Sipple's syndrome: A case diagnosed preoperatively

A case of familial Sipple's syndrome diagnosed preoperatively is presented. Clinically, thyroid carcinoma and its metastasis to the cervical and upper mediastinal lymph nodes were first noticed. The diagnosis of medullary carcinoma was strongly suspected on the physical and roentgenologic evidences unique to this variety of thyroid cancer. Clinically pheochromocytomas were asymptomatic, but urinary catecholamine study revealed an increased epinephrine excretion. Furthermore this case had a parathyroid adenoma and preoperative serum parathormone (PTH) was high, though the serum calcium level remained normal. The patient was successfully treated by total adrenalectomy followed by thyroidectomy.     

VITAMIN A AND THE THYROID

High serum levels of thyroxine and triiodothyronine were observed in vitamin A-deficient rats. Thyrotropin (TSH) content of pituitary and Thyrotropin Releasing Hormone (TRH) content of hypothalamus were also raised. It is postulated that in vitamin A deficiency the negative feedback regulation of the brain by thyroid hormone is disturbed.     

Immediate effects of total visual deafferentation on single unit activity in the visual cortex of freely behaving cats. I. Tonic excitability changes

Summary Effects of total visual deafferentation (eye enucleation) on maintained and evoked single unit activity in the cat visual cortex (VC) were studied. Three recording states were distinguished: resting arousal (RA), light sleep (LS) and deep sleep (DS). Two characteristic discharge patterns were noted in deafferented units. One was characterized by rhythmic synchronous firing of several units which was accompanied by high-amplitude slow wave bursts in the EEG (6–8/sec) during RA. Another was the abrupt occurrence of long-lasting spike trains which appeared unpredictively irrespective of vigilance levels. The overall discharge rate tended to decrease after deafferentation in both RA and DS while in LS tended to increase slightly. Three types of VC units were distinguished, as in intact ones, on the basis of the correlation function between the mean discharge rate in RA and its changes in LS. The relative incidence for the three types were different in the deafferented VC. The largest group (47.2%) had a sequence of mean discharge rate DS相似文献   

Multiple neuroendocrine carcinomas (so-called Merkel cell tumours) of the skin

Summary Two neuroendocrine carcinomas of the skin (so-called Merkel cell tumours) are presented. In both cases multiple tumour nodules developed within the course of the disease. The light and electron microscopic observations correspond with the findings reported in other neuroendocrine carcinomas. As a variable morphological and clinical pattern for these tumours seems to exist we consider our two cases with their unique clinical picture to be an obviously infrequent variant of this tumour disease, we propose for it the term multiple neuroendocrine carcinoma syndrome.     

Diagnosis and Treatment of Thyroid Myopathy

Twenty-five patients with thyroid myopathy were referred to our Strabismus Clinic for treatment of diplopia. Prism treatment was effective in only three. When the remaining 22 patients' ocular motility problems and thyroid states were stable, surgical management was undertaken. The preoperative evaluation included visual fields, iris angiograms, binocular diplopia fields, intraocular pressures in different positions of gaze and A-scan echography. The goal of surgery was to produce as large a binocular visual field from primary as possible. Supramaximal recessions of the involved muscles were often needed and adjustable sutures were an important part of the surgical management. The complications encountered included limitation of movement into the field of the recessed muscle, inducement of an A-pattern in downgaze, and postoperative instability.     

DNA fragmentation and DNA repair synthesis induced in rat and human thyroid cells by four rat thyroid carcinogens

Four chemicals that are known to induce in rats thyroid follicular-cell adenomas and carcinomas were assayed for their ability to induce DNA damage and DNA repair synthesis in primary cultures of human thyroid cells. Significant dose-dependent increases in the frequency of DNA single-strand breaks and alkali-labile sites, as measures by the Comet assay, were obtained after a 20-h exposure to the following subtoxic concentrations of the four test compounds: 2,4-diaminoanisole (DAA) from 0.10 to 1.0 mM, 4,4'-methylene-bis(N,N-dimethyl)benzenamine (MDB) from 0.32 to 1.8 mM, propylthiouracil (PTU) from 1.8 to 5.6 mM, and 4,4'-thiodianiline (THA) from 0.032 to 0.18 mM. Under the same experimental conditions, DNA repair synthesis, as evaluated by quantitative autoradiography, was present in thyreocytes exposed to DAA but absent after treatment with MDB, PTU, and THA. Consistent with their thyroid-specific carcinogenic activity, all the four chemicals, administered p.o. in rats in a single dose corresponding to 1/2 LD50, induced a statistically significant degree of DNA fragmentation in the thyroid, whereas any substantial evidence of DNA lesions was absent in liver, kidney, and lung, which, with the exception of liver tumors caused by THA, are not targets of the carcinogenic activity of the four test compounds. These findings indicate that the DNA damage observed in thyroid cells was consistent with the carcinogenicity of the four test compounds, and suggest that DAA, MDB, PTU, and THA might be carcinogenic to thyroid in humans.     

Expression of pendrin in benign and malignant human thyroid tissues

The Pendred syndrome gene (PDS) encodes a transmembrane protein, pendrin, which is expressed in follicular thyroid cells and participates in the apical iodide transport. Pendrin expression has been studied in various thyroid neoplasms by means of immunohistochemistry (IHC), Western blot and RT-quantitative real-time PCR. The expression was related to the functional activity of the thyroid tissue. Follicular cells of normal, nodular goitre and Graves' disease tissues express pendrin at the apical pole of the thyrocytes. In follicular adenomas, pendrin was detected in cell membranes and cytoplasm simultaneously in 10 out of 15 cases. Pendrin protein was detected in 73.3 and 76.7% of the follicular (FTC) and papillary (PTC) thyroid carcinomas, respectively, where pendrin was solely localised inside the cytoplasm. An extensive intracellular immunostaining of pendrin was observed in six out of 11 (54.5%) of positive FTCs and 19 out of 23 (82%) of PTCs. Focal reactivity was detected in one follicular- and three papillary carcinomas, whereas pendrin protein was absent in three of 15 FTC and four of 30 PTC; mRNA of pendrin was detected in 92.4% of thyroid tumours. The relative mRNA expression of pendrin was lower in cancers than in normal thyroid tissues (P<0.001). The pendrin protein level was found to parallel its mRNA expression, which was not, however, related to the tumour size and tumour stage. In conclusion, pendrin is expressed in the majority of differentiated thyroid tumours with high individual variability but its targeting to the apical cell membrane is affected.     

母亲孕期甲状腺功能亢进症和服用抗甲状腺药物对新生儿甲状腺功能的影响

目的探讨妊娠期间母亲合并甲状腺功能亢进症(甲亢)和服用抗甲状腺药物(ATDs)对新生儿甲状腺功能的影响.方法选取1983年1月1日～2003年12月31日在北京协和医院出生、其母亲妊娠期间合并甲亢、出生后5～7 d内测定过甲状腺功能的35例新生儿,根据母亲孕期甲状腺功能状态和开始服用ATDs的时间分组,对新生儿甲状腺功能异常率及其影响因素进行回顾性分析.结果新生儿甲状腺功能异常比例为48.6%(17/35),其中新生儿甲状腺功能低下(甲低)、高促甲状腺激素(TSH)血症分别占29.4%、29.4%,低T4血症和中枢性甲低分别占35.3%和5.9%.甲亢母亲孕晚期才开始服用ATDs组的新生儿甲状腺功能异常显著增加(P＜0.01),早产儿、母亲中重度妊高征、脐血抗甲状腺过氧化物酶抗体阳性和脐血TSH水平异常时,新生儿甲状腺功能异常比例显著增加(P＜0.05).结论母亲甲亢孕晚期才开始治疗可导致新生儿甲状腺功能异常发生增加.对母亲孕期甲亢应做到早期发现、早期治疗,以减少新生儿甲状腺功能异常的发生.     

Interspecialty and intraspecialty differences in the management of thyroid nodular disease and cancer

INTRODUCTION: The management of thyroid cancer includes multiple medical specialties. Physicians from different specialties may vary in opinion regarding the optimal investigation and treatment of patients. Little data exist evaluating the differences within or between various specialties treating thyroid disease. This study aims to examine responses from a variety of specialty physicians closely involved in the medical or surgical management of thyroid disease to provide evidence as to whether any difference exists. METHODS: A cross-sectional survey of attendees at the 5(th) Biennial Course on the Management of Thyroid Nodular Disease and Cancer was conducted using an anonymous electronic touch pad system. Touch pads were given to 213 attendees who were asked to respond to 44 questions. This study analyzes the responses obtained from 19 selected questions (43%) and compares the results between endocrinologists (n = 48), general surgeons (n = 41), otolaryngologists (n = 61), and pathologists (n = 20). RESULTS: Responses were obtained from 69% of endocrinologists, 68% of general surgeons, 72% of otolaryngologists, and 65% of pathologists. Statistically significant interspecialty differences were observed in 12 (63%) of 19 questions. Each question and a summary of responses from all touch pads were recorded. CONCLUSIONS: Significant differences in the attitudes toward, and presumably the practice of, managing thyroid nodular disease and cancer exist between specialties. An understanding of these differences is helpful when working as a multidisciplinary team to optimize patient care.