Search

Twenty-six patients with endocrine ophthalmopathy without signs of thyroid disease (according to ultrasonic scanning, measurements of free thyroxin and thyrotropic hormone-TTH) were examined. Edematous exophthalmos in the compensated stage was diagnosed in 13 patients, subclinical stage of this condition in 10, and endocrine myopathy in 3 patients. Russian drug thyroliberin was used for accurate diagnosis of thyroid dysfunction; injection of this drugs to normal subjects leads to a drastic (3.5-5-fold) increase of TTH level. After measurement of TTH, the drug was infused intravenously by jet injection in a dose of 500 micrograms. Ten normal subjects were controls. 30 min after thyroliberin injection, TTH was measured. It was sharply increased in half of patients and in the control group. In one-third of cases (mainly with edematous exophthalmos) TTH level increased negligibly or even decreased after the test. After 1.5-2 years, signs of hyperthyrosis manifested in one-third of this group of patients. The authors consider that patients with the so-called Graves' disease are at a high risk of thyroid abnormalities and should be regularly consulted by both ophthalmologist and endocrinologist.

The paper is devoted to early myocardial pathology in patients with hyper- and hypothyroidism (15 patients with diffuse toxic goiter and 18 patients with primary hypothyroidism). They were investigated by radionuclide scintigraphy of the myocardium with -201TlCl. The myocardium in thyroid pathology was shown to suffer from dystrophic disorders, determined by metabolic derangements. The absence of disturbed perfusion processes in the myocardium and a diffuse decrease in metabolic activity of cardiomyocytes were revealed. Similar changes were found in patients without signs of myocardial involvement on ECG.

It has been shown that stimulated TSH and prolactin levels in intranasal administration of rifathyroin are comparable with the results of i.v. administration of the drug. Intranasal administration can be used for both therapeutic and diagnostic purposes.

Individual sensitivity of the hypothalamo-hypophyseal-thyroid system was studied in 12 patients with various degrees of euthyroid hyperplasia in the first 2 days of thyroxine therapy and during prolonged therapy. The effectiveness of thyroxine substitution therapy was compared with that of therapy with thyroid drugs in 55 patients with hypothyroidism. Euthyroid hyperplasia of III degree was accompanied by a more marked decrease in the level of TSH than in II degree, however during 3 mos. of therapy the size of the gland did not change. L-thyroxine administration for substitution therapy for 3-5 mos. was accompanied by a stable decrease in the level of TSH and improvement of clinical indices in hypothyroidism.

The authors describe rather rare clinical forms of diffuse toxic goiter with bradycardia, pretibial myxedema, the absence of ophthalmic sings and noticeable cachexy. All necessary investigations for more rational differential diagnosis are enlisted. A possibility of the development of the clinical picture of thyrotoxicosis in TTH producting hypophyseal adenomas, chorionepithelioma and hydatidiform mole is emphasized.

Hyperthyroidism was diagnosed in 4.8% of 21 patients with persistent ventricular arrhythmias (grades 2 to 5 by the Lown-Wolf classification), and latent hypothyroidism was diagnosed in 38.1% of those, using up-to-date radioimmune assays of thyroid hormones and the thyroliberin (TRH) test. It was those conditions that made arrhythmias resistant to antiarrhythmic treatment in most cases. Latent thyroid dysfunction was particularly common in elderly patients with ventricular arrhythmias and aggravated thyroid history or abnormal thyroid scintigraphic findings. Substitution therapy for hypothyroidism was conducive to the disappearance of paroxysms of ventricular tachycardia and the decrease in total number and grades of ventricular extra-systoles in patients with ventricular arrhythmias; moreover, sensitivity to antiarrhythmic agents developed to replace an earlier resistance.

Determination by the radioimmunological method of thyrotropic hormone (TTH), thyroxin and triiodothyronine in the blood serum of patients with Itsenko-Cushing's disease showed thyroxin level to decrease depending on the duration of the disease and the severity of the clinical course of the disease. Triiodothyronine content rose against the background of the elevated TTH content, this indicating the presence of latent hypothyroidism in these patients; one of the causes of the latter can be changed in thyroxin metabolism with the formation of a less active form of triiodothyronine.

Twenty-nine patients with paroxysmal supraventricular tachycardias of different origins and clinical pattern were investigated to detect latent thyroid disorders; hyperthyroidism was diagnosed in 2 of those, and hypothyroidism, in 4. Functional thyroid disorders were more common in patients with mitral prolapse and supraventricular tachycardias due to additional conductive pathways (the Wolff-Parkinson-White syndrome) and paroxysmal nodal reciprocal tachycardia, particularly if they were resistant to antiarrhythmic treatment and/or had aggravated thyroid history. It is suggested that thyroid dysfunction is just a triggering factor of arrhythmia since thyrostatic and replacement therapy eliminate paroxysms of tachycardia, while organic pathology of the heart and its conductive network remains unaffected.