprotein(a) [apo(a)]. Apo(a) has several genetically determined phenotypes differing in molecular weight, to which Lp(a) concentrations in plasma are inversely correlated. High plasma levels of Lp(a) are associated with atherosclerotic diseases.

Acute changes in thyroid volume and function following 131I therapy of multinodular goitre.

Objective: Many textbooks claim that radioiodine (131I) treatment should be given with care to a goitre with substernal extension, for fear of acute swelling of the gland and thus respiratory problems. Since 131I is used increasingly in the treatment of non-toxic as well as toxic goitre we have evaluated the acute changes in thyroid volume following 131I therapy.

Design: Evaluation of potential acute changes in thyroid volume and function after 131I treatment in patients with non-toxic goitre treated because of compression symptoms or for cosmetic reasons, as well as in patients with toxic goitre.

Bispecific thyroglobulin and thyroperoxidase autoantibodies in patients with various thyroid and autoimmune diseases.

Recent evidence indicates that thyroid autoimmune disorders are associated with the presence of circulating autoantibodies (aAb) with dual specificity for thyroglobulin (TG) and thyroperoxidase (TPO). The question of whether these aAb, called TGPO aAb, are of clinical relevance compared to TG and TPO aAb remains to be determined. The availability of purified preparations of human TG and TPO allowed the development of a specific and sensitive RIA for TGPO aAb in serum.

High frequency of thyroid dysfunction in patients with vitiligo.

An association between vitiligo and autoimmune thyroid disease has previously been suspected. This study was undertaken to determine the frequency and type of thyroid disease in 35 consecutive patients admitted because of vitiligo compared with a matched control group. One or more signs of thyroid disease was demonstrated in 15 out of 35 patients (43%) with vitiligo, as compared to 7 out of 35 (20%) in the matched control group (p = 0.

Cigarette smoking and the thyroid.

Relevant English language articles published from 1970 through 1993 regarding the possible influence of cigarette smoking on the thyroid were identified through a MEDLINE search and manual searches of identified articles. Thiocyanate in tobacco smoke influences the thyroid by a competitive inhibition of iodine uptake and organification in the gland. Also the stimulation of the sympathetic nervous system by cigarette smoke and benzpyrene, another constituent of tobacco, is thought to influence thyroid gland function.

Long-term follow-up of thyroid scintigraphies after 131I therapy of solitary autonomous thyroid nodules.

The aim of the present study was to assess thyroid scintigraphies after 131I treatment of autonomous thyroid nodules with respect to evolution of the hot nodules as well as the extranodular tissue. A 99mTc pertechnetate scintigraphy was carried out 1-16 years (median 8 years) after 131I treatment of a solitary autonomous nodule in 66 patients remaining euthyroid. At the time of diagnosis, 9 of the patients were euthyroid and 57 were hyperthyroid, of whom 27 received antithyroid drug therapy prior to 131I treatment.

Acute change in parathyroid function in primary hyperparathyroidism following ultrasonically guided ethanol injection into solitary parathyroid adenomas.

Ultrasonically guided percutaneous injection of 96% ethanol into solitary parathyroid tumours in patients with primary hyperparathyroidism may be used as an alternative to surgery in selected patients. Contrary to surgical parathyroidectomy, the acute changes in parathyroid function following ultrasound-guided chemical parathyroidectomy have never been described. Seven consecutive and highly selected patients with primary hyperparathyroidism were treated with ultrasonically guided injection of ethanol (96%) into solitary and biopsy-verified parathyroid tumours.

Rapid brain uptake of manganese(II) across the blood-brain barrier.

54Mn2+ uptake into brain and choroid plexus from the circulation was studied using the in situ rat brain perfusion technique. Initial uptake from blood was linear with time (30 s to 6 min) and extrapolated to zero with an average transfer coefficient of approximately 6 x 10(-5) ml/s/g for brain and approximately 7 x 10(-3) ml/s/g for choroid plexus. Influx from physiologic saline was three- to fourfold more rapid and exceeded that predicted for passive diffusion by more than one order of magnitude.

Observer variation in ultrasound assessment of the thyroid gland.

In order to determine observer variation in the assessment of the thyroid gland by ultrasonography, two specialists (one endocrinologist and one radiologist) independently evaluated 76 thyroid glands, and assessed the sonogram as homogeneous, inhomogeneous, containing a solitary solid lesion or a solitary cyst in each of 152 thyroid lobes. The observed agreement between the two observers ranged from 0.80 to 0.

Ultrasonically guided chemical parathyroidectomy in patients with primary hyperparathyroidism: a follow-up study.

Objective: We evaluated the long-term results in two different groups of patients with primary hyperparathyroidism treated with ultrasonically guided percutaneous ethanol (96%) injection into parathyroid tumours.

Design: A prospective long-term follow-up (more than 6 months). Ethanol (96%) was injected under ultrasonic guidance into biopsy verified solitary parathyroid tumours.

Inadequacy of the WHO classification of the thyroid gland.

In order to evaluate the reproducibility of the WHO classification of goitre, the observer variation was estimated as kappa coefficients. Three observers independently inspected and palpated the thyroid gland of 53 patients twice and assessed the thyroid according to the five grades of the WHO classification. The thyroid volume was also measured by ultrasonography.

Is standard 555 MBq 131I-therapy of hyperthyroidism ablative?

The effect of a standard 555 MBq 131I dose in ablating the thyroid gland was investigated in 116 consecutive hyperthyroid patients. Fifty-one had Graves' disease, 50 a multinodular toxic goitre and 15 had a solitary toxic nodule. 555 MBq 131I was given regardless of size or type of the gland and severity of the disease.

Impaired 1,25-dihydroxyvitamin D production in pregnancy-induced hypertension.

The aim of the study was to evaluate the calcium metabolism in pregnancy-induced hypertension. Fifty-three women with pregnancy-induced hypertension were studied and the control groups comprised 20 women with uncomplicated pregnancies in the third trimester and 51 non-pregnant women, respectively. The mean serum concentrations of 1,25-dihydroxyvitamin D in women with pregnancy-induced hypertension was low (38.

Subtle changes in serum thyrotrophin (TSH) and sex-hormone-binding globulin (SHBG) levels during long-term follow-up after radioactive iodine in multinodular non-toxic goitre.

Objective: We investigated possible changes in the pituitary-thyroid axis after radioactive iodine (RAI) treatment of multinodular non-toxic goitre.

Design: Consecutive patients with multinodular non-toxic goitre, who remained euthyroid after radioactive iodine (RAI) treatment.

Patients: Twenty-three women with multinodular non-toxic goitre were followed after treatment with RAI.