Radioiodine treatment of multinodular non-toxic goitre.

OBJECTIVE--To investigate the long term effect of radioactive iodine on thyroid function and size in patients with non-toxic multinodular goitre. DESIGN--Consecutive patients with multinodular non-toxic goitre selected for radioactive iodine treatment and followed for a minimum of 12 months (median 48 months) after an intended dose of 3.7 MBq/g thyroid tissue corrected to a 100% uptake of iodine-131 in 24 hours. PATIENTS--69 patients with a growing multinodular non-toxic goitre causing local compression symptoms or cosmetic inconveniences. The treatment was chosen because of a high operative risk, previous thyroidectomy, or refusal to be operated on. MAIN OUTCOME MEASUREMENTS--Standard thyroid function variables and ultrasonically determined thyroid volume before treatment as well as 1, 2, 3, 6, and 12 months after treatment and then once a year. RESULTS--56 patients were treated with a single dose of 131I, 12 with two doses, and one with four doses. In 45 patients treated with one dose and remaining euthyroid the median thyroid volume was reduced from 73 (interquartile range 50-106) ml to 29 (23-48) ml at 24 months in the 39 patients in whom this was measured during follow up. The median reduction was 40 (22-48) ml (60% reduction, p < 0.0001), half of which occurred within three months. Patients treated with two doses as well as those developing hypothyroidism and hyperthyroidism had a significant reduction in thyroid volume. Eleven patients developed hypothyroidism (cumulative five year risk 22%, 95% confidence interval 4.8% to 38.4%). Side effects were few: three cases of hyperthyroidism and two cases of radiation thyroiditis. Only one patient was dissatisfied with the result; she was referred for operation six months after treatment. CONCLUSIONS--A substantial reduction in thyroid volume accompanied by a low incidence of hypothyroidism and few side effects makes the use of radioactive iodine an attractive alternative to surgery in selected cases of non-toxic multinodular goitre.     

Induction of TSH-receptor antibodies in patients with toxic multinodular goitre by radioiodine treatment.

Previous studies have indicated pre-existing subclinical Graves' disease (GD) in many patients with the scintigraphic diagnosis of disseminated thyroid autonomy (DISA) or toxic multinodular goitre (TMG) type A. After radioiodine (RAI) treatment, an increase or the induction of TSH-receptor antibodies (TRAbs) in patients with GD or TMG has been repeatedly reported.In the present study, we investigated whether RAI could induce TRAbs in patients with TMG in whom pre-existing GD was excluded with highly sensitive TBII and TSAB assays. Therefore, TRAbs, anti-thyroperoxidase antibodies (anti-TPO-Abs) and anti-thyroglobulin antibodies (anti-TG-Abs) were determined in 43 consecutive patients at the nuclear medicine outpatient clinic with the scintigraphic diagnosis of toxic adenoma (TA; n = 20) or TMG type A (n = 11) or type B (n = 12) before and after RAI treatment. After RAI therapy, we detected TRAbs in 36 % (4 of 11) of patients with TMG type A only, whereas TRAbs were not detectable in patients with TMG type B or in patients with TA. Furthermore, 3 of the 4 patients with detectable TRAbs after RAI showed positive anti-TPO-Abs before RAI therapy. These findings provide further evidence for pre-existing GD in patients with TMG type A or DISA as previously suggested. Therefore, patients with TMG type A and high anti-TPO-Abs seem to be at increased risk of developing TRAbs or side-effects such as relapse of hyperthyroidism or thyroid associated ophthalmopathy. These patients therefore require more frequent evaluation after RAI treatment.     

Methyl-bis (beta-chloroethyl)amine in large doses in the treatment of neoplastic diseases

Conscious and unconscious need for continued punishment may complicate the postoperative course of surgical procedures if the patient seeks to satisfy that need by preventing the healing of the operative wound. Recognition of the underlying emotional factors is difficult, and often delay leads to chronic states of invalidism with its attendant social and economic loss.     

The germfree leopard frog (Rana pipiens): preliminary report.

Eggs and sperm were aseptically collected from leopard frogs (Rana pipiens) and passed into sterilized flexible film isolators. Egg fertilization was accomplished, and germfree tadpoles were produced. The germfree tadpoles were active and free-swimming for 3 weeks, but only 6.2% survived to 4 weeks of age. None survived after the 4th week.     

Oxidation products and antioxidant markers in plasma of patients with Graves' disease and toxic multinodular goiter: effect of methimazole treatment

Oxidative stress plays an important role in hyperthyroidism-induced tissue damage, as well as in development of autoimmune disorders. To clarify influence of thyroid metabolic status and autoimmune factors on blood extracellular indices of reactive oxygen species (ROS) generation and free radical scavenging in hyperthyroidism, we studied patients with newly diagnosed and untreated Graves' disease without infiltrative ophthalmopathy (17 female and 8 male, aged 41.8±8.9) and toxic multinodular goiter (15 female and 9 male, aged 48.4±10.1) under the same antithyroid treatment protocol. Initially and after achievement of stable euthyroidism with methimazole, plasma levels of hydrogen peroxide (H₂O₂), lipid hydroperoxides (ROOH) and ceruloplasmin (CP) and serum concentrations of thiobarbituric acid-reacting substances (TBARS) were determined. Similarly, activities of plasma superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and glutathione reductase (GR) were assayed. The results were compared to those of age- and sex-matched controls. Average duration of hyperthyroidism and treatment period were similar in both patients groups. H₂O₂, ROOH and TBARS concentrations were significantly higher in hyperthyroid patients compared to controls. Hyperthyroidism caused an evident increase in SOD and CAT activities and CP level, as well as a decrease in GPx and GR activities. Achievement of euthyroidism resulted in normalization of all analyzed parameters in both hyperthyroid patients groups. These findings suggest that the changes in blood extracellular indices of oxidative stress and free radical scavenging in hyperthyroid patients are influenced by thyroid metabolic status, and are not directly dependent on autoimmune factors present in Graves' disease.     

The mutagenic effect of repeated small radiation doses to mouse spermatogonia: III. Does repeated irradiation reduce translocation yield from a large radiation dose?

Previous results had suggested that daily repeated doses of 10 rad X- or γ-rays to mouse spermatogonia decreased their sensitivity to translocation yield. This was tested by comparing the effects of a dose of 300 rad γ-rays given before, 24 h after, or 8 days after, 30 daily doses of 10 rad γ-rays to male mice. The yield of translocations per cell from those receiving the 300 rad dose 24 h after the repeated ones (7.3%) was significantly lower than that from the other two regimes (9.4 and 9.7% respectively). This was consistent with the explanation that the repeated irradiation had temporarily increased the resistance of the spermatogonial cell population to translocation yield. However, there must remain some doubt about this interpretation since the absolute values of translocations found were too high, and the yield from those which had received the 300-rad dose 24 h after the repeated ones was not significantly below the sum of those from a single dose and from repeated doses given separately.     

The effects of repeated intravenous iohexol administration on renal function in healthy beagles - a preliminary report

ABSTRACT: BACKGROUND: Contrast induced nephrotoxicity (CIN) is a well described syndrome in humans undergoing contrast medium examinations. To date CIN has received minimal attention in the veterinary literature despite increasing use of contrast medium examinations in computed tomographic studies. METHODS: This prospective study evaluated the effect of 1290 mg/kg iohexol given intravenously to 5 normal beagle dogs in a divided dose at an interval of 6--8 weeks. Renal function was evaluated by means of scintigraphically determined glomerular filtration rate (GFR) and a variety of laboratory assays. RESULTS: Only GFR showed a significant decrease (17%) after the second injection but not to a clinically or pathologically significant level. CONCLUSIONS: No clinically significant effect of repeated contrast medium administration was determined in this limited study. However in dogs with reduced renal function the risk of CIN is likely to increase dramatically post contrast administration.