A CASE OF RIEDEL'S THYROIDITIS.

BACKGROUND: Riedel thyroiditis is a rare, chronic inflammatory disease of the thyroid, characterized by a dense fibrosis that replaces normal thyroid parenchyma. In literature descriptions of individual cases of Riedel thyroiditis can be found. CASE REPORT: We present an euthyroid patient with multinodular goiter who was diagnosed with Riedel thyroiditis using pathology. Imaging diagnostic methods (Ultrasonography, X-ray computed tomography, Magnetic resonance imaging, Radionuclide imaging) or various tests of thyroid function cannot confirm the diagnosis of Riedel thyroiditis. CONCLUSION: Only level of IgG4 may be helpful for the diagnosis of Riedel thyroiditis, while pathology is used for its definitive confirmation.

The correlation between endothelin-1 levels and spirometry in dialysis patients compared to healthy subjects.

BACKGROUND AND AIM: Several studies demonstrated a six-fold increase in plasma concentration of endothelin-1 (ET-1) in diaysis patients (hemodialysis and peritoneal dialysis) compared to healthy control subjects. However, the effects of ET-1 on respiratory function in these patients are less known. The aim of this study was to determine the potential differences in spirometric values in relation to ET-1 levels. METHODS: The study included 28 patients (15 male, 13 female, mean age 55.9 +/- 16. 2 years) with end stage renal diseases (ESRD) receiving regular hemodialysis (HD), 23 patients (10 males, 13 females, mean age 55.8 +/- 15.8 years) with ESRD treated with continuous ambulatory peritoneal dialysis (CAPD) without any cardiovascular or respiratory diseases, and 30 healthy volunteers (14 male, 16 female, mean age 51.8 +/- 15.6 years) in control group. In each of the three groups the participants were divided into two additional sub-groups according to the serum levels of ET-1. The spirometry values were recorded before the onset of hemodialysis and prior to emptying the peritoneal cavity in CAPD patients. The results were analyzed using standard statistical methods (Student's t-test). RESULTS: Patients who were treated with HD or CAPD were found to have significant difference in values of most pulmonary function parameters between subjects with ET-1 levels lower than 6.6 pg/ml and subjects with ET-1 levels higher than 6.6 pg/ml. In the control group there was no difference in pulmonary function parameters in correlation with ET-1 levels. ET-1 values in patients of both dialysis groups were significantly higher compared to healthy subjects. CONCLUSIONS: Higher levels of ET-1 in dialysis patients over healthy subjects is associated with lower parameters of lung function tests. A possible pathophysiological mechanism for deterioration of pulmonary function might be explained by progression of inflammation, pulmonary oedema also known as "uraemic lung" or/and the progression of pulmonary hypertension.

[Correlation of ultrasound and radioisotope studies in subacute de Quervain thyroiditis]. / Korelacija ultrazvucnog i radioizotopskih ispitivanja tokom subakutnog de Quervainovog tireoiditisa.

INTRODUCTION: The first report on ultrasonic findings in subacute thyroiditis was published in 1975 (1). More detailed studies combining ultrasonographic and clinical findings are still missing. The present paper compares echostructure of the thyroid gland with the level of hormones--triiodthyronine (T3), thyroxine (T4), thyroidstimulating hormone (TSH) and thyroglobulin (tg) and thyroglobulin autoantibodies (tg-ab). MATERIAL AND METHODS: This study included 30 patients with subacute thyroiditis de Quervain. The diagnosis was based on typical clinical symptoms, ultrasonic findings, metabolic test with J-131 uptake with thyroid scintiscan, level of hormones--T3, T4, TSH then tg and tg-ab and fine-needle aspiration biopsy of thyroid gland. The patients were followed-up for 6 months, i.e. from the onset of the disease until treatment. Every month the following tests were done: ultrasound of the thyroid gland ("real time" ultrasound with a 5 MHz linear transducer), hormones T3, T4, TSH, then tg and tg-at (original radioimunoassay "Vinca" and "Inep" Zemun). RESULTS: During the acute phase of subacute thyroiditis pathological findings were detected by ultrasound in every patient. The gland increased in volume (p 0.05), unclear contours, nonhomogenous echostructure demonstrates in three ways: as hypodense with "pseudocysts", as hypodense, and multiple hypodense area, 6 months later, all patients had normal echostructure of the thyroid gland. In acute phase all patients had low J-131 uptake by the thyroid. Cytological findings of all patients refer to subacute thyroiditis. In the first 6 months the difference between hormone levels and echostructure of the gland is significant (p 0.05). The difference between tg-ab and echostructure of the gland is also significant. Only in the 6th month, there is no difference between these values (p 0.05). In acute phase, after 1 month and 6 months tg levels are not related to echostructure (p 0.05). The difference is significant in the period from the 2th to 6th month. DISCUSSION: Changed ultrasonic findings in subacute thyroiditis have been described in literature. Although sonographic characteristics of the acute phase are well known, reports of long-term ultrasonic findings in subacute thyroiditis are rare (4,5). Ultrasonic findings are not uniform (6,10). They are in correlation with the form and phase of the disease. They may be related to the intensity of inflammation and edema seen in this disorder (11,12). Subacute thyroiditis is followed by hormonal dysbalance, increase of tg level and tg-ab occurrence (3). Recovery is associated with a return to normal functional and ultrasonic characteristics of the thyroid gland (2). By comparing levels of hormones, tg and tg-ab with the ultrasonic findings it can be noted that the thyroid gland has been recovering functionally more than morphologically. Subacute thyroiditis does not cause ultrasonically visible changes in parenchyma of the thyroid gland. CONCLUSION: In serial examinations no correlation was found between sonographic findings and hormone levels (T3, T4, TSH) as in sonographic findings and tg-in acute phase of disease, only in convalescence period. Correlation was found between sonographic findings and tg in acute phase and convalescence period of disease. Ultrasonography provides useful information for follow-up of the course of disease.

Autoantibodies to triiodothyronine and thyroxine in primary hypothyreosis.

The role of autoantibodies to triiodothyronine and thyroxine hormones is still obscure. Our investigation of autoantibodies in primary hypothyreosis gave controversial results. We have investigated 40 patients with primary hypothyreosis caused by chronic atrophic thyroiditis and lymphocytic Hashimoto thyroiditis. We have examined autoantibodies to triiodothyronine (T3) and thyroxine (T4) in patients prior to and during substitution therapy. The control group of 50 subjects with no signs of thyroid gland disease were also examined. Positive antibodies to their own T3 or T4 hormones were not found in this group. Out of 40 patients with primary hypothyreosis, autoantibodies to their own hormones were found in 11 patients (27.5%). At the same time, antibodies to T3 and T4 were found in 3 patients, antibodies to T3 in 7 and antibodies to T4 were found in only 1 patient. In the course of substitution therapy (L-thyroxine) there was an increase in number of patients with antibodies to T4, thus having no statistical significance in comparison with the total number of patients with positive antibodies to T3 and T4.

The frequency of thyrotoxicosis in war time period.

The frequency of thyrotoxicosis in peace and war time periods was compared in the same region with the same population. In one year peace and war time periods 54 and 87 cases of thyrotoxicosis were found, respectively, which indicates the increase for 62%. The results point to the conclusion that psychic trauma increases the number of patients affected by thyrotoxicosis.