Hyperthyroidism
	Amarante et al., Sao Paulo, Brasil, studied if urinary collagen cross-links excretion, correlates with free hormone levels in 23 patients with untreated Graves' disease. They measured excretion of pyridinolin and deoxypyridinolin in urine and found a better correlation with free T3 than with free T4. The exretion of these collagens is correlated with bone turnover in hyperthyroidism. Mercuro et al., Cagliari, Sardinia, Italy, studied cardiac function and skeletal muscle performance in 14 patients before treatment of hyperthyroidism and at several instances during and after treatment. They found that impaired exercise tolerance was caused both by decreased cardiac performance and skeletal muscle performance (presumably due to decreased muscular oxidative capacity). In addition it appeared the faster hyperthyroidism was corrected, the longer it took to restore muscular function, whereas a slow and progressive return to euthyroidism normalized muscular function earlier. Nystrom et al., Goteborg, Sweden, studied bone mineral density and body composition in 8 patients with hyperthyroidism before and one year after treatment. They found that after one year all subjects increased in bodyweight, bone mineral content and total calcium. However, urinary calcium excretion was still low after one year in 5/8 patients, while the mean parathyroid hormone level was increased. These findings point to a negative calcium balance still one year after treatment and the authors question if these patients should not receive calcium supplementation after treatment. Vaisman et al., Rio de Janeiro, Brasil, investigated muscle performance and did anthropometric measurements in 9 patients before and after medical treatment for Graves' disease. They found that the increase in bodyweight was mainly due to increase in lean body mass and that the improvement in muscle performance resulted both from enhanced intrinsic muscle function as well as increased muscle mass. Gerasimov et al., Moscow, Russia, measured left ventricular contractility before and after treatment for hyperthyroidism in 19 patients with Graves' disease. They found that parameters of left ventricular contractility like stroke volume, cardiac output, left ventricular ejection fraction all correlated with FT4. They also found 8% of patients having mitral valve prolaps before, but only 4% after treatment. Hüfner et al., Göttingen, Germany, tested the efficacy of prophylactic administration of 20 mg methimazole or 900 mg perchlorate to prevent iodine induced thyrotoxicosis in patients with autonomy of thyroid function (low TSH and normal FT3 and FT4). Treatment was started 12h before coronary angiography and continued for 14 days. In total 51 patients were included in the study. They found that either of these medical regimens could not prevent mild hyperthyroidism in some cases as measured 30 days after angiography. The lab results however indicate some protection against excess of iodine. (Comment: In the experience of the authors it is in most instances possible to prevent even mild thyrotoxicosis when 60 mg methimazole and 1200 mg perchlorate daily are given together until 1 week after iodine excess, after which perchlorate can be discontinued completely and methimazole tapered off in the course of a few weeks.) Jarlof et al., Odense, Denmark, compared two regimens of RAI treatment for hyperthyroidism. The first regimen consisted of administration of 185, 370, 555 mBq for small (< 30ml), medium (30-60 ml), or large glands (> 60 ml) (volumes were assessed by palpation) versus a so-called compensated l3lI therapy based on type of thyroid gland, accurate thyroid volume and 24h RAI uptake determinations. In total 163 patients were studied and no differences in therapeutic outcome were found in any of the three types of hyperthryoidism (Graves' disease, multinodular toxic goiter, and toxic adenoma). They conclude that the first semiquantative approach is probably as good as the more elaborate one and is clearly more cost-effective. Cortelazzi et al., Milan, Italy, report the first patient with a toxic nodule who was treated with ethanol injections during pregnancy in the 13th week of gestation. Four injections of 3 ml ethanol (95%) one, every 3 days, were given, successfully resulting in euthyroidism 3 weeks after the first injection. The nodule reduced to 1/3 of its original volume. Apart from a transient pain and a burning sensation no adverse affects were seen, either in the mother or in the fetus.