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We present a 56-year-old patient with cyclic Cushing's disease (CCD) observed for 28 months, who presented clinically and biochemically with alternating episodes of hyper-, normo- and hypocortisolemia. The course of the disease was fatal, the patient died due to severe hypokalemia.

Objective: Thyroid hemiagenesis (THA) is an anomaly resulting from the developmental failure of one thyroid lobe. Etiopathogenesis, clinical significance, and management of patients in whom THA is diagnosed are still a matter of debate. The aim of the study is to provide the first systematic analysis of a large cohort of subjects with THA., Design: Forty patients with THA are described in comparison to a control group of 80 subjects with fully developed thyroid gland., Methods: Serum concentrations of thyrotropin (TSH), free thyroxine (FT(4)), free triiodothyronine (FT(3)), and thyroid autoantibodies were measured. In 37 patients, thyroid ultrasonography and Tc-99m thyroid scintiscan were performed, followed by fine-needle aspiration biopsy if indicated. The remaining archival three cases were diagnosed with the use of I-131 scintiscan under basal conditions and after TSH stimulation., Results: Patients with THA, while usually clinically euthyroid, presented with significantly higher levels of TSH and FT(3) as well as with higher FT(3)/FT(4) concentration in comparison to the control group. Furthermore, a higher incidence of associated functional, morphological, and autoimmune thyroid disorders in patients with THA was observed when compared to subjects with bilobate thyroid (P<0.05)., Conclusions: Our results revealed that individuals with THA are more likely to develop thyroid pathology. The observed high incidence of associated pathologies is presumably due to long-lasting TSH overstimulation. Therefore, THA diagnosis should be followed by systematic observation and adequate levothyroxine treatment in patients with elevated TSH level.

Objective: To evaluate the efficacy of radioiodine therapy using I in a group of patients with large multinodular goitre (LMG)., Methods: The study was carried out in patients with goitre volume greater than 100 cm and in patients with LMG who were disqualified from surgery. The study included 34 female participants (age range: 62-84 years) with LMG: 26 patients were hyperthyroid and eight patients had a nontoxic goitre. The patients were treated with 800 MBq of radioiodine administered four times at 3-month intervals (total activity of 3.2 GBq). Before each therapy course, serum thyrotropin, free thyroxin, free triiodothyronine and antithyroid antibodies were measured, ultrasonography and thyroid scan were performed. Patients were followed up for a minimum of 24 months. Fine-needle biopsy was done before qualification to the study., Results: Before therapy, median thyroid volume was 145 cm. It decreased during therapy to 65-76 cm after 12 months and to 50-62 cm after 24 months. After 24 months, 60% of patients were euthyroid and 40% of patients were hypothyroid. During therapy, significant increases in TSHRAb, TPOAb and TgAb levels were observed. No correlation between the levels of antithyroid antibodies, radioiodine uptake, reduction of goitre volume and hormonal status was found., Conclusion: In most cases of LMG, repeated administration of radioiodine is safe and effective. The highest response of the thyroid volume is observed after the first course of treatment. On account of a high incidence of hypothyroidism, the patients should be monitored during and after therapy.

Introduction: The treatment-of-choice for differentiated thyroid carcinoma (DTC) is a total thyroidectomy with subsequent radioiodine therapy. In order to increase an iodine uptake in thyroid tissue remnants, the L-thyroxine withdrawal is required. It is recommended to achieve TSH levels higher than 25 mU/ml. As TSH is a known key factor in thyroid cell proliferation regulation, prolonged stimulation of the cells during L-thyroxine withdrawal can be a causative factor for a re-growth. Our aim was to assess the degree of thyroid re-growth in the patients after total thyroidectomy due to DTC and its possible clinical implications., Material and Methods: 23 patients operated due to papillary and follicular thyroid cancer were included into the study. Biochemical determinations and ultrasound thyroid imaging were performed (TSH, Tg) during suppressive L-thyroxine therapy as well as 4-5 weeks after the withdrawal., Results: The mean volume of thyroid tissue remnants increased after withdrawal for substantial 30.1%. The difference was extremely significant., Conclusions: L-Thyroxine withdrawal in the patients after total thyroidectomy due to DTC can cause re-growth of the tissue remnants. The phenomenon may be of a clinical significance in the selected cases influencing therapeutic decisions.

The radioiodine therapy can favour and induces of autommunological reaction in thyroid gland. The aim of the study was evaluation of antithyroid autoantibodies in patients with multinodular large toxic goiter treated with repeated doses of 131I before and after therapy. Studies were conducted in 24 women (age range: 65-84 yrs) with multinodular large toxic goiters--goiter volume assessed by USG over 100 ml. Serum TSH, fT4, antithyroid antibodies (anti-TPO, anti-Tg, TSHR-Ab) levels were estimated in all patients parallel with radioiodine uptake test (after 5 and 24 hours), 131I thyroid scintigraphy and fine needle biopsy. These studies and therapy with 22 mCi 131I were repeated every 3 months. Before therapy median of thyroid volume was approximately 195 ml and during therapy gradually decreased to 110 ml after 12 months. After 12 months we found 11% of patients with hyperthyrodism, 62% of patients with euthyroidism and 27% of patients with hypothyroidism. Before radioiodine treatment aTg and aTPO presence were detected in the most of patients, but only in 5 cases above normal value. TSHRAb were detected (normal, very low values) in 16 patients. During therapy statistically significance increase of TSHRAb levels (median: from 0,27 to 0,65 after 6 months and to 0,71 IU/l after 9 months) was observed; aTPO and aTg antibodies levels showed marked tendency to rise, but without significant differences (aTPO median: from 40 IU/ml to 48 IU/ml; aTg - median: from 27 IU/ml to 46 IU/ml). During these observations we didn't find evident correlation between the levels of antithyroid antibodies, radioiodine uptake, proved reduction of goiter volume and TSH, FT4, FT3 values.

Introduction: The aim of the study was to evaluate of efficiency of iodine prophylaxis based on obligatory model of salt iodization., Material and Methods: The study included 1444 children from the rural and urban area, with the proportional sex and age (8-12 years) distribution--432 children in 1992 (before salt iodization), 558 children in 2000 and 454 children in 2005 (during salt iodization from 1996)., Results: The prevalence of goiter detected in children population in 1992 was 40% (recount by current criteria), in 2005 was reduced to 6% (p < 0.01). Parallel, median of urinary iodine concentration increased from 44 microg/l in 1992 to 107 microg/l (p < 0.01) in 2005. The increase of incidence of autoimmunological thyroid diseases is observed, especially chronic thyroiditis., Conclusions: The study proves high efficiency of iodine prophylaxis in Wielkopolska Region, but it is still the area with mild iodine deficiency.

Background: This article describes the process by which HealthSystem Minnesota (a vertically integrated health care organization), functioning in a competitive managed care environment, has been implementing a hypertension services program. The program involves a team approach to care, with emphasis on patient participation in treatment; decentralized care delivery by nurse coordinators at primary care practice sites; ongoing training and education for patients and providers; and the continuous monitoring and evaluation of patient outcomes and satisfaction. JOB-LEVEL ISSUES: A variety of issues, such as the role and responsibilities of the nurse coordinator, became evident as the program moved towards operational status at four primary care practice sites, which prolonged the implementation period. PROCESS-LEVEL ISSUES: Issues relating to work process changes were more complicated to resolve and required, in some cases, changes in the proposed model. The most significant process-level issues related to educating physicians about the program to secure their participation and support. ORGANIZATION-LEVEL ISSUES: Such issues, which were the most difficult for program implementors to anticipate and resolve, included an organizational culture that emphasized decision making autonomy at primary practice sites. In part, the difficulty encountered in resolving organization-level issues reflected the implementors' lack of awareness of the strength or complexity of the environmental pressures facing the organization, as well as a lack of sensitivity to nuances relating to organizational culture., Moving Ahead: Two groups of hypertensive patients--at the implementation and comparison sites--will be compared with respect to satisfaction with care, clinical outcomes, and costs. Expansion of the model to patients with other chronic conditions is under consideration.

Parathyroid imaging with 99m Tc-MIBI, introduced at the beginning of the 90's seems to be a promising method for parathyroid adenomas localization. The aim of the study was to assess the efficacy of parathyroid imaging with 99m Tc-MIBI for preoperative localization of parathyroid adenomas and to compare that method with the high-resolution ultrasonography. Thirteen patients with primary hyperparathyroidism of duration from 2 to 25 years were included in the study. The presence of parathyroid adenomas was confirmed by histopathology in all patients. The sensitivity for scintigraphy and ultrasonography was 92.8% and 78.5%, the number of false positive results was 0 and 2 and false negative-0 and 1, respectively. Parathyroid imaging with 99m Tc-MIBI is a useful method for parathyroid adenomas localization, and in contrast to ultrasonography its sensitivity does not decrease if a parathyroid adenoma is located ectopically. Nevertheless, because of the greater accessibility, lower costs and its simplicity ultrasonography should be used as a screening modality for parathyroid adenoma localization.