Search PubMed⌕ Search

Biomedical subjects

J D Wiener

Publications and source records attributed to J D Wiener.

15 recordsLinked to original sources
PubMed1988

Long-term follow-up of patients with residual thyroid autonomy after surgical treatment of Plummer's disease.

Residual autonomously functioning tissue after surgical treatment of Plummer's disease was previously shown to be present in 18 of 87 patients; no clear symptoms were found in these cases. In the present study the results are presented of a second follow-up study in 15 of these 18 patients, an average of 12.2 years after the operation (or 5.8 years after the previous study). Overt hyperthyroidism was found in one case, minor (scintigraphic and/or biochemical) signs of progression in nine others. It is concluded that clinical recurrence may eventually develop in some operated patients, but rarely within ten years.

Adolescent↗
PubMed1985

Autoimmunity and the pathogenesis of localized thyroid autonomy (Plummer's disease).

The pathogenesis of Plummer's disease (localized thyroid autonomy) is incompletely known. It has been shown that a normal thyroid follicle can harbour cells with widely different properties, and hyperactive follicles may arise from cells with both high replicating and hormonogenic potencies under the influence of chronic mild stimulation. We now find thyroid growth-stimulating immunoglobulins (TGI) to be present in low or intermediate titre in the serum of 7 of 9 patients with Plummer's disease. Haemagglutinating antibodies against thyroid microsomal antigen were present in low titre in two of these as well as in three of 21 other patients with this disorder. Two of the patients had a suppressible goitre in addition to the autonomous nodule. One of these is described in more detail. The possibility is discussed that autoimmunity may play a pathogenic role in Plummer's disease. TGI, in relatively low titres as found here, could exert the chronic mild stimulation supposed to be the prime event in the generation of hyperactive follicles. Whether autonomy is intrinsically present in these follicles or triggered by stimulation, remains to be established. Hyperthyroidism supervenes only when the mass of autonomous cells surpasses a certain limit. It appears that these patients with Plummer's disease should be included in the multidimensional spectrum of autoimmune thyroid disease.

Adenoma↗
PubMed1979

Evaluation of cold areas on the thyroid scan with 99mTc-bleomycin.

The value of 99mTc-bleomycin scintigraphy in the evaluation of cold areas on a 99mTc-pertechnetate scan was investigated in 35 patients. A histological diagnosis was obtained in 31 patients. Only one of the six malignant lesions was considered as positive and two as doubtful. Of the remaining 25 patients with non-toxic colloid goitre, one was clearly positive and four were doubtful. These results indicate that 99mTc-bleomycin scintigraphy is not a valuable procedure in the further evaluation of patients with cold lesions.

Bleomycin↗
PubMed1979

On the natural history of Plummer's disease.

Plummer's disease (autonomous goiter) presents a spectrum of forms, raging from solitary autonomous thyroid nodules to numerous small autonomous areas, and from unequivocal to servere hyperthyroidism. Progression is often very slow, but data on long-term follow up are scare, contradictory and limited to solitary nodules. We re-examined 58 untreated patients on one or more occasions. Follow-up time ranged from 1 to 12 years (average 4 years). There were gross clinical or scintigraphic changes in 13 patients. Three included six euthyroidal patients who became (mildly) hyperthyroid, one with a change from single to numerous "hot spots," and one in which the radionuclide disappeared in one of two separate autonomous areas. Minor changes were seen in 14 patients. Changes occurred irrespective of the scintigraphic pattern. In contrast, progression was very rapid in two of 300 other patients with the disease, leading to fatal thyrotoxic crisis withing three months in one. In another patient, transient hyperthyroidism was documented after excessive iodine administration. It is concluded that patients may be left untreated as long as serious complaints and clinical suspicion of associated malignancy are absent.

Adenoma↗
PubMed1977

Evaluation of cold areas on the thyroid scan with 99mTc solcocitran.

Cold areas on a 99mTc pertechnetate thyroid scan were reevaluated using 99mTc Solcocitran in 31 patients. In 27 patients surgical specimens were obtained for histologic studies. Of 20 benign lesions, five showed a relatively increased uptake of 99mTc Solcocitran. Two of seven malignant lesions were interpreted as positive on the 99mTc Solcocitran scan. This study indicates that 99mTc Solcocitran is not a valuable radiopharmaceutical for differentiating cold areas.

Citrates↗
PubMed1976

Ultrasonic examination of the thyroid gland. Possibilities and limitations.

In 440 patients with various thyroid disorders scintiphotography and ultrasonography were carried out. For ultrasonic examination both the A-mode and B-mode display technics were employed, included in the study were 324 patients with hypofunctioning solitary nodules; a histopathologic diagnosis could be obtained in 151 of these. The method proved to be especially valuable for differentiating between solid and cystic nodules. This is of practical importance because completely cystic nodules are nearly always benign and may be treated by thin needle puncture with aspiration of the cyst fluid. In addition, ultrasonography is of some value in making a better functional classification of nodules, better estimating the size of the thyroid and in the follow-up of patients with various thyroid disorders who are under treatment or untreated. Differentiating between benign and malignant solid nodules was not possible with the technic used. The examination can be safely carried out in pregnancy. The limitations of the technic are discussed.

Adenocarcinoma↗
PubMed1976

Triiodothyronine withdrawal-a possible test for hypothalamic-pituitary-throid adequacy.

The aim of this study was to develop a test which could be used as a complement to the assay of serum TSH and the TRH test in the evaluation of hypothalamic-pituitary-thyroid adequacy. When T3, 75mug per day, was given to healthy subjects for 7 days (days 1-7), a significant rebound of serum TSH over the basal value was found on at least two of days 15-17 in nine of ten cases, provided potassium iodide, 10 mg per day, was also given on days 6-16. A much more pronounced rebound of TSH was obtained when thyroid hormone release was more rigorously blocked with the following medication: 125 mug T3 on days 1-7, 500 mg KI on days 1-16, and 400 mg of a slowly resorbed lithium carbonate preparation on days 1-16. In the latter case TSH rose from an average basal value of 0.96 muU/ml to a mean of 3.41 muU/ml on day 17 in 10 healthy subjects. In a subsequent experiment a similar TSH rebound was obtained with with 125 mug T3 (days 1-7) and 500 mg KI (days 1-16) only. The mechanism whereby the TSH rebound is brought about, remains to be established. One possibility is a transhypothalamic action. In this case the procedure may prove useful as a clinical test for the detection of slight degrees of hypothalamic insufficiency which cannot be diagnosed with certainty by the TRH test. The present experiments provide indirect evidence for a suppressive action of comparatively small doses (10 mg per day) of KI on thyroid hormone release in healthy subjects.

Humans↗
PubMed1975

Evaluation of cold areas on the thyroid scan with 67Ga-citrate.

Cold areas on 131I or 99mTc thyroid scans were re-evaluated using 67Ga-citrate in 134 patients. In 62 patients surgical specimens were obtained for histologic studies. Of 46 benign lesions, all had negative 67Ga scans, and 67Ga scans in 5 of the 16 lesions judged to be malignant were positive. It was thought that the sensitivity of the method did not warrant its use for routine screening in evaluations of malignancy of thyroid nodules.

Gallium Radioisotopes↗