[Unifocal autonomy and carcinoma of the thyroid gland]

Two cases operated upon with the clinical diagnosis of unifocal autonomous functioning thyroid nodules (AFTN) are reported where the histological diagnosis revealed a well differentiated thyroid carcinoma (follicular, papillary) without metastasis. The pathogenesis of differentiated thyroid carcinomas in cases of AFTN may be coincident. Alternatively it may evolve from thyroid epithelial cells of the hot nodule, resulting in a "hot" well differentiated thyroid carcinoma. These cases show that under the clinical diagnosis of AFTN a differentiated thyroid carcinoma can be hidden occasionally.

[A comparative study of cytological and histological studies of the thyroid gland]

We compare the results of fine-needle aspiration cytology of the thyroid gland with postoperative histological findings in 533 patients with thyroidectomy operated on between 1987 and 1994. The classification of the cytological preparations followed the proposal of Weiss and Pilz [35] with the groups 0-IV. In group 0 the most frequent findings were cystic changes in multinodular goitre or malpuncture, respectively. The groups I and II contained cases with multinodular goitre, thyroiditis and follicular adenomas, but 4 carcinomas too. The group III comprised particularly follicular adenomas and carcinomas (8 cases). Both cases in group IV were carcinomas. In group III (cytologic group with suspicious findings) there were 65 cases with false positive results of the cytologic investigation resulting in a specificity of 86.4%. 4 out of 14 thyroid carcinomas could not be detected by cytologic preparations corresponding to a sensitivity of 71.4% for carcinomas. The false negative rate for thyroid carcinomas in group II was caused by regression areas in the center of the tumors (3 cases) as well as one microcarcinoma. Preoperative fine-needle aspiration cytology of the thyroid gland reduces the number of patients operated on for multinodular goitre or cold nodules especially in cases suspicious of carcinoma.

[Bromocriptine treatment of hyperprolactinemia]

In 36 female patients with microprolactinoma was carried out a primary therapy and in 19 patients (10 males, 9 females) with a postoperatively persisting hyperprolactinaemia a secondary therapy with bromocriptine. In close correlation between the PRL-levels and the bromocriptine dose we achieved a normalisation of the hormone levels in the microprolactinomas. A normalisation of the cycle was observed in 80%, a persisting of the galactorrhoea in about 90% and a conception in nearly two thirds of the women. Also in those patients who underwent a secondary therapy in nearly 80% a decrease of the PRL-levels into the normal region developed. In a longterm therapy with bromocriptine a reduction of the dose may become possible, so that controls of the hormone levels are necessary in larger intervals. Most side effects of a bromocriptine treatment are transitory.

[Operative findings and therapeutic results in patients with primary hyperparathyroidism]

In the period from 1976 to September 1982 39 patients with the clinical diagnosis of primary hyperparathyroidism were operated on. Among then were 24 women and 14 men. The most frequent manifestation form is the renal one (n = 26). The proportion of patients with hypercalcaemic crisis was very large (n = 4). Topographically and anatomically the adenomas were most frequently found in the region of the right lower pole of the thyroid gland. 23 patients had a singular adenoma, 11 patients showed multiple adenomas and only 2 had a diffuse hyperplasia. In patients with persisting hyperparathyroidism before a repeated intervention an attempt of localization should be performed by a selective phlebography with taking of blood samples for the determination of PTH. The success of the operation is to be read off most clearly at the behaviour of the post-operative values of serum calcium. In 29 patients a normocalcaemia was achieved. 6 patients showed at first a hypocalcaemia, which however, was only temporary in 4 patients. 3 patients had a persisting hyperparathyroidism. In accordance with the literary data the formation of renal calculi clearly decreased after a successful operation.

[First experiences with short-term lithium therapy in severe thyrotoxicosis]

Even nowadays the therapy of severe, particularly of contrast remedy-induced hyperthyroidism is not without any problems. According to reports in literature the application of lithium salts seems to be an expedient from this dilemma. We controlled the effect of a short-term lithium therapy of 7 days in combination with methimazole in comparison to a group with methimazole monotherapy. The examination showed a good effectiveness and tolerability of the lithium methimazole therapy. While the decrease of the thyroxin concentration in the two groups was not different, in the group with combined therapy a more rapid per cent decrease of the triiodothyronine concentration appeared. In primarily strict selection of the therapy severe side-effects are not to be expected. According to the results yielded up to now the described form of therapy is an actual enrichment for selected forms of hyperthyreosis.

[Control of therapy for hyperthyroidism. Comparison of in-vitro and in-vivo methods]

55 patients with treated hyperthyroidism (thyreostatics) underwent a T3 suppression test and a TRH stimulation test. 60% of the patients had a positive and 40% a negative T3 suppression test. While patients with a positive T3 suppression test always showed a positive TRH test, the behaviour of the TRH test in negative suppression test was different (68.2% positive, 31.8% negative). These discrepant findings are to be explained from the establishment of different phases of regulation. In negative TRH test the concentrations of hormones were significantly higher. Increased basal TSH values are an expression of an overtreatment with thyreostatics. In positive suppression test and TRH test after a therapy lasting at least one year the medication can be stopped. In negative suppression test, however, the therapy should be changed. The TRH test allows only evidence about the quality of the regulation of therapy. Finally it can be established that the two tests on account of their different working points in the regulatory system are necessary and not changeable between each other.

[Interdisciplinary cooperation in the diagnosis and therapy of diseases of the adrenal glands and the parathyroid glands]

It is reported on the interdisciplinary cooperation between internists, radiologists and surgeons in the diagnostics and therapy of endocrinological diseases (suprarenal gland, parathyroid gland). On the basis of instances diagnostic step programmes are represented and first experiences of the cooperation are reported.

[Drug therapy of hyperthyroidism]

The possibilities of the treatment of hyperthyroidism are mentioned, in which cases the author especially deals with the medicamentous therapy, taking into consideration the different chemical groups (imidazol derivations, thiourazil derivations, perchlorates) and their therapeutic mechanisms. The indications and contraindications of this treatment and the possible side effects are compiled in form of a table. The in-vitro-parameters which are necessary for the observation of the course are estimated in their significance. The author deals with the problems of the additional treatment. Taking into consideration indications and contraindications as well as controls of the course of functional parameters the medicamentous therapy concerned is a treatment with a good prognosis. It is promising particularly in such cases, when suitable parameters are used for the solution of the question concerning the end of the therapy. For this purpose nowadays two tests are at our disposal: 1. modified Alexander's test (radioiodine-test and suppression test under thyreostatic therapy) and 2. TRH-test with radioimmunological determination of TSH. The treatment should be carried out in adequate endocrinological dispensaries, as there are certain risks in not optimal therapy.