[Epidemiological aspects of Graves'-Basedow's disease].
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Biomedical subjects
Publications and source records attributed to G Lungu.
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We studied the calcium tolerance on 59 subjects with tetania latenta. The calcium tolerance was tested by induced hypercalcemia (Klotz's test). In 12 cases the dynamic changes of serum magnesium were also investigated during the same test. Eight cases exhibited a normal tolerance and 51 exhibit an abnormal response, calcemia remaining at a high value after 4 hours of the test. The magnesium values remained low when finishing the test (p less than 0.001). It was concluded that 86 per cent of the subjects having tetania latenta and exhibiting an increase of calcium tolerance had a possible calcitonin deficiency. The significance of the magnesium decrease remains unclear. These phenomena have not been observed in Graves' disease and in the Turner's syndrome.
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Cell immunity aspects were studied in patients with untreated Graves' disease or thyreotoxicosis relapsing after anti-thyroid drug therapy interruption. The peripheral blood T-lymphocyte count was significantly low (p less than 0.05) in the untreated patients. The leucocyte inhibition factor (LIF) test showed only a slight sensibilization of lymphocytes to thyroglobulin in the untreated patients, whereas in those with relapsed thyreotoxicosis there was a marked sensitization to thyroglobulin and microsomal antigen. Our observations suggest that part of the untreated patients have some abnormalities in the function of their lymphocytes. All the relapsed cases showed an intense sensitization of lymphocytes in the direct LIF test. The possibility of using the LIF test as an indicator of thyreotoxicosis release after interruption of the anti-thyroid drug therapy is suggested.
The submaximal triangular-type test was used for studying the adaptive capacity, on an ergometric bicycle. It was performed continuously, starting from O W, with a load increment of 10 watts/min up to optimal maximum heart rate (fmo). The heart rate, arterial blood pressure, electrocardiogram, CO2 output and O2 consumption computed maximal O2 consumption (VO2 max, ml/kg/min) (Astrand) were predicted, also taking into consideration the subjective sensations linked to effort, measured on a modified Borg scale. The capacity to effort was expressed by the "adaptability coefficient" (AC) according to formula: AC = W' divided by 2 + (W' --f). 40 hyperthyroid patients, compared to a lot of normal thyroid subjects were examined, both at the beginning and after the treatment at certain intervals of time. A decrease of the effort capacity before the treatment and its increase after was noticed in hyperthyroid patients.
30 women, aged between 21 and 52, with 2nd and 3rd grade obesity were investigated. Total lipids, total cholesterol, HDL cholesterol, tryglicerides and lipoprotein electrophoretic fractions from blood plasma were determined. The subjects were tested at a submaximal exercise intensity of a triangular type on the ergometric bicycle, starting from zero Watt to a progressive increasing load of 10 Watt/min., till the maximal optimal heart rate was reached. The heart rate, blood pressure, CO2 produced and O2 consumption were determined at rest, during exercise at each step, and in the recovery period, predicted the maximum oxygen consumption, evaluated by the Astrand method. The subjective sensation concerning the effort was taken into consideration, based on the modified Borg scale and adaptability to exercise was evaluated, expressed by the "adaptability coefficient" (AC). The index of correlation between the plasma lipid fractions and AC was also determined. Lipidograma showed modifications of 94.44 percent of which 27.77 percent belonged to type IV of H-LP. AC diminished to 50.2 percent as opposed to the ideal values; the maximum oxygen consumption was diminished as well, with an important functional aerobic impairment. There was not found a statistically significant correlation between plasma lipid fractions and AC.
Fifteen cases of chronic lymphocytic thyroiditis (CLT) diagnosed on the basis of both clinico-functional criteria and humoral autoimmunity (auto-ACAT in the serum) were studied. The auto-ACAT were avaluated both by Boyden's passive hemagglutination and by the complement fixation reactions. In all the diagnosis received histopathologic confirmation, the lesional picture being analysed from a qualitative-semiquantitative aspect. In 5 of the 15 cases, thyroid silver impregnation according to Slidders's technique was also done. Corroborating lesional aspects with humoral auto-immunity, we found a correlation between the extension of the inflammatory infiltrates dominated by lymphocytes and the titres of the antimicrosomal antibodies. The titres of the antithyroid antibodies do not correlate with the thyroid function status. Conversely, the extent of fibrosis agrees well with the incidence of myxedema. Silver impregnation reveals severe lesions of the argyrophilic fibres, with diffuse distribution. These lesional aspects may precede the real thyroiditic process.
In 25 cases of spasmophilia the parathyroid function was assessed by complete exploration of the P-Ca metabolism and radioimmunoassay (RIA) of parathormone (PTH). Concomitantly the bone mineralization status was assessed by induced hypercalciuria tests and administration of 30 mg vitamin D2. RIA of PTH revealed increased values in 50% of the cases. The values fall within the range of secondary hyperparathyroidism, but this percentage varies with the values of the parathyroid function obtained by P-Ca metabolism explorations. The increased PTH values do no correlate with the level of plasma total calcium, ionic calcium, and magnesemia. Nor do they correlate with the bone mineralization disorders or the duration of the disease and the age of the patients.
The dynamics of endemic goiter morbidity in Timiş county is evaluated comparing the studies carried out 30 years ago with the present-day ones. A positive correlation is found between the extension and severity of the endemic, on the one hand, and the iodine content of the drinking water sources, on the other. Eradication of the endemic has been achieved by borin gartesian wells (having a higher iodine content than dug wells), by intensive iodine prophylaxis and therapy as well as by the socioeconomic changes characterized by a high degree of pre-urbanization of the country-side.