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The frequency of thyroid disease has been surveyed in 300 patients with ulcerative colitis (UC) and 600 controls. The controls were drawn from visitors to the general medical wards of the Radcliffe Infirmary and were matched for age and sex with the UC patients. Two observers independently assessed all these subjects for thyroid enlargement of the simple goitre type. Although there were minor variations between the results obtained by the two observers, they found simple goitre in 8.7-6.3 percent among the UC patients compared with 4.3-3.3% percent among the controls; a difference which is significant. A history of thyrotoxicosis was obtained in 3.7 percent of the UC patients compared with 0.8 percent of the controls (p greater than 0.01). In more than half of the UC patients with a history of hyperthyroidism, the hyperthyroidism occurred years before the onset of the colitis. It is therefore highly unlikely that hyperthyroidism is a complication of the colitismpossible reasons for the association of the two diseases are discussed but it is concluded that no satisfactory explanation exists at present.

The thyroxine binding globulin (TBG), thyroxine binding prealbumin (TBPA), albumin, thyroxine (T(4)) and the triiodothyronine uptake test (T(3)-test) values have been estimated in serum of twenty patients with ulcerative colitis (UC) or Crohn's disease. The patient group was compared with twenty healthy control subjects matched for sex and age. The T(4) and the T(3)-test values were similar in the two groups. TBPA and albumin in serum were significantly lower, while the TBG values were significantly higher in the patients than in the controls. Treatment with corticosteroids influenced the results significantly. It is also concluded that in UC and Crohn's disease sometimes both the T(4) and the T(3)-test values can be abnormal so that misdiagnosis of hyperthyroidism is easy to make.

Inflammatory bowel diseases (IBD) are probably multifactorial diseases caused by an interplay of the external and internal environment. External environmental factors revealed in the literature so far can be grouped into four major groups or hypotheses: (a) the sheltered child, (b) infectious agents, (c) dietary factors, and (d) vascular factors. Internal environmental factors mainly concern genetics which have been studied in families or twins. At present, HLA class II antigens are most in focus but also genetic markers such as pANCA. However, the internal environment can be changed by external factors changing the balance of the faecal or mucosa related flora, such as infectious agents or antibiotic treatment. This in turn may upset the building up and degradation of colonic mucin, making the mucosa more vulnerable. The increasing knowledge of external and internal environmental factors might affect our way of treatment in the future. So also may our increasing knowledge of immunology which will probably lead to targeted treatment directed against individual components within the inflammatory cascade.

Between 1971 and 1980 34 children (18 boys and 16 girls) were diagnosed as having Crohn's disease in Orebro county, Sweden, corresponding to a yearly incidence of 6.1 and a prevalence of 41 per 100,000 children. Classical gastrointestinal symptoms were common, but initially only five patients presented with extraintestinal symptoms and had a normal ESR. Of the patients 13 have only been treated medically and 21 have been operated on. Nine of the children have had a quiescent course, whereas 13 had a recurrent and 11 a chronic course. Most of the children have a good quality of life, which we think is the result of a carefully individualized therapy. One child died.