Changes in iodine supply in adult Czech population after iodine deficit eradication and causes. Random study of adults in two regions in the Czech republic with inbetween period of 5 years

J. Čeřovská, R. Bílek, H. Zamrazilová, P. Hoskovcová, M. Vosátková

Vnitr Lek 2006, 52(10):858-863  

Introduction:By iodine, similar to many other elements that are important for human body, the daily intake has some limitations. Neither deficiency, nor surplus are required. In the second half of the nineties in the 20th century, iodine deficiency in Czech republic could have been eradicated to a great extent. However, changes in iodine supply in population still have to be monitored, looking for the causes in nutrition.Aim:To monitor the changes in ioduria in adult population and search for causes of these changes in dietary habits.Methods:In 1999, 2000, 2004 and 2005, urinary iodine was determined...

Thyroid autoimmunity in adults with diabetes mellitus type 1. Own experience gained by 11-year monitoring

K. Vondra, J. Vrbíková, I. Šterzl

Vnitr Lek 2006, 52(10):864-872  

The results of study on thyroid autoimmunity and its clinical importance gained during 11-year follow-up of 47 adults with type 1 diabetes mellitus (DM1) are presented. The study proved the preponderance of women among subject affected with thyroid autoimmunity, the autoantibodies against thyroid gland (T-Ab) were significantly more often detected in women compared to men (68% vs. 32%, p < 0.05). Also, serious forms of thyroid autoimmunity manifested with persistence of both T-Ab, faster development of subclinical hypothyroidism (TSH > 4.5 mIU/l in 100% within 4 years after first detection of T-Ab positivity, and within 8 years after DM1 manifestation,...

Selenium deficiency of west bohemia population

J. Kvíčala, V. Jiránek, J. Němeček, J. Čeřovská, M. Dvořáková, R. Bílek

Vnitr Lek 2006, 52(10):873-880  

To estimate status and intake of selenium in inhabitants of the most Western region of the Czech Republic (Cheb region) 241 serum, 404 urine and 30 hair samples from randomly selected persons in the age between 6 and 65 years is performed. Serum and hair samples were analysed by means of instrumental neutron activation analysis (INAA), while Se in urines was detected by means of fluorimetry. Urine iodine was determined in the same group by Sandell-Kolthoff method for the possibility to detect concomitant Se and I deficiency and/or correlations between these two essential trace elements necessary for metabolism of thyroid hormones. Average values of...

Iodine and thyroid hormones

R. Bílek, J. Čeřovská

Vnitr Lek 2006, 52(10):881-886  

In the years 1995–2002, a survey was conducted involving 5 263 individuals (2 276 males, 2 987 females) between the ages of 6–98. They were selected randomly from the central registery in 7 counties in the Czech Republic. The level of urinary iodine in these individuals was established using the Sandell-Kolthoff rection which was preceded by the alkaline ashing of the samples as follows: (n = 5 263), thyroglobulin (TG, n = 3 902), thyrotropin(TSH, n = 5 162) freee thyroxin (fT₄, n = 5 160) and free triiodothyronine (fT₃, n = 4 931), where the thyroid hormones, TSH, and TG were determined in serum using immunoassays....

The role of adiponectin in increased insulin sensitivity of patients with anorexia nervosa

I. Dostálová, K. Smitka, H. Papežová, H. Kvasničková, J. Nedvídková

Vnitr Lek 2006, 52(10):887-890  

The aim of the present study was to determine the relationship between plasma levels of adipocytokine adiponectin and the degree of insulin sensitivity in patients with anorexia nervosa (AN). AN is a psychiatric disorder characterized mainly by severe malnutrition and loss of body fat. We measured fasting plasma adiponectin, insulin and glucose levels in ten women with a restrictive type of AN and in twelve healthy normal-weight women. Plasma adiponectin levels were significantly increased in patients with AN compared to healthy women (p < 0.01) and were negatively related to body mass index and percent body fat in both groups. Plasma adiponectin...

Autoimmune thyroiditis - selected etiopathogenic mechanisms

I. Šterzl, P. Hrdá, P. Matucha, B. Potužníková, J. Procházková

Vnitr Lek 2006, 52(10):891-899  

Autoimmune thyroiditis occurs as organ specific autoimmune disease not only as an isolated impairment of thyroid gland, but also linked to many autoimmune endocrinopathies. Genetic predisposition in the area of HLA antigens was followed up by patients with autoimmune thyroiditis diagnosed in this way and it appeared that genetic predisposition in isolated autoimmune thyroiditis is different when compared to the occurrence linked to endocrine polyglandular disease. In selected groups of patients with autoimmune disease also the influence of extraneous factors on the development of the autoimmune process was followed up, namely the influence of heavy...

Is decreased thyroid echogenity a good indicator of thyroid autoimmune disorder?

M. Dvořáková, M. Hill, J. Čeřovská, Z. Novák, I. Šterzl

Vnitr Lek 2006, 52(10):900-905  

Introduction:Thyroid gland with mildly decreased or significantly decreased echogenity is indicating possible autoimmune disorder even before first symptoms, i.e. change in laboratory tests measuring the level of thyroid hormones and antibodies to thyroid antigens occur. Target: to consider changes in thyroid gland echogenity suspecting thyroid autoimmune disorder and to determine antibodies to thyroid antigens in the respective type of thyroid echogenity (increased, normal, mildly decreased or significantly decreased) to consider the activity of autoimmune thyropathies related to echogenity and to compare these factors.Methods:

Primary aldosteronism in gravidity

A. Kreze jr, M. Pura, M. Dobáková, N. Földešová

Vnitr Lek 2006, 52(10):906-908  

Endocrinology and obstetrics have one thing in common - diagnosis and treatment endocrine diseases in gravidity. These are modified by physiological changes in gravidity, often missing data and tests in normal condition and the influence of diagnosis and treatment on the pregnant female and fetus have also to be taken into consideration. If diagnosis of primary aldosteronism is suspected, suprimed plasmatic renin activity is determinant indicator (disregarding arterial hypertension, hypokaliaemia, hyperkaliuresis and proteinuria) as well as ultrasound diagnostics or adrenal gland diagnostics means magnetic resonance imaging. Aldosteron produced adenomas...

Testosteron treatment in sarcopenia

L. Stárka

Vnitr Lek 2006, 52(10):909-911  

Testosterone increases muscle mass and decreases fat mass by mechanism including androgen receptors. Testosterone induces skeletal muscle fibre hypertrophy and increases the number of satellite cells. It also promotes the differentiation of mesenchymal multipotent cells into myogenic lineage and inhibits their differentiation into the adipogenic lineage. Meta-analyses of clinical trials provide evidence that testosterone treatment, depending on dose, increases the skeletal muscle mass and to some degree also muscle strength. The most frequent adverse effects of testosterone treatment in aging men are an increase of hematocrit and increased risk of...

New aspects of the epidemiology of goitre

P. Langer

Vnitr Lek 2006, 52(10):912-918  

Due to successful progress in monitored iodine prophylaxis of iodine deficiency during the last decades the prevalence of endemic goitre in several countries considerably decreased. Nevertheless, epidemiological studies have been also indicating a certain prevalence of small thyroids in the areas of iodine deficiency too, and, vice versa, that even after successful iodine prophylaxis the thyroid volume (ThV) is not equally decreasing in all subjects and goitre does still exist. This phenomenom has been called sporadic goitre and hereditary etiological factors were suspected. It is shown that after 40 years of successfully monitored and mandatory consumption...

Incretins

J. Vrbíková, K. Vondra

Vnitr Lek 2006, 52(10):919-925  

Insulin secretion is greater after peroral challenge than after intravenous glucose administration due to so-called incretin effect. The major incretins are glucagon-like peptide 1 and glucose-dependent-insulinotropic peptide. Physiology, pathophysiology and therapeutic implications of incretins in diabetes, neurodegenerative disorders and stress-induced hyperglycemia are concerned.

Thyroid carcinomas and Hirschsprung's disease - 10-year experience with molecular genetic testing of the RET proto-oncogene

B. Bendlová, Š. Dvořáková, E. Václavíková, V. Sýkorová, P. Vlček, R. Škába

Vnitr Lek 2006, 52(10):926-934  

In the last ten years, research has confirmed the role of the RET proto-oncogene in the pathogenesis of thyroid cancer such as medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC), multiple endocrine neoplasia type 2 (MEN 2) and Hirschsprung’s disease that can be associated with MTC or MEN 2. Through the use of molecular genetic testing, we are able to detect gene mutations and the course the disease might take can be predicted, thus enabling us to cure mutation carriers among the high-risk patients can at a very early, clinically asymptomatic stage of the disease; prophylactic total thyreoidectomy in said patients is...

Mechanisms of the intracellular activities of thyroid gland hormones

J. Brtko

Vnitr Lek 2006, 52(10):935-940  

Function of thyroid hormones affecting broad spectrum of various biochemical and molecular biology reactions in organisms is unimaginable without fully functional nuclear receptors. On account of this fact, research on the role and function of thyroid hormone receptors that play a role as thyroid hormone inducible transcription factors, belongs to dynamically developing branches of molecular endocrinology. In organism, full functionality of thyroid hormone receptors in the form of heterodimer with nuclear 9-cis retinoic acid receptor is essential for biological effects of 3,5,3'-triiodothyronine.

Hormonal diseases after traumatic brain injury

J. Čáp

Vnitr Lek 2006, 52(10):941-946  

Traumatic brain injury represents major medical and social problem in all developed countries. Its incidence is about 200 per 100,000 inhabitants per year. In the acute phase immediately after injury the posterior pituitary dysfunction is well-known. The incidence of severe grossly hypernatremic cases of diabetes insipidus (DI) is about 3 %, less severe form of ADH insufficiency was recognized in 21–26 %. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) was described in about 14 %. These changes are transient in most cases, persisting DI has an incidence of 5–7 % and SIADH cases recover almost always. Since the beginning...

Contemporary theories concerning chronic lymphocytic thyroiditis

Z. Límanová, J. Jiskra

Vnitr Lek 2006, 52(10):947-953  

Review of contemporary theories and hypothesis concerning chronic lymphycytic thyroiditis is presented. The origin of the disease depends on various factors: genetics, immunological conditions, cytokins, iodine supply, hormones, TSH and its receptors, apoptosis activation and inhibition. The environmental conditions include goitrogens, selenium, polutants and other still unknown factors. Whether the disease will be accompanied with goiter, nodules or thyroid atrophy with functional disorder is still not evident.

Hashimoto's encephalopathy

H. Vondrová

Vnitr Lek 2006, 52(10):954-956  

Hashimoto's encephalopathy (HE) is not an often complication of autoimmune thyroiditis, usually at the time the patient is already euthyroid i.e. with normal TSH-value but positive antibodies to thyroid hormones. Signs and symptoms are acute or sub-acute, such as cerebrovascular accident, epileptic seizures generalised, myoclonic or partial, cognitive function disorder with dementia and psychical disorders. Pathological findings, even non-specifical, can be found in cerebrospinal fluid, by electroencefalography (EEG) or by brain scan with magnetic resonance (MR). Pathogenesy of the disease is unclear; however, corticoid treatment is usually succesful....

Congenital adrenal hyperplasia due to 3β-hydroxysteroid dehydrogenase deficiency

M. Marunová

Vnitr Lek 2006, 52(10):957-962  

Deficiency of 3β-hydroxysteroid dehydrogenase belongs to less frequent types of congenital adrenal hyperplasia. It is a deficiency of the enzyme converting pregnenolon to progesteron, 17-OH-pregnenolon to 17-OH-progesteron and dehydroepiandrosteron to androstendion in the adrenal glands and gonads. Exact prevalence of forms with clinical symptoms is known; however, it is less frequent compared to deficiency of 21-hydroxylase. Clinical manifestation is very variable, from serious salt disorder, ambiguous genitalia and precocious puberty to oligosymptomatic forms with late effects or asymptomatic forms. No routine genetic analysis in Czech republic...

Subclinical thyropathies

K. Drbalová, K. Herdová, P. Pačesová, M. Šimon

Vnitr Lek 2006, 52(10):963-968  

Subclinical thyreopathies are pathological states of the thyroid gland that show no corresponding clinical symptoms, yet may be detected sporadically by laboratory examination or screening methods. They represent a novel diagnostic entity (analogous to glucose tolerance impairment - IGT or impaired fasting glycemia - IFG), which appeared due to innovations in laboratory diagnostics (sensitive TSH detection methods) and recent focus on pre-clinical stages of manifestative diseases. From a wider point of view, subclinical thyreopathies include subclinical hypothyroidism, subclinical hyperthyrodism, thyroid volume or structure changes found accidentally...

Radionuclid screening in endocrinology

P. Vlček, K. Michalová, K. Táborská, P. Sýkorová

Vnitr Lek 2006, 52(10):969-972  

The study provides an overview of current possibilities for use of nuclear medicine methods in endocrine diagnostics and therapy. Somatostatin receptor analogue is applied to the hypothalamus-hypophysis system, analogue medium to is used, in thyroid diagnostics, besides the determined tumour markers, tenchecium-labelled MIBI radioiodine 131 is used to determine and monitor carcinomas. Recently, rhTSH before starting thyroid carcinoma treatment is used. Neuroendocrinology tumours are suspected through ¹²³I-MIBG; when scintigraphy is positive, therapeutic ¹³¹I-MIBG can be administrated. In diagnostics of the pituitary gland, two-step...

Natural antiglucocorticoids

R. Hampl, K. Vondra

Vnitr Lek 2006, 52(10):973-978  

Dehydroepiandrosterone, as a sulfate after cholesterol the most abundant circulating steroid displays a number of remarkable actions, especially on immune system, where it counteracts immunosuppressive effects of glucocorticoids. Recently it has been found that in some instances the locally active agents are 7-oxygenated metabolites of this steroid, so far believed to be only degradation products. In the survey so far known effects of dehydroepaindrosterone and its metabolites are summarized on cytokine production, activation of apoptosis, their influence on macrophage migration into affected peripheral tissues, their plausible effect on angiogenesis,...

Enteral nutrition in diabetes mellitus

Z. Rušavý

Vnitr Lek 2006, 52(10):979-982  

In the last 15 years enteral nutrition has been getting ahead of parenteral nutrition. Enteral nutrition allows natural supply of nutrients, stimulates immunity, reduces overgrowth of intestinal microflora, reduces intestinal permeability, and has a positive effect on intestinal peristalsis. Substrates of enteral nutrition are nutritionally defined, low osmolar, and usually residual-free, do not contain lactose and gluten. A number of substances is flavoured, allowing continual drinking of the nutrition throughout the whole day. This mode of nutrition is increasingly used and referred to as sipping or drink feeding. Enteral nutrition is also suitable...

Serious manifestation of primary hypothyroidism

H. Kvasničková, J. Švejda, J. Šochman

Vnitr Lek 2006, 52(10):988-991  

Thyroid gland diseases are the most frequent endocrinopathy and can be often seen in adult population. They occur at least by 5 % of the population and the occurence increases with age, in females aging 45 and more, as thyroid gland diseases in this age group are represented approximately by 20 %. Due to a complex influence of thyroid hormones in humans, diagnosis of thyroid disease may remain unsuspected under other disease with typical symptoms; the most serious of them is cardiogenic manifestation. When thyroid disease suspected, methods of diagnostics are very comprehensive and broad. Treatment on time can prevent serious complications. Case-study...

Profesor MUDr. Václav Zamrazil, DrSc. sedmdesátníkem

Vojtěch Hainer

Vnitr Lek 2006, 52(10):856-857

Václav Zamrazil - pokračovatel v Šilinkově jodové profylaxi strumy

Vratislav Schreiber

Vnitr Lek 2006, 52(10):857

Contribution to the discussion on the connection between mammary and thyroid gland diseases

M. Bičíková, N. Kaňová

Vnitr Lek 2006, 52(10):983-984  

The authors use results from their own study on 150 women in perimenopause who for preventive purposes, had both their mammary and thyroid glands checked. They discuss possible common factors which might play a role in the occurence of mammary and thyroid gland diseases.

A recommended procedure in laboratory-based diagnostics of thyroid function - yes or not?

O. Topolčan

Vnitr Lek 2006, 52(10):985-987  

The author discusses the current status of laboratory-based thyroid diagnostics in the Czech Republic, and compares it with the procedure recommended by the National Academy of Clinical Biochemistry (NACB), USA. Based on an analysis of the current situation, the author recommends the introduction of a Czech version of the above-mentioned recommended procedure.