Poteškoće u određivanju protutijela štitnjače

Nowadays, different methods for determination of thyroglobulin autoantibodies (TGA), microsomal autoantibodies (TMA) and autoantibodies to enzyme thyroid peroxidase (TPO) have been developed. The specificity and sensitivity of these methods depend on the purity of autoantigen preparation itself, valid standardization and type of the methodology used, e.g., agglutination of gelatine particle carriers sensitized with antigen, radioimmunoassay (RIA), immunometric assay (IRMA), enzyme immunoassay (EIA) or luminometric assay (LIA). Although variable in their sensitivity and specificity, these tests are useful parameters in clinical practice, especially for patients with autoimmune thyroid disease, patients with differentiated thyroid cancer and pregnant women. Among six different methods (A-F) that were used in this study, four methods are based on the EIA principle, and one on the LIA and agglutination methodology each. Comparison of TGA, TMA and TPO values obtained by two, three and four methods in parallel was done on 527 frozen serum samples of outpatients. The concordance of TGA results was found to be in the range from 66% to 83% for two methods and 65% for three methods. The concordance of TMA/TPO results was in the range from 42% to 100% for two methods and 48% for four methods. The results suggest that the thyroid autoantibody methods need to be standardized and we are not yet certain which one of the methods is most reliable. False negative/positive TGA and TPO autoantibodies may cause a mistake in the diagnosis of autoimmune thyroid disease patients. Only an accurate, nonbiased TGA method can provide reliable TGA values that may interfere during thyroglobulin (Tg) measurement changing its concentration in serum of differentiated thyroid cancer patients.Danas postoji više metoda određivanja tireoglobulinskih i mikrosomskih protutijela štitnjače (TGA,TMA) kao i protutijela na enzim tiroidnu peroksidazu (TPO). Osjetljivost i specifičnost tih metoda ovise o čistoći antigena i standarda te o primijenjenoj metodologiji kao što su aglutinacijska metoda, radioimunološka (RIA), imunoradiometrijska (IRMA), enzimska (EIA) ili luminometrijska (LIA). Premda su te metode različitog stupanja osjetljivosti i specifičnosti, korisne su u praćenju bolesnika s autoimunim bolestima štitnjače (ATD), diferenciranim karcinomom štitnjače (DTC) i trudnica. Od šest metoda ( 4 TGA, 3 TPO, 1 TMA) primijenjenih u ovom radu četiri su bile EIA metode i po jedna LIA i aglutinacijska metoda. Usporedili smo rezultate TGA,TMA i TPO u serumu ambulantnih ispitanika (N= 527) koji su određeni sa dvije, tri i četiri metode. Podudarnost rezultata dviju TGA metoda kretala se u rasponu od 66% do 83%, a dviju TMA/TPO metoda u rasponu od 65%do 100%. Sukladnost triju TGA metoda i četiriju TMA/TPO metoda iznosila je 65% i 48%. Idealna, 100%-tna podudarnost TMA i TPO rezultata postignuta je metodama A i E (N= 33). Ovi rezultati ukazuju na potrebitost međunarodne standardizacije TGA i TPO metoda kojima bi se postigla veća ujednačenost tj. smanjio broj lažno pozitivnih ili lažno negativnih rezultata. Smatramo da se samo TGA metodom visoke osjetljivosti i specifičnosti može pouzdano odrediti TGA protutijela koja ponekad mogu utjecati na promjenu razine tireoglobulina (TG) u serumu bolesnika s diferenciranim karcinomom štitnjače. Lažno pozitivni ili negativni TGA i TPO rezultati također mogu utjecati na nepouzdanost dijagnoze bolesnika s ATD

Poteškoće u određivanju protutijela štitnjače

Nowadays, different methods for determination of thyroglobulin autoantibodies (TGA), microsomal autoantibodies (TMA) and autoantibodies to enzyme thyroid peroxidase (TPO) have been developed. The specificity and sensitivity of these methods depend on the purity of autoantigen preparation itself, valid standardization and type of the methodology used, e.g., agglutination of gelatine particle carriers sensitized with antigen, radioimmunoassay (RIA), immunometric assay (IRMA), enzyme immunoassay (EIA) or luminometric assay (LIA). Although variable in their sensitivity and specificity, these tests are useful parameters in clinical practice, especially for patients with autoimmune thyroid disease, patients with differentiated thyroid cancer and pregnant women. Among six different methods (A-F) that were used in this study, four methods are based on the EIA principle, and one on the LIA and agglutination methodology each. Comparison of TGA, TMA and TPO values obtained by two, three and four methods in parallel was done on 527 frozen serum samples of outpatients. The concordance of TGA results was found to be in the range from 66% to 83% for two methods and 65% for three methods. The concordance of TMA/TPO results was in the range from 42% to 100% for two methods and 48% for four methods. The results suggest that the thyroid autoantibody methods need to be standardized and we are not yet certain which one of the methods is most reliable. False negative/positive TGA and TPO autoantibodies may cause a mistake in the diagnosis of autoimmune thyroid disease patients. Only an accurate, nonbiased TGA method can provide reliable TGA values that may interfere during thyroglobulin (Tg) measurement changing its concentration in serum of differentiated thyroid cancer patients.Danas postoji više metoda određivanja tireoglobulinskih i mikrosomskih protutijela štitnjače (TGA,TMA) kao i protutijela na enzim tiroidnu peroksidazu (TPO). Osjetljivost i specifičnost tih metoda ovise o čistoći antigena i standarda te o primijenjenoj metodologiji kao što su aglutinacijska metoda, radioimunološka (RIA), imunoradiometrijska (IRMA), enzimska (EIA) ili luminometrijska (LIA). Premda su te metode različitog stupanja osjetljivosti i specifičnosti, korisne su u praćenju bolesnika s autoimunim bolestima štitnjače (ATD), diferenciranim karcinomom štitnjače (DTC) i trudnica. Od šest metoda ( 4 TGA, 3 TPO, 1 TMA) primijenjenih u ovom radu četiri su bile EIA metode i po jedna LIA i aglutinacijska metoda. Usporedili smo rezultate TGA,TMA i TPO u serumu ambulantnih ispitanika (N= 527) koji su određeni sa dvije, tri i četiri metode. Podudarnost rezultata dviju TGA metoda kretala se u rasponu od 66% do 83%, a dviju TMA/TPO metoda u rasponu od 65%do 100%. Sukladnost triju TGA metoda i četiriju TMA/TPO metoda iznosila je 65% i 48%. Idealna, 100%-tna podudarnost TMA i TPO rezultata postignuta je metodama A i E (N= 33). Ovi rezultati ukazuju na potrebitost međunarodne standardizacije TGA i TPO metoda kojima bi se postigla veća ujednačenost tj. smanjio broj lažno pozitivnih ili lažno negativnih rezultata. Smatramo da se samo TGA metodom visoke osjetljivosti i specifičnosti može pouzdano odrediti TGA protutijela koja ponekad mogu utjecati na promjenu razine tireoglobulina (TG) u serumu bolesnika s diferenciranim karcinomom štitnjače. Lažno pozitivni ili negativni TGA i TPO rezultati također mogu utjecati na nepouzdanost dijagnoze bolesnika s ATD

Ultrazvučna analiza štitnjače u trudnoći

The aim of the study was to determine whether pregnancy induced ultrasonographically detectable changes of the thyroid gland. It is a very interesting clinical feature, because some parts of inland Croatia were an endemic goiter area before the implementation of the 1996 act on salt iodination. Sixty-six pregnant women with no history of thyroid disease were repeatedly examined by ultrasound during the course of pregnancy. The size and echostructure of the thyroid were estimated. The thyroid volume increased slightly during pregnancy, but mostly remained within the normal range for particular age. A significant thyroid volume enlargement was observed in third trimester as compared with either first trimester (p=0.02) or control group (p=0.01). Mild goiter of 16% was found in pregnant women in comparison to control group. Morning urine sample, thyroid hormone, TSH and thyroid antibodies were also analyzed in 89 women. Median urine iodine was 8.8 µg/dL. Sixty percent of pregnant women had an iodine concentration below 10 µg/dL. In four out of nine subjects with goiter, urinary iodine excretion was below 5 µg/dL. Elevated serum TSH concentration was recorded in three (3%) women; however, they were euthyroid at the time of the study. Results of the study supported the hypothesis that thyroid volume and thyroid function adapt to the physiologically increased iodine and energy demands. The possible goitrogenic effect of pregnancy could be prevented by an increased iodine intake by diet rich in iodine.U kontinentalnim dijelovima Hrvatske prije uvođenja novoga pravilnika o jodiranju soli 1996. godine zabilježena je endemska gušavost. Stoga je svrha ovoga istraživanja bila utvrditi postoji li i u kojoj mjeri gušavost, odnosno povećanje volumena štitnjaču trudnica sa zagrebačkog područja. Šezdeset šest zdravih trudnica u kojih prethodno nije postojala bolest štitnjače u više je navrata pregledano ultrazvukom, pri čem je određen volumen i ehostruktura štitnjače. Utvrđen je porast volumena štitnjače u sva tri trimestra trudnoće koji je, međutim, prelazio gornju granicu normalne veličine štitnjače (18 mL) i to uglavnom u trećem trimestru. Značajan porast veličine štitnjače ustanovljen je u trećem trimestru u odnosu na prvi trimestar (p=0,02) te na kontrolnu skupinu (p=0,01). Umjerena guša nađena je u 16% trudnica u odnosu na kontrolnu skupinu. U skupini od 89 trudnica određena je koncentracija joda u mokraći, koncentracija hormona štitnjače, TSH te tiroidna protutijela. Utvrđen je medijan koncentracije joda u mokraći od 8,8 µg/dL, a 60% trudnica imalo je koncentraciju nižu od 10 µg/dL. U četiri od devet trudnica s ustanovljenom gušom razina joda bila je ispod 5 µg/dL. Povišena razina TSH u serumu nađena je u 3% trudnica, ali uz normalne razine hormona štitnjače. Ovim smo ispitivanjem potvrdili očekivani porast volumena štitnjače u trudnoći kao posljedicu povećane potrebe za energijom i jodom. Stoga zaključujemo da se očekivani goitrogeni učinak trudnoće može spriječiti prehranom obogaćenom jodom

Tumorski biljeg CYFRA-21-1 u serumu i pleuralnom izljevu bolesnika s karcinomom pluća

Tumor marker CYFRA-21-1 may be used as an additional parameter in the diagnosis, prognosis and follow-up of patients with non-small cell lung carcinoma (NSCLC), especially those with squamous cell carcinoma. From 1994 till 2001, the concentration of CYFRA-21-1 was determined in serum and/or pleural effusions of 166 patients with NSCLC, and in serum of 28 control subjects. Serum CYFRA-21-1median in the control, benign and malignant group was 0.8 ng/mL, 2.6 ng/mL and 6.3 ng/mL, respectively (p>0.05). In pleural effusions, CYFRA-21-1 median differed significantly between the benign (8.2 ng/mL) and malignant (146 ng/mL) group (p0,05). Nasuprot tome, u pleuralnom izljevu medijani CYFRA-21-1 benigne i maligne skupine od 8,2 ng/mL i 146 ng/mL bili su značajno različiti (p<0,0000). Osjetljivost i specifičnost CYFRA-21-1 u serumu bila je 62% odnosno 76%, a u pleuralnom izljevu su oba parametra iznosila 73%. Naši dosadašnji rezultati potvrđuju da je CYFRA-21-1 koristan dodatni parametar u razlikovanju benignih od malignih pleuralnih izljeva, ali ne i benignih od malignih seruma

Tumorski biljeg CYFRA-21-1 u serumu i pleuralnom izljevu bolesnika s karcinomom pluća

Tumor marker CYFRA-21-1 may be used as an additional parameter in the diagnosis, prognosis and follow-up of patients with non-small cell lung carcinoma (NSCLC), especially those with squamous cell carcinoma. From 1994 till 2001, the concentration of CYFRA-21-1 was determined in serum and/or pleural effusions of 166 patients with NSCLC, and in serum of 28 control subjects. Serum CYFRA-21-1median in the control, benign and malignant group was 0.8 ng/mL, 2.6 ng/mL and 6.3 ng/mL, respectively (p>0.05). In pleural effusions, CYFRA-21-1 median differed significantly between the benign (8.2 ng/mL) and malignant (146 ng/mL) group (p0,05). Nasuprot tome, u pleuralnom izljevu medijani CYFRA-21-1 benigne i maligne skupine od 8,2 ng/mL i 146 ng/mL bili su značajno različiti (p<0,0000). Osjetljivost i specifičnost CYFRA-21-1 u serumu bila je 62% odnosno 76%, a u pleuralnom izljevu su oba parametra iznosila 73%. Naši dosadašnji rezultati potvrđuju da je CYFRA-21-1 koristan dodatni parametar u razlikovanju benignih od malignih pleuralnih izljeva, ali ne i benignih od malignih seruma

The story of the Croatian village of Rude after fifty years of compulsory salt iodination in Croatia

The village of Rude is situated near Zagreb, the capital of Croatia in the last Alpine valley on Balkan. In the past, the village was well-known area of severe iodine deficiency disorders (IDD). In 1952', distinguished Croatian endocrinologist Professor Josip Matovinovic carried out detailed village survey. Goiter prevalence in school-age children was 85.0% (with 2.3% of cretins in the village). In 1953, the first regulation on compulsory salt iodination with 10 mg of KI/kg of salt was established in former Yugoslavia. Ten years later a dramatic decrease in goiter prevalence was recorded in all endangered areas of the country and no new cretins appeared. However, at the beginning of 1990' mild to moderate iodine deficiency still persisted in Croatia. In 1991, the village of Rude survey demonstrated goiter prevalence in school-age children of 35.0% and median of urinary iodine excretion (UIE) of 7.4 microg/dL. In 1996, the new obligatory regulation with 25 mg of KI/kg of salt was established in Croatia. The study aim was to monitor IDD status in the village after the new law on compulsory salt iodination. Measurements of UIE and thyroid volumes (Tvol) by ultrasound were performed in 7-11-y-old schoolchildren living in the village of Rude. Medians of UIE and body surface area (BSA)-adjusted Tvol in boys and girls were calculated. The study included 84 children in 1997, 132 in 2000, 72 in 2002, 85 in 2003 and 46 in 2004 for UIE measurement. Thyroid volumes were measured in 1999 (43 boys and 26 girls) and in 2005 (22 boys and 26 girls). Data were compared with the new WHO/ICCIDD reference values. Medians of UIE in schoolchildren from the village of Rude demonstrated rising values in microg/dL: 11.4 in 1997, 14.3 in 2000, 17.3 in 2002, 15.4 in 2003 and 19.0 in 2004. Significant decrease in BSA-adjusted Tvol was recorded from 1999-2005 in boys and girls from the village of Rude and in 2005 Tvol were within the normal range according to the new international reference values for Tvol in iodine-sufficient schoolchildren. As a result of increased iodine prophylaxis, IDD no longer exist in Croatia. Monitoring of IDD status in the village of Rude after new law on compulsory salt iodination in Croatia demonstrated rising medians of UIE together with significant reduction of Tvol. In 2005, Tvol in schoolchildren from the village of Rude were within the normal range according to the new international reference values for Tvol in iodine-sufficient schoolchildren