Nontoxic Diffuse Goiter Research Articles

TSH receptor autoantibody levels in patients with non-toxic diffuse and nodular goiter

TSH receptor autoantibody levels in patients with non-toxic diffuse and nodular goiter

Uncovering a Causal Connection between Gut Microbiota and Six Thyroid Diseases: A Two-Sample Mendelian Randomization Study.

Recent studies have established associations between the gut microbiota (GM) and thyroid diseases (TDs). However, their causal relationships remain elusive. To investigate this causality, we conducted a two-sample Mendelian randomization (MR) analysis using genome-wide association study (GWAS) data from MiBioGen and FinnGen, with GM as the exposure and six TDs as outcomes. We identified 32 microbial taxa linked to the risk of six TDs. The Clostridium innocuum group, Ruminiclostridium5, and Lachnoclostridium exhibited protective effects against nontoxic diffuse goiter (NDG). Conversely, an increased risk of NDG was associated with Ruminococcaceae UCG002, Alistipes, Methanobrevibacter, Marvinbryantia, and Ruminococcaceae UCG014. Bifidobacterium and Sutterella were protective against nontoxic multinodular goiter (NMG), while the Ruminococcus gauvreauii group and Rikenellaceae RC9 gut group heightened NMG risk. Protective effects against nontoxic single thyroid nodule (NSTN) were observed with Defluviitaleaceae UCG011, Ruminococcus1, and Ruminococcaceae UCG010, whereas increased risk was linked to Alistipes, the Ruminococcus gauvreauii group, and Lachnospiraceae UCG010. Ruminiclostridium9, Victivallis, and Butyricimonas offered protection against thyrotoxicosis with Graves' Disease (GD), while the Eubacterium rectale group, Desulfovibrio, Bifidobacterium, Collinsella, Oscillospira, and Catenibacterium were risk factors. For thyrotoxicosis with Plummer Disease (PD), protective taxa included Butyricimonas and Lachnospira, whereas Dorea, Eggerthella, Odoribacter, Lactobacillus, Intestinimonas, and Phascolarctobacterium increased risk. Lastly, Parasutterella was protective against thyrotoxicosis with toxic single thyroid nodule (TSTN), while increased risk was associated with Sutterella, Oscillibacter, and Clostridium sensu stricto1. Our findings support a causal relationship between specific GM and TDs at the genetic level, laying the foundation for future research into potential mechanisms and the identification of novel therapeutic targets.

Amyloid goiter secondary to familial Mediterranean fever with E148Q mutation: A unique case.

Amyloid goiter secondary to familial Mediterranean fever with E148Q mutation: A unique case.

Статистические связи с дозой облучения и оценка радиационных рисков неонкологических заболеваний эндокринной системы ликвидаторов чернобыльской аварии с учётом возможных ошибок в постановке и регистрации диагнозов

The paper provides research on statistical relationship between endocrine diseases registered in the Chernobyl liquidators and radiation dose they received. Data of clinical and epidemiological observations accumulated at the National Radiation Epidemiological Register (NRER) for the period from 1986 to 2020 were used for analysis. The cohort contained 41,979 liquidators with 107,713 established diagnoses included in the ICD-10 Е00-E90 blocks. Statistical relationship between radiation doses and endocrine diseases was investigated with the use of statistical methods. Statistical Data Mining methods free of apriori guesses for probable doses and diagnoses distribution, models of dose-effect (disease) relationship were used for analysis of statistical relationship between radiation dose and the diagnoses structure. Statistically significant relationship between radiation doses and diagnoses were found in the blocks E01 (iodine deficiency), E04 (goiter), E06 (thyroiditis), E11 (type II diabetes mellitus). Relationships between radiation dose and diagnosis were also found in the E01.2 block (endemic goiter, caused due to iodine deficiency) and in E04.0 block (non-toxic diffuse goiter). Existence of identified statistical relationship is supported with the estimates of excess relative risk (ERR) and the relative risk (RR). The threshold relationship between RR and radiation dose with threshold of 0.3 Gy shows that radiation effect on human endocrine system is a deterministic effect (tissue reactions). Quantitative risks estimates for endocrine diseases in the liquidators are stable in relation to the diagnostic specificity index up to 90%. The general statistic Data Mining method to search relationship between a disease diagnosis and radiation dose is useful for the diseases identification in order to estimate radiation risk with conventual radiation epidemiology approaches.

Захворювання органів травлення в структурі соматичної патології у підлітків, хворих на дифузний нетоксичний зоб

З метою визначення місця захворювань органів травлення в структурі соматичної патології у підлітків із дифузним нетоксичним зобом обстежено 145 дівчаток та 177 хлопчиків 10–17 років із зобом. Проводили ультразвукове дослідження щитоподібної залози, вивчали концентрацію тиреотропіну та вільних фракцій тиреоїдних гормонів. Для діагностики супутньої соматичної патології проводили розширене комплексне обстеження з визначенням показників ліпідного спектра крові. Встановлено, що більшість підлітків (87,0 %) мали два та більше супутніх соматичних захворювання. Хронічну патологію травної системи визначили у 81,5 % обстежених, серед яких переважали функціональні розлади жовчного міхура за гіпотонічним типом (76,3 %). У підлітків із зобом діагностовано патологічні зміни в ліпідному спектрі внаслідок збільшення концентрації бета-ліпопротеїдів (51,9 %), загального холестерину (39,9 %) та холестерину ліпопротеїдів низької щільності (23,7 %), що були найбільш притаманні хворим із несприятливим прогнозом перебігу тиреопатії. Підтверджують тісний зв’язок між показниками ліпідного спектра та тиреоїдного профілю.

Jod-Basedow fenomen - fenomenalna tirotoksikoza?

A Deucalione iodine is an essential mineral vital for the optimal function of the thyroid gland in human beings. Apart from being found in a variety of foods, it is a component of various medications, amiodarone and expectorants, iodine-based swabs used for skin cleaning before interventional and surgical procedures, and iodinated contrast media in medical settings. Jod-Basedow Phenomenon, also known as Jod-Basedow Syndrome or iodine-induced thyrotoxicosis, is a rare cause of thyrotoxicosis that characteristically refers to a paradoxical phenomenon in which large loads of exogenous iodine can cause hyperthyroidism. This phenomenon is mainly seen in populations already at risk for thyroid diseases, such as autoimmune thyroid diseases, prior thyroid surgical history, latent Graves' disease, and prior non-toxic diffuse or nodular goiter formation, or those with underlying kidney disease, such as chronic kidney disease and end-stage renal disorders, which can impact iodine excretion. Typically, it is recognized in those with the administration of a large iodine load, dietary supplement, iodinated contrast media used in conjunction with computed tomography scans, angiography, and various other imaging studies, iodinated antiseptic solutions and oral supplements, or a medication, mainly amiodarone, class III antiarrhythmic drug used in the treatment of recurrent severe ventricular arrhythmias, paroxysmal atrial tachycardia, atrial fibrillation and maintenance of sinus rhythm after cardioversion of atrial fibrillation. Prophylactic medical management of the phenomenon may include antithyroid drugs, methimazole, or perchlorate, to be considered for patients at risk for developing iodine-induced thyrotoxicosis that is scheduled for imaging modalities by using iodinated contrast media. Moreover, the preliminary management modality comprises cessation of iodine administration, avoiding further exposure, administration of beta-adrenergic antagonists, thionamides, corticosteroids, and rarely lithium. Prognosis is usually favorable, although a small percentage of cases could suffer permanent sequelae from iodine-induced thyrotoxicosis. Nevertheless, complications are remarkable including thyroid storm, permanent hyperthyroidism, atrial fibrillation, and fetal hypothyroidism with goiter development, in terms of ordering iodinated contrast media in pregnants. Jod-Basedow Phenomenon should not be overlooked and should be managed by an interprofessional healthcare team serving and officiating not only to treat it but also to concern themselves, actively in the relevant prophylaxis.

Jodom-izazvan hipertireoidizam - da li ste?

Iodine can be obtained by consumption of the foods that include it or to which it is added. Iodine-induced hyperthyroidism, also known as Jod-Basedow Syndrome, usually rise in the cases of underlying thyroid disease, such as autoimmune thyroid disease, latent Graves disease, non-toxic diffuse or nodular goiter or previous thyroid surgery. Iodine-induced hyperthyroidism is frequently self-limited with a period of 1-18 months after the discontinuanceation of iodine supply/replation. The prognosis is frequently favorable, the majority returns to the baseline hormonal status. The long-term outcomes of Jod-Basedow effects remain unknown due to the scarcity of phenomenon. Nonetheless, it is remarkable that treatment, devoted to the underlying thyroid diseases, should be addressed after resolution of the acute episode. Furthermore, an interprofessional health care team must serve and officiate not only to treat iodine-induced hyperthyroidism, but also to concern themselves actively in prophylaxis.

The features of the functional condition of the GH—IGF­1 system in adolescent boys with different course of puberty and nontoxic diffuse goiter

Objective — to assess the production of growth hormone(GH) and insulin-like growth factor 1 (IGF­1) in adolescent boys taking into account the state of the thyroid system and the course of puberty.Materials and methods. In 233 adolescents 14—17 years old, the state of the thyroid system was studied, the degree of sexual and physical development was assessed. The following groups were identified: the control group — healthy adolescents; adolescents with a normal volume of the thyroid gland and delayed sexual development (DSD); adolescents with nontoxicdiffuse goiter (NDG) and normal sexual development; adolescents with NDG and DSD. In the blood serum, the level of GH, IGF­1 and sex hormones was determined by the radioimmunoassay; thyrotropin, free thyroxine and free triiodothyronine by enzyme immunoassay. Mathematical processing of the obtained results was carried out using the SPSS Statistics 17.0 and Excel software packages with the description of the main statistical parameters of the series.Results and discussion. Adolescents with NDG and normal sexual development had a level of GH ((3.65; 1.00—8.15) IU/l) and IGF­1 ((290.80; 157.00—370.00) ng/ml), which was not significantly different from the control, due to a wide range of values. In adolescent boys with low growth, delayed sexual development and NDG, the lowest level of basal GH and IGF­1 was determined. Among adolescents with NDG, low growth and DSD, the lowest level of basal IGF­1, GH and reduced reserve capacity of somatotrophs were recorded. The close relationship between the functional state of the GH—IGF­1 system, thyroid and sex hormones was confirmed by regression analysis, and the nature of the relationship between them depended on the course of puberty and the presence of goiter.Conclusions. In adolescents with delayed sexual development and nontoxic diffuse goiter there is a decrease in the functional activity of the GH—IGF­1 system, which leads to a slower growth rate and the formation of a body weight deficit.

Study of<sup> 99m</sup>Tc Pertechnetate Radiopharmaceuticals in Relation to Thyroid Hormone for Toxic and non-Toxic Diffuse Goiter

Abnormalities of the thyroid gland in the form of enlargement of the thyroid gland are called a goiter. Goiter is divided into two types, namely toxic and non-toxic diffuse goiter. Diagnosis could be done with thyroid scan (in vivo) and test for thyroid hormone value (in vitro). Thyroid scan is applied by giving injection of 99m Tc Pertechnetate as much as 2 - 5 mCi intravenally in the arm and then thyroid gland and salivary glands imaging were conducted in the fifth minute, tenth minute and fifteenth minute using gamma camera. Thyroid hormones test in blood is done with radioimmunoassay method. The same pattern showed the accumulation polad of the radioactive number from quotation of salivary glands. The accumulation percentage activity of 99m Tc Pertechnetate in thyroid gland for the case of toxic diffuse goiter is larger than the case of non-toxic diffuse goiter. The results of this study indicate that the predictors for the case of toxic diffuse goiter could be characterized by high thyroid uptake which the the value of T 3 hormone ≥ 3.3 ng/dl, the value of T 4 hormone ≥ 165 nmol/l, and the value of TSH hormone ≤ 0.2 μIU/ml. While the case of non-toxic diffuse goiter could be characterized by low thyroid uptake which the value of T 3 hormone ≥ 1.2 ng/dl, the value of T 4 hormone ≥ 90 nmol/l, and the value of TSH hormone ≤ 1.8 μIU/ml. Received: 14 November 2011; Revised: 18 April 2012; Accepted: 21 April 2012

Lead, cadmium, manganese, cobalt, zinc and copper levels in whole blood of urban teenagers with non-toxic diffuse goiter

The amount of lead (Pb), cadmium (Cd), manganese (Mn), cobalt (Co), zinc (Zn), and copper (Cu) present in whole blood of 118 teenagers were determined by atomic absorption spectrometry. The blood samples of 23 healthy teenagers were compared with the blood samples of 95 adolescents who were diagnosed with non-toxic diffuse goiter (NTDG). The study was aimed at examining whether in addition to mild iodine deficiency other trace elements could contribute to the development of non-toxic diffuse goiter. The results indicated that the levels of Pb, Cd and Mn in the blood samples of teenagers diagnosed with NTDG were higher than that in healthy children. Also, the results indicated that higher levels of metals were present in the blood samples with NTDG in adolescent patients who lived in areas with a higher amount of pollution.

The condition of thyroid gland in patients with chronic renal failure on a long-term hemodialysis

To lean the condition of thyroid gland and thyroid function in patients with chronic renal failure on a hemodialysis. A total of 234 patients (105 males and 129 females) with chronic renal failure who are being treated by a long-term hemodialysis from 1 to 167 months, living in different city of Eastern Siberia were examined. All patients included in the study have ultrasonografic scan of thyroid. Free thyroid hormones, thyrotropin and thyroid peroxidase antibodies blood levels were determined. Among the examined cases in 60 (25.4%) was diagnosed thyroid disease (autoimmune thyroiditis without dysfunction, subclinical hypothyroidism, nontoxic diffuse or nodular goiter) for the first time. In 102 (43.6%) of cases the thyroid disease has not revealed, in 39 (16.7%) euthyroid sick syndrome type 1 or 2 was determined.

Efficiency of iodine prophylaxis in pregnant women with nontoxic diffuse goiter in a mild iodine-deficiency area

Thirty-four pregnant women with nontoxic diffuse goiter (NDG), living in a mild iodine-deficiency area, were examined. The absence of iodine prophylaxis causes a higher than normal increase in thyroid-stimulating hormone levels by the end of pregnancy and a high frequency (87.5%) of hypothyroxinemia In the second half of pregnancy. These unfavorable events are prevented by the administration of iodine in a daily dose of 150-200 g; the early initiation of iodine prophylaxis is most effective. In women with NDG, pregnancy is most commonly complicated as threatening miscarriage, particularly in those who have not received iodine prophylaxis. Smoking during pregnancy enlarges the thyroid, which is not prevented by iodine prophylaxis.

Relationship between thyroid autoimmunity and Yersinia enterocolitica antibodies.

It has previously been proposed that subclinical Yersinia enterocolitica infection may play a role in autoimmune thyroid disease (AITD). In this study, we investigated the relationship between the thyroid autoantibodies and the antibodies that produced against different serotypes of Y. enterocolitica. A total of 215 subjects were included into the study (65 newly diagnosed Graves' disease [GD], 57 Hashimoto's thyroiditis [HT], 53 nontoxic diffuse goiter [NTDG], and 40 subjects for control group [CG]). Thyroid receptor antibodies (TRAb), thyroid and agglutinating antibodies against Y. enterocolitica serotype O:3, O:5, O:8, O:9 were measured in the blood samples. The highest incidence of Y. enterocolitica antibody positivity was measured in GD (53.8% for O:3, 29.2% for O:5, 44.6% for O:8, and 40% for O:9) and followed by HT. In patients with GD, TRAb levels were also higher than in patients with HT, NTDG, and CG. There was no difference between NTDG and CG in respect to the titer levels and the positivity of both TRAb and Y. enterocolitica antibodies. There was also a weak linear correlation between TRAb level and the titer of antibodies against Y. enterocolitica antigens. It can be concluded that Y. enterocolitica infection may play a role in etiology of GD in Turkey.

Prevalence of thyroid diseases in patients with acromegaly: results of an Italian multi-center study.

Acromegaly is frequently associated with the presence of thyroid disorders, however the exact prevalence is still controversial. An Italian multicenter study was performed on 258 patients with active acromegaly (high levels of IGF-I and lack of suppression of serum GH levels below 2 microg/l after an OGTT). The control group was represented by 150 patients affected by non-functioning and PRL-secreting pituitary adenomas. Two hundred and two out of 258 acromegalic patients (78%) were affected by thyroid disorders with a significantly higher prevalence with respect to the control group (27%, p<0.0001). One hundred and three patients presented (39.9%) non-toxic nodular goiter, 46 (17.8%) non-toxic diffuse goiter, 37 (14.3%) toxic nodular goiter, 1 toxic diffuse goiter (0.4%), 12 (4.6%) Hashimoto's thyroiditis, 3 (1.2%) thyroid cancer. Two patients presented a co-secreting TSH pituitary adenoma. Thirty-six patients had been previously treated for various thyroid abnormalities. Among the 222 acromegalic patients never treated for thyroid disorders thyroid ultrasonography was performed on 194 subjects. Thyroid volume in patients with thyroid abnormalities was 28+/-17.5 ml (median 23) while it was 10.8+/-3.6 ml (median 10) in patients without thyroid disorders (p<0.0001). Thyroid volume was correlated with the estimated duration of acromegaly (r=0.7, p<000.1), but not with age or with serum GH, IGF-I and TSH concentrations. Thyroid volume was higher in acromegalic patients than in the above control population (23.5+/-16.9 ml vs 13.9+/-12.8 ml, p<0.0001). In 62 acromegalic patients 101 fine-needle biopsies of thyroid nodules were performed; 7 nodules were suspicious and the patients were submitted to thyroid surgery: papillary thyroid carcinoma was found in 3 patients. In conclusion, in a large series of acromegalic patients an increased prevalence of thyroid disorders (78%), particularly non-toxic nodular goiter, has been observed. Thyroid volume, evaluated by ultrasonography, was correlated to the estimated duration of acromegaly. Finally, the prevalence of thyroid carcinoma was slightly increased than in the general population.

On the frequency of thyroid diseases in outpatients in an ENT clinic.

The prevalence of thyroid diseases was studied in the ENT department of Kobe Teishin Hospital. Between January 1990 and June 1994, 6,348 outpatients (3,004 women and 3,344 men) visited the ENT department with problems of ear, nose, and throat. Among them 114 patients (82 women and 32 men) were revealed to have thyroid diseases (1.8%). The prevalence of thyroid diseases increased in patients over the age of 40 (4.6% for 40-80 year aged women, 1.6% for 40-80 year aged men). The male/female ratio was about 1:2.7. There was no subjective symptom in 86.8% of the patients. The prevalence of Hashimoto's thyroiditis was 53.5%, nontoxic diffuse goiter 16.7%, cyst(s) 8.8%, adenoma 7.0%, nontoxic nodular goiter 4.4%, subacute thyroiditis or acute exacerbation of Hashimoto's thyroiditis 4.4%, Graves' disease 1.8%, thyroid carcinoma 1.8%, adenomatous goiter 0.8%, and primary hypothyroidism 0.8%. Visible goiter was observed in only 5 patients and 93% of the patients had palpable but not visible thyroids. Therefore, it is important to palpate the thyroid gland during examination of the neck not only in women but also in men. Hashimoto's thyroiditis is thought to be increasing in frequency and is becoming a more important disease in the ENT clinic.

Ultrasound scanning assessment of L-Thyroxine treatment effectiveness in a group of children with diffuse goiter

Ultrasound scanning is an accurate and objective method to assess thyroid volume; therefore it is useful to evaluate the effectiveness of L-thyroxine treatment in reducing goiter size, especially in children where clinical evaluation is inaccurate. In this prospectic study we evaluated the effectiveness of one-year L-thyroxine treatment in a group of children with nontoxic diffuse goiter coming from an area with low iodine intake. We examined 11 children (7 females, 4 males), age range 9-14 years. At clinical examination, 6 patients had a goiter classified Ia (according to WHO criteria), 4 had a class Ib and only 1 had a class II goiter. In order to achieve an accurate goiter evaluation, the thyroid volume was determined by ultrasonic scanning with a 5 MHz linear probe before and after treatment. Patients were given a dose of L-thyroxine (1.5-2.0 micrograms/kg/die) in order to significantly reduce serum TSH levels (from 1.8 +/- 0.6 to 0.8 +/- 0.5 mU/l, mean +/- SD). Patients were reexamined at 12 months of therapy and again at 10 months after therapy withdrawal. A significant reduction of the goiter volume (greater than 20%) was obtained in 6/11 (54%) patients, although serum TSH levels were fully suppressed only in one. The mean goiter size reduction in "responders" was -31.2 +/- 9.3% (m +/- SE). After therapy withdrawal goiter size increased in the majority of cases (in 4/11, greater than 20%). Our study demonstrates that L-thyroxine treatment is effective in reducing goiter size in the majority of children with a diffuse goiter.(ABSTRACT TRUNCATED AT 250 WORDS)

Thyroglobulin Autoantibodies in Children and Adolescents: Its Relation to Thyroid Disease

Thyroglobulin autoantibodies were detected in 23 of 146 (16%) consecutive patients admitted to hospital because of other than thyroid diseases. A thyroid disorder was found in 9 of the 20 children who underwent thorough examination (45%). Two had an autoimmune thyroiditis, and 5 had nontoxic diffuse goiter. One child had a granulomatous thyroiditis, and 1 had a secondary hypothyroidism. Twelve children (60%) had a positive heredity for thyroid disease, and 7 (35%) had another autoimmune disease. Therefore, in children with positive heredity for thyroid disease or with another autoimmune disease, evaluation of the thyroid function is recommended.

Factors affecting suppression of endogenous thyrotropin secretion by thyroxine treatment: retrospective analysis in athyreotic and goitrous patients.

Factors affecting TSH suppression by L-T4 administration were retrospectively evaluated in 452 patients: 180 who were athyreotic after total thyroidectomy and remnant radioiodine ablation for differentiated thyroid carcinoma and 272 with nontoxic diffuse or nodular goiter. All patients were considered clinically euthyroid. TSH secretion was assessed by iv TRH stimulation testing. The T4 dose associated with an undetectable basal serum TSH level and no increase in serum TSH after TRH administration (suppressive dose) averaged 2.7 +/- 0.4 (SD) micrograms/kg body weight (BW)/day in athyreotic patients and 2.1 +/- 0.3 micrograms/kg BW/day in goitrous patients (P less than 0.001). The 25th-75th percentile intervals were 2.5-2.9 micrograms/kg BW/day for athyreotic patients and 1.9-2.3 micrograms/kg BW/day for goitrous patients. The suppressive dose of T4 was dependent in both groups on patient age, younger patients needing higher doses than older patients. The duration of treatment also proved to be an important parameter, since in both groups the percentage of patients with suppressed TSH secretion increased if TRH testing was carried out after at least 6 months after the initiation of therapy. Serum total T4, total T3, free T3 (FT3), free T4 (FT4) index, and FT3 index values did not differ in the two groups and were significantly higher (P less than 0.001) than in normal subjects. Mean serum FT4 was significantly higher in athyreotic patients than in goitrous patients with suppressed TSH secretion. Among athyreotic patients with suppressed TSH secretion, 24% had elevated serum FT4 and FT3, and 47% had elevated serum FT4 alone. Of goitrous patients with suppressed TSH secretion, 20% had elevated serum FT4 and FT3, and 27% had elevated serum FT4 alone. On the other hand, 35% of athyreotic patients and 14% of goitrous patients whose TSH secretion was not suppressed had elevated serum FT4. Serum sex hormone-binding globulin concentrations were measured in 3 groups of goitrous women. Values above normal limits were found in 13/26 patients (50%) with high serum FT4 and FT3, in 4/30 patients (13%) with elevated serum FT4 alone, and in 1/25 patients (4%) with normal FT4 and FT3. TSH suppression requires daily doses of T4 between 2.5 and 2.9 micrograms/kg BW in athyreotic patients and between 1.9 and 2.3 micrograms/kg BW in goitrous patients, with appropriate adjustments in relation to the age of the patient; Assessment of the adequacy of treatment should not be carried out before 6 months after the institution of therapy.

Further studies on thyroid growth-stimulating immunoglobulins in euthyroid nonendemic goiter.

Sixty-two consecutive patients with sporadic euthyroid goiter (57 women and 5 men) from noniodine-deficient areas, including 15 patients with diffuse goiter, 39 patients with multinodular goiter, and 8 patients with a single nodule, were studied for the presence of serum thyroid growth-stimulating immunoglobulins (TGI) by the ultrasensitive cytochemical bioassay based on DNA cytophotometry (Feulgen-cytochemical bioassay). Using strictly specified conditions, 43 patients (67%) were positive. Values tended to be high in diffuse goiter, nodular goiters reccuring after partial thyroidectomy, and those with recent growth. Thirty-seven individual immunoglobulin (Ig)-rich fractions obtained by ammonium-sulfate precipitation from 20 normal subjects, 13 atrophic thyroiditis patients, and 4 dyshormonogenetic goiter patients were tested similarly, and only 3 gave positive growth assays. These results lend further support to our concept that a majority of patients with sporadic nontoxic simple goiters have a variant of thyroid autoimmune diseases separate from lymphocytic thyroiditis. With regard to assays thought to reflect activities of TSH receptor antibodies, none of 20 tested Ig preparations stimulated thyroid cAMP production. The TSH binding inhibition assay gave weak positive activity, but failed to correlate with either TGI or TSH unresponsiveness to TRH. These findings suggest that sporadic goiter TGI is not directed to the TSH-binding site. Dose-response studies performed with Igs of patients with nontoxic goiters and with human TSH standard and goitrous hyperthyroid Graves Igs as controls all revealed bell-shaped responses. Similar maximal values were reached regardless of the growth stimulus applied. However, approximately 10 times more Ig was needed to reach maximal responsiveness in sporadic goiter than in goitrous Graves' disease (i.e. 125-500 micrograms vs. 15-125 micrograms Ig/ml culture fluid). The optimal dose of human TSH ranged from 0.01-1.0 microU/ml. The assays in the present series of the 62 consecutive patients with nontoxic diffuse or nodular goiter were all carried out with a fixed amount of 125 micrograms Ig/ml and considering a value above 5% of cells in the S-phase as a positive assay. Some Ig preparations negative for TGI at this concentration may contain TGI when tested using other doses, and these are a prerequisite to assess the potency of growth antibodies in individual patients.

Congenital iodide organification defect accompanied by a large nodular goiter. A case report.

A girl who had a nontoxic diffuse goiter with a congenital organification defect of iodide was first seen at the age of 8 years, and since then she has been followed up for a long period. The nodularity of the thyroid gland had gradually progressed, because of intermittent failure of ingestion of thyroid hormone preparation which was followed by excess TSH secretion. 18 years later, a nodular goiter developed and the patient underwent subtotal thyroidectomy. In order to prevent the development of nodular change in the thyroid gland in this disorder, supplemental thyroid hormone medication should be started as soon as the diagnosis is confirmed, and the therapy should be carried out regularly.