Thyroid volume of 1397 German and 303 Swedish adults were estimated by sonography. Thyroid size of 6-16 year old Germans (n = 619) was determined and compared with findings on palpation. Thyroid volume was more than twice as great in German (21.4 +/- 15.6 ml, mean +/- SD) than in Swedish adults (10.1 +/- 4.9 ml). The echopattern was abnormal in 16% of the Germans and in 3.6% of the Swedes. German children have a thyroid volume ranging from 1.8 +/- 0.4 ml at 6 years to 10.8 +/- 6.0 ml at 16 years of age. Palpation is by comparison an unreliable method for determining thyroid size. In Germany, the iodine excretion was less in children (n = 619, 39.5 +/- 30.5, 34.1 micrograms I/g creatinine, mean +/- SD, median) than in adults (n = 1193, 83.7 +/- 94.4, 62.6), (P less than 0.001) and much lower than that observed in Sweden (adults n = 98, 170.2 +/- 93.3, 141.4; 13 year olds n = 113, 172.9 +/- 224.1, 124), (P less than 0.0001). Serum thyrotropin concentration was significantly higher (P less than 0.001) in Sweden (n = 62, 1.49 +/- 0.82 mU/ml), than in Germany (n = 91, 0.97 +/- 0.52 mU/ml), while serum thyroglobulin was increased in Germany (n = 91, 72.6 +/- 50.6 micrograms/l) as compared to Sweden (n = 62, 23.5 +/- 17.4), (P less than 0.0001). These results indicate the goitrogenic effect of iodine deficiency and the continuing need for an effective iodine prophylaxis in the FRG.

The automatic determination of hormone levels in serum by column chromatograhoic methods using a 25 channel peristaltic pump, allows the simultaneous chromatography of 25 samples. The different volumes which are necessary for the successive elution steps are set by the tubing size of the pump and by a preset switch clock. The eluates from the 25 columns are collected simultaneously in fractionated volumes which are also determined in the same electronic clock device. The assays so far adapted to this principle are reviewed: Serum thyroxine (competitive protein binding assay), T3-uptake test (dextran gel filtration), triiodothyronine (radioimmunoassay) and cortisol (competitive protein binding assay or radioimmunoassay). The main advantages of this procedure are increased frequency, improved specificity and standardization at lower costs for these methods. The principle of simultaneous column chromatography appears to be most suited for assays, which require various extraction steps prior to the determination of the hormone, since it allows extraction, specific protein binding and bound/free separation on only one column.

Bei 72 Patienten wurden TSH-Teste mit unterschiedlichen TSH-Dosen durchgefuhrt und der TSH-Effekt am Anstieg der 131J-Speicherung und des Schilddrusenhormonspiegels (PB127J, %T3, T4-J, Index des freien Schilddrusenhormons) gemessen. Die 131J-Speicherung stieg im Mittel um den Faktor 2 an und konnte durch hohere Dosen als 2 X 5 IE TSH nicht weiter gesteigert werden, wahrend der Schilddrusenhormonspiegel durch 3 X 10 IE TSH weiter erhoht werden konnte. In 50% stieg nach euthyreoter Ausgangslage der Index des freien Schilddrusenhormons in den hyperthyreoten Bereich an, in 25% uberstieg er 4,0 pig/ 100 ml, so das der Test besonders bei autonomen Adenomen gefahrvoll sein kann (thyreotoxische Krisen). Beide Verfahren sind geeignet, die TSH-Stimulation der Schilddruse zu erfassen. Ursachen fur das Ausbleiben eines erwarteten TSH-Effektes werden diskutiert.

What is the validity of the TRF-stimulation test for the differentiation of hypothalamic and pituitary secondary hypothyroidism? What is the TSH-response to TRF-stimulation in patients with „autonomous adenoma“ of the thyroid with and without hyperthyroidism?