Iodized oil as a complement to iodized salt in schoolchildren in endemic goiter in Romania.

OBJECTIVE: To evaluate the long-term efficacy and possible side effects of low doses of iodized oil on iodine nutrition and thyroid function in endemic goiter in Romania. METHODS: Random selection of 214 schoolchildren aged 6-14 years. Serial measurements of urinary iodine, thyroid volume with ultrasound, serum concentrations of thyrotropin, free thyroxine, thyroglobulin and thyroid autoantibodies before and up to 2 years after the oral administration of 200 mg iodine in iodized oil. RESULTS: Urinary iodine concentrations indicated a moderate iodine deficiency before therapy, sharply increased soon after therapy and slowly decreased thereafter but remained within the normal range up to more than 1 year after therapy. The prevalence of goiter was 29% before the administration of iodized oil and 9% 1 year later. Thyroid function tests and autoantibodies were normal before and up to 2 years after therapy. CONCLUSION: A single dose of 200 mg iodine from oral Lipiodol appears adequate and safe for correcting moderate iodine deficiency in children.

Thyroid volume and urinary iodine in European schoolchildren: standardization of values for assessment of iodine deficiency.

Up to 1992, most European countries used to be moderately to severely iodine deficient. The present study aimed at evaluating possible changes in the status of iodine nutrition in 12 European countries during the past few years. Thyroid volume was measured by ultrasonography in 7599 schoolchildren aged 7-15 years in one to fifteen sites in The Netherlands. Belgium, Luxemburg, France, Germany, Austria, Italy, Poland, the Czech and Slovak Republics, Hungary and Romania. The concentrations of urinary iodine were measured in 5709 of them. A mobile unit (ThyroMobil van) equipped with a sonographic device and facilities for the collection of urine samples visited all sites in the 12 countries. All ultrasounds and all urinary iodine assays were performed by the same investigators. The status of iodine nutrition in schoolchildren has markedly improved in many European countries and is presently normal in The Netherlands, France and Slovakia. It remains unchanged in other countries such as Belgium. There is an inverse relationship between urinary iodine and thyroid volume in schoolchildren in Europe. Goiter occurs as soon as the urinary iodine is below a critical threshold of 10 micrograms/dl. Its prevalence is up to 10 to 40% in some remote European areas. This work produced updated recommendations for the normal volume of the thyroid measured by ultrasonography as a function of age, sex and body surface area in iodine-replete schoolchildren in Europe. This study proposes a method for a standardized evaluation of iodine nutrition on a continental basis, which could be used in other continents.

Effects of radioiodine therapy in hyperthyroidism (thyroid function, thyroid volume, Graves' ophtalmopathy, thyrotoxic heart disease).

The study group consisted of 135 hyperthyroid patients--128 with Graves' disease and 7 with toxic multinodular goiter. A single dose of radioiodine was given in 110 cases (81.48%), two doses in 22 patients (16.3%) and three doses in 3 patients (2.22%); mean total dose was 6.8 mCi (range = 3-24 mCi). The main goal of radio iodine therapy is to achieve euthyroidism; after radioiodine treatment, 61 patients (45.2%) were euthyroid, 60 patients (44.4%) with permanent hypothyroidism and 14 (10.36%) with PERSISTING HYPERTHYROIDISM--the mean duration of follow-up being 4.2 years. After radioiodine therapy, goiter became absent in 30 patients (28%); in those patients, goiter was moderately enlarged or large before therapy. Around 63% (12 cases) of the patients with thyrotoxic atrial fibrillation reverted to sinus rhythm. During the last four years (1990-1994) the patients with Graves' ophthalmopathy from the study group were treated with Prednisone after radioiodine therapy; this corticotherapy contributes to the lower percentage (1.5%) of worsening Graves' ophthalmopathy after radioiodine therapy.

Management of hyperthyroidism due to Graves' disease: a retrospective analysis of 1,000 inpatient cards.

There are three different modalities to treat hyperthyroidism due to Grave's disease: anti-thyroid drugs (ATD), radioiodine and surgery, each of them having its own advantages and disadvantages. The option for one of the three therapeutical approaches has both subjective and objective components. In Europe, a screening on the therapeutical options in Graves' disease was performed at the European Thyroid Association (ETA) initiative, being based on a questionnaire. In the Thyroid Department of the Endocrinology Institute in Bucharest, w analysed the managements of hyperthyroidism due to Graves' disease on 1,000 cards of hyperthyroid patients admitted there during the last five years. In order to diagnose Graves' disease, in vivo tests radioiodine uptake (RIU) at 2 and 24 hrs, 93.39% scintigram (92.93%), thyroid ultrasonography (15%) and reflexogram (98.06%), were carried out. Out of the in vitro tests, PBI (protein bound iodine) was performed prioritarily, while T4, T3 (variable), TSH (13.91%) were performed according to the economic factors. For the patient with moderate hyperthyroidism, antithyroid therapy was alternative with the radioiodine one (51.61% and 48.35%, respectively). The age of the patient played a major role in the decision to take. The frequency of cases treated with radioiodine was considerably higher in the patients with recurrence and in the elderly. The initial dose of antithyroid treatment was high (50-60 mg), and was reduced according to the thyroid function. The therapy duration was not pre-determined. The ATD treatment was prolonged for a time-interval ranging between 2 and 5 years, depending of the clinical status (age, sex, goiter size, exophthalmic syndrome) and the social conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

A retrospective study on the treatment and evolution of Graves' ophthalmopathy.

Although Graves' ophthalmopathy (GO) seems to be unanimously considered as an autoimmune disease, its pathogenesis is still unknown. That is why the different therapeutical formulas led to ambiguous results. We think that a critical retrospective analysis on our therapeutical possibilities in GO will help us to become aware of our limits in treating this pathology. Our study performed on 123 patients with GO-stage III-IV who were admitted several times in the Thyroid Department of our Institute between 1975-1991; mean age 42 yrs (42 in men and 43 in women. One hundred and twelve patients presented GO associated with thyroid hyperfunction and 11 patients--with hypo- and euthyroidism. Thyroid status was evaluated through clinical examination and laboratory investigations (radioiodine uptake--RIU, 2h, 24 hrs, Achillean reflexogram--AR, T4, T3--radioimmunoassay-RIA). Three therapeutical formulas which were available to us were used in our subjects with GO: 1) general corticotherapy (C) was given in 77.6% of the cases; initial doses: 60-40 mg prednisone for 3 weeks followed by decreasing doses for 2 months (number of cures according to GO severity); 2) orbital radiotherapy (RT) alone was administered from the very beginning to the subjects in whom general C was not possible (7.4% of the cases); 3) general C associated with orbital RT were applied in the very severe cases of GO stage IV-VI (15% of the cases). The two available formulas acted particularly on oedematous symptoms (53% with C and 55.55% with RT alone). Muscular changes were improved by C in 30.83% and by RT only in 11.11% of the cases. It was noticed a mild positive effect on protrusion under C in only 11.66%, and under RT in 33% of the cases. The less favourable results in the cases under both C and RT can be explained by the fact that these groups included cases with stages IV-VI of GO with severe evolution. In 24% of the patients we noted an aggravation of the GO evolution regardless the therapy administered. The possible pathological relationship between the exophthalmic syndrome (ES) and hyperthyroidism (HT) is also supported by our data. The onset of ES together with HT occurred in 63% of the cases. On the other hand, we can notice that it was a more severe disease evolution when both ES and HT were associated. The treatment of hyperthyroidism led to GO aggravation (following 131I, thyroidectomy and antithyroid agents (ATD) in 43%, 52% and 29% of the cases, respectively).

Study on the evolution of endemic goiter in Romania.

In population studies on children carried out in 1978-1979 as well as in 1986 we reported the persistence of endemic goiter. This made us extend our study onto other populational categories, namely: a) adults and children from five villages of 500-1500 inhabitants from known endemic areas; goiter was encountered in a high percentage: 41% and 52.5% and prevailed above the age of 50. In children goiter was present in 28-30% but most of it was of the zero degree; b) women aged 18-57 years from urban industrial areas as follows: 1720 from Bucharest, situated in the plain, 280 from Rm-Vîlcea, and 560 from Ploiesti, the latter two being sub-Carpathian areas. Goiter was present in 35.7% and 29.89%, respectively, mostly of the 1st and 2nd degree; nodular goiter was in 3.89% and 12.90%, respectively. Thyroid function was also tested by RIA of T3, T4 and TSH, in the blood collected from 150-200 subjects from each group. The values were within normal limits. However, in one of the endemic areas T3 RNA in children was significantly high. Urinary iodine assay (24 hrs creatinine) was tested in 50 of the women living and working in an industrial urban area situated in the plain. The values were around 50 mg/24 hours or less, in 75% of the cases.

Epidemiological surveillance of iodine deficiency in Romania by urinary iodine determinations in children aged 6-16 years from 30 counties.

Epidemiologic studies on school-children aged 6-16 years along 1978-1980 and in 1986, according to the WHO classification revealed the persistence of endemic goiter even in high incidence in some areas. Following UNICEF WHO recommendations, a new epidemiologic study was initiated in 30 counties for assessing urinary iodine through the spot urine sample method, which has widely been accepted as a satisfactory index of iodine intake. The urine samples were collected from lots of 100-200 children aged 6-16 years within each district. The results showed low iodine values, i.e., 2.4-5.5 micrograms/dl urine in 12 areas and 6-12.1 microgram/dl urine in the rest of the country. Comparison of the data on goiter endemic and iodine values in various counties shows lack of correlation in some areas. This prompted an extension of the study of urinary iodine over to larger groups of children in some counties.

The serum osteocalcin levels in patients with thyroid diseases.

The mechanism of bone, calcium, phosphorus and proteins abnormalities observed in hyperthyroidism is rather complex and as yet not wholly understood. Increased serum osteocalcin was recently reported in hyperthyroid patients and its decrease after 4-8 months of treatment. Osteocalcin was measured by RIA in the sera of 211 women and 18 men with thyroid diseases. The patients were divided into 3 groups according to diagnosis: I. polynodular goitre and subacute thyroiditis (59 women, 5 men); II. Graves' disease (70 women, 3 men) and III. thyroid cancer, after treatment by surgery and 131I (82 women, 10 men). The osteocalcin levels in the sera of these patients were: 2.97 +/- 2.63 ng/ml (mean +/- SD) for the women and 3.56 +/- 2.10 ng/ml for the men in the 1st group; 16.31 +/- 11.34 ng/ml for the women and 12.75 +/- 6.09 ng/ml for the man in the IInd group and, 1.01 +/- 0.60 ng/ml for the women and 0.78 +/- 0.46 ng/ml for the men in the IIIrd group. No differences were found between the osteocalcin concentrations in the hyperthyroid female patients treated with antithyroid drugs (no = 58) and the non-treated hyperthyroid women (no = 12): 16.22 +/- 11.40 ng/ml vs 16.74 +/- +/- 11.53 ng/ml. These data suggest that bone resorption stimulated by endogenous thyroid-hormones is a rather resistant processus, persisting even after 6-8 mos of associated anti-thyroid therapy. Further are analyzed the possible causes of the subnormal osteocalcin levels observed in patients with thyroid cancer treated by surgery and radioisotope, whose suppression therapy was discontinued 2-3 weeks before blood sampling.(ABSTRACT TRUNCATED AT 250 WORDS)

The "cat eye" syndrome--report of a case with hypothyroidism.

Clinical, genetic and endocrine findings in a male patient aged 27, diagnosed as a "Cat Eye" syndrome bearer are presented. Clinically the patient shows: moderate psychic retardation, high forehead, epicanthus, strabismus, microretrognathism, large, low inserted ears, kypho-scoliosis, genu valgum; mild hypothyroidism. Cytogenetic examination reveals the presence of an additional small acrocentric chromosome.

Hyperthyroidism and pregnancy. II. Thyroid function in normal pregnancy and in pregnancy associated with hyperthyroidism.

Starting from the diagnostic difficulties when hyperthyroidism is associated with pregnancy, PBI, total T4 and free thyroxin, triiodothyronine (T3), rT3, TBG, TSH and LATS were assayed in a group of euthyroid pregnant women (136) more or less equally distributed between month 2 and 9 of pregnancy; the same tests were applied to 14 pregnant hyperthyroid women (month 2-3), the latter also undergiving a test for urinary elimination of catecholamines. The results were referred to the normal values of techniques employed. The work presents the alterations in the thyroid status parameters when pregnancy is associated with hyperthyroidism, as against normal pregnancy, pointing out the need for performing a complex set of assays "in vitro" in order to establish correctly the diagnosis of hyperthyroidism in pregnancy and apply the right therapy at the right moment. Increased T3 and free T4 levels in hyperthyroidism referred to an increased TBG level in euthyroid pregnancy are considered as discriminators.

Evolution of endemic goiter in the Valea Jiului area after 30 years of iodine prophylaxis.

After 30 years of iodine prophylaxis the incidence of goiter in the Valea Jiului area was reassessed. A number of 7,892 pupils aged 7-16 years were examined, of whom goiter was found in 32%. Before iodine prophylaxis started the incidence was 91.8%. The present survey shows that the small-sized goiters markedly prevail over middle-sized ones, while large-sized goiters became extinct. The diffuse to nodular goiter ratio changed by the disappearance of the nodular forms. The neurologic and psychic complications in goiter-bearing children disappeared. Attempts to correlate taste sensitivity to thiocarbamide with goiter failed. Examination of the digito-palmar dermatoglyphics showed a greater incidence of the higher atd angle, with transition forms of sulcus palmaris.

Modifications of dermatoglyphics in thyreopathy.

Examination of the digito-palmar and plantar dermatoglyphics of 50 thyreopathic women revealed no statistically significant variations depending on the clinical form of thyreopathy, for the quantitative aspects of digito-palmar and plantar dermatoglyphics. Qualitative determatoglyphic differences were found (reoccurrence of the patterns on areas of the palm and plant) according to the clinical form of thyreopathy. These differences are more obvious in Graves's disease patients which may support the idea of a hereditary factor implied in the disease.

Thyroid hormones homeostasis and TSH in autonomic thyroid nodule.

Thirty patients with autonomic thyroid nodules were studied. Thyroid scintigram, iodine uptake at 2 and 24 hrs, PBI, total thyroxine, serum T3(RIA), basal TSH and 30 minutes after TRH administration were performed. A lack of concordance was found between the clinical signs and the laboratory data. According to the data obtained the patients were grouped into 3 categories: having 1) autonomic thyroid nodules with normal PBI, T4t, T3 values and absent or diminished TSH response to TRH; 2) autonomic thyroid nodules with increased T3 secretion and no response to TRH despite a normal T4 and iodine uptake, 3) hyperfunctional autonomic nodules in which PBI, T4t, T3 and iodine uptake are increased. TSH response to TRH is the most sensitive test for hyperthyroidism, more sensitive than the circulating thyroid hormones assay, and best fitted for adequate therapeutic management. Serum triiodothyronine was found to be increased in 95% of the patients. Thus, there is a T3 thyreotoxicosis in most of the autonomic nodules. TRH test and serum T3 assay being essential elements in starting the treatment, they have to be included among the tests used in autonomic thyroid nodules investigation.

The inhibitory action of the pineal extract on TRH.

The effects of a single dose and of 5 doses (5 days) of a bovine polypeptide pineal extract (PE) on the pituitary TSH reserves and on the blood level of thyroid hormones were studied on hypothyroid patients. The blood levels of PBI, total T4 (radiocompetitive), free T4, T3 and TSH (RIA) in basal conditions and during the TRH test (i.v. administration of 200 mug TRH), In the presence and absence of the treatment with PE were determined. Thirty minutes following i.m. administration of PE a decrease was noticed in the high level of the basal TSH in all the patients as well as maintenance or even exaggeration of the TRH response. After 5 days of PE administration a decrease was noticed in the basal TSH, with preservation of a strong response of the TSH release after TRH administration. In these patients a slight decrease was observed in PBI, total and free T4 and T3, when their initial level was close to normal. The results show the results show the intervention of the pineal extract by inhibiting the endogenous TRH.