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D. Reinwein and E. Klein

ABSTRACT

The effect of an increased iodide level in the blood for one week on the iodine metabolism of the thyroid was investigated in 28 patients with nontoxic goiter by means of isotope and chemical analyses. The average initial values of 0.8 μg/100 ml blood iodide and of 14.3 μg/h absolute iodine uptake of the thyroid did not deviate from the previously found normal values. Increasing the iodide concentration in blood caused at first stimulation and then inhibition of the thyroid iodine uptake. Normally its complete block was reached at 30.0 μg/10 ml, whilst for the nontoxic goiter this did not occur below 100.0 μg/100 ml blood iodide. An increased thyrotrophin-effect and not the larger thyroid volume is responsible for this difference. The secretory activities of the nontoxic goiter and of the normal thyroid were equally little influenced by iodine administration.

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D. Reinwein and E. Klein

ABSTRACT

In 26 euthyroid persons without goiter the influence of various concentrations of iodide in blood on the iodine metabolism of the thyroid was investigated. This iodide level in blood was maintained for 7 days.

  1. 1. At a normal iodide level in blood of about 0.8 μg/100 ml the average iodine uptake of the thyroid was 13.3 μg/h.

  2. 2. Increasing iodide concentration in blood caused depressed uptake of 131I from a tracer dose as well as decreased T/S ratio. With the exception of 3 cases there was no uptake above 20 μg/100 ml.

  3. 3. The absolute iodine uptake of the thyroid depending on the concentration of iodide in blood was stimulated by moderate increases, but inhibited respectively blocked by higher ones. At a middle iodide level of 6.1, 15.1, 34.4 and 86.4 μg/100 ml of the absolute iodine uptake amounts to 82.0, 32.7, 2.0 resp. 2.1 μg/h.

  4. 4. The hormonal phase of the thyroidal iodine metabolism remained in most cases unchanged by the one week's iodide medication. In two cases only an activated iodine metabolism was suggested. The hormonal iodine concentration in blood never showed a thyrogenic increment.

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D. Reinwein and K. Irmscher

ABSTRACT

The effect of various concentrations of thiocyanate in the blood on the iodine metabolism of the thyroid and the renal excretion of iodide was investigated in 39 euthyroid subjects with no goiter. The thiocyanate level in blood was maintained for 14 days.

  1. Increasing thiocyanate concentrations in the blood caused a decreased uptake of 131I from a tracer dose. Only three subjects with concentrations of thiocyanate above 7.2 mg/100 ml showed a demonstrable uptake. Vice versa the serum iodide increased up to 9.6 μg/100 ml.

  2. The absolute iodine uptake of the thyroid was at first stimulated and then inhibited by increasing concentrations of thiocyanate. A complete inhibition could not be found even with a thiocyanate level of 12.6 mg/100 ml. The hormonal phase of the thyroidal iodine metabolism and PB127I remained unchanged in most cases. In only 2 cases was there some indication of activated iodine metabolism.

  3. The renal excretion of iodide was not significantly altered. Since only a euthyroid subject and not a patient with primary hypothyroidism showed increasing inorganic 131I and 127I after thiocyanate, the iodide increase in the serum is assumed to originate mainly from the thyroid.

  4. The dissociatable thyroid iodide amounts to 0.4 mg under the experimental conditions used. On the basis of these results a competitive inhibition of the iodide concentration mechanism of the human thyroid is suggested.

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D. Reinwein and F. A. Horster

ABSTRACT

The effect of an increased iodide level in the blood on the thyroidal iodine metabolism was investigated in 24 hyperthyroid patients. This iodide level in blood was maintained for 8 days. With a physiological iodide level in blood of about 0.9 μg/100 ml the absolute iodide uptake (AIA) of the thyroid amounted to 32.6 μg/h. With an iodide level of 17.9 μg/100 ml the AIA increased by a factor of 15. A further increase inhibited AIA and blocked it completely at iodide levels in the blood above 83 μg/100 ml. Compared to euthyroid controls and nontoxic goiter, hyperthyroid patients showed the following characteristics:

  1. With increasing iodide level in blood, the maximal 131I uptake of the thyroid is reached faster. The average AIA at all observed iodide concentrations in blood is higher than those of euthyroid subjects.

  2. The PB131I, PB127I and basic metabolic rates return to normal values at an average iodide level in blood of 8.2 μg/100 ml. The only indicator at normal iodide level in blood, whether or not inhibition of organification by iodide can be obtained, is the increased AIA and not the T/S ratio.

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TH. OLBRICHT, H.-G. HOFF and D. REINWEIN

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R. WINDECK, A. WACKER and D. REINWEIN

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D Sandrock, T Olbricht, D Emrich, G Benker and D Reinwein

A group of 375 untreated euthyroid patients with solitary autonomous adenoma of the thyroid were studied in a long-term follow-up (observation period 52.8 (mean)/46 (median), range 3–204 months). During the period of observation, 133 (34.2%) of all initially untreated patients underwent treatment (surgery, radioiodine, antithyroid medication) because of hyperthyroidism, mechanical problems, or at the patient's request. Sixty-seven patients developed hyperthyroidism resulting in a mean incidence of 4.1% per year. The incidence of hyperthyroidism increased during follow-up (3% in the first seven years, 10% in the following years). Age, sex, nodule size, initial scintigraphic appearance and the TRH test were of no individual prognostic value in predicting hyperthyroidism. Eleven of 14 patients with untreated hyperthyroidism became euthyroid without treatment during the time of follow-up. After iodine excess (by history or elevated iodine levels in urine, N=45), 14 patients (31%) developed hyperthyroidism. In conclusion, we recommend a definitive treatment of autonomous adenoma at least in patients with advanced age, concomitant diseases and a higher probability of iodine exposure.

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G. BENKER, D. REINWEIN, P. KOTULLA, H. SCHLEUSENER and H. SCHATZ