Evaluation of tumour markers in patients with burning mouth syndrome.

Burning mouth syndrome (BMS) is an enigmatous condition both for the patient and the clinician, and is diagnosed on the basis of the patient's symptoms when they have on examination an apparently healthy looking oral mucosa. A variety of local and systemic factors are known to contribute to burning mouth syndrome. Some authors reported that underlying malignancy could be a possible cause for BMS. In 23 patients with burning mouth syndrome as well as in 20 age, sex, and race matched healthy controls levels of tumour markers-CEA, CA 19-9, AFP, and CYFRA 21-1-were determined from sera. Immunoradiometric assay (IRMA) for detection of ELSA-CEA, ELSA-CA 19-9, ELSA 2-AFP, ELSA-CYFRA 21-1 (CIS bio international, ORIS group, France) was used. Statistical analysis showed no significant differences in the level of tumour markers CEA, CA 19-9, AFP, CYFRA 21-1 in patients with burning mouth syndrome when compared to the healthy controls. We can conclude that evaluation of tumour markers in patients with burning mouth syndrome is not useful and in terms of cost-benefit this investigation should not be performed in patients with burning mouth syndrome.

First beneficial results of the implementation of Croatian new law on salt iodination.

Presented pilot-study on urinary iodine excretion among schoolchildren in main geographic regions of Croatia indicates a significant improvement in iodine excretion only 12 months after introduction of a new mandatory salt iodination with 25 mg KI/kg of salt. Measurements of urine iodine excretion in 663 schoolchildren of both sexes, aged 9-16 years, from Zagreb, Rude, Bednja, Osijek, Dakovo, Rijeka, Pazin and Dubrovnik showed that from 77.9% to 94.8% of subjects have had urinary iodine above 5 microg/dl. Also from 41.2% to 70.8% of children have had urinary iodine excretion above 10 microg/dl. Before introduction of a new law mostly borderline values of urinary iodine excretion were recorded; therefore recent values present significant positive shift and actually they are the best signs of almost adequate iodine intake in Croatian youth. Nevertheless, further measures for improvement of iodine intake are recommendable because still 31% of controlled table-salt samples from households and 15.7% of imported salt samples have had KI level below 20 mg/kg of NaCl. Salt produced in Croatia was (Pag and Nin salt plants) completely in accordance with iodination regulations. On the other hand, as recent increase in urinary iodine excretion could not be simultaneously followed by reduction in goiter prevalence, in the following years further epidemiological surveys of iodine deficiency disorders shall be warranted.

Follow-up of patients with gastrointestinal cancer by tumor marker determination.

In addition to clinical examination and various diagnostic procedures, patients with gastrointestinal cancer (GIC) were also monitored by tumor marker (TM) determination. In total, 202 patients with GIC were postoperatively followed-up. According to in vivo diagnostic procedures, there were 133 (66%) patients without metastases, 63 (31%) patients with distant metastases, 48 (76%) of them with liver metastases, and six (3%) patients with local recurrences. During the 1990-1995 period, they were followed-up by serum TM concentration measurements on 1-8 occasions. At the time of initial diagnosis, TM were determined in a varying percent of the patients: CA 19-9 (100%), TPA (54%), CA 72-4 (49%), IAP (41%), CEA (41%) and AFP (25%). In the group of patients without metastases, the percentage of normal TM values ranged between 73%-100%, and TM sensitivity between 0%-86%. No ideal TM has as yet been discovered either for any malignant disease or for patients with GIC. Therefore, in the follow-up of patients with GIC we suggest the concentrations of at least two instead of only one TM (CA 19-9 and TPA or CEA) to be determined. It is also difficult to choose the best TM among numerous TM kits available on the market and to keep using it during a longitudinal follow-up study.

Endogenously labeled thyroid hormones (131I-T3/T4) in sera of patients with differentiated thyroid carcinoma.

Patients with differentiated thyroid carcinoma (DTC), who have undergone thyroidectomy and radioablation with iodine (131I), are usually monitored with ultrasonography (US) of the neck, 131I whole body scan (WBS), and determination of thyroglobulin (Tg) concentrations in serum. A chromatographic method (CHROM), designed for detection of in vivo labeled thyroid hormones (131I-T3/T4) that circulate in the body after administration of 131I for a WBS, may be used in monitoring of these patients. This study included 35 patients with DTC. Ultrasonography, WBS, Tg, and CHROM method were performed for each of them. One patient was followed-up 6 times, 11 were monitored twice, and the remaining group of 23 patients was examined only once (51 diagnostic tests). We found CHROM results to be in disagreement with the WBS and/or Tg findings in three patients out of 35 at the time of the first visit. In one of them WBS was negative, while Tg and CHROM findings were positive. In this patient the local metastases were proven by US with fine needle biopsy (FNB). In another patient (without signs of thyroid tissue remnant, determined by WBS, Tg, and US) only CHROM was positive. Finally, in the third patient, a thyroid remnant was proven positive on WBS and US (negative CHROM and Tg). We registered an additional peak (peak 4) in chromatograms of 12 out of 35 patients. This component could be tentatively characterized as 3,3'-diiodo-L-thyronine (131I-3,3'-T2). Although this preliminary study included a small number of patients, we show that the CHROM method can be useful as an additional test in monitoring of patients with DTC, especially those with discordant WBS and Tg results.

Thyroglobulin determination, neck ultrasonography and iodine-131 whole-body scintigraphy in differentiated thyroid carcinoma.

UNLABELLED: The long-term prognosis of patients with differentiated thyroid carcinoma depends on the early diagnosis and treatment of metastases and local recurrences. We evaluated serum thyroglobulin measurements, neck ultrasonography with ultrasound-guided biopsy and 131I whole-body scintigraphy in the follow-up of 359 patients after surgical thyroidectomy and radioiodine ablation of the thyroid remnant. METHODS: Serum thyroglobulin levels were determined and considered abnormal when the values were > 5 ng/ml. Ultrasonography over the entire neck region and fine-needle aspiration biopsy of the mass or enlarged lymph nodes were carried out using 5- and 7.5-MHz transducers and 23-gauge needles. Whole-body scintigraphy was performed after administration of 185 MBq (5 mCi)131I. RESULTS: Increased levels of thyroglobulin (ranging from 12 to > 600 ng/ml) were measured in 40 of 55 (73%) patients with metastases or local recurrences. Ultrasonography revealed occult neck masses that were not detected by other methods. Neck ultrasonography and ultrasound-guided biopsy were positive for malignancy in 23 patients. Thyroglobulin levels were undetectable in 12 (52%) of these patients and 131I whole-body scintigraphy was negative in 19 (83%) of them. CONCLUSION: The combined use of three diagnostic modalities (measurement of serum thyroglobulin, neck ultrasonography with ultrasound-guided biopsy for detecting recurrences of carcinoma in the neck region and 131I whole-body scintigraphy) appears to give the best results in the follows-up patients with differentiated thyroid carcinoma.

Effect of chronic hemodialysis on thyroid function tests in patients with end-stage renal disease.

In patients with end-stage renal disease (ESRD), serum concentrations of thyroid hormones are often found to be disturbed. The aim of the study was to evaluate the effect of chronic hemodialysis (CHD) on the regulation of decreased levels of thyroid hormones and thyroxine-binding globulin (TBG) in serum of patients with ESRD. This effect was analyzed during two phases of CHD in patients with ESRD. The first period of CHD (FCHD) lasted 14.6 months and the second period (SCHD) was prolonged by additional 16.7 months. The concentrations of thyroid hormones (T4, FT4, T3, FT3, rT3), thyrotropin (TSH) and TBG were determined in serum samples obtained before the patients started hemodialysis (BHD) and at the end of FCHD and SCHD. From the first group of 48 patients with ESRD who had previously been tested BHD, 28 patients received FCHD and only 10 of them continued to receive additional SCHD. The levels of all thyroid hormones were found to be decreased, especially some hormones such as FT3 (87% BHD), T3 (93% FCHD) and FT4/FT3 (90% SCHD). The concentration of TSH did not change significantly during CHD and about 10% of decreased and 10% of increased values were recorded. Only TBG level from decreased values (37% BHD) returned to the normal range at the end of SCHD. Results of rT3 could not be interpreted with certainty, because two different commercial kits were used during the study. Although CHD lasted for 31.3 months, it did not have any positive effect on the regulation of disturbed thyroid hormones to the normal levels.

Thyroid peroxidase prevails over thyroid microsomal and thyroglobulin antibodies in thyroidal and nonthyroidal illnesses.

Autoimmune thyroid disease is usually related to the presence of autoantibodies (TPO, TMA, TGA, TSH-R) in patients' sera. In this study the presence of autoantibodies in the sera of patients with thyroid disease, patients with end-stage renal disease and in several groups of euthyroid subjects have been evaluated (N = 217). The percentages of positive values detected in six groups ranged: 0-47%, 2-94% and 3-100% for TGA, TMA, and TPO, respectively. Autoantibodies were mostly present in the sera of patients with Hashimoto thyroiditis (TPO 100%, TMA 94%, TGA 47%), and sporadically in the control subjects (TPO 4%, TMA 2%, TGA 0%). Authors's results confirm the prevalence of TPO over TGA and TMA in the sera of all investigated groups. The authors did not find changes in ATA levels during methimazole therapy of their patients with Graves' disease. Some of serum autoantibodies were constantly present or absent in spite of remission.

[The inductive approach in the routine laboratory diagnosis of thyroid dysfunction]. / Induktivni pristup rutinskoj laboratorijskoj dijagnostici disfunkcije stitnjace.

The method for defining strategy for thyroid function laboratory testing is presented in this study. In order to accomplish this task an available software, ASSISTANT Professional, was used. The strategy is generated by induction from routine data, using the method of minimizing entropy. Each of 1002 patients was described by 15 attributes and thyroid function status (euthyreosis, hyperthyreosis, hypothyreosis). Seventy per cent of the patients were chosen at random for generating and 30% for testing the strategy. The result is the decision tree or a set of decision rules. Absolute prognostic accuracy is estimated to 96% and relative to 90.16%.

Tumor marker determinations.

A combination of 2 or 3 tumor markers was determined in the serum of 478 patients with malignant tumors. In 195 out of 213 patients with differentiated thyroid cancer and without relapse or metastases, the Tg concentration has undetectable. In 9 patients with nonfunctioning thyroid metastases the Tg level was correlated with the progress of the disease or the success of the treatment. In 114 patients with gastrointestinal cancer CA 19-9, TPA and IAP were measured simultaneously. The highest discrepancies between patients with relapse or metastases (increased values in 1/2 of patients) and patients without relapse or metastases (increased values in 1/4 of patients) were given by CA 19-9. In the serum of 90 patients with breast cancer increased CA 15-3 values were found in 2/3 of patients with relapse or metastases and in 1/4 of patients without signs of tumor. A combination of universal tumor markers TPA and IAP had no value in monitoring 26 patients with melanoma.

The effect of fenclofenac on thyroid function.

The non-steroidal anti-inflammatory agent fenclofenac competitively inhibits the binding of thyroxine(T4) and triiodothyronine (T3) by thyroxine-binding globulin(TBG). Eight male volunteers completed a 4-week study during which they took fenclofenac 600 mg twice daily. The concentration of fenclofenac in serum reached a plateau after 1 week of therapy after which the mean concentration(+/SEM) of the drug in serum was 78.6 o.2 mg/1. During the steady state period on treatment there were reductions of the mean serum concentrations of total T4 to 35% (P less than 0.001), total T3 to 55% (P less than 0.001), free T4 to 69% (P less than 0.001) and free T3 to 90% (NS) of the respective pretreatment values. There were also significant changes in the concentrations of thyrotropin and reverse T3 in serum. After starting treatment with fenclofenac serum concentrations of thyrotrophin fell to a nadir after 2-4 days at which time the mean concentration was 34% (P less than 0.01) of the pretreatment value, whilst reverse T3 values increased to a maximum of 136% (P less than 0.001) of the pretreatment values over 1-2 days. There was subsequently an increase of the thyrotrophin and a reduction in reverse T3 concentrations to normal by 2 weeks of pretreatment. Transient pituitary suppression was also suggested by the response to to thryotrophin-releasing hormone (TRH): 7 days after starting fenclofenac the mean thyrotrophin response was 62% (P less than 9.001) of the pretreatment value. After 4 weeks of fenclofenac the response of TRH had returned to normal. After discontinuing fenclofenac there was a transient increase in the mean concentration of thyrotrophin in serum, to 129% of the pretreatment value (P less than 0.001), with a subsequent return to normal. Four weeks after discontinuing fenclofenac the serum concentrations of thyroid hormones and thyrotrophin were normal.