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Anna-Stina Suhonen, Juhani Leppäluoto, and Jorma Salmi

Abstract. Urine samples from 8 healthy subjects, from 16 patients with primary hypothyroidism and 8 patients with Graves' hyperthyroidism were pre-purified in SP-Sephadex-C-25 cation-exchange-chromatography, subjected to reverse phase high-pressure liquid chromatography (HPLC) with 0.01 M ammonium acetate pH 4 as a polar and propanol as a non-polar solvent with a 1%/min gradient and assayed in our TRH radioimmunoassay. Urine TRH-immunoreactivity levels were measured before and after 3 months of treatment with thyroxine or methimazole. The urine TRH-levels in healthy subjects were 5.5 ± 1.4 ng/l (mean ± sem, n = 8).

In the hypothyroid patients, the urine TRH levels were 50.6 ±40 ng/l before and 71.7 ± 45.3 ng/l after 3 months of treatment with thyroxine. These values did not significantly differ from those in healthy subjects. The large variations were due to highly elevated values in 3 patients. In 2 hypothyroid patients with initially high urine TRH values, 67 and 657 ng/l, urine TRH was measured 5 and 18 months later and was found to have decreased to 5 and 11 ng/l. In the hyperthyroid patients, urine TRH levels were 10.3 ± 3.9 ng/l before and 8.9 ± 3.3 ng/l after the treatment with methimazole and did not differ significantly from the levels in healthy subjects. After 3 months of treatment, the hyper- and the hypothyroid patients were euthyroid.

Our results show, that, except in 2 hypothyroid patients, there does not appear to be any relationship between urine TRH levels and serum TSH or thyroid hormone levels in hypothyroid and hyperthyroid patients.

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Pekka Collin, Jorma Salmi, Olavi Hällström, Timo Reunala, and Amos Pasternack

Collin P, Salmi J, Hällström O, Reunala T, Pasternack A. Autoimmune thyroid disorders and coeliac disease. Eur J Endocrinol 1994;130:137–40. ISSN 0804–4643.

Eighty-three patients with autoimmune thyroid disorders were screened for coeliac disease. The screening was performed with IgA-class reticulin and endomysium antibody, IgA- and IgG-class gliadin antibody tests, and various biochemical tests for malabsorption. None of the tested subjects had selective IgA deficiency, which excludes the possibility of not detecting positives by an IgA-class test. Of the 83 patients, three asymptomatic coeliac patients were found, and one patient with coeliac disease previously diagnosed, an overall frequency of 4.8%. In addition, 25 patients with a solitary nodule of the thyroid gland were examined and one of them (4%) was found to have coeliac disease. By contrast, one (0.4%) out of 249 age- and sex-matched blood donors was found to have coeliac disease. All newly detected coeliac patients had IgA-class gliadin, reticulin and endomysium antibodies, but none of the patients had any gastrointestinal symptoms or abnormal biochemical findings suggesting coeliac disease. Treatment of thyroid disorders and coeliac disease was successful in these patients. The present results confirm that the frequency of subclinical coeliac disease is increased among patients with autoimmune thyroid disorders. IgA-class reticulin, endomysium or gliadin antibody tests are suitable screening methods for detecting these patients, as far as selective IgA-deficiency is excluded.

Pekka Collin, Department of Clinical Sciences, University of Tampere, PO Box 607, SF-33101 Tampere, Finland

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Antti Aro, Jussi K. Huttunen, Bror-Axel Lamberg, Risto Pelkonen, Eero Ikkala, Arto Kuusisto, Viljo Rissanen, Jorma Salmi, and Sakari Tervonen

Abstract.

Seventy thyrotoxic patients were treated with carbimazole (36 patients) or propranolol (34 patients) prior to and for 6 weeks after a therapeutic dose of 131I. The therapeutic response was evaluated on the basis of the serum free thyroxine index (FT4I) value and the thyrotoxicosis therapy-index (TTI) of Crooks et al. (1960b). Propranolol alleviated many symptoms and signs (palpitations, hyperkinesia, finger tremor, resting pulse rate) as effectively as carbimazole, whereas others (dyspnoea on effort, tiredness, heat intolerance, sweating, nervousness, bodyweight) were not equally affected. Biochemical euthyroidism was achieved significantly slower in the propranolol group (after 100.6 ± 40.5 days vs. 48.5 ± 24.0 days in the carbimazole group) although the dose of 131I was administered after a mean interval of 22 days from the start of treatment in the propranolol group and after 66 days in the carbimazole group. Between 2 and 6 months after 131I the FT4I and TTI followed a similar course in both treatment groups.

As judged from the TTI scores 2 weeks after the 131I-therapy no evident aggravation of hyperthyroidism occurred in either group of patients. However, one patient in each group showed marked exacerbation of symptoms which was due to inadequate dosage of the drugs. It is concluded that propranolol, given prior to radioactive iodine, is equally effective as carbimazole in preventing aggravation of thyrotoxicosis after the administration of 131I. In the propranolol-treated patients the tests of thyroid function are more reliable during the drug therapy, but the slow development of euthyroidism may be of clinical importance in patients presenting with severe symptoms.

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Anu Virkkala, Matti Välimäki, Risto Pelkonen, Kauko Huikuri, Arvi Kahri, Leena Kivisaari, Timo Korhonen, Jorma Salmi, and Pentti Seppälä

Abstract.

To determine endocrine activity of adrenal tumours incidentally discovered on CT, we examined 20 consecutive patients. They underwent thorough hormonal assessment and scintigraphic scanning with radioactive cholesterol under dexamethasone suppression (19 patients). Biochemical findings compatible with cortisol hypersecretion were detected in 5 patients. One patient had reduced reserves of cortisol secretion and one had hyporeninemic hypoaldosteronism. The scintigraphy showed no uptake in 10, unilateral uptake in 4, and bilateral uptake in 5 patients. In 3 patients the finding was unilateral on CT, but bilateral on scintigraphy. Signs of autonomous cortisol production were more common among patients who had uptake on scintigraphy. At the operation of 8 patients only benign lesions were found. During the follow-up (9 to 49 months) of the 12 unoperated patients, the tumour disappeared in one and remained unchanged in the others. No changes occurred in the biochemical findings except in one patient whose cortisol response to 1 mg of dexamethasone became abnormal. Since slight hypercortisolism or a bilateral disease often exists behind an incidentally discovered adrenal tumour, we emphasize the importance of careful assessment of cortisol metabolism and a scintigraphic scanning under dexamethasone suppression in the examination of these patients.