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Hypothyroidism in patients with renal failure (RF) causes many metabolic and clinical problems, and both these diseases can mutually exacerbate their disturbances., Aim: The aim of this study was to evaluate the effect of hypothyroidism, and end-stage renal disease (ESRD) on conversion of thyroid hormones (TH) in patients with ESRD treated with chronic hemodialysis (HD)., Materials and Methods: The study was performed in 74 patients, including 41 women (K) and 33 men (M) aged 28-83 y.o. in 4 groups: G1 - 12 people with ESRD treated with HD and with newly diagnosed hypothyroidism without substitution (6 K and M 6) aged 66,83±12,90 y.o., G2 - 26 patients with ESRD treated with HD without hypothyroidism (10 F, 16 M) aged 58,85±15,52 y.o., G3 - 11 hypothyroid patients without RF (9 K, 2 M) aged 54,73±21,26 y.o., G4 - 25-persons from control group of healthy subjects (16 M, 9 M) aged 51,24±12,58 y.o. In all subjects the concentration of TSH and TH (T4, T3, fT4, TSH, FT3, rT3) were measured and values of conversion factors (T3/T4, FT3/ fT4, rT3/fT4 and rT3/fT3) and binding TH to protein factors (fT4/T4 and fT3/T3) were calculated., Results: Lower concentration of T3 (p=0.012), fT3 (p<0.001) i fT4 (p=0.014) was found in patients without hypothyroidism than in healthy subjects. Renal failure with concomitant hypothyroidism intensify the disturbances of T4 to T3 conversion (p=0.034) and hypothyroidism with concomitant renal failure disrupts binding of T3 to proteins (p=0.001). FT3 to fT4 ratio in renal failure with concomitant hypothyroidism group was significantly lower than in each other group. rT3 concentrations were the highest in healthy subjects., Conclusions: Concomitance of hypothyroidism and end-stage renal disease reduces the conversion of thyroxine to triiodothyronine, but does not increase the production of rT3. Hypothyroidism significantly increases the disorders of thyroid hormones in end-stage renal disease. There is decreased tendency to bind of thyroid hormone to protein in hypothyroidism in patients with end-stage renal disease.

Unlabelled: The impact of subclinical hypothyroidism (SH) on the cardiovascular system has not been well determined. Due to contradictory views on clinical consequences of SH there is no clear opinion on the indications for treatment of this disorder. The aim of study was to analyse the L-thyroxin therapy effect on normalization of cardiac irregularities in patients with SH observed in physical, electrocardiographic (at rest and 24-hour) and echocardiographic examinations., Materials and Methods: 25 patients with SH and 25 in euthyreosis --C were included in the study, mean age +/- SD: SH- 43 +/- 17.4; C--51 +/- 17.2; NS. The frequency of irregularities in the physical, echocardiographic, electrocardiographic (at rest and 24-hour) examinations in both examined groups were compared. The effectiveness of a six-month treatment of SH as well as the impact of normalization of the TSH on results of the above tests were also analyzed., Results: It was observed that SH does not significantly affect results of the physical examination. However, normalization of the TSH decreased differences between the SH and C groups with regard to the frequency of irregularities in rest electrocardiographic examination (SH: 60% vs. C: 24%, p < 0.01). It also reduced the total number of irregularities observed in echocardiographic examination (p < 0.01). The changes included mainly an improvement of systolic and diastolic functions of the left ventricle. Moreover, less intensive supraventricular and ventricular arrhythmia in 24-hour electrocardiographic examination in some patients as well as an average positive correlation (R = 0.420, p < 0.05) between the number of irregularities in this examination and the TSH level were also observed., Conclusions: Normalization of the TSH level after a six-month treatment period contributes to positive changes with regard to essential cardiac parameters in some patients.

Till now there has not been reported data related to the influence of leflunomide on the thyroid gland function of the treated person. The authors described the case of woman with rheumathoid arthritis and hypothyroidism who revealed hyperthyroidism in 7 months after starting leflunomide tablets treatment containing povidone iodine as well. Also both autonomical tissue area in thyroid right lobe and hight TSHRAb level were found. Leflunomid tablets containing povidone iodine in its structure can cause hyperthyroidism in the person with previous hypothyroidism and nodular goiter, probably as a result of immunological reconversion and tissue nodular functional autonomisation. In persons with nodular goitre one should prefer free of povidone iodine leflunomide treatment and also monitor serum thyroid hormone contents and thyroid antibodies as well.

There are discordant opinions about the influence of subclinical hypothyroidism to the fertility of the women. No unequivocal opinion has been presented concerning the purposefulness of the diagnostics process and treatment of the pregnant women with subclinical hypothyroidism. Few clinical studies suggest that there is a connection between thyroid antibodies and infertility, spontaneous miscarriages, implantation failures and fetal malformations.

Hormones have influence on many tissues and organs including the cardiovascular system. This article analyzes fluctuations that happen in a child's cardiovascular system in selected endocrinopathies. We are pointing out the higher risk, in the course of diabetes, of development of arterial hypertension and atherosclerosis including participating mechanisms in their pathogenesis - disorders of the lipid metabolism, hiperinsulinaemia, insulin resistance or/and autonomic neuropathy. We are describing how the increased and reduced action of thyroid hormones on certain molecular pathways in the heart and vasculature causes relevant cardiovascular derangement. In the article, we are signaling also that the cardiovascular consequences of cortisol excess are elevation of blood pressure, obesity, hyperinsulinemia and/or dyslipidemia. This review analyzes the relationship of cortisol excess to these cardiovascular risk factors and to putative mechanisms for hypertension. In reference to clinical studies we are describing how the deficiency of the growth hormone is connected with a development of risk factors of cardiovascular diseases. In conclusion we underlined that early diagnosis and proper treatment of illnesses of the endocrine system can protect our pediatric patients from serious cardiac complications in later years.

The prevalence of depressive disorders in hypothyroidism is the subject of long-term studies and controversies. The studies on big populations appear to confirm a substantially higher prevalence rate of depression in patients diagnosed with hypothyroidism. Considering interdependence between depression and hypothyroidism the possibility of coincidence of the two disorders cannot be forgotten. The aim of the work is a case of late diagnosed hypothyroidism in the course of which a severe depressive episode with psychotic symptoms occurred. A female patient, aged 39, commenced outpatient psychiatric treatment because of sleeplessness in May 2008. In the following months a lack of appetite, skin dryness and hair loss occurred. As a result of hypothyroidism diagnose she started endocrinological treatment in the Center of Thyroid Illness Treatment in Rzeszów. On the 25th of October she was admitted to Psychiatry Department of the Medical University of Lublin after taking clorazepate as a suicide attempt. While being admitted she was heavily depressed, uttered nihilistic delusions, had suicidal thoughts and was disoriented for time. From etiological point of view the situation can be considered in two categories. On one hand psychotic symptoms may have been the climax of the disturbance of the central nervous system function in long-lasting undiagnosed hypothyroidism. On the other hand, the coincidence of the two disorders cannot be excluded. The presented case implicate the role of the early diagnose of hypothyroidism for the prevention of depression.

The case of a 20-year old female, who had been followed because of von Willebrand disease (vWD) was presented in this paper . She had a past history of menorrhagia and bleeding after dental procedures and the activity of von Willebrand factor (vWF) was decreased. Because of suggestive clinical features, the workup for hypothyroidism was performed and the patient was found to have severe hypothyroidism due to Hashimoto thyroiditis. After the institution of replacement therapy with levothyroxine, von Willebrand factor activity returned to normal range and symptoms of von Willebrand disease disappeared. Based on these findings, the diagnosis of acquired von Willebrand syndrome (AvWS) due to hypothyroidism was made. The development of myasthenia led to the final diagnosis of autoimmune polyglandular syndrome type 3 (APS) with myasthenia gravis and vitiligo.

A case of a 32-year-old woman with type 1 diabetes diagnosed 1.5 year before presention. The patient was referred to the diabetology department due to decompensation of diabetes and excessive hypodermic atrophy of both thighs. Early symptoms of lipoatrophy appeared after 1.5-2 months of insulin glargine use, in spite of frequently changed hypodermic needles and injection sites on both thighs. Simultaneously, deterioration of diabetes compensation was observed (hyperglycaemia between meals and in the morning), which was corrected by the patient with extra injections of a short acting analogue. Additional examinations confirmed type 1 diabetes (C-peptide <0.01 ng/ml) with concomitant hypothyroidism in the course oh Hashimoto disease. After change of insulin (Insulatard twice daily, Novo Rapid with meals) and injection site (administration to hypodermic tissues of arms and abdomen was started), diabetes compensation was achieved. At follow-up visit after 12 months, diabetes was still under control - HbA1c 6.8%. Moreover, progress of lipoatrophy is not observed.

Patients with autoimmune type 1 diabetes mellitus have often, besides immune diabetic markers, also other organ-specific antibodies. In many diabetic patients autoimmune thyroid diseases, i.e. Hashimoto thyroiditis and Grave's disease, with silent clinical course can be diagnosed. Because 50% of children with diabetes and significant titres of thyroid autoantibodies (ATA) develop thyroid problems within 3-4 years, examinations of thyroid antibodies should be performed yearly. In cases of significant antibody titres, thyroid function tests and ultrasound assessment are recommended in order to minimize the risk of undiagnosed hypothyroidism in these patients. Coeliac is an other disease commonly coexisting with type 1 diabetes mellitus and autoimmune thyroid diseases. It is recommended that screening for coeliac disease should be part of the routine investigation for all patients. Potential benefits of treatment coeliac disease is more prevalent in individuals with type 1 diabetes mellitus, and when untreated is associated with a number of medical complications, including poor glycaemic control. Identification of patients with coeliac has been facilitated in recent years by serological screening. Initial normal screening does not exclude coeliac and repeated screening is indicated, a positive IgA antibody test to tTG is a more sensitive parameter than EmA for silent coeliac disease in patients with diabetes. Confirmatory small bowel biopsy, however, remains necessary for diagnosis as some patients with positive antibodies may be without histological changes.

Hypolipemic agents, both statins and fibrates, may cause a spectrum of side-effects, including the transient increase in creatine phosphokinase (CPK) activity. Muscle injury may present as common myalgia, non-specific myositis with normal CPK levels, myopathy and in the most serious cases, as rhabdomyolysis. Muscle damage is much more probably in patients with concomittant kidney and liver diseases, hypothyroidism, and serious infections or after some injuries or a heavy physical effort. On the other hand, one of the most common causes of secondary hypercholesterolemia and myopathy is hypothyroidism. This condition, which may enhance the risk of muscle damage in the course of hypolipemic treatment, may sometimes present with an atypical clinical presentation, making its diagnosis challenging. In this article, we present the case of a 50-year-old male physical worker presented with marked dyslipidemia, in whom myopathy was diagnosed during therapy with hypolipemic agents. Cessation of the treatment resulted in the only moderate reduction of CPK activity. Only just the introduction of thyroid hormone supplementation led to regression of symptoms and normalization of abnormalities found in laboratory examinations including remarkable improvement in lipid profile. After several months of observation we consider that hypolipemic treatment probably revealed previously occult autoimmune thyroid disease in this patient.

Thyroid hormones are essential to maintain normal function of many systems including the cardiovascular system. Their excess or deficiency may upset human body homeostasis. Hyperthyroidism leads to cardiovascular system's hyperdynamic status which is characterized by tachycardia, increased difference between systolic and diastolic arterial pressure, significant increase of the stroke volume and improvement of the left ventricular diastolic function. Long-lasting thyrotoxicosis in patient with heart disease may result in atrial fibrillation, deterioration of angina pectoris or congestive heart failure. Hypothyroidism leads to hemodynamic disturbances which are quite different than those observed in hyperthyroidism, but cardiac symptoms are scant in clinical practice. Hypothyroidism's clinical significance is limited to atherosclerosis progression and intensification of ischaemic heart disease symptoms. Both leads to symptomatic cardiovascular system failure or its deterioration. We should emphasize that cardiovascular system dysfunction associated with thyrometabolic disturbances subsides when euthyreosis is restored. It sounds promising that there are reports suggesting a potential advantage of thyroxin treatment in patients with acute or chronic cardiovascular system diseases. These hypotheses result from the observations that heart dysfunction in hypothyroidism is similar to that observed in heart failure.

Unlabelled: Studies performed in recent years in different countries suggest a considerable prevalence of depressive disorders in primary care patients. The aim of our study was the assessment of depressive disorders among primary care patients in Poland., Material and Methods: Three-hundred thirty-three randomly chosen private and public primary care clinics from the whole country took part in the study. In each centre, 20 or 25 patients aged 18-65 years coming for a regular visit were asked to participate in the study. All patients filled in the Beck Depression Inventory (BDI). Additionally, basic demographic data and information on the presence of chronic somatic diseases were collected. Those patients who scored 12 or more points on BDI (cut-offpoint for depression in Poland) were evaluated by a primary care physician for presence of a depressive disorder upon the ICD-10 criteria and subsequently referred for a psychiatric consultation to the nearest psychiatric outpatient clinic for establishing plausible diagnosis of depression., Results: Out of 7360 patients approached, 7289 (95.5%) agreed to participate. The mean age of the sample was 43.3 +/- 13.2 and 71% were females. Forty one percent of patients (2985) had 12 or more points on the BDI and were referred for a psychiatric evaluation. Only half of them came for a psychiatric consultation. Depressive disorder was recognised in 906 patients. Estimated prevalence of depressive disorders in the whole sample was 23.3%. The patients in whom depressive disorders were confirmed by psychiatric assessment had significantly more often hypertension, ischaemic heart disease, anaemia, stroke and hypothyroidism., Conclusions: The results obtained show that depressive disorders' prevalence in primary care patients in Poland is significant. The patients who had depressive disorders significantly more often than patients without depression suffered from some somatic diseases. In light of the results, both recognition and adequate treatment of depressive disorders in primary care patients should be regarded as equally important as the recognition and treatment of cardiovascular diseases or other common somatic illnesses.

Hypothyroidism is one of the common causes of the secondary hypercholesterolemia. The prevalence of hypothyroidism in the general population is estimated to be as high as about 1.5%. Frequency of the hypothyroidism in patients with hyperlipidemia is high, and can be observed in 4.2-10% in different populations. Most commonly, there is no need to treat the hypothyroid patients with the hypolipidemic drugs. Substitution treatment with the thyroid hormones usually results in either normalization or significant decreasing of the lipid levels. Hypothyroidism with symptoms of involvement of skeletal muscles is referred as to hypothyroid myopathy in English literature, and can be present in 30-80% patients with deficiency of the thyroid hormones. Hypothyroidism is a risk factor of developing of toxic injury of muscles, what is thought to be related to hypolipidemic drug intake. We report a case of a patient with undiagnosed hypothyroidism with muscle involvement manifestation, who was treated with fenofibrate due to accidentally diagnosed hypercholesterolemia. Hypolipidemic management resulted in rapid exacerbation of previously moderate myopathy. High concentrations of muscle enzymes and moderate increasing of creatinine concentration were detected. Improvement was observed after discontinuation of fenofibrate administration, but muscle symptoms and elevation of muscle enzymes and creatinine persisted. After administration of levothyroxin, muscle weakness and laboratory abnormalities were observed no longer. After several months of follow-up we believe that treatment with fenofibrate in our patient was complicated with muscle tissue damage and exacerbated symptoms of myopathy originally related to decompensated hypothyroidism.

Unlabelled: Thyroid disorders exert a major effect on cardiac function and on ECG. Few studies examined the effect of thyroid hormones on ventricular repolarization, measured by corrected QT interval (QTc). Prolonged QTc is associated with increased risk of arrythmias and cardiac mortality. The aim of this study was to examine the influence of subclinical hypothyroidism on ventricular repolarization measured by corrected QTc in standard 12-lead electrocardiogram. The examined group consisted of 32 patients with hypothyroidism, the controls were 39 healthy individuals. The mean corrected QTc was 0.434, SD +/- 0.0296 seconds and 0.414, SD +/- 0.0208 in the examined groups and in controls, respectively (p < 0.01). QTc did not correlate with free thyroxine concentrations (p = 0.4064). In the group with subclinical hypothyroidism we did not observe a significant difference in heart rate (74.3 vs. 73.7, SD +/- 13.58, NS)., Conclusion: Corrected QT intervals were significantly prolonged in patients with subclinical hypothyroidism.

The authors describe a case of a 50-year-old woman admitted to hospital with clinical symptoms of a cardiac tamponade. Pericardiocentesis was done and 850 ml of fluid were drained during three days. Relatively slow heart rate (82/min before, and 60/min post intervention) and initial laboratory data: marked hipercholesterolemia (8.2 mmol/l) and high CK activity (1830 IU/l) were typical of hypothyroidism. Examination of hormone levels confirmed this suspicion (TSH 162 uIU/ml, fT4 0.11 microg/dl, fT3 0.4 pmol/l). USG image and antithyroid antibodies presence (anti-TPO >3000 U/ml) helped in diagnosing of autoimmune thyroiditis. During substitution therapy with L-thyroxine her clinical status improved systematically. Additionally, an increased raised serum titre of Coxackie B virus antibodies (B3-B5 >1/256) suggested coexisting viral pericarditis. Two months before hospitalization she had symptoms of viral infection. A review of current literature on the subject is presented.

A case of 24-year old woman with chronic renal failure and primary hypoparathyroidism is presented. Primary hypothyroidism and bilateral hypoacousis were also found. Typically concomitant with chronic renal failure is development of secondary hyperparathyroidism and its co-morbidities, i.e. renal osteodystrophy that consists of osteomalacia, osteoporosis and pathological fractures. In case of some patients with very high concentration of parathormone (PTH) and with signs of renal osteodystrophy, which is the case of tertiary hyperparathyroidism, subtotal parathyroidectomy is the optimal treatment. Reduction of PTH concentration protects bones from further destruction and from accumulation of calcium phosphate in tissues. The accompanying primary parathyroid failure would probably protect from the further consequences of PTH over-production--renal osteodystrophy. The case is reported in view of a rare occurrence of such co-existence, lack of its description in Polish literature as well as diagnostic difficulties.

Several reports have appeared in the literature proving that hypothyroidism is associated with increased risk for cardiovascular disease, especially coronary heart disease. This increased risk for premature atherosclerosis is supported by autopsy and epidemiological studies in patients with thyroid hormone deficiency. Hypothyroid patients have increased diastolic blood pressure (as a result of increased systemic vascular resistance), altered lipid profile (elevated levels of total cholesterol, LDL-cholesterol and apolipoprotein B). More recently homocysteine, C-reactive protein, increased arterial stiffness, endothelial dysfunction and altered coagulation parameters have been recognized as a "new" risk factors for atherosclerosis in patients with thyroid hormone deficiency. The plasma total homocysteine concentration, an independent risk factor for atherosclerosis, is moderately elevated in overtly hypothyroid patients and it decreases with thyroid replacement therapy. Several experimental study have shown that hypothyroidism affects folate metabolism and the enzymes involved in the remetylation pathway of homocysteine (particularly 5,10-methylenotetrahydrofolate reductase - MTHFR). In hypothyroid condition the hepatic activity of flavoenzyme - MTHFR, is decreased. Thyroid hormone may affect the availability of FMN and FAD - necessary for stabilizing MTHFR. An impairment of enzyme involved in transsulfuration pathway is suggested. The increased serum creatinine level in hypothyroidism probably reflects a reduced glomerular filtration rate, which is linked to impaired renal homocysteine clearance and hyperhomocysteinemia.

Onychomycosis is a frequent disorder in adults. The objective of the study was evaluation of finger and toe nails susceptibility to Candida albicans and a dermatophyte Trichophyton mentagrophytes infection in patients with symptomatic hypothyroidism and hyperthyroidism as compared with healthy persons. The materials comprised finger and toe nails from 23 patients with hypothyroidism (in 8 cases postoperative, and in 15 cases caused by Hashimoto type thyroiditis), and from 27 patients with hyperthyroidism (including 17 cases of Graves-Basedow disease, and 10 with nodular goitre). Nails from 22 healthy persons of similar sex and age distribution served as controls. A significantly more frequent and more intensive than in control group toe nail infection with C. albicans was found in the patients with both hypothyroidism and hyperthyroidism. The enhanced toe nail susceptibility to C. albicans infection did not depend on autoimmunological aetiology of both hypothyroidism and hyperthyroidism.

The idea of our work were to estimate the function of thyroid in newborns and their mothers in the group of pregnant women with thyroid disturbances. We examined 38 pregnant women and their newborns. We confirmed that diabetes appeared more frequently in all cases. The mean gestational age of newborns was 39 weeks. The cesarean sections were performed more frequently in the group of mothers with Graves-Basedow disease. The general condition of newborns after delivery were assessed as good acc. Apgar score. The newborns from pregnancies complicated with Graves-Basedow disease in majority cases were dystrophic.

A case of 78 year-old woman with primary hypothyroidism and atrial fibrillation treated with sotalol, complicated with cardiac arrest due to ventricular fibrillation (VF) and torsade de pointes (TdP) is presented. The QT interval was prolonged to 660 msec. Episodes of polymorphic ventricular tachycardia and VF recurred. Lidocaine, tosylate bretylate and betabloker successfully eliminated VF but short-lasting episodes of TdP were still present. Increased doses of hormonal substitution with thyroid hormones successfully eliminated malignant ventricular arrhythmias and normalised QT interval to 430 msec.

Aim: There are clinical similarities between anorexia nervosa (AN) and hypothyroidism. Previous reports have shown decrease FT3, increase rT3, sporadically decrease FT4 and normal levels of serum TSH., Method: To assess thyroid function in 36 patients with AN (4 males, 32 females the subjects ages ranged from 12 to 18 yrs) serum levels of FT4, FT3, rT3, TSH were measured. Out of this group, 24 patients have been singled out to examine the lipid metabolism by measuring the level of cholesterol, HDL, LDL, triglycerides., Results: 67% (24) of the examined group resulted in low level of FT4 (0.75-0.97 ng/dcl), but decrease FT3 (= 0.67 pg/ml) was only found with 1 patient. The level of rT3 (measured in 94% (34) patients) were normal. The level of TSH were low (0.87-0.97 muIU/ml) in 25% (9) of patients, but 6 of them also manifested decrease FT4 (0.87-0.97 ng/dcl). At the same time, we found higher level of cholesterol in 63% of patients, decrease HDL in 71%. It is interesting to notice that in 80% of cases with a lipid metabolism disorder we found decrease FT4., Conclusions: Thyroid dysfunctions may be one of the essential reasons for lipid metabolism disorder in AN.

We report a case of 18 year old woman with pseudohypoparathyroidism type la presenting with low bone mineral density and primary hypothyroidism. The patient was diagnosed because of muscular cramps, accompanied by elevated parathormone (PTH) level and hypocalciuria, but normal serum calcium, phosphate and magnesium levels. She had features of Albright's osteodystrophy: short stature with normal bone age, shortening of IV and V metacarpal bones, and small cerebral calcifications shown by CT.

The aim of the study is to present results of the olfactory testing in congenital hypothyroidism in the group of 20 subjects. The etiology of hypothyroidism included: Pendred's syndrome in 2 cases, hypoplasia in 2 cases, athyreosis in 5 cases and ectopy of thyroid gland in 11 cases. Olfactory testing involved olfactometry by Elsberg-Levy modified by Pruszewicz for 4 odorants: coffee, lemon, mint and anise; smell fatigability test by Pruszewicz et al. for lemon. Level of plasma TSH was determined in each subject. Age of the subjects, at which hormonal replacement therapy was started and regularity of the treatment were taken into consideration. Obtained results: impaired odorant identification and shortened smell fatigability period prove a significant impact of thyroid status on central nervous system development most probably already prior to birth and on cognition processes.

The case of a 32-year old female patient with primary hypothyroidism suffering from severe myxoedema as a consequence of denying thyroxin taking is presented. Severe expression of pathological changes in circular-respiratory system and uncommon skin changes are discussed.

We present a case of a 19.5 years old, hemodialyzed, girl with frequent and dramatic episodes of hypotension. She presented slightly expressed symptoms of hypothyroidism, while the serum levels of hTSH, T3, T4 and fT4 were close to the bottom border of norm. The therapy with L-thyroxin (1.75 mg/kg b. w./24h) normalized the arterial blood-pressure and led to subside coexisting symptoms of hypothyroidism.

Enlargement of the thyroid gland, local tenderness and thyroid function disorder are common symptoms of thyroiditis. Hashimoto's thyroiditis (chronic lymphocytic thyroiditis) is the most common form of thyroiditis in children. This disease is a frequent cause of acquired hypothyroidism. Hashimoto's thyroiditis (HT) is characterised by infiltration of the thyroid gland by lymphocytes, gradual destruction of the gland and production of various thyroid autoantibodies, mainly antimicrosomal (ATM) and antithyroglobulin antibodies (ATGL). 54 children (45 girls and 9 boys) aged from 11 to 18 with confirmed or suspected HT were observed. The clinical diagnosis of HT was confirmed by fine needle aspiration biopsy (FNAB) in 27 patients. In one case HT was histologicaly confirmed after thyroid surgery. FNAB was not carried out in 19 patients and in 7 cases FNAB was thyroiditis negative. All patients were positive for ATM and/or ATGL. Initially 24 patients were euthyroid. Hypothyroidism was recognized in 8 children, subclinical hypothyroidism in 11 children. One patient was hyper- thyroid. 51 patients were treated with l-thyroxin. Ultrasonography revealed variable thyroid abnormality in all patients: hyperplasia in 38 patients, multinodular goiter or solitary nodule in 15 patients. 8 children suffered from associated disease: 5 patients from allergy, 1 patient from trombocytopenia, 1 from alopecia areata, 1 from secondary amenorrhea. Follow up examination of children with HT must be continued due to the risk of hypothyroidism or neoplastic disease of thyroid.

Congenital hypothyroidism occurs in 1:4000 newborns. Mass screening for congenital hypothyroidism constitutes a major progress in the prevention of mental retardation. The neonatal screening programme in Poland was established and implemented by the National Research Institute of Mother and Child from the middle of the 70. and reorganised in 1997. Recall examinations in the infants, substitute therapy with l-thyroxine and the follow-up of hypothyroid infants and children are presented.

Central nervous system involvement is seldom reported in patients with systemic sclerosis (SSc). Cognitive functions were determined in 21 patients with definite SSc and 42 healthy controls. Thyroid function was also measured in order to eliminate the effect of hypothyroidism on cognitive functioning. It was found that the SSc patients with normal thyroid function showed defective long-term and recent memory, learning ability, criticism, perception and visuo-perceptual skills, their simple reaction time was prolonged. Similar but less advanced cognitive defects were shown in the SSc patients with overt or latent hypothyroidism. The obtained results indicate that the central nervous system involvement is more common in patients with SSc than it has been reported earlier.

Three cases are presented of hypothyroidism at the age of 6-13 years. Attention is paid to differences in the clinical picture in every of the observed children.

Unlabelled: 45 patients with hyper and hypothyroidism in the time 1989-1990 were observed. The Graves' disease was diagnosed in 29 and rather in the younger patients, but 16 had the toxic nodular goiter and those were elderly. In 27 the hypertension was secondary (symptomatic) and after the successful treatment of the hyperthyroidism was completely controlled. In 14 cases the hypertension was primary (essential) and the application of the hypotensive drugs was also necessary. Among 4 patients with primary hypothyroidism and associated hypertension and coronary insufficiency the early treatment by the thyroid preparation was successful: the blood pressure was lowered and the coronary insufficiency was improved; but if the replacement therapy was stopped and the hypothyroidism was relapsed, the blood pressure was increases and the coronary insufficiency was aggravated., Conclusions: 1. The secondary (symptomatic) hypertension associated with the hyperthyroidism may be controlled by successful treatment of the thyrotoxicosis, but the primary (essential) must be treated by the hypotensive drugs also. 2. The early treatment of the hypothyroidism may control the associated hypertension and the coronary insufficiency. 3. Graves' disease is associated mostly with symptomatic hypertension, in nodular toxic goiter in most of the cases the essential hypertension was established.

Intestinal absorption of vitamin B12 as measured by the Schillin test was studied in 50 patients with primary hypothyroidism of autoimmune origin. The impaired absorption of vitamin B12 was found in 24% of the patients studied, and in 6% a clinically evident form of pernicious anemia was diagnosed. The patients with hypothyroidism and simultaneous defect in absorption of vitamin B12 were characterized by more frequent occurrence of the high titer of antithyroid microsomal antibodies, higher blood serum concentration of TSH and lower blood content of hemoglobin as compared with hypothyroid patients having normal intestinal absorption of vitamin B12.