[Differentiated thyroid carcinoma. Diagnosis and therapeutic aspects]. / Carcinomul tiroidian diferentiat. Aspecte diagnostice si terapeutice.

The significant increase in incidence of thyroid cancer in the last decade, augmented the interest in reevaluation of treatment and diagnosis methods. Those aspects let us into making this retrospective study regarding the differentiated thyroid carcinoma. The clinical material consist in 70 C.T. patients, of which 54 (77.14%) C.T.D. patients, ages between 17-80 year old, sex ratio W/M 3.5/1.9. Preoperatively malignancy diagnosis was made by FNAC in 38.88%, intraoperatively by extemporaneous pathological exam 42.59%, postoperatively by paraffin exam 18.51%. Papillary CTD 30 (55.55%), follicular 20 (41.25%), Hürthle cells carcinoma 4 (7.2%). From the therapeutical point of view, the elective procedure of thyroidectomy was dictated by the histological type, staging and specific prognostic factors. There was 41 (75.9%) patients with total thyroidectomy (T.T), with a specific morbidity of 7 (12.96%) and 5-years survival rate of 88.88%. Preoperatively diagnosis of C.T was suspected through clinic, ultrasonography and scintigraphy arguments and confirmed by FNAC. The non conclusive cases were diagnosed intraoperatively by extemporaneous exam or postoperatively by paraffin exam. In most cases total thyroidectomy remains the essential surgical procedure. Also clinical, imaging and biological postoperative monitoring as well as suppress and substitution hormonotherapy are mandatory.

Graves' ophthalmopathy.

The Graves' ophthalmopathy consists of all the pathological changes in orbital tissues, preceding, accompanying of following hyperthyroidism. Although ophthalmopathy has its clinical expression only in 50% of patients with Graves disease, the ultrasound exploration and the CT scan of the orbital area, as well as the values of intraocular pressure showed that occult changes exist in all patients. The etiopathological autoimmune mechanism responsible of ophthalmopathy doesn't imply the same autoantibodies, though ophthalmopathy is associated with thyrotoxicosis, and the degree of ocular changes is not related to the level of autoantibodies directed against the TSH receptors nor to the level of antibodies involved in thyroid cells' growth. It occurs that there exist two different autoimmune mechanisms. The ocular prognosis depends on the amplitude and the duration of the ocular changes, the functional state, the presence of complications. Good results are conditioned by the precocity of the treatment. The treatment in Graves' ophthalmopathy consists of local and endocrinological treatment.

Conventional and Doppler ultrasound in thyroid disease diagnosis.

Ultrasonography is a useful tool for diagnosis diseases of the thyroid gland. The method is reliable, inexpensive and of high diagnostic efficiency. The structural information provided by the ultrasound technique complements the results of laboratory tests and other in-vivo techniques. The article reviews the indications, the accuracy and the usefulness of conventional and Doppler ultrasonography in the diagnosis of thyroid diseases. In our opinion ultrasound examinations should immediately follow the patient's history and physical examination. Additional in vivo methods should be performed according to the specified problems.

Leprechaunism: report of two cases and review.

Two new cases of leprechaunism are reported, one of which from consanguinous parents. Both cases show the clinical picture characteristic of this syndrome: severe pre- and postnatal growth failure, psychic backwardness, lack of adipose tissue, cutis laxa; elf-like face, large ears, globular eyes, hypertelorism, micrognathia and various degrees of external genitalia hypertrophy. Endocrinologically, one of the patients shows the syndrome of low T3. The role of the endocrine alterations in the etiology of the syndrome is discussed.

Investigation of thermic transition and renaturation of high polymerized DNA extracted from thyroid nodule.

The study was carried out on 16 cases of mixed thyroid hypertrophy in which total or partial thyroidectomy was performed. Fragments collected intraoperatively from the thyroid nodule were used for extraction of high polymerized DNA. At the same time with quantitative evaluation of DNA, RNA and proteins were also assayed. The thermic transition mean temperature of the DNA extracted from the thyroid nodule is compared to other standards (DNA-HP-standard, calf thymus DNA, normal leukocytic DNA) and the thermic transition curves are presented. Hyperchromicity after thermic denaturation and renaturation is analysed and expressed in per cent values.

Effect of short-term lithium carbonate administration in hyperthyroidism, with or without associated ophthalmopathy.

The study was carried out on 21 female hyperthyroid patients aged 22-53 years, with or without associated ophthalmopathy, admitted to the Endocrinology ward of the 1st Medical Clinic of the Craiova County Hospital, Romania, between 1983 and 1985. Administration of lithium carbonate was proceeded and followed by radioimmunoassay (RIA) determinations of T3 and T4 and measurement of Achilles' reflex (AR). Two regimens were employed. The first comprised ten patients receiving doses of 500 mg/day lithium carbonate and the second 11 patients who had an associated ophthalmopathy and who received 250 mg/day lithium carbonate and 30 mg/day carbimazole. Lithium administration was discontinued after 4 weeks. The results of the therapy suggest a possible intervention of lithium carbonate in the process of blocking the biosynthesis of thyroid hormones and/or its regulating processes, with concomitant improvement of the clinical status, much more in the patients without ophthalmopathy.

Histochemical and enzymatic study of the thyroid nodule.

Twenty-four cases of uninodular and polynodular thyreopathy subjected to partial or total thyroidectomy in 1980--1981 were studied. At the same time with the general morphological study, the activity of the following cellular enzymes in the thyroidian tissue were assayed: lactic dehydrogenase (LDH), glutamic oxalacetate transaminase (GOT), glutamic pyruvate transaminase (CPT) and creatine phosphokinase (CPK). Correlations between the morphophysiopathology of the thyroid nodule and its enzymatic activity have been made.