Stimulation of thyroidal iodothyronine 5'-monodeiodinase by long-acting thyroid stimulator (LATS)

To evaluate the effect of long-acting thyroid stimulator (LATS) on thyroid iodothyronine monodeiodinating activity, we have studied the in vitro conversion of T4 to T3 by mouse thyroid homogenate comparing tissue from LATS treated (0.1 ml LATS(+) serum, ip, for 3 days) with tissues from LATS(-) Graves' disease patients' serum or normal serum treated controls. Five out of seven LATS(+) sera were shown to stimulate the T4 5'-deiodinase significantly in mouse thyroid. There was no significant correlation between LATS titre and deiodinase activities in the different sera tested. To compare the effect of LATS and TSH (0.2 IU, ip daily), studies were carried out from 12 to 72 h. LATS had a similar latency of 12 h on the stimulation of thyroid deiodinase compared to TSH as reported earlier. However, the conversion activities reached a plateau by 12 h after LATS treatment, while it continued to rise upon daily TSH injection from 24 to 72 h. In addition, TSH caused a marked reduction of thyroid protein and an early peaking in serum T3 and T4 at 12 h, whereas LATS caused no detectable change in thyroid protein and a gradual rise in circulating T3 and T4. The kinetic analysis indicated that LATS-mediated stimulation of T4 5'-deiodinase was, similar to TSH, associated with an increase in maximum velocity (Vmax were 139, 208 and 505 pmol/mg protein/30 min respectively in control, LATS and TSH-treated animals) without a demonstrable change in the apparent Km (approximately 2.0 microM for T4). The present study demonstrated that some LATS-rich sera stimulate thyroid T4 to T3 conversion in mouse. It provides an insight into the mechanism of increased T3 secretion from Graves' thyroid glands.

Presence of hepatitis B virus DNA in serum of surface-antigen-seronegative immunocompromised patients

We compared the prevalence of serum hepatitis B virus (HBV) DNA in cancer patients who were immunocompromised with that in healthy subjects. Testing positive for serum HBV DNA were 27 of the 232 (11.6%) surface-antigen-negative cancer patients and 7 of the 382 (1.8%) surface-antigen-negative healthy subjects. These data suggest that the negative serology, at least in immunocompromised individuals, is probably not sufficient to exclude HBV infection.

Cold-induced increase in brown fat thyroxine 5'-monodeiodinase is attenuated in Zucker obese rat

In this study we examined the possibility that the reduced brown adipose tissue (BAT) thermogenesis in the Zucker obese rat may result from a limited capacity for enzymic conversion of thyroxine (T4) to triiodothyronine (T3) in BAT. A total of 34 lean and obese rats, approximately 4 mo old were divided into three treatment groups: group 1 (5 lean and 6 obese) was fed Purina rat chow for 21 days, and group 2 (5 lean and 6 obese) was fed a cafeteria diet for 21 days, and group 3 (6 lean and 6 obese) was fed Purina rat chow and maintained in the cold (8 +/- 1 degrees C) for 7 days. The lean and obese rats in all three groups of animals were matched closely for age and respective body weight. Activity of T4 5'-deiodinase was determined as the rate of T3 production from added T4 under controlled in vitro conditions. Serum T4 and T3 were determined by radioimmunoassay. The rate of T4-to-T3 conversion in BAT was similar in the lean and obese rats maintained at room temperature, whether fed rat chow or a cafeteria diet (approximately 40-50 pmol T3/scapular BAT depot per h). However, expressed per scapular BAT depot, lean rats exposed to cold displayed about a fivefold increase in BAT T3 production (P less than 0.0001), whereas only a small increase was observed in the cold-exposed obese rats. Serum T3 levels tended to be reduced in the Zucker obese rats. Our data indicate a reduced capacity for T3 production in Zucker rat BAT exposed to cold.(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrence of papillary thyroid carcinoma presenting as a focal neurologic deficit

Papillary-follicular thyroid carcinoma usually remains localized to the thyroid bed and, in cases of metastasis, almost always involves the lung, bone, or liver. The two patients described here presented with papillary carcinoma and neurologic dysfunction. Total body iodine 131 scans disclosed cerebral uptake, and cerebral masses were confirmed by computed tomographic scan. Both patients presented diagnostic and therapeutic dilemmas, and ultimately underwent craniotomy. One patient's cerebral metastasis recurred and was treated by a second craniotomy. The other patient received postoperative external cerebral radiotherapy and a novel intraoperative treatment: implantation of 22 iodine 125 seeds in the tumor bed, estimated to yield 16,000 rad (160 Gy) in one year. To date, cerebral metastases have not recurred in the latter patient, although tumor has reappeared in other sites. There is little reported in the medical literature concerning cerebral metastases of thyroid carcinoma, and the present report reviews this experience and discusses treatment alternatives.

Serum thyroid hormones and tissue 5'-monodeiodinase activity in acutely thyroidectomized newborn lambs

After either total thyroidectomy or sham operation in full-term fetal sheep, fetuses were delivered and serial blood samples were obtained for measurements of thyroxine (T4), triiodothyronine (T3), and catecholamines. Despite comparable serum T4 values (T4 means +/- SE, sham 7.1 +/- 0.6 micrograms/dl, thyroidectomized 6.8 +/- 0.7 micrograms/dl at 60 min after birth), serum T3 values were lower in the thyroidectomized animals (T3 means +/- SE, thyroidectomized 39 +/- 4.8 ng/dl, sham 153 +/- 20.1 ng/dl at 60 min after birth). Four hours after birth, the animals were killed with an intravenous overdose of barbiturate. Brain, thyroid, liver, kidney, and brown adipose tissues were dissected and analyzed for thyroxine 5'-monodeiodinase (5'-MDI) activity in vitro. 5'-MDI activity was comparable in all tissues from sham-operated and thyroidectomized lambs. Plasma epinephrine and norepinephrine concentrations, mean arterial pressure, mean pulse, rectal temperature, and arterial blood gas values were similar in the two groups of animals. These data support the hypothesis that the thyroid gland is the major source of T3 for the T3 surge in the immediate newborn period. They also indicate that the neonatal T3 surge has limited immediate metabolic significance in euthyroid newborns.

Biochemical and ontogenic characterization of thyroxine 5'-monodeiodinase in brown adipose tissue from fetal and newborn lambs

We characterized T4 5'-monodeiodinase (5'-MDI) and its ontogenic changes in brown adipose tissue (BAT) of fetal lambs from a gestational age of 99 days to the newborn period. BAT 5'-MDI activity in fetal or newborn lamb was markedly enhanced by dithiothreitol (DTT); a near-maximum stimulation was reached at a DTT concentration of 1 mM. The enzyme is heat-labile (inactivated when heated to 56 C for 5 min) and has a pH optimum at 6.5. In the presence of 1 mM DTT, BAT 5'-MDI was extremely sensitive to propylthiouracil (PTU): 0.04 mM PTU resulted in 94% inhibition of the T4 to T3-converting activity. An increase of DTT concentration to 20 mM in the incubation media reduced the inhibition by 0.04 mM PTU to 59%. Kinetic analysis, in the presence of 4 mM DTT, revealed a Michaelis-Menten constant (Km) of 1.43 microM for T4 and an inhibitory constant (Ki) of 22 microM for PTU. A marked and progressive rise of BAT 5'-MDI was noted from the 99-day fetus to the newborn period [6.0 vs. 94 +/- (SE) 12 pmol T3/mg protein X h]. The total sulfhydryl content in BAT varied from 3.8 to 5.4 mmol/kg wet weight equivalent, whereas nonprotein sulfhydryl content varied from 0.5 to 0.9 mmol/kg in groups of lambs between 99 days and the newborn period, without a significant change with age. These results indicate that 5'-MDI in fetal lamb BAT increases progressively between 99 days gestation and the neonatal period. Ovine fetal BAT 5'-MDI is highly sensitive to the inhibitory effect of PTU at low DTT concentration (1 mM) and is relatively insensitive to PTU only at high DTT concentration (20 mM). Finally, 5'-MDI in BAT from the fetal lamb reaches maximal activity near term and seems similar in its biochemical characteristics to the 5'-MDI of liver, kidney, or thyroid.

The mechanism of low serum T3 in the fetus: hepatic T4-5'-monodeiodinase versus tissue sulfhydryl content--a clarification

Using optimal tissue concentration, supplemented with a thiol-protecting agent, the fetal liver has lower T4 5'-monodeiodinating activity than maternal or neonatal tissue. This is a true deficiency and is not due to deficiency of sulfhydryl groups in fetal tissue as previously suggested. Evidence indicates a dissociation of the neonatal surge of serum T3 and the increase in hepatic T4 to T3 conversion activity, suggesting that the neonatal T3 surge is related more to thyroid gland stimulation than to T4 to T3 conversion in non-thyroid tissues.

Meal-induced brown fat thermogenesis and thyroid hormone metabolism in rats

The relationship between the meal-induced increase in brown adipose tissue (BAT) thermogenesis, determined by the level of GDP binding to BAT mitochondria, and thyroid hormone metabolism have been examined. A single low-protein, high-carbohydrate meal resulted in a significant increase in the thermogenic activity of BAT. This effect on BAT thermogenesis was accompanied by significant increases in activity of thyroxine 5'-monodeiodinase in the BAT (P less than 0.05) and liver (P less than 0.02) but not with any significant changes in serum concentrations of the thyroid hormones. The stimulatory effects of the meal on BAT thermogenesis and hepatic thyroxine (T4) to triiodothyronine (T3) conversion persisted at least as late as 24 h after meal onset. Food deprivation for 40 h was associated with large reductions in serum concentrations of T3 (P less than 0.01) and T4 (P less than 0.001), but deprivation for 18 h had no significant effect on serum T3 and T4 concentrations. Our data indicate that the meal-induced increase in BAT thermogenesis can be independent from changes in serum concentrations of thyroid hormones and suggest that T3 produced in BAT in response to feeding may play a role in the thermic response of this tissue to meals.

Long term treatment of Graves' hyperthyroidism with sodium ipodate

To investigate the long term usefulness of sodium ipodate (Oragrafin) in the management of Graves' hyperthyroidism, we studied the effects of ipodate (500 mg, orally, daily for 23-31 weeks) on serum T3, T4, rT3, and some clinical parameters in five newly diagnosed Graves' hyperthyroid patients. Mean pretreatment serum T3, T4, and rT3 concentrations were 780 ng/dl, 25.4 micrograms/dl, and 118 ng/dl, respectively. One day after the first dose of ipodate, serum T3 decreased by 62% (P less than 0.01), and it was within the normal range thereafter throughout treatment. The serum T4 concentration decreased by 20% (P = 0.09) at 24 h and by 43% (P less than 0.05) at 14 days. Subsequently, serum T4 was 41-65% lower than before treatment throughout the study; rT3 increased 24 h after the first dose of ipodate (118% above baseline; P = 0.1), remained elevated (97-109%) for 10 weeks, and then gradually decreased to the pretreatment level. A marked gain in body weight [5.1 +/- 1.1 (+/- SEM) kg] occurred in all patients. After discontinuation of ipodate, mean thyroid radioiodine (RAI) uptake values increased serially in four patients and were similar to pretreatment values: pretreatment, 74 +/- 6% (+/- SEM); after 7 days, 66 +/- 8%; after 14 days, 71 +/- 7%; after 28 days, 69 +/- 7%. The fifth patients's RAI uptake was 12-16% (vs. a pretreatment value of 48%) from 7-28 days after the end of a 31-week course of ipodate. He remained euthyroid without further treatment for the subsequent 4 months. We conclude that 1) ipodate (500 mg daily) reduces serum T4 and T3 levels as fast and as much as does the 1-g daily dose studied previously; 2) long term use (for 23-31 weeks) of ipodate for the treatment of Graves' hyperthyroidism is clinically feasible; no adverse effects occurred during or after ipodate treatment; and 3) RAI uptake returns to pretreatment levels as early as 7 days after the discontinuation of ipodate. Hence, use of ipodate does not prevent use of 131I therapy for those patients for whom it is otherwise desirable.

Carcinoma of the thyroid with a mixed medullary, papillary, follicular, and undifferentiated pattern

While papillary and follicular thyroid carcinomas are frequently mixed, this is a case of a medullary, papillary, follicular, and undifferentiated carcinoma of the same gland. In addition, all four tumor types were metastatic to regional lymph nodes. The patient described herein did not demonstrate features of the multiple endocrine neoplasia type 2 syndrome. Immunoperoxidase staining for calcitonin and thyroglobulin was positive in the follicular and medullary areas of tumor. Because the embryologic origin of the thyroidal follicular cells is from the endoderm and the origin of the parafollicular cells of the medullary carcinoma is from the ectodermal neural crest, this case seems noteworthy for demonstrating mixed metastatic tumor of composite embryologic origin. Alternatively, this case may represent an extension of what has recently been termed differentiated thyroid carcinoma, intermediate type by Ljungberg and co-workers.

Characterization of thyrotropin-induced increase in iodothyronine monodeiodinating activity in mice

To further characterize the effect of TSH administration on thyroid iodothyronine monodeiodinating activity, we have evaluated the in vitro conversion of T4 to T3 (outer ring deiodination) and T3 to 3,3'-diiodothyronine (T2; inner ring deiodination) by mouse thyroid, liver, and kidney homogenates, comparing tissues from TSH-treated mice (0.1-200 mU bovine TSH, ip, for 1-3 days) with tissues from saline-treated controls. The in vitro conversion activity was studied in the presence of 1-20 mM dithiothreitol; most of the studies were carried out at 4 mM. Studies were carried out at optimal pH 6.5 for outer ring and 7.8 for inner ring deiodination. The iodothyronine monodeiodinase in mouse thyroid is similar to the ones in liver and kidney. It is heat labile (inactivated at 56 C for 5 min), inhibited by propylthiouracil (0.2 mM) and ipodate (0.2 mM), and unaffected by methimazole (up to 20 mM), ascorbate (up to 0.1 M) or KI (up to 20 mM). The mean +/- SE baseline rates of T4 to T3 and T3 to T2 conversion were 100 +/- 6.3 and 56.5 +/- 2.9 pmol/mg thyroid protein X 30 min at 37 C, respectively. A significant increase in each conversion activity was found after TSH treatment (0.2 U, ip, daily for 3 days); T4 to T3 conversion rose to 282 +/- 15.4, and T3 to T2 increased to 153 +/- 7.4 pmol/mg thyroid protein (P less than 0.001). A 12.8% increase in thyroid weight was found in the TSH-treated group (P less than 0.03 compared with saline control group). Similar but less marked increased in monodeiodinating activities were seen in the liver. A minimal but significant increase in inner ring monodeiodination with no significant increase in T4 to T3 converting activity was found in kidney, which, in the mouse, has markedly less outer ring deiodinase than liver or thyroid. The iodothyronine monodeiodinating activities did not increase until 12 h in thyroid and 48 h in liver after the first dose of TSH. Significant increases in T4 to T3 and T3 to T2 conversion were seen with doses of TSH as low as 0.1 mU (ip, daily for 3 days), and there was a linear dose-response thereafter. The decay of the increased iodothyronine monodeiodinating activities after a single dose of TSH (0.2 U) appeared to be linear, with a decay t 1/2 of 1.3 days for T4 to T3 conversion and about 1.0 day for T3 to T2 conversion.(ABSTRACT TRUNCATED AT 400 WORDS)

I-131 total-body scan: localization of disseminated gastric adenocarcinoma. Case report and survey of the literature

This is a case of striking radioiodine and [99mTc]pertechnetate uptake by disseminated nonthyroidal (gastric) adenocarcinoma. A 65-yr-old man was euthyroid and serum thyroglobulin concentration was normal at 11 ng/ml. Bone-marrow biopsy showed that the metastatic tumor cells were negative for thyroglobulin on immunoperoxidase stain and the secretory product was mucicarmine-positive. We estimate that radioiodine uptake in the normal thyroid gland was less than 10% of total tumor uptake. At autopsy, the stomach was the site of the primary tumor, which had the same cellular and histochemical characteristics as the metastatic lesions in bone and liver. It is emphasized that the use of pertechnetate for screening patients with gastric adenocarcinoma may be clinically useful in the early detection of metastatic lesions.

Combination chemotherapy with 5-fluorouracil, CCNU, and vincristine in metastatic colorectal carcinoma

Twenty-four patients with metastatic colorectal carcinoma were treated with a chemotherapeutic regimen consisting of 5-fluorouracil, CCNU, and vincristine (FCV). Twenty patients were evaluable for response and 22 were evaluable for drug toxicity. One patient (5%) showed partial response, eight patients (40%) had stabilization of disease, and the remaining 11 patients (55%) had progression of disease. There was no statistically significant difference between the median survivals of patients with stabilization and of those with progression of their disease (p greater than 0.01). We were unable to demonstrate objective efficacy of the FCV regimen in the schedule used.

Lymphadenopathic type of Kaposi's sarcoma presenting with generalized petechial hemorrhages. A case report from taiwan

An 8-year-old Taiwanese girl presenting with generalized petechial hemorrhages, severe thrombocytopenia and lymphadenopathy was found to have primary Kaposi's sarcoma of lymph node without cutaneous involvement. This patient is a first-documented case of lymphadenopathic type of Kaposi's sarcoma in Taiwan. The associated severe thrombocytopenia resulting in generalized petechial hemorrhages as the initial manifestation is also unique in this case.