Schilddrüsenvolumina und Jodversorgung 6- bis 17jähriger Schüler

[Iodine-rich thermal water in cure and rehabilitation from the perspective of the thyroid gland]

Bei einzelnen Schilddrüsenerkrankungen (Immunthyreopathie Morbus Basedow, Immunthyreopathie Hashimoto, Struma mit Autonomie) sollte eine übermäßige Jodzufuhr vermieden werden. Betreffend alimentärer Jodzufuhr gibt es dazu reichliches Informationsmaterial. Kuranwendungen werden zu einem breiten Indikationsspektrum eingesetzt und tragen einen wichtigen Teil zur Therapie gerade chronisch degenerativen Erkrankungen, zur Rehabilitation nach Traumen oder Tumorerkrankungen bei. Eine Jodzufuhr ist auch bei Kuranwendungen mit jodhaltigem Thermalwasser möglich, das Ausmaß der Jodzufuhr ist dabei abhängig von der Applikationsform und der Expositionsdauer. Informationsmaterial dazu ist nur spärlich in der Literatur zu finden. Der Artikel betrachtet jodhaltige Kuranwendungen aus thyreologischer Sicht im Spannungsfeld von positiven und möglichen negativen Auswirkungen einer jodhaltigen Kuranwendung. Neben einem Einblick in die Physiologie und Pathophysiologie des Jodstoffwechsels und Auswirkungen auf einzelne Schilddrüsenerkrankungen wird die Intensität einer Jodaufnahme bei unterschiedlichen Kuranwendungen dargestellt. Eine Übersicht von Kurorten/Thermen mit jodhaltigem Wasser in Österreich und seinen Nachbarstaaten ergänzt von einem Algorithmus zur Selektion von Patienten für eine Kur in Kurorten mit jodhaltigem Wasser wird präsentiert, um mögliche negative jodinduzierte Schilddrüsenfehlfunktionen schon vor Kurantritt zu vermeiden. Dem klinisch tätigen Arzt wird damit eine Unterstützung in der Entscheidungsfindung bei der Auswahl bzw. Ablehnung einer jodhaltigen Kuranwendung für seine Patienten zur Verfügung gestellt.

[The thyroid gland in old age : Physiology and pathology]

In healthy older people the metabolism of thyroid hormones is physiologically altered and can possibly even actively contribute to longevity. This should also be taken into consideration in the treatment of diseases of the thyroid and principally also for younger patients. For example, with progressing age comorbidities become more prevalent and especially in cardiovascular diseases, hyperthyroidism is less well tolerated, and should be treated more aggressively. Benign multinodular goiter also becomes more prevalent in old age and should be surgically treated when causing mechanical symptoms. The treatment concept for malignant diseases should be adapted to the holistic situation of the patient but principally in the same manner as in younger patients. Old and very old patients also benefit from adequate, risk-adapted treatment of thyroid gland diseases so that appropriate diagnostics and clarification are meaningful, regardless of age.

Percutaneous microwave ablation of benign thyroid nodules

Aim: Thyroid nodules represent a common clinical issue. Amongst other minimally invasive procedures, percutaneous microwave ablation (MWA) poses a promising new approach. The goal of this retrospective study is to find out if there is a correlation between volume reduction after 3 months and 99mTcuptake reduction of treated thyroid nodules. Patients, methods: 14 patients with 18 nodules were treated with MWA. Pre-ablative assessment included sonographical and functional imaging of the thyroid with 99mTcpertechnetate and 99mTc-MIBI. Additionally, patients underwent thyroid scintigraphy 24 hours after ablation in order to evaluate the impact of the treatment on a functional level and to ensure sufficient ablation of the targeted area. At a 3-month follow-up, ultrasound examination was performed to assess nodular volume reduction. Results: Mean relative nodular volume reduction after three months was 55.4 ± 17.9% (p < 0.05). 99mTcuptake 24 hours after treatment was 45.2 ± 31.9% (99mTc-MIBI) and 35.7 ± 20.3% (99mTcpertechnetate) lower than prior to ablation (p < 0.05). Correlating reduction of volume and 99mTc-uptake, Pearson's r was 0.41 (p < 0.05) for nodules imaged with 99mTc-MIBI and –0.98 (p < 0.05) for 99mTc-pertechnetate. According to scintigraphy 99.6 ± 22.6% of the determined target area could be successfully ablated. Conclusions: MWA can be considered as an efficient, low-risk and convenient new approach to the treatment of benign thyroid nodules. Furthermore, scintigraphy seems to serve as a potential prognostic tool for the later morphological outcome, allowing rapid evaluation of the targeted area in post-ablative examination.

Iodine deficiency in pregnant women in Austria

BACKGROUND/OBJECTIVES

In Austria, iodine deficiency has been considered to be eliminated owing to table salt fortification with iodine, but whether this also applies to pregnant women is unclear. Even mild iodine deficiency during gestation may lead to neurocognitive sequelae in the offspring.

SUBJECTS/METHODS

This is a cross-sectional investigation of urinary iodine excretion in 246 pregnant women (first trimester n=2, second trimester n=53, third trimester n=191, gestational diabetes mellitus n=115, no gestational diabetes mellitus n=131). The iodine content of morning spot urine samples was determined using inductively coupled plasma mass spectrometry.

RESULTS

Pregnant women in the Vienna area had a median urinary iodine concentration (UIC) of 87 μg/l. Only 13.8% of the cohort were in the recommended range of 150-249 μg/l, whereas 21.5% had a UIC of 0-49 μg/l, 40.2% had a UIC of 50-99 μg/l and 19.5% had a UIC of 100-149 μg/l. In all, 4.9% had a UIC over 250 μg/l. A total of 137 women of foreign origin had a significantly higher iodine excretion compared with Austrian-born women. Maternal or gestational age had no influence on UIC. Although 79 women on iodine supplementation had a significantly higher iodine concentration compared with women without iodine supplementation (97.3 vs 80.1 μg/l, P=0,006), their UIC was below the recommended range, indicating that doses of 100-150 μg per day are not sufficient to normalize iodine excretion. Sodium and iodine concentrations in the urine were tightly correlated (R=0.539, n=61), suggesting that low intake of iodized salt might contribute to insufficient iodine supply.

CONCLUSIONS

This study shows that pregnant women in the Vienna area have a potentially clinically significant iodine deficiency and that currently recommended doses of iodine supplementation may not be sufficient.

[Colour-coded duplex-sonography versus scintigraphy. Can scintigraphy be replaced by sonography for diagnosis of functional thyroid autonomy?]

Since the development of colour coded duplex-sonography (ccds), several attempts have been made to implement this technique for diagnosis of focal lesions in the thyroid. There are controversial discussions on whether ccds might replace thyroid scintigraphy in diagnosis of hyperfunctional thyroid nodules. Aim of this study was the comparison of ccds and thyroid scintigraphy in diagnosis of functional thyroid autonomy.

PATIENTS, MATERIAL AND METHODS

192 patients with thyroid nodules > 10mm detected by conventional sonography underwent thyroid scintigraphy. Additionally, these patients were subjected to ccds of the thyroid. In total, 286 thyroid nodules were examined by scintigraphy, ccds and blood tests.

RESULTS

Thyroid scintigraphy showed 67% of thyroid nodules as hyperfunctional, 19% indifferent and 14% as hypofunctional. Mean 99mTc uptake of hyperfunctional nodules was 2.19%, of indifferent nodules 1.12% and of hypofunctional nodules 1.06% respectively. The ccds allowed perinodular measurement of flow speed (hyperfunctional: 0.23 ± 0.1 m/s; hypofunctional: 0.22 ± 0.1; indifferent: 0.21 ± 0.09), resistance index (hyperfunctional: 1.21 ± 1.16; hypofunctional: 0.62 ± 0.48; indifferent: 0.93 ± 1.02) and pulsatility index (hyperfunctional: 0.97 ± 0.45; hypofunctional: 0.84 ± 0.4; indifferent: 1.04 ± 0.6) in all nodules as well as intranodular measurement in some of the nodules (24% in hyperfunctional, 2% in indifferent and 15% in hypofunctional nodules). Statistic analysis of the obtained ccds data did not show any practically relevant correlations (p>0.05) with 99mTc uptake, basal TSH, fT3 or fT4.

CONCLUSION

Thyroid scintigraphy cannot be replaced by ccds for diagnosis of functional thyroid autonomy. Reliable diagnostics still require a combination of thyroid scintigraphy, sonography and blood tests.

[Thyroid and treatment with amiodarone diagnosis, therapy and clinical management]

Amiodarone is a frequently used antiarrhythmic drug with a high antiarrhythmic potency. However, beside its antiarrhythmic effects Amiodarone also reveals a variety of adverse effects and drug-related complications. The affected organs include the eyes, skin, lungs, nervous system, liver, gastrointestinal tract and the thyroid. The thyroid is one of the most frequently affected organs by Amiodarone. An altered hormone equilibrium always occurs and has to be distinguished from Amiodarone induced hyperthyroidism and hypothyroidism. The differentiation of these states frequently causes problems and may even be a diagnostic and therapeutic challenge in certain cases. The article gives an overview on the interactions between Amiodarone and the thyroid, the diagnostic and therapeutic options and management strategies of patient on Amiodarone therapy in the view of thyroid function.

Descriptive epidemiology of thyroid carcinoma in Carinthia, Austria: 1984-2001. Histopathologic features and tumor classification of 734 cases under elevated general iodination of table salt since 1990: population-based age-stratified analysis on thyroid carcinoma incidence

INTRODUCTION

The aim of the study was to investigate the current thyroid carcinoma (TC) incidence in Carinthia, a former iodine-deficient, goiter-endemic region in Austria with approximately 550,000 inhabitants from 1984 to 2001. Using age-cohort analysis we analyzed the TC incidence under the impact of two regional risk factors: the contamination of Austrian soils by the radioactive fallout in from Chernobyl 1986 and the increased iodination of table salt in a general program of goiter prophylaxis begun in 1991. To evaluate the characteristics of TC incidence, we compared the results of the periods 1984-1989, 1990-1995, and 1996-2001.

RESULTS

A total of 734 TC cases were diagnosed. Papillary, follicular, medullary, oxyphilic, and anaplastic TC accounted for 76%, 18%, 3%, 1%, and 2%, respectively. The female to male ratio was 3:1. The annual incidence rate increased by 8.05% in females and 11.6% in males. TC cases younger than 40 years of age accounted for 22.6%, with a rate increase of 18% per year in young males, the female-to-male ratio decreased from 8.3, 6.1, 2.7 younger than 40 in the compared periods. Along with a further increase in papillary TC incidence and papillary thyroid carcinoma (PTC) follicular thyroid carcinoma (FTC) ratio in the adult population, the ratio tended to decrease in the younger than 40-year-old population. T4 class TC and loco-regional lymph node involvement increased significantly.

INTERPRETATION

The observed changes in TC incidence, particularly in the young population, as in adults, could be linked to the abovementioned risk factors involved in the initiation and early growth of TC, and iodine may play a role in stimulating overall thyroid activity.

Knowledge, Attitudes, and Practices of People in Ulaanbaatar, Mongolia, with Regard to Iodine-Deficiency Disorders and Iodized Salt

In 1995 Mongolia introduced a national programme of salt iodization to eliminate iodine-deficiency disorders. To investigate the extent of acceptability and utilization of iodized salt, a study of people's knowledge, attitudes, and practice (KAP) was carried out in the capital city, Ulaanbaatar, in 1996 and 1997. A total of 838 people (housewives, parents of schoolchildren, post-partum women, and pregnant women) were interviewed about their KAP regarding iodine-deficiency disorders and iodized salt. In addition, the amount of salt consumption at the household level was examined. Over 95% of the study population knew about iodine-deficiency disorders and iodized salt, and most of them received the information from television and radio. About 90% of them had already used iodized salt. The price of iodized salt is a little higher than that of common salt, but it is still affordable for most people. This study demonstrates the possibility of the expansion of the programme nationwide.