[The lactate-pyruvate quotient in the framework of modern thyroid diagnosis]

In literature a big number of central and peripheral parameters for the diagnosis and control of therapeutical measures in diseases of human thyroid gland is described. That means, that none of the methods used has a sufficient weight. The enzymatic estimation of pyruvate and lactate reflect the peripheral effect of the hormones of thyroid gland. The pyruvate and lactate levels differ in the several groups of patients with euthyreosis, hypothyreosis, hyperthyreosis and euthyreotic goitre. Between these all groups the lactate/pyruvate ratio showed highly significant differences. The comparison of the lactate/pyruvate ratio and the T3-values showed highly significant correlation between both parameters. This good conformity is underlined by the behaviour of the parameters in courses of therapy, with additional support by farther functional tests--ETR-, T3- and T4-test. Our results confirmed the suggestion, also in agreement with literature, that the lactate/pyruvate ratio represent a possible enrichment in the laboratory programme for diagnosis and control of therapy in patients with thyroid diseases.

[Gynecomastia]

Gynaecomasty is no disease sui generis, but a symptom which may underlie different causes. Steroidal substances, above all oestrogens play a dominating role in these cases. Diagnostic and therapeutic measures must comply with the known causal factors. The gynaecomasty during puberty exhibits a high spontaneous retrogression rate. Only seldom an operative correction becomes necessary.

[Possibilities of ultrasonic diagnosis of thyroid and gastrointestinal diseases]

Issuing from the physical principles of the ultrasound technique and the explanation of the different investigation methods, the possibilities of the ultrasonic diagnosis are demonstrated on own results in 1,166 cases of struma nodosa and 154 palpatorically and radiologically, respectively, localised enlargements of the organs or demands of space in the abdominal region. The establishment of 46 cysts in 357 scintigraphically warm nodes of the thyroid gland allows the conclusion that a relatively high percentage of the warm nodes contains solid cold regions. In several cases the ultrasonic diagnosis makes a clear diagnosis, in other cases it is an important supplementation to the other diagnostic possibilities. The A-picture-apparatuses produced in the GDR are suitable for the differential diagnosis of palpatorically or radiologically localised enlargements of the organs or space demands. In diffuse diseases of the organs and for the search of disturbances in extended regions B-picture-apparatuses with improved resolving power are necessary.

[Behavior of the erythrocyte glucose-6-phosphate dehydrogenase in patients with functional thyroid disorders and in hyperthyroxinemic rats]

This paper deals with the activity of glucose-6-phosphate dehydrogenase in patients with hyper- and hypothyroidism as well as in hyperthyroxinaemic rats. The activity of glucose-6-phosphate dehydrogenase is enhanced in red blood cells of hyperthyreotic patients and hyperthyroxinaemic animals. The activity will be decreased to normal range in patients by administration of antithyreotic drugs, such as thiamazole. Patients with hypothyroidism exhibit decreased enzymatic activity. It is suggested that thyroid hormones stimulate the HMP-shunt in red blood cells as a defence mechanism against additional oxidative stress.

[The behavior of free fatty acids and free glycerin in functional thyroid gland disorders]

It is reported on the behaviour of the fasting serum levels of the free fatty acids and the free glycerol in patients with hyper- and hypothyroidism. The two parameters were significantly increased in hyperfunction of the thyroid gland, whereas a decrease was found in hypofunction. The possible causes are discussed with the help of literature.

[Thyroid gland function in obesity]

It is reported on in vitro tests of the thyroid gland in 7 males with normal weight and 9 adipose ones. No clear difference was found in the two groups. The TSH level, too, after TRH stimulation is not significantly different so that a latent primary hypothyroidism cannot be ascertained.

[Therapy of thyroid diseases]

A survey is given on the therapy of hyperthyroidism, hypothyroidism and the bland struma including the thyrogenic crises. Indications and contraindications of the therapeutic measures available are described. During the therapy of hyperthyroidism the suppression test for the control of the course is recommended. Furthermore it is shown that the thyroxine is more favourable for the long-term treatment than triiodine thyronine or the combination preparations offered at present. But the rules described for the treatment of diseases of the thyroid gland must always be adapted to the individual case.

[Nephrotic syndrome after treatment with penicillamine in Wilson's disease]

In a 33-year-old man with Wilson's disease a nephrotic syndrome appeared as a severe complication under penicillamine therapy. Under strong observation and exact controls of protein in the urine, leucocytes, differential blood picture and thrombocytes after interruption of the medication and retrogression of the side-effects a retarding new stabilisation of penicillamine can take place. Other side-effects of penicillamine observed as well as control measures under a long-term treatment with penicillamine are briefly discussed.

[Behavior of lactate and pyruvate as well as lactate/pyruvate quotient in blood in human thyroid gland disorders]

The pyruvate and lactate levels in blood of patients with thyroid diseases were investigated and also the lactate/pyruvate ratio. The levels of pyruvate were significantly elevated in hyperthyreotic patients in comparison with the euthyreotic control group; in hypothyreotic patients the levels were lowered. Only in hypothyreotic patients the lactate level was slightly increased. In all the three groups the lactate/pyruvate ratio showed highly significant differences, in hyperthyreosis decreased, in hypothyreosis increased in comparison with normal subjects. In patients suffering from hyperthyreosis as well as in cases with euthyreotic goitre we found similar pyruvate levels and lactate/pyruvate ratios as in the hyperthyreotic cases. It seems likely to be an inexpected effect of the treatment with pure triiodothyronine or triiodothyronine/thyroxine in combination.

Bioptical liver changes in florid hyperthyreosis

In 42 non-selected patients with a clinically, biochemically and radio-iodine proved hyperthyreosis, previously untreated, a Menghini liver needle biopsy was carried out for evaluation of histomorphologic changes of the liver. As a result, "reactive hepatitis" was found in 8 patients. Moreover, in about 40% of the cases vacuolated nuclei of hepatocytes were observed in such a great number, as has been found so far only in diabetes mellitus. The microscopic findings, however, are in general unspecific and without particular pathologic value, showing no positive correlation to the biochemical findings.