Ferritin concentrations in patients with differentiated thyroid cancer.
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Biomedical subjects
Publications and source records attributed to D Nöthig-Hus.
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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.
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.
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.
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.
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.
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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.