Suppurative thyroiditis caused by Salmonella enteritidis

Bacterial thyroiditis is a rare disease, and one of which the clinical symptoms and signs are frequently misleading. On the other hand, prompt diagnosis is crucial for successful treatment. We report the case of an 82 year-old man with diabetes mellitus type 2 and a history of steroid treatment who presented with severe odynophagia and dysphagia associated with fever, chills, sore throat and right ear pain. Based on the clinical picture, radiological studies, thyroid cytology, blood and thyroid aspirate culture, suppurative thyroiditis caused by Salmonella enteritidis was diagnosed. The patient was successfully treated with antibiotics and surgical drainage.     

Histological, clinical and laboratory findings of acute exacerbation of Hashimoto's thyroiditis--comparison with those of subacute granulomatous thyroiditis

As reported previously, acute exacerbation of Hashimoto's thyroiditis shows quite unique histological findings, namely localized edematous inflammation. Similar histological characteristics and clinical manifestations were observed in 7 of 492 patients with Hashimoto's thyroiditis (A group). Their clinical and laboratory findings were compared with those of 15 cases with subacute granulomatous thyroiditis (S group). Age and sex distribution and goiters in A group were 39 +/- 21 years old (mean +/- s.d.), 7/0 (F/M), and 6/1 (diffuse/nodular), respectively. These were somewhat different from those of S group (45 +/- 9, 12/3, and 3/12, respectively). Thyroid functions in A group showed wide variation: 3 cases were euthyroid, 2 were mildly hypothyroid, and one was mildly thyrotoxic and one borderline thyrotoxic, and all of the S group patients were thyrotoxic. Their thyroid radiopertechnetate uptake, scintigraphy, duration from the onset till the first visit, and ESR and CRP values were also different from those of S group. Clinical courses and outcomes of A group were generally favorable, but one of them finally underwent a total thyroidectomy. Per os and intrathyroidal administrations of steroid were effective, but there was observed a recurrence of symptoms in 3 cases. Finally, all 6 cases were left with diffuse goiters, 4 of them remaining euthyroid, and 2 falling into hypothyroidism. The acute exacerbation of Hashimoto's thyroiditis is a rare complication, which is found to be different from subacute thyroiditis on histological, clinical and laboratory findings and is generally subtle. Steroid medication is considered to be the therapeutic choice but careful observation is necessary to avoid a recurrence.     

A case of acromegaly improved by pituitary apoplexy.

This report deals with a detailed course of one patient with acromegaly who had a pituitary apoplexy. The pituitary apoplexy occurred suddenly 5 days after administration of a oral hypoglycemic agent, buformin, during hospitalization. Immediately after the attack changes of the concentrations of several hormones such as serum growth-hormone, serum thyroid hormone and urinary 17-hydroxycorticosteroids were followed until the development to hypopituitary state. Simultaneously with the decrease of the concentrations of the above-mentioned hormones, a regression of the physical manifestations of acromegaly and a complete amelioration of diabetes mellitus were observed.     

How short-term transdermal treatment of men with 7-oxo-dehydroepiandrosterone influence thyroid function

Dehydroepiandrosterone may influence thyroid function. Its metabolite, 7-oxo-dehydroepiandrosterone, a precursor of immunomodulatory 7-hydroxylated metabolites and thermogenic agent, belongs to candidates of steroid replacement therapy. The question was addressed whether its application does influence laboratory parameters of thyroid function. 7-Oxo-dehydroepiandrosterone in the form of emulgel, 25 mg/day, was applied transdermally to 21 healthy men for 8 consecutive days. Morning blood was collected before the treatment (Day 0, Stage 1), during treatment (Day 5, Stage 2), on the first day after the last administration (Day 9, Stage 3), one week (Day 16, Stage 4), and 9 weeks (Day 72, Stage 5) after treatment termination. The levels of thyrotropin, free thyroxine and triiodothyronine, dehydroepiandrosterone, its sulfate and its 7-hydroxyepimers were measured. The changes were evaluated by analysis of variance and correlation analysis. During treatment a significant rise of 7beta-hydroxy-dehydroepiandrosterone was observed, which persisted 1 week after treatment termination. No changes were observed in dehydroepiandrosterone and its sulfate. Though a slight but significant rise of TSH and of both thyroid hormones occurred during treatment, its levels soon returned to the basal values. It was concluded that treatment of 7-oxo-dehydroepiandrosterone affects the thyroid parameters only temporarily and that it provides a considerable persistent amount of 7beta-hydroxy-dehydroepiandrosterone.     

Strongyloidiasis in a Diabetic Patient Accompanied by Gastrointestinal Stromal Tumor: Cause of Eosinophilia Unresponsive to Steroid Therapy

We report here a case of strongyloidiasis in a 72-year-old diabetic patient (woman) accompanied by gastrointestinal stromal tumor receiving imatinib therapy, first diagnosed as hypereosinophilic syndrome and treated with steroids for uncontrolled eosinophilia. She suffered from lower back pain and intermittent abdominal discomfort with nausea and diagnosed with gastrointestinal stromal tumor. After post-operative imatinib treatment eosinophilia persisted, so that steroid therapy was started under an impression of hypereosinophilic syndrome. In spite of 6 months steroid therapy, eosinophilia persisted. Stool examination was performed to rule out intestinal helminth infections. Rhabditoid larvae of Strongyloides stercoralis were detected and the patient was diagnosed as strongyloidiasis. This diagnosis was confirmed again by PCR. The patient was treated with albendazole for 14 days and her abdominal pain and diarrhea improved. This case highlights the need for thorough investigation, including molecular approaches, to test for strongyloidiasis before and during steroid therapies.     

Foreign-body granuloma following bilateral facial reconstruction with an omental flap

Bilateral facial reconstruction using an omental free-flap transfer for soft-tissue augmentation was performed on a 23-year-old man who had undergone previous surgical resection of an embryonal-cell rhabdomyosarcoma followed by radiation and chemotherapy. Eight weeks following surgery, the patient presented with pain and edema from a foreign-body reaction documented by electron microscopy. This was successfully managed with a course of steroid administration. The patient has remained symptom-free for 5 years.     

Correlation between thyroid peroxidase activity and histopathological and ultrastructural changes in various thyroid diseases

A morphological and biochemical study was performed on thyroid tissue with various thyroid diseases. The thyroid peroxidase (TPO) activity of normal thyroid tissues ranged from 2.6 to 7.0 mGU/mg DNA. The activity was low in adenomas and extremely low in carcinomas, and there was no significant relationship between the histological subclassification of follicular adenomas (simple, colloid, oxyphil) and TPO activity. The activity was various in the cases of chronic thyroiditis, ranging from non-detectable to 9.8 mGU/mg DNA, and the TPO activity showed a close correlation with the degree of lymphoid cell infiltration of the diseases. In the seven cases of Graves' disease, the values were high, though the elevation was not so remarkable in three cases which had already been euthyroid or slightly hypothyroid after long-term treatment. By means of subcellular fractionation, more than 50% of peroxidase activity was shown to be localized in the microsomal pellets, and this result well coincided with the electron microscopic findings of prominent development of rER.     

The impact of long-term exposure to space environment on adult mammalian organisms: a study on mouse thyroid and testis

Hormonal changes in humans during spaceflight have been demonstrated but the underlying mechanisms are still unknown. To clarify this point thyroid and testis/epididymis, both regulated by anterior pituitary gland, have been analyzed on long-term space-exposed male C57BL/10 mice, either wild type or pleiotrophin transgenic, overexpressing osteoblast stimulating factor-1. Glands were submitted to morphological and functional analysis.In thyroids, volumetric ratios between thyrocytes and colloid were measured. cAMP production in 10(-7)M and 10(-8)M thyrotropin-treated samples was studied. Thyrotropin receptor and caveolin-1 were quantitized by immunoblotting and localized by immunofluorescence. In space-exposed animals, both basal and thyrotropin-stimulated cAMP production were always higher. Also, the structure of thyroid follicles appeared more organized, while thyrotropin receptor and caveolin-1 were overexpressed. Unlike the control samples, in the space samples thyrotropin receptor and caveolin-1 were both observed at the intracellular junctions, suggesting their interaction in specific cell membrane microdomains.In testes, immunofluorescent reaction for 3β- steroid dehydrogenase was performed and the relative expressions of hormone receptors and interleukin-1β were quantified by RT-PCR. Epididymal sperm number was counted. In space-exposed animals, the presence of 3β and 17β steroid dehydrogenase was reduced. Also, the expression of androgen and follicle stimulating hormone receptors increased while lutenizing hormone receptor levels were not affected. The interleukin 1 β expression was upregulated. The tubular architecture was altered and the sperm cell number was significantly reduced in spaceflight mouse epididymis (approx. -90% vs. laboratory and ground controls), indicating that the space environment may lead to degenerative changes in seminiferous tubules.Space-induced changes of structure and function of thyroid and testis/epididymis could be responsible for variations of hormone levels in human during space missions. More research, hopefully a reflight of MDS, would be needed to establish whether the space environment acts directly on the peripheral glands or induces changes in the hypotalamus-pituitary-glandular axis.     

Histological Changes in the Pituitary, Thyroid Gland and Gonads of the Fourspine Sculpin (Cottus kazika) during Downstream Migration

The Fourspine sculpin (Cottus kazika) is a catadromous fish which is widely distributed in the rivers of Japan. The fish was used to examine the relationship between the migration behavior and hormonal control by studying the histological changes in the pituitary gland, thyroid gland and gonads during its downstream migration. By use of the immonocytochemical and histochemical techniques, 7 types of cells were identified in the pituitary gland namely; immunoreactive (ir)-PRL, GH, TSH, GTH, ACTH, MSH and SL cells. From among the first 4 types of the aforementioned cells, remarkable histological changes were observed in cells containing ir-GTH during the downstream migration. At this time also, the gonads were obsereved to be well developed, while the thyroid glands did not show clear changes morphologically. These results suggest that the gonadotropin regulates gonadal development in the Fourspine sculpin during downstream migration and possibly sex hormones synthesized by the gonads cause the downstream migration of this catadromous fish.     

Response of thyroid hormones in peripheral and thyroid venous blood to TRH administration in man

Thyroid vein and cubital vein samples were collected simultaneously in 6 moderately hypercalcemic patients and 1 eucalcemic hypothyroid patient, and thyroid hormones were measured in the serum in the basal state, as well as 30 and 60 min after intravenous administration of TRH. No gradient was detectable between peripheral and thyroid blood in the case of T4, and no significant changes were observed following TRH. The levels of T3 were higher in the thyroid venous effluent than in the periphery and a marked increase occurred following TRH. Serum thyroglobulin also increased following TRH, but there was no peripheral vs. thyroid gradient. Calcitonin demonstrated a marked positive gradient in the thyroid vein compared to the periphery, but no change was observed following TRH. It is concluded that the patterns of response of individual thyroid hormones reflect differences in their secretion and, specifically, that intrathyroid conversion of T4 to T3 occurs during the thyroid hormone secretion.     

Fungal Thyroiditis: An Overview

The authors review the epidemiology, clinical manifestations, diagnosis, and treatment of fungal thyroiditis cases previously reported in the medical literature. Aspergillus was by far the most common cause of fungal thyroiditis. Immunocompromised patients, such as those with leukemia, lymphoma, autoimmune diseases, and organ-transplant patients on pharmacological immunosuppression were particularly at risk. Fungal thyroiditis was diagnosed at autopsy as part of disseminated infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of infection were indistinguishable from other infectious thyroiditis and included fever, anterior cervical pain, thyroid enlargement sometimes associated with dysphagia and dysphonia, and clinical and laboratory features of transient hyperthyroidism due to the release of thyroid hormone from follicular cell damage, followed by residual hypothyroidism. Antemortem diagnosis of fungal thyroiditis was made by direct microscopy and culture of a fine-needle aspirate, or/and biopsy in most cases. Since most patients with fungal thyroiditis had disseminated fungal infection with delay in diagnosis and treatment, the overall mortality was high.     

Morphological and enzymological changes of small intestine of adult female rats and youngs born from madiol-treated pregnant rats

Some histological and histoenzymological changes of the small intestine of adult female Wistar rats treated with Madiol were studied. The steroid did not influence the tissular aspect, but obviously stimulatory effects on protein and enzyme reactions were induced. Similar Madiol-action on the small intestine of 21-day-old young rats was observed when the steroid was administered during pregnancy to their mothers, suggesting influences on the embryonic development.     

Recurrent Acute Suppurative Thyroiditis Attributable to a Piriform Sinus Fistula in an Adult

ObjectiveTo report a case of recurrent acute suppurative thyroiditis (AST) caused by a piriform sinus fistula (PSF).MethodsWe review the related literature and describe the clinical presentation, diagnostic evaluation, and management of a patient with recurrent AST due to PSF.ResultsA 50-year-old woman presented with recurrent episodes of pain and swelling in the left anterior neck area and odynophagia. The initial episode, 1 year previously, lasted for 1 month, and her condition improved with a short course of prednisone. Subsequently, the neck pain recurred and extended upward to both sides of the neck. She was suspected of having thyroiditis and was treated with prednisone for 6 weeks, but the symptoms persisted. Physical examination showed tenderness and induration of the skin over the left lobe of the thyroid. Ultrasonography disclosed an ill-defined solid-cystic area in the left thyroid lobe. Fine-needle aspiration cytology revealed acute inflammation, consistent with an infected cyst. A computed tomographic scan of the neck showed obscuration of the fat planes involving the left strap musculature and evidence suggestive of microabscesses. Prolonged intravenous antibiotic treatment ultimately alleviated the symptoms. Direct laryngoscopy revealed a fistula extending anteriorly from the apex of the piriform sinus. The patient underwent complete fistulectomy and left thyroid lobectomy and was asymptomatic on followup.ConclusionPSF should be suspected as a cause of recurrent AST. Absence of fever, toxemia, and local erythema does not rule out the condition. Unresponsiveness to corticosteroid therapy in thyroiditis should suggest the diagnosis. Complete fistulectomy and resection of the involved thyroid lobe result in permanent cure. (Endocr Pract. 2007;13:662-666)     

Relationship of ovarian and thyroid function

In an investigation of relationships between ovarian function and thyroid function, three groups of ten women each were studied by means of radioactive iodine uptake. In the first group no significant changes were noted during normal menstrual cycles. The second group, women who had dysfunctional uterine bleeding and were under treatment with diethylstilbestrol, most of the patients had no significant change in the uptake of radioactive iodine. Three patients did show a small increase in the uptake. (A fourth patient had a very bizarre result with a very great increase in the uptake, but it is felt that some undetected error was involved.)The third group was made up of women without evident ovarian function. Under treatment with diethylstilbestrol one patient showed a small increase in iodine uptake. The other nine had no significant change. No convincing evidence was found of any change in thyroid function as measured by the uptake of radioactive iodine-either during normal menstrual cycles or following the administration of diethylstilbestrol in dosages of 3 mg. daily for two to three weeks.     

NEWS AND NOTES

In an investigation of relationships between ovarian function and thyroid function, three groups of ten women each were studied by means of radioactive iodine uptake. In the first group no significant changes were noted during normal menstrual cycles.The second group, women who had dysfunctional uterine bleeding and were under treatment with diethylstilbestrol, most of the patients had no significant change in the uptake of radioactive iodine. Three patients did show a small increase in the uptake. (A fourth patient had a very bizarre result with a very great increase in the uptake, but it is felt that some undetected error was involved.)The third group was made up of women without evident ovarian function. Under treatment with diethylstilbestrol one patient showed a small increase in iodine uptake. The other nine had no significant change.No convincing evidence was found of any change in thyroid function as measured by the uptake of radioactive iodine—either during normal menstrual cycles or following the administration of diethylstilbestrol in dosages of 3 mg. daily for two to three weeks.     

Spontaneous serial fractures of metatarsal bones in female patient with rheumatoid arthritis on long-term steroid therapy

Low-dose oral steroid therapies are very effective in active rheumatoid arthritis (RA), reducing disease activity in acute crisis either while waiting for disease-modifying antirheumatic drugs (DMARDs) to take effect or if it was slow in response to DMARDs. However, long-term steroid therapies are associated with serious side effects, such as osteoporotic reduction of bone mass and frequent fractures. This paper reports a female patient who has suffered RA treated with low-dose oral steroid therapy in a long-term period. Suddenly, she developed severe pain and oedema of forefeet during home distance level walking, with no history of trauma. The diagnosis of spontaneous serial fractures of the 2nd to 4th metatarsal (MT) bone bilaterally was performed by feet radiography. Furthermore, in widening the diagnostic approaches the authors had performed diagnostic musculoskeletal ultrasound to exclude metatarsophalangeal joint effusion and exacerbation of RA. They also made a static analysis of feet on the electronic baropodometer system in order to register biomechanical changes in bipedal standing. One year after, the same diagnostic procedures were done, on which occasion the healing of fractures were verified, with better results in biomechanical static analysis of the feet but without complete regression of static disbalance. This could lead to further disturbances during level walking and daily activities. This paper reports a unique case of the RA patient on long-term low-dose steroid therapy with previously unreported sites of spontaneous metatarsal fractures of feet which causes further static disbalance; consequently the patient might experience problems in every-day life activities.     

Genetic Models in Applied Physiology. Differential role of nitric oxide synthase isoforms in fever of different etiologies: studies using Nos gene-deficient mice.

Male C57BL/6J mice deficient in nitric oxide synthase (NOS) genes (knockout) and control (wild-type) mice were implanted intra-abdominally with battery-operated miniature biotelemeters (model VMFH MiniMitter, Sunriver, OR) to monitor changes in body temperature. Intravenous injection of lipopolysaccharide (LPS; 50 microg/kg) was used to trigger fever in response to systemic inflammation in mice. To induce a febrile response to localized inflammation, the mice were injected subcutaneously with pure turpentine oil (30 microl/animal) into the left hindlimb. Oral administration (gavage) of N(G)-monomethyl-l-arginine (l-NMMA) for 3 days (80 mg. kg(-1). day(-1) in corn oil) before injection of pyrogens was used to inhibit all three NOSs (N(G)-monomethyl-d-arginine acetate salt and corn oil were used as control). In normal male C57BL/6J mice, l-NMMA inhibited the LPS-induced fever by approximately 60%, whereas it augmented fever by approximately 65% in mice injected with turpentine. Challenging the respective NOS knockout mice with LPS and with l-NMMA revealed that inducible NOS and neuronal NOS isoforms are responsible for the induction of fever to LPS, whereas endothelial NOS (eNOS) is not involved. In contrast, none of the NOS isoforms appeared to trigger fever to turpentine. Inhibition of eNOS, however, exacerbates fever in mice treated with l-NMMA and turpentine, indicating that eNOS participates in the antipyretic mechanism. These data support the hypothesis that nitric oxide is a regulator of fever. Its action differs, however, depending on the pyrogen used and the NOS isoform.     

PAGET'S DISEASE—Changes Occurring Following Treatment with Newer Hormonal Agents

From experience in six cases the anabolic steroid hormones, especially long-acting testosterone and estrogen preparations, are the treatment of choice in Paget''s disease, as in postmenopausal osteoporosis. Details of the management of three patients over a period of four years are presented.Roughly 4 per cent of the population, mostly persons over 40, show some evidence of Paget''s disease. Only a small number of them, however, have severe manifestations requiring treatment, such as pain, howing or fracture of the bones, pressure on nerves or heart failure. In rare cases malignant changes occur in the involved bone.Since the cause of Paget''s disease is not known, treatment in the past has been largely empirical. Reifenstein and Albright had advocated the therapeutic use of calcium, vitamin D and ascorbic acid, and, in postmenopausal women, administration of estrogens; but with fractures or immobilization, intake of calcium-containing foods, such as milk, must be restricted to avoid dangerous piling up of calcium and kidney stones, and fluids must be forced. In recent years anabolic steroid hormones, principally oral androgens and estrogens, have been employed by Gordan and others to promote bone repair, lessen bone pain and decrease urinary excretion of calcium. While these hormones probably do not arrest the disease, they seem to stabilize it and bring relief of symptoms.More recently, Albright and Henneman demonstrated that very large doses of corticotropin (ACTH) or cortisone resulted in immediate cessation of bone pain, decrease in urinary excretion of calcium and histologic evidence of regression of the disease process. The large doses required, however, also produce dangerous side effects, such as psychosis and osteoporosis, indicating that such treatment probably should not be continued over long periods.     

Changes in the thyrocytes to the administration of intermedin under conditions of the aminazine-altered functional state of the nervous system]

Histological and electron microscopial investigations of the thyroid gland were performed in white mice after exogeneous administration of intermedin (MSH) and intermedin against the background of aminasin. It may be concluded that while a prolonged injection of MSH results in the stimulation of the thyroid gland, the administration of the hormone in question against the background of aminasin results in the same ultramorphological structural changes of the gland which are observed after injection of aminasin alone, causing a decreased functional activity of the thyroid gland. The effect of intermedin upon the thyroid is supposed to be realized through those hypothalamus structures which are responsible for the regulation of the thyrotropic function of the hypophysis.     

Increased number of beta-adrenergic receptors on cells of the rat adenohypophysis after thyroid hormone administration

The authors studied the effect of administration of thyroid hormones on the beta-adrenergic receptors of rat adenohypophyseal cells. The administration of triiodothyronine and thyroxine was followed by an increase in specific binding for 3H-dihydroalprenolol. No significant differences were found in cyclic adenosine monophosphate levels before and after isoprenaline stimulation. The significance of changes in these receptors for the hyperplastic reaction after oestrogens is discussed with reference to the inhibitory effect of the thyroid hormones on hyperplasia of the adenohypophyseal cells after the administration of oestradiol.