The site of leakage of intrafollicular thyroglobulin into the blood stream in simple human goiter.

Serum thyroglobulin is increased in many thyroid diseases, including simple goiter. We followed thyroglobulin levels in 19 patients with diffuse and nodular euthyroid goiters by serial measurements of 80 samples over 2 yr. The large intraindividual variations suggested episodic release of thyroglobulin in this thyroid disease. To test the hypothesis that the phenomenon was due to sporadic release of colloid from diseased follicles, we studied 98 multinodular goiters by conventional histological techniques. Sixty-four surgical samples were auto-radiographed. Focal necrosis of single follicles as well as large necrotic areas, involving multiple follicles together with interstitial stroma, were found in 42% of the goiter specimens. The earliest stage of necrosis was focal death of epithelial cells, often followed by hemorrhages. Through the epithelial gaps, colloid leaked out into the interstitial space. In later stages, granulation tissue containing numerous macrophages invaded damaged follicles. Fibrous scars remained as ultimate witness of repair processes. In one chance observation, acute release of highly labeled thyroglobulin from follicular lumina into the interfollicular interstitium was autoradiographically documented. We conclude that the varying concentrations of thyroglobulin in serum of patients with simple goiter may result from episodic necrosis of follicles, permitting leakage of colloid into the interfollicular space.

Malignant follicles of a differentiated thyroid carcinoma releasing iodinated thyroglobulin into the lymphatic vessels.

Serial sections across a follicular thyroid carcinoma taken from a 71-year-old woman with hyperthyroidism and grossly elevated serum thyroglobulin were examined by PAS staining and autoradiographic techniques. PAS positive material, presumably thyroglobulin, was found in the interstitial network between follicles. Some of this material was autoradiographically positive for 125I within 17 h after tracer application. Direct connections between the lumina of tumour follicles and the lymphatic vessels surrounding them were identified. These channels can explain the release of iodinated thyroglobulin by some differentiated carcinomas.

[Diagnostic significance of blood thyroglobulin determination]. / Die diagnostische Bedeutung der Thyreoglobulinbestimmung im Blut.

Thyroglobulin (Tg) is a protein which is synthesized in the thyroid. In healthy individuals only minute amounts of Tg can be found in the serum. In patients with thyroid disorders serum Tg levels are usually elevated, but the extent of this increase gives no indication of the nature of the underlying disease. Measurement of serum Tg is an established method in screening for thyroid disorders and in follow-up of patients with differentiated carcinomas of the thyroid. It seems likely that serum Tg determinations will also prove useful for other purposes (e.g. as an aid in deciding whether to treat a simple goiter by thyroid hormone administration or surgery).

[Psychogenic water intoxication]. / Psychogene Wasserintoxikation.

Six new cases of psychogenic water intoxication are discussed in the light of 150 observations published in the literature since 1935. 87% of all patients were schizophrenic, and 13% had other psychoses and a variety of functional and organic psychopathies. Psychogenic polydipsia is a prerequisite of psychogenic water intoxication. Water intake either overrides an intact osmoregulation (46% of all cases) or, allied to an inadequate urinary dilutional capacity (54%), leads to a transitory, sometimes repeated, and (in 8% of all cases) lethal water intoxication and hypoosmolality. - The consequence of hypoosmolality is metabolic encephalopathy, with agitation, convulsions and coma as its most common symptoms. Profuse diuresis, enuresis and urinary retention, gastric dilatation, watery vomiting and watery diarrhea are diagnostically helpful symptoms of polydipsia typically denied by the patients. Hypoosmolality/hyponatremia are the hallmarks of water intoxication. However, fewer than 50% of all patients present with the expected maximal urinary dilution. Inadequate ADH activity and increased sensitivity of the renal tubule to antidiuretic hormone are the pathogenetic factors in this inappropriate urinary dilution, while psychosis, psychotropic drugs, diuretics, nicotine and alcohol withdrawal are possible causes and cofactors of polydipsia and inadequate urinary dilution. New aspects of treatment are discussed.

[Unilateral sacroiliitis in multiorgan tuberculosis]. / Unilaterale Sakroiliitis bei tuberkulösem Multiorganbefall.

A tight but painless soft-tissue swelling in the left parasternal region, with chronic cough and lumbo-ischial pain becoming progressively more severe over several months, occurred in a 27-year-old man. The chest X-ray film was normal, radiography of the iliosacral joints revealed right-sided sacroiliitis. In the further course of the illness night sweat, nightly fever up to 38 degrees C and weight loss of 7 kg in two months, as well as severe treatment-resistant earache developed. When hospitalized, another chest X-ray film showed disseminated small nodular foci pointing to tuberculosis. Sputum and irrigation fluid from the right middle-ear contained Mycobacterium tuberculosis. Biopsy material from the parasternal tumour and middle-ear mucosa contained caseous granulomas, confirming the diagnosis of tuberculous sacroiliitis as part of multi-organ tuberculosis. Tuberculostatic treatment--400 mg isoniazid, 600 mg rifampicin, and 1,500 mg pyrazinamide daily (the latter discontinued after 8 weeks)--normalized the appearance in the chest X-ray film. The patient returned to his home in Holland and, four years later, reported that he was free of any symptoms, even during sport activity.

[Acute myocardial infarct following chemotherapy for testicular carcinoma: on the coronary toxicity of cytostatic agents]. / Akuter Myokardinfarkt nach Chemotherapie bei Hodenkarzinom: zur koronaren Toxizität der Zytostatika.

Two young patients who had been treated with cisplatin and bleomycin for testicular cancer developed acute myocardial infarction. 8 additional cases of premature myocardial infarction following chemotherapy for testicular cancer have been reported in the literature. The infarctions occurred several months or years after chemotherapy while most patients were in complete remission and had no significant risk factors for coronary artery disease. However, the pathogenesis of the assumed coronary toxicity associated with antineoplastic agents, usually with cisplatin and bleomycin, is not well understood; lesions of the endothelium with obstructive coronary fibrosis as well as disorders of the clotting system and coronary vasospasm have been considered as possibilities. We conclude that in patients treated for testicular cancer, special attention should be paid to symptoms suggestive of coronary artery disease.