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

Current Status of Iodine Intake in Croatia – The Results of 2009 Survey

In 1996, due to persistence of mild to moderate iodine deficiency, new law on obligatory salt iodination with 25 mg of potassium iodide (KI) per kg of salt was implemented in Croatia. Along with a new law, a new program formonitoring of iodine prophylaxis was implemented. Investigations of goiter and iodine intake performed in 2002, demonstrated sufficient iodine intake in Croatia with overall median of urinary iodine concentration (UIC) for schoolchildren in Croatia of 140 mg/L. In 2002, thyroid volumes (TV) measured by ultrasound in schoolchildren from all four geographic regions of Croatia were for the first time within the normal range according to ICCIDD reference values. Nowadays, Croatia is internationally recognized as iodine sufficient country. The aim of the present study was to assess current status of iodine intake in Croatia. The investigation was carried out in 2009. A total of 386 schoolchildren aged 7–10 years from all four major geographic regions of Croatia, 103 euthyroid pregnant women and 36 women of child-bearing age from Zagreb, the capital, were included in the survey. Urinary iodine concentration (UIC) was measured in all participants. Thyroid volumes were measured by ultrasound in schoolchildren from the capital of Zagreb (N=101) and the village of Rude (N=56). In the time period 2002–2009, the content of KI was analyzed in 384 salt samples from Croatian salt plants and samples of imported salt. An overall median UIC for schoolchildren in Croatia was 248 mg/L. Median UIC in pregnant women was 159 mg/L, with 50% of samples below and under 150 mg/L. Median UIC in women of child-bearing age was 136 mg/L. Thyroid volumes in schoolchildren were within the normal range according to the new reference values. Mean value of KI/kg of salt in samples from Croatian salt plants was 25.5 mg/kg and 24.9 mg/kg in samples of imported salt. A total of 72/384 (18.8%) of salt samples didn’t corresponded to the Croatian law on obligatory salt iodination. Presented data indicate sufficient iodine intake of the Croatian population. Current medians of UIC in schoolchildren in Croatia are significantly higher than medians measured in 2002. This indicates that other potential sources of iodine are present in Croatian diet that may contribute to overall iodine intake. Due to rising medians of UIC in schoolchildren in Croatia, it is important to conduct nutrition studies to identify potential sources of »silent prophylaxis« in order to avoid iodine excess

Current Status of Iodine Intake in Croatia – The Results of 2009 Survey

In 1996, due to persistence of mild to moderate iodine deficiency, new law on obligatory salt iodination with 25 mg of potassium iodide (KI) per kg of salt was implemented in Croatia. Along with a new law, a new program formonitoring of iodine prophylaxis was implemented. Investigations of goiter and iodine intake performed in 2002, demonstrated sufficient iodine intake in Croatia with overall median of urinary iodine concentration (UIC) for schoolchildren in Croatia of 140 mg/L. In 2002, thyroid volumes (TV) measured by ultrasound in schoolchildren from all four geographic regions of Croatia were for the first time within the normal range according to ICCIDD reference values. Nowadays, Croatia is internationally recognized as iodine sufficient country. The aim of the present study was to assess current status of iodine intake in Croatia. The investigation was carried out in 2009. A total of 386 schoolchildren aged 7–10 years from all four major geographic regions of Croatia, 103 euthyroid pregnant women and 36 women of child-bearing age from Zagreb, the capital, were included in the survey. Urinary iodine concentration (UIC) was measured in all participants. Thyroid volumes were measured by ultrasound in schoolchildren from the capital of Zagreb (N=101) and the village of Rude (N=56). In the time period 2002–2009, the content of KI was analyzed in 384 salt samples from Croatian salt plants and samples of imported salt. An overall median UIC for schoolchildren in Croatia was 248 mg/L. Median UIC in pregnant women was 159 mg/L, with 50% of samples below and under 150 mg/L. Median UIC in women of child-bearing age was 136 mg/L. Thyroid volumes in schoolchildren were within the normal range according to the new reference values. Mean value of KI/kg of salt in samples from Croatian salt plants was 25.5 mg/kg and 24.9 mg/kg in samples of imported salt. A total of 72/384 (18.8%) of salt samples didn’t corresponded to the Croatian law on obligatory salt iodination. Presented data indicate sufficient iodine intake of the Croatian population. Current medians of UIC in schoolchildren in Croatia are significantly higher than medians measured in 2002. This indicates that other potential sources of iodine are present in Croatian diet that may contribute to overall iodine intake. Due to rising medians of UIC in schoolchildren in Croatia, it is important to conduct nutrition studies to identify potential sources of »silent prophylaxis« in order to avoid iodine excess