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Diagnostisches Vorgehen bei Verdacht auf Funktionsstörungen der Schilddrüse

Diagnostic and pathophysiological concepts for thyroid gland diseases

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Summary

In an attempt to derive diagnostic concepts for thyroid diseases we present pathophysiological models for the prevalent thyroid disorders. ‘Euthyroid goiter’ is a disease mainly caused by iodine deficiency but an additional immunepathogenesis was recently proposed. The ‘immunthyropathy’ is the thyroid disease with orbitopathy and other extraglandular immunological manifestations. A complete model of the immunological phenomena which begin with a tolerance defect is given, and both the T-cell- and B-cell-mediated pathways are detailed. The complex interaction of immunoglobulins at the thyroid-stimulating hormone receptor and their dependency on human leukocyte antigen loci are presented. The peripheral metabolism depends ultimately upon a prevalence of thyroid gland stimulation (thyrotoxicosis) or glandular destruction (hypothyroidism) and this is true for overt thyroid disease under antithyroid drug therapy or any other therapy. Euthyroidism during ‘immunethyropathy’ is presented as an equilibrium between thyroid stimulation and destruction. This concept allows an exact description of the thyroid disease and the resulting clinical situation provided that established laboratory tests are used as suggested by the model. ‘Disseminated thyroid autonomy and autononous thyroid adenoma’ develops during goitrous thyroid disease as a consequence of uncoupling of thyroid cellular growth stimulation, iodine utilization, and thyroid hormone synthesis. The polyclonal origin seems more frequent than monoclonal foci. The size of autononous tissue and individual iodine supply determines the endocrine function in this disease. The TRH test monitors with great sensitivity subtle increases in T4 or T3 production and indicates critical clinical situations earlier than the scintiscan. The exposure of the thyroid gland to large amounts of iodine precipitate thyroid storm and this has lead us to propose a protocol for patients in danger which seems clinically useful. It is hoped that the diagnostic procedures for thyroid diseases are more rational, effective, and less expensive when they are based on modern concepts of pathophysiology.

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  1. Department Innere Medizin, Medizinische Hochschule Hannover, Abteilung für klinische Endokrinologie, Germany

    R. -D. Hesch

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Nach einem Vortrag auf dem Schilddrüsensymposium der Sektion Schilddrüse des Berufsverband Deutscher Internisten, Wiesbaden 1982

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Hesch, R.D. Diagnostisches Vorgehen bei Verdacht auf Funktionsstörungen der Schilddrüse. Klin Wochenschr 62, 1059–1073 (1984). https://doi.org/10.1007/BF01711375

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