Hypothyroidism
	Baptista et al., Lisbon, Portugal, studied the prevalence of subclinical hypothyroidism in patients with Down's syndrome and, if present, if this affected psychomotor development. They found in 43 children with Down's syndrome that serum TSH was signifantly increased (4.9 vs. 2.5 in first degree siblings serving as normal controls). Serum T4 and T3 levels were not different. Thirty patients had a TSH above normal limit. There was no difference in psychomotor performance between Down's syndrome subjects with TSH below or above normal level. It is concluded that psychomotor performance is not affected in Downs' syndrome patients with subclinical hypothyroidism. Walker et al., Toronto, Canada, assessed hearing ability of 100 children with congenital hypothyroidism born between 1976 and 1985, and identified 17 cases with hearing abnormalities, comprising mostly mild unilateral or bilateral sensorineural hearing loss. These children perform poorer in mechanical reading, spelling and writing throughout the first six grades of school. Tunbridge et al., Newcastle, UK, did a follow-up study to determine any association between raised serum TSH and thyroid antibodies identified 20 years ago on the development of ischaemic heart disease at present as part of the so-called Whickham study. Eighthundred twenty-five subjects (30 % of the sample) had died and of these 1/3 had died of ischaemic heart disease. Of the 1877 survivors, 96 % participated in the follow-up. No increased risk of death for all causes was found either in the men or in the women, nor was it found in both sexes for ischaemic heart disease in relation to the presence of thyroid autoantibodies. In 126 women with initially an increased serum TSH (> 6mU/L) in the absence of overt thyroid disease no significant difference was found for the presence of ischaemic heart disease when matched with controls, nor were their differences regarding fasting bloodsugar, serum cholesterol and triglyceride, mean arterial blood pressure, or bodymass index. This survey on a large scale over a long period of time does not show any significant association between the evidence of thyroid failure, documented at first survey with mortality or development of ischaemic heart disease 20 years later. (Comment: It is still a controversy whether so-called subclinical hypothyroidism should be treated to prevent increased risk for ischaemic heart disease. This study very much supports the non-treatment standpoint. However, to our opinion the controversy still exists, for example studies have been reported in the literature indicating that in this type of patients atherogenic changes occur in the lipid profile, at least theoretically implicating that ischaemic heart disease may be induced. However, that increased ischaemic heart disease develops in these patients, has, as far as we know, never been documented. The controversy goes on!) Tielens et al., Rotterdam, The Netherlands, performed multiple gated equilibrium radionuclide ventriculography (MUGA) in consecutive outpatients with untreated longstanding hypothyroidism or hyperthyroidism. In both groups marked scintigraphic abnormalities in both diastolic and systolic cardiac function were detected despite the absence of evident clinical cardiac disease. In the hyperthyroid group evidence was found for augmented contractility. In the hypothyroid group diastolic dysfunction is most pronounced and correlates with circulating thyroid hormone concentration. No diastolic hypertension was detected in hypothyroid patients. Rovet et al., Toronto, Ontario, Canada, tested psychoeducational outcome in 52 third grade and 42 sixth grade children with early treated congenital hypothyroidism. Third grades performed poorer in arithmethic and reading comprehension but not in spelling, writing or mechanical reading. Fewer differences were present in 6 grades. Greater in attention was reported for both groups. Poorer skill in language arts was associated with more severe and longstanding hypothyroidism. Biancanala et al., Sao Paulo, Brasil, studied the presence of TG antibodies and TPO antibodies in four groups of patients: I 38 consecutive patients with myocardial infarction (median age 64.5 year), II 40 control subjects (median age 34 year), III 26 patients with symptoms of coronary artery disease but normal coronary angiography (median age 56 year), and IV 39 patients with documented coronary artery disease (median age 61.5 year). The frequency of TG antibodies and TPO antibodies in group I, II and III were: 21%-34%, 11.5%-7.7%, and 36%-36% respectively. These data indicate that asymptomatic thyroiditis (TSH was normal in all groups) was common in patients with myocardial infarction and coronary atery disease. Thus, thyroid autoimmunity with normal thyroid function may have an influence on the pathogenesis of coronary sclerosis. (Comment: The conclusion of the authors would indicate that autoimmune thyroiditis without abnormal thyroid function could have a pathogenic role in atherosclerosis of the coronary arteries. However, an alternative hypothesis seems also possible in that both abnormalities have an autoimmune genesis.) Sato et al., Fukuoka, Japan, determined the recovery course of different types of hypothyroidism i.e. (A) 26 patients with iodine induced hypothyroidism without thyroid antibodies, (B) 20 patients with postpartum hypothyroidism, (C) 5 patients following painless thyroiditis, (D) 20 patients with idiopathic hypothyroidism with antithyroid antibodies, and (E) 5 patients with subacute thyroiditis. Recovery time in group (A) was 6.1 +/- 3.1 days, (B) 16.2 +/- 5.8 days, (C) 15.3 +/- 5.2 days, (D) 16.8 +/- 9.6 days, and (E) 18.5 +/- 8.9 days.