Hepatic dysfunction in primary hypothyroidism

Twenty-seven patients with primary hypothyroidism were studied to evaluate the relationship between hepatic function and thyroid hormone deficiency in this disorder. In hypothyroidism, hypergammaglobulinemia was found in 71%, elevated glutamic oxaloacetic transaminase (GOT) in 48%, high lactic dehydrogenase (LDH) in 58%, hypercholesteremia in 52% and low elimination rate constant of indocyanin green (KICG) in 44%. In each criterion of liver function, these patients were divided into two groups, normal level and abnormal level group, respectively. T3 and T4 in patients with abnormal levels of GOT, glutamic pyruvic transaminase (GPT), gamma-glutamyl transpeptidase (gamma-GTP), leucine aminopeptidase (LAP), alkaline phosphatase (ALP) and 45 minutes retention rate of bromsulphalein (BSP) were not different from those in the normal level group. However, T3 and T4 in patients with abnormal levels of LDH, cholesterol, cholinesterase (ChE) and KICG were lower than those in the normal level group. The abnormal KICG group had a statistically higher cardio-thoracic ratio (CTR) than the normal group (65.7 +/- 18.8% vs 50.4 +/- 8.3%, p less than 0.05). In patients with pericardial effusion, CTR was 65.9 +/- 14.6%, while that in patients without pericardial effusion was 49.9 +/- 7.5% (p less than 0.05). These abnormalities of liver function were normalized in all cases after hormone replacement therapy. Liver biopsy in three cases disclosed normal liver in two cases and mild infiltration of monocyte into Glisson's capsule in one case.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dopaminergic influence on thyrotropin secretion in primary hypothyroidism.

This study was conducted to assess the influence of dopamine on thyrotropin secretion in patients with primary hypothyroidism before and after optimized L-thyroxin replacement therapy. Thyrotropin responses to dopamine infusion (4 microg/kg/min over 3 hours) and IV metoclopramide (10 mg bolus), a dopamine receptor blocker were studied in 25 consecutive patients with primary hypothyroidism before and after achieving stable euthyroid state and compared with 15 normal age-matched controls. Thyrotropin response to both dopamine infusion (decremental) and IV metoclopramide bolus (incremental) was greater in patients with primary hypothyroidism than that in the control subjects. Thyrotropin response was greater in women than in men. The magnitude of decremental thyrotropin response to dopamine infusion and the incremental response to IV metoclopramide bolus significantly correlated with the basal T3 and T4 levels. Thyrotropin response was blunted to dopamine infusion but not to metoclopramide at follow-up after six-month replacement with L-thyroxin, and both the responses were comparable in women and men in patient group. We conclude that modulation of dopaminergic system by dopamine or by dopamine receptor blocker has a greater influence on thyrotropin secretion in patients with primary hypothyroidism than euthyroid normal subjects.     

Association of primary autoimmune hypothyroidism with Addison's anemia]

Intestinal absorption of vitamin B12 as measured by the Schillin test was studied in 50 patients with primary hypothyroidism of autoimmune origin. The impaired absorption of vitamin B12 was found in 24% of the patients studied, and in 6% a clinically evident form of pernicious anemia was diagnosed. The patients with hypothyroidism and simultaneous defect in absorption of vitamin B12 were characterized by more frequent occurrence of the high titer of antithyroid microsomal antibodies, higher blood serum concentration of TSH and lower blood content of hemoglobin as compared with hypothyroid patients having normal intestinal absorption of vitamin B12.     

A novel Fryns Anophthalmia-plus syndrome associated with primary hypothyroidism

A novel Fryns anophthalmla-plus syndrome associated with primary hypothyroidism: Here, we report a newborn male with anophthalmia-plus syndrome and primary congenital hypothyroidism. To our knowledge this is the first case of 'anophthalmia-plus' syndrome associated with congenital hypothyroidism in the literature up to date.     

Pathophysiological role of thyroid blocking antibody in patients with primary hypothyroidism

The pathophysiological role of thyroid blocking antibody (TBAb) in patients with adult primary hypothyroidism and the mechanism of TBAb action were studied. A sensitive bioassay for TBAb, which inhibits the TSH-induced cAMP accumulation, was established using normal human thyroid cells in culture. Thirty-four patients with primary hypothyroidism consisting of 17 goitrous and 17 non-goitrous patients were examined. Two out of 17 goitrous patients (11.8%) and three out of 17 non-goitrous patients (17.6%) were TBAb positive. There were no significant differences between TBAb positive and negative patients in terms of the severity of hypothyroidism or the titers of MCHA or TGHA. Four out of the five TBAb-positive IgGs had strongly positive thyrotropin binding inhibitor immunoglobulin activities. All five TBAb-positive IgGs inhibited the cAMP increase induced by Graves' IgG, but did not affect the action of either prostaglandin E1 or cholera toxin. However, three TBAb positive IgG also inhibited the cAMP increase induced by forskolin. These findings indicate: 1) TBAb is present in hypothyroid patients with autoimmune thyroiditis and TBAb may play a role in the pathophysiology of these patients. 2) TBAb may inhibit the action of TSH not only at the level of the TSH receptor, but also at a different site from the TSH receptor.     

Birth prevalence of primary congenital hypothyroidism by sex and ethnicity.

Over 5 million infants have been screened for primary congenital hypothyroidism in California since 1980. This large number along with the multi-ethnic nature of California's population allows for a detailed analysis of the effects of ethnic origin, sex, and their interaction on birth prevalence. Sex is the most important factor, with at least a 2:1 (female:male) ratio across all major ethnic groups except blacks. The sex ratio among Hispanics is more striking; female cases outnumber male cases by a ratio of 3:1, and the birth prevalence for Hispanic females is 1 in 1886 births. Previously published rates for Asians and blacks are suspect because of small sample sizes, and Hispanic rates also may be misleading if sex is not taken into account. These factors are important when screening tests, such as the serum T4 test, are used as a statistical prescreening before thyroid stimulation hormone levels can be determined and before the influence of ethnic group and sex can be taken into account, because other factors may prevent high-risk groups (such as Hispanic females) from being declared positive.     

Evaluation of TSH secretion after GnRh in patients with primary hypothyroidism

6 women (mean age 38 years) with high Thyroid Stimulating Hormone (TSH) serum levels because affected from primary hypothyroidism were studied. 6 healthy women (mean age 31 years) represented the control group. All subjects underwent evaluation of serum TSH, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), basally and 20, 30, 60, 120 minutes after administration of Gonadotropin Releasing Hormone (GnRH: 100 meg. IV). Seric FSH and LH show a large increase 30 minutes after GnRH either in healthy or in hypothyroid subjects. TSH is unresponsive to GnRH in normal condition, while shows a clear decrease (-78%) 30 minutes after GnRH in primary hypothyroidism. Rarely the hypothalamic releasing hormones possess an inhibitory effect on anteipophyseal secretions. Previously a GnRH inhibitory effect on prolactin (PRL) release from PRL secreting tumors in rat. The GnRH inhibitory effect on TSH release in pathological conditions such as primary hypothyroidism is difficult to explain: it may be that GnRH acts on Central Nervous System or at pituitary level: in the last case it could bind sites which are not quite different in the different glycoprotein secreting cells.     

Inapparent visual field defects in multiple sclerosis patients

To assess inapparent visual field defects in patients with multiple sclerosis free from optic neuritis. During 5 years period 120 patients with multiple sclerosis were examined at the University Department of Ophthalmology, Zagreb University Hospital Center. They were divided into three groups with 40 patients each: patients with acute unilateral optic neuritis, referred to ophthalmologist and treated with pulsed steroid therapy; patients with subjective feeling of blurred vision, normal visual acuity and no signs of acute optic neuritis; and patients free from subjective signs of visual impairment. Study patients underwent standard ophthalmologic examination and visual field testing in photopia by use of quantitative kinetic Goldmann perimetry. The initial and control examination by visual field testing were performed at least 6 months apart. Study results showed 65% of multiple sclerosis patients to have visual field defects without subjective signs of impaired vision. The most common defects were mild to moderate visual field narrowing with blind spot enlargement and depression from above. The following results were recorded: acute optic neuritis group: normal in 13/40 (32.5%) for the affected eyes and 27/40 (67.5%) for fellow eyes; mild visual field narrowing in 4/40 (10%) for the affected eyes and 10/40 (25%) for fellow eyes; moderate visual field narrowing with blind spot enlargement in 14/40 (35%) for the affected eyes and 1/40 (2.5%) for fellow eyes; and paracentral and arcuate scotomata in 9/40 (22.5%) for the affected eyes and 2/40 (5%) for fellow eyes; subjective symptom group: normal in 8/40 (20%) for the affected eyes and 11/40 (27.5%) for fellow eyes; mild visual field narrowing in 11/40 (27.5%) for the affected eyes and 16/40 (40%) for fellow eyes; moderate visual field narrowing with blind spot enlargement in 18/40 (45%) for the affected eyes and 10/40 (25%); andparacentral and arcuate scotomata in 3/40 (7.5%) for both affected and fellow eyes; and subjective symptom-free group: normal in 24/80 (30%), mild visual field narrowing in 22/80 (27.5%) moderate visual field narrowing with blind spot enlargement in 24/80 (30%); and paracentral and arcuate scotomata in 10/80 (12.5%). The presence of subclinical form of optic nerve involvement could be demonstrated in a very early stage of multiple sclerosis by the introduction of visual field testing in the standard examination protocol.     

Inapparent infection ofDiatraea grandiosella byHeliothis virescens cytoplasmic polyhedrosis virus

The terminal stage of infection with cytoplasmic polyhedrosis viruses (CPVs) is formation of crystal-like inclusion bodies (polyhedra) in host insects. The degree of susceptibility of larvae to CPV, based on light microscopy and presence of polyhedra, varies with the host species.Heliothis virescens (F.) andSpodoptera exigua (Hübner) are highly susceptible to CPV. In CPV treatedDiatraea grandiosella (Dyar), polyhedra were absent in all 400 + insects examined with light and electron microscopy. However,H. virescens larvae became infected when fed haemolymph ofD. grandiosella larvae or pupae (36±10 days post treatment) developed from CPV-treated larvae. No difference in pathology was observed betweenH. virescens larvae infected with CPV polyhedra and haemolymph fromD. grandiosella. This study provides evidence thatD. grandiosella can serve as a symptomless (no occlusion bodies) carrier of a CPV which is fully expressed inH. virescens species. The observation is interesting because it reveals a potentially important aspect of the epizootiology of this insect virus.     

Inapparent twin malignancy in thyroglossal cyst: Case Report

BACKGROUND: Although malignancy has been reported in thyroglossal cysts, synchronous occurrence of two malignancies is extremely rare. CASE REPORT: A case of concurrent papillary and squamous carcinoma arising in the thyroglossal cyst is presented here. CONCLUSIONS: Papillary and squamous carcinoma simultaneously occurring in a thyroglossal cyst is rarely diagnosed prior to surgery and pose a therapeutic dilemma. In view of the extreme rarity of the condition, controversies do exist regarding the optimal strategy to be adopted. The ideal procedure needs to be individually tailored and involve a combination of surgery, radio ablation, thyroid suppression and external radiotherapy.