In a group of 129 female patients with nodular goiter, Graves' disease and primary hypothyroidism, the PRL and TSH secretions were studied in parallel. Concurrent changes in the two hormones were evident only in conditions of marked hyper- or hypothyroidism. In the patients with non-toxic nodular (single or multiple) goiter the TSH showed low or normal values, while the PRL appeared normal or elevated. From these results two important conclusions can be drawn: 1. the T3 and T4 levels interact with PRL secretion concomitantly with TSH only when they undergo a huge deviation from the normal range; 2. the goitrogenic action of PRL that has been reported in experimental animals cannot be excluded in man.

Adolescent↗

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Correlation of Tc-99m-red blood cell phleboscintigraphy with clinical severity of chronic venous disease.

Equilibrium red blood cell phleboscintigraphy of the lower limbs for the diagnostic management of chronic venous disease has been proposed. The aim of this study was to verify the correlation of the phleboscintigraphic assessment of chronic venous disease with the clinical grading of the severity of the disease, since other diagnostic modalities have been recently demonstrated a poor and only partial correlation. Equilibrium Tc-99m-red blood cell phleboscintigraphy was performed in 27 patients with chronic venous disease. Scintigraphic images of 52 limbs were classified according to a four-class qualitative grading of the severity of the venous disease, and a quantitative scintigraphic index (saphena /femoral ratio) was assigned to each limb. The scintigraphic qualitative grading showed a highly significant correlation with the clinical grading (Rs=0.82, p<0.01), a good interobserver and intraobserver agreement (86.5% and 92.3%, respectively) and more than 90% sensitivity and specificity to identify the categories "minimal or no chronic venous disease" or "more significant disease" (assessed according to the Bayes theorem). Sensitivity and specificity results for the quantitative assessment were not as good. Phleboscintigraphy correlates well with the clinical grading of the severity of chronic venous disease of the lower limbs and may have potential as a valuable diagnostic tool for the noninvasive assessment of chronic venous disease.

Chronic Disease↗

PubMedDate not supplied

[The physician facing death].

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Death↗

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Hyperthyroidism with concurrent thyroid cancer.

The occurrence of thyroid malignancy is considered a rare event in hyperthyroid patients. With the aim of assessing the clinical relevance of this association, we have analyzed the incidence of thyroid cancer in hyperthyroid patients treated by surgery. The incidence of thyroid cancer was retrospectively evaluated in 202 hyperthyroid patients who underwent thyroidectomy during a twenty-year period. A thyroid cancer was diagnosed in 12 cases (5.9 per cent). Histologic examination revealed the presence of papillary carcinoma in 9 cases, follicular carcinoma in 1 case and Hürthle cell carcinoma in 2 cases. The association between thyroid cancer and hyperthyroidism was more frequent in toxic adenomas (17.8 per cent) than in toxic diffuse (5.3 per cent) or multinodular goiters (1.7 per cent). In 8 patients they presented as an occult carcinoma (maximum diameter below 1 cm), but unfavourable histologic features, such as local invasiveness and multifocality, were found in 5 of them. Follow-up data indicate that all 12 patients are currently alive and apparently free of disease. Hyperthyroid patients, particularly those affected by toxic adenomas, should be carefully evaluated to exclude the presence of concurrent malignancy. A special attention should be made moreover to the presence of "occult" lesions that, in our study was characterized in a higher proportion (62.5 per cent) of cases, by unfavourable histologic features.

Adult↗

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