Die blande Struma

Eine mechanische Teil-Indikation kann auch schon bei blander Struma des Stadium I bestehen. Die Indikation auf Wunsch des Patienten ist berechtigt, wenn die Schilddrüsenhormonbehandlung erfolglos oder wenig aussichtsreich ist. Die prophylaktischdiagnostische Operationsindikation wird nach Abwägung von statistischem und individuellem Malignom- und Operationsrisiko gestellt. Letztere Indikation überwiegt heute bei weitem. — Die Kropf-Prophylaxe mit jodiertem Speisesalz könnte die mittlere Strumafrequenz in der Bundesrepublick von 15 auf 3 % reduzieren.Surgical treatment can be justified already for nontoxic goiter stage I (WHO) because of tracheal stenosis. Surgery for cosmetic reasons may be adequate, if treatment with thyroid hormones is neither successful nor promising. Diagnostic (histologic) or prophylactic reasons are today the most frequent causes for surgery, in order to detect or avoid thyroid malignancies. — Iodine prophylaxis is advocated in the Federal Republic of Germany, where iodine deficiency and endemic goiter (15 %) are still prevalent

Antigen receptor variable region repertoires expressed by T cells infiltrating thyroid, retroorbital, and pretibial tissue in Graves' disease

To date, it has remained unclear whether T cells infiltrating thyroid, retroorbital, and pretibial tissue of patients with Graves' ophthalmopathy and pretibial dermopathy represent a primary immune response that is directed against certain antigenic determinants shared among these involved tissues. To characterize these T cells at the molecular level, we compared the T cell antigen receptor (TcR) variable (V) region gene usage in thyroid, retroorbital, pretibial tissue, and peripheral blood mononuclear cells of two patients with Graves' disease, ophthalmopathy, and pretibial dermopathy. Ribonucleic acid was extracted, reverse transcribed, and amplified using the PCR and 22 V alpha and 23 V beta gene-specific oligonucleotide primers. The resulting TcR V alpha and V beta transcripts were verified by Southern hybridization analysis using TcR C region-specific, digoxigenin-labeled oligonucleotide probes. In addition, complementarity determining regions 3 and junctional regions of TcR V beta genes were sequenced. Marked similarities of intrathyroidal, retroorbital, and pretibial TcR V alpha and V beta gene repertoires were noted with respect to the degree of TcR V gene restriction and the patterns of individual V genes expressed. Sequence analysis of junctional domains of V beta families revealed oligoclonality of intrahyroidal, retroorbital, and pretibial T cells. In addition, certain conserved junctional motifs were shared by T cells derived the thyroid gland and the extrathyroidal sites. Our results suggest that in the two patients with Graves' disease and extrathyroidal manifestations studied, similar antigenic determinants may have contributed to the recruitment and oligoclonal expansion of T cells both within the thyroid gland and at the involved extrathyroidal sites