[Hyperparathyroidism after high-voltage irradiation of the neck].
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Biomedical subjects
Publications and source records attributed to S Karstrup.
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Thyroid function, the clinical occurrence of goitre and ultrasonically determined thyroid gland volume were investigated in 219 healthy subjects randomly chosen from hospital employees. Thirty-five subjects (16%) had a clinically detectable goitre. The frequency of goitre among smokers was higher (32 of 107, 30%) than among non-smokers (3 of 112, 3%), (P less than 0.001). Median thyroid volume was significantly higher in smokers, 26 ml (range 11-55 ml), compared with non-smokers, 15 ml (range 8-37 ml), (P less than 0.001). The median serum thyroglobulin levels were significantly higher and median serum thyrotropin levels lower in smokers compared with non-smokers. There were no differences between the groups regarding serum levels of T4, T3, rT3, free T4 index, free T3 index, thyroglobulin antibodies and 131I uptake (24 h) in the thyroid gland. It is suggested that these findings could partly be due to inhaled thiocyanate and/or increased adrenergic stimulation of the thyroid gland in smokers.
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A 38-year old man developed hypercalcaemia 13 years after treatment with mantle field radiation for Hodgkin's disease. A parathyroid tumour was removed surgically. The histological diagnosis was parathyroid adenoma with marked central fibrosis. Hyperparathyroidism as a possible late complication of radiation therapy of malignant diseases has, to our knowledge, not been described before. Key words: Hodgkin's disease, hyperparathyroidism, irradiation, parathyroid adenoma.
In 50 consecutive patients with Graves' disease treated with PTU, 7 (group 1) developed increasing goitre in spite of unmeasurable TSH. Thyroid variables were compared with those from 10 controls with an ordinary response to PTU (group 2). Serum T4 decreased in group 1 from 246 +/- 47 nmol/l (mean +/- SD) to 40 +/- 9 nmol/l after 6 weeks of PTU treatment and continued to be below the normal range during the next 4 months. In group 2 serum T4 decreased from 190 +/- 35 to 88 +/- 47 nmol/l and stayed in the normal range. Serum T3 was normalized in both groups after 6 weeks but increased to values above the normal range in group 1 after that time. In spite of unmeasurable TSH during the 6 months of treatment in group 1, thyroid volume, determined ultrasonically, increased significantly from 60 +/- 29 to 93 +/- 68 ml (P less than 0.05), but was unaltered in group 2 about 25 ml. Thyroid stimulating antibodies (TSAb) measured by adenylate cyclase activation (normal below 109%) decreased in group 2 from 117 +/- 23 to 90 +/- 17% (P less than 0.01) (6 months of therapy), but increased significantly in group 1, from 201 +/- 47% to a maximum value of 234 +/- 69% (P less than 0.05). TSH binding inhibitory immunoglobulins (TBII) (given as per cent inhibition, normal below 26%) decreased in group 2 from 43 +/- 29 to 29 +/- 27% (P less than 0.05) but were unaltered high in group 1, 66 +/- 25% before therapy and 57 +/- 26% after 6 months of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Thyroid function and thyroid gland volume, ultrasonically determined, were investigated in ninety consecutive untreated patients with Graves' disease. Twenty-eight patients (31%) had no clinically detectable goitre. Median thyroid gland volume was 31 ml (range 12-99 ml). Twenty-one patients (23%) had a normal calculated thyroid volume. Thyroid volume did not correlate with any measure of thyroid function. The lack of a goitre in a large portion of patients with Graves' disease could be responsible for delayed diagnosis and subsequent treatment of these patients.
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Ultrasonically guided fine needle aspiration from 22 ultrasonically suspect enlarged parathyroid glands was performed in 21 consecutive patients with biochemically confirmed hyperparathyroidism. Histologic examination revealed parathyroid tissue in 20 and thyroid tissue in 2 of the 22 ultrasonically suspect parathyroid glands. The aspirated material (21 patients) was analysed for PTH content and compared with the PTH content in aspirates from corresponding thyroid tissue. In all but one, a higher PTH content was found in aspirates from parathyroid glands. Further, the aspirated material (16 patients) was cytologically examined for parathyroid cells. In 10 of 14 histologically confirmed parathyroid glands cells of parathyroid origin were found, but in 4 cases only cells of endocrine origin were seen. The results and the use of fine needle aspiration in relation to the ultrasonic findings are discussed.