Die psychische Belastung behandelter Basedow-Patienten wurde 5 Jahre nach Diagnosestellung in einem rezidivfreien Intervall mit Hilfe psychometrischer Fragebögen erhoben.

Zusammenfassung Die 3 beschriebenen Kasuistiken demonstrieren eindrücklich die typischen klinischen Symptome einer thyreotoxischen hypokaliämischen Lähmung. In 2 der beschriebenen Fälle ließ sich bei persistierend hyperthyreoter Stoffwechsellage durch Zufuhr kohlenhydratreicher Nahrung oder Kortikoide ein akuter Anfall auslösen. Im Falle einer jungen Patientin mit Thyreotoxicosis factitia ließen sich unter bereits euthyreoter Stoffwechsellage bei der Durchführung eines oralen Glukosetoleranztests keine Lähmungen provozieren. Dies hebt nochmals die Behandlung der Hyperthyreose als wichtigsten therapeutischen Schritt hervor. Die Euthyreose stellt einen Schutz vor einer Manifestation der TPP dar. Wenngleich die TPP bislang in der westlichen Bevölkerung als Rarität beschrieben ist, sollte sie bei entsprechender klinischer Symptomatik als Komplikation einer Hyperthyreose mitberücksichtigt werden.

OBJECTIVESeveral studies have suggested that iodine may influence thyroid hormone status, and perhaps antibody production, in patients with autoimmune thyroid disease. To date, studies have been carried out using large amounts of iodine. Therefore, we evaluated the effect of small doses of iodine on thyroid function and thyroid antibody levels in euthyroid patients with Hashimoto's thyroiditis who were living in an area of mild dietary iodine deficiency.METHODSForty patients who tested positive for anti-thyroid (TPO) antibodies or with a moderate to severe hypoechogenic pattern on ultrasound received 250 microg potassium iodide daily for 4 months (range 2-13 months). An additional 43 patients positive for TPO antibodies or with hypoechogenicity on ultrasound served as a control group. All patients were TBII negative.RESULTSSeven patients in the iodine-treated group developed subclinical hypothyroidism and one patient became hypothyroid. Three of the seven who were subclinically hypothyroid became euthyroid again when iodine treatment was stopped. One patient developed hyperthyroidism with a concomitant increase in TBII titre to 17 U/l, but after iodine withdrawal this patient became euthyroid again. Only one patient in the control group developed subclinical hypothyroidism during the same time period. All nine patients who developed thyroid dysfunction had reduced echogenicity on ultrasound. Four of the eight patients who developed subclinical hypothyroidism had TSH concentrations greater than 3 mU/l. In 32 patients in the iodine-treated group and 42 in the control group, no significant changes in thyroid function, antibody titres or thyroid volume were observed.CONCLUSIONSSmall amounts of supplementary iodine (250 microg) cause slight but significant changes in thyroid hormone function in predisposed individuals.

Using a consecutive sample of 19 patients (2 male and 17 female) with decompensated Graves' disease, and against the background of a controversial scientific discussion, we investigated the following questions: 1. Are there indications of an increased predisposition to stress in these patients (or a subgroup) and 2. Is there a link between this and differences in the development of psychopathological complaints? The status of the psychical symptomatology was evaluated using self-assessment questionnaires (STAI X1, X2, BDI, SCL-90-R) at the time of the hyperthyrosis, and after 3 months of and 1 year of antithyroid drug therapy. On the basis of a systematic evaluation of depth-psychology-oriented interviews, a relatively little psychologically stressed group (A) could be distinguished from a relatively severely psychically stressed group (B). In the results from the lists of psychopathological symptoms, group B showed clearly higher summated values, which also remained at a clearly higher level after normalization of metabolism. By incorporating an individual evaluation of the questionnaires, 2 patients could be extracted who, contrary to expectations, showed a worsening of their psychical symptomatology under normalization of metabolism. The results of the depth-psychology-oriented interviews, as well as also the psychological test investigations, support the hypothesis that the earlier differences in research results can be explained by shortcomings in methodology, and that a clear indication of a predisposition to stress is also shown by a subgroup of the Graves' disease patients (in our sample 63%) under euthyrosis.

A heterogeneous enzyme immunoassay for the determination of thyroxine binding globulin (TBG) was developed and assessed in clinical trials in 12 laboratories. The assay is based on the competition principle and employs plastic tubes coated with goat anti-TBG. CV's between 1.4-8.9% for intra-assay precision and 2.9-8.6% for inter-assay precision were found over the concentration range of 4-40 mg/l TBG. In comparative studies using highly purified TBG as standard, values with Enzymun-Test TBG were found to be on average 30% lower than those obtained by various TBG-RIAs. A broad-base study, to determine reference values, was carried out on a group of control persons 18 to 50 years old without previous history of thyroid disease. This study revealed a median of 14.33 mg/l TBG, with 95% of all values between 9.6 and 18.5 mg/l TBG. The median in women of 14.5 mg/l TBG was significantly higher than in men (13.4 mg/l TBG). TBG values in hyperthyroid patients were within the reference range while those in hypothyroid individuals were elevated. Highly elevated TBG values were seen in women receiving oestrogen (median: 22.2 mg/l TBG) and in pregnant women (median: 28.5 mg/l TBG). The T4/TBG ratios made it possible to distinguish between euthyroid, hyperthyroid and hypothyroic subjects (median: 4.9, 11.3 and 1.0, respectively). These ratios were significantly lower in pregnant women (median: 3.1) than in the control persons.

T4-, T3- and reverse-T3 concentrations were measured in the sera of 365 subjects beyond the age of 65 in order to evaluate if the decrease of serum T3 frequently observed in old age can be attributed to old age per se or to concomitant non-thyroidal disease. The results obtained from a carefully selected healthy group of elderly people show that 1) total and free T3 levels are lower in senescence but well within the range for euthyroidism in younger healthy controls; 2) the decrease of serum T3 is more pronounced and occurs earlier in healthy old males than in females, so that for subjects over the age of 75, the upper limit for euthyroidism has to be adjusted by 10% in women and by 20% in men; and 3) there is no low T3 syndrome characterized by decreased serum T3 and increased serum reverse T3, solely due to old age.

A functional diagnosis of the diencephalohypophyseal system was carried out in patients with Sheehan syndrome, chromophobic adenoma, craniopharyngioma, prolactin-producing pituitary tumours, acromegaly, hypothalamo-pituitary dwarfism and constitutional retardation. A combined insulin hypoglycaemia/LH-RH/TSH test was performed to define frequency and extent of anterior pituitary insufficiency. With these illnesses, almost generally, a somatotropic insufficiency (except in acromegaly) was found. An impairment of gonadotropic function was often present, in general a pathologic LH-RH test correlating with a more or less developed androgen deficiency. An adrenocorticotropic insufficiency was found in most patients with sheehan syndrome, chromophobic adenoma and craniopharyngioma while in acromegaly and hypothalamo-pituitary dwarfism it was present less frequently, necessitating a substitution with corticoids. The TRH test reflects only incompletely a secondary hypothyroidism, and can be normal with organic processes of the diencephalo-hypophyseal region, making a T3 and T4 estimation in the blood decisive for a thyroid hormone substitution. A clear-cut separation of the hypothalamic from the pituitary cause of the insufficiency is neither possible with the LH-RH nor with the TRH test.

Die funktionsdynamische Diagnostik des Zwischenhirn-Hypophysensystems erfolgte bei Patienten mit Sheehan-Syndrom, chromophobem Adenom, Craniopharyngiom, Prolaktin-produzierenden Hypophysentumoren, Akromegalie, hypothalamo-hypophysärem Minderwuchs und konstitutionell bedingter Entwicklungsverzögerung. Dabei wurde ein kombinierter Insulinhypoglykämie/LH-RH/TRH-Test angewandt, um die Häufigkeit und das Ausmaß der Hypophysenvorderlappeninsuffizienz zu beurteilen.

Unter Hyperthyreosen werden — nach der Definition der Deutschen Gesellschaft für Endokrinologie — Krankheitsbilder verstanden, bei denen in der Peripherie ein Überschuß an Schilddrüsenhormon vorliegt. Entsprechend ist eine Hypothyreose durch einen Mangel an Schilddrüsenhormon in der Peripherie gekennzeichnet. Unter Peripherie sollten im strikten Sinne die hormonsensitiven peripheren Gewebe aufgefaßt werden, in denen beim Menschen der Hormonüberschuß bzw. -mangel nicht direkt nachgewiesen werden kann. In diesem Sinne stellen Hormonkonzentrationen im Blut lediglich indirekte Parameter zur Beurteilung der Schilddrüsenstoffwechsellage dar. Aus diesem Grunde wird z. Z. intensiv nach einem praktikablen und verläßlichen Verfahren gesucht, das, wie der Grundumsatz, Rückschliisse auf die Wirkung von Schilddriisenhormon an den peripheren Geweben ermöglicht.

During enhanced endogen estrogen production (pregnancy) as well as during exogen estrogen application a rise occurs in TBG concentration in serum, which seems to be dose related. Simultaneously with the TBG there is an increase in total T4 and T3; the concentrations of the free T4 and T3 however decrease. Towards the end of pregnancy AFT4 is significantly decreased, compared to the controls, AFT3 being in the lower normal range. The lower concentrations of the free hormones are also documented by a decline in the T4/TBG and T3/TBG ratios. Normal basal TSH concentration in serum suggest a metabolic state which is still compensated. Oral contraceptives with low estrogen content have no influence on TBG, T4 and T3 concentrations.