Piriform sinus fistula. A route of infection in acute suppurative thyroiditis

Fifteen patients had acute suppurative thyroiditis resulting from infection through the left piriform sinus fistula. Characteristic clinical features included (1) onset in infancy or childhood, (2) left lobe involvement, and (3) frequent recurrence unless the fistula was extirpated completely. Fistulectomy in eight patients demonstrated three distinct courses of the fistula: lateral to, medial to, and penetrating the left thyroid lobe. Anatomical and histological findings suggest that the fistula is a remnant of the third pharyngeal pouch. We believe that the fistula is a common route of infection in acute suppurative thyroiditis, allowing bacterial infection to begin either in the perithyroidal space, spreading into the thyroid gland secondarily, or in the thyroid gland, primarily in cases where it penetrates the gland. Complete removal of the fistula is essential to a permanent cure.

Effects of thyroid state on the formation and early morphological development of Bergmann glia in the developing rat cerebellum

The formation and morphological maturation of Bergmann glia cells, which might play an important role in the histogenesis of the cerebellar cortex, was studied by histological and electron microscopic techniques in the cerebellum of normal young rats and animals made hypothyroid since the 18th day of gestation or hyperthyroid since birth. In comparison with controls, an acceleration in the morphological development of Bergmann glia cells was observed in the hyperthyroid animals; on the contrary, in the thyroid-deficient rats, the formation and morphological maturation of these cells were retarded and their final number was increased.

Congenital thyroid cyst of ultimobranchial gland origin

The ultimobranchial gland (UBG) is an endocrine gland which contributes C cells to the thyroid gland in mammals. Dysembryonic tissues derived from the UBG have been described as cystic bodies. The following case illustrates the criteria which characterize dysembryogenesis of the UBG.

Thyroid-pituitary feedback during iodine repletion

The changes in serum triiodothyronine (T3), thyroxine (T4), and thyrotropin (TSH) were measured during iodine repletion in a woman who was severely iodine-deficient because of a congenital iodide-trapping defect. Serum T3 became detectable 12 h after iodine was begun and reached 68 ng/dl, a level within the normal range, by 36 h. It rose progressively during the first 9 days reaching a supra-normal level (200 ng/dl) and then fell slowly to 130 ng/dl. Serum T4 was not detected (less than 1 mug/dl) until the 9th day and then rose to 6.8 mug/dl. Serum TSH fell rapidly during the first 9 days (disappearance rate was 0.17/day); there was a significant negative correlation with serum T3 (P less than 0.01). From the 10th through the 32nd day serum TSH fell more slowly (disappearance rate was 0.05/day) and correlation was with serum T4 (P less than 0.001), not T3. It appears that either T3 or T4 may regulate TSH secretion by direct effects on the thyrotroph, although their intracellular mode of action has not been defined.

Congenital hypothyroidism and hyperthyroidism in monozygotic twin girls

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Typical and atypical cases of Pendred's syndrome in one family

Pendred's syndrome is a condition which, in its complete form, is characterized by congenital deaf-mutism, goitre, and defective organic binding of iodide in the thyroid. However, there are less typical cases, e. g. without a goitre, with only limited hearing loss, or a normal perchlorate discharge test.

A family was studied in which Pendred's syndrome was found in two generations. The complete form was present in two members; two other members were considered to show less typical forms of the same disorder. All were euthyroid. Three out of five sons were deaf-mute and goitrous. Perchlorate caused a discharge of radioiodine from the thyroid in two of them, and also in the father who had no goitre and a slight loss of hearing only detectable by audiometry.

Peripheral deiodination of radioactive diiodotyrosine was normal in all patients, but had been abnormal in one son while he was hypothyroid.