著者

大滝 幸哉

出版者

一般社団法人 日本内分泌学会

雑誌

日本内分泌学会雑誌 (ISSN:00290661)

巻号頁・発行日

vol.41, no.8, pp.983-993,930, 1965

被引用文献数

1

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The previous reports showed that the prevalence of goiter was comfirmed on the coast of Hokkaido, the northern island of Japan, where the usual diet of the inhabitants contained a large quantity of "iodine-rich" seaweed. Some of these goitrous patients from the endemic coast revealed high plasma inorganic iodine level and marked increment of thyroidal iodine space and thyroidal iodine content. However, all the goitrous patients from the endemic coast were clinically euthyroid, and serum total cholesterol level, protein bound-iodine and basal metabolic rate were within normal ranges.<BR>The present investigation is designed to elucidate a mechanism of the synthesis of thyroid hormone in the goitrous patients from this endemic coast.<BR>1. Thiocyanate test was examined in twelve goitrous patients from the endemic coast by the method of Floyd et al. In all the six patients taking their usual diet marked discharge of I<SUP>131</SUP> from the thyroid following intravenous administration of thiocyanate, while no discharge was found in any of the remaining six patients one week after withdrawal of seaweed from the usual diet.<BR>2. Metabolism of I<SUP>131</SUP> -labeled L-diiodotyrosine (L-DIT I<SUP>131</SUP>) was studied in five goitrous patients from the endemic coast put on the usual diet and three control patients after intravenous injections of L-DIT I<SUP>131</SUP> by the method of Stanbury et al. All the patients from the endemic coast excreted 2.7 to 6.2 per cent of L-DIT I<SUP>131</SUP> in an unchanged form within four hours after injection. Three control patients excreted 2.3 to 5.0 per cent.<BR>3. Radiochromatographic analysis of thyroid tissue was performed in seven goitrous patients from the endemic coast and two control patients with a single adenoma by Suzuki's modification of the method of Roche et al. All the patients were put on "iodine-restricted" diet for one to three weeks before partial thyroidectomy. Removal of thyroid tissue was carried out at twenty four hours after oral administration of carrier-free I<SUP>131</SUP>. Paranodular tissue was analyzed in control patients. The solvents used were butanol-acetic acid-water (78 : 5 : 17) in descending phase and butanol-dioxaneammonia (4 : 1 : 2) in ascending phase. The ratios of radio-monoiodotyrosine to radiodiiodotyrosine (MIT/DIT) ranged from 1.1 to 3.3 in all the goitrous patients from the endemic coast, and the proportions of radio-thyroxine plus radio-triiodothyronine (T<SUB>4</SUB> + T<SUB>3</SUB>) ranged from 1.3 to 6.0 per cent in all but one. Control subjects represented 0.5 to 0.8 in the MIT/DIT ratio and 10.7 to 20.4 per cent in the proportion of T<SUB>4</SUB>+ T<SUB>3</SUB>.<BR>Significant discharge of I<SUP>131</SUP> from the thyroid, as well as the previous report of dynamic analysis of stable and radioactive iodine, indicates that a large quantity of iodine remained as an inorganic form and suggests a markedly decreased rate of organification of I<SUP>131</SUP> in the patients with seashore goiter taking the usual diet. Similar abnormalities were shown also in the iodide goiter reported by Paris et al.<BR>From the results of urinary excretion of L-DIT I<SUP>131</SUP>, it is found that there is no defect at least in peripheral deiodination of iodotyrosine in the seashore goiter.<BR>Radiochromatographic analysis obtained from the thyroid tissues of the seashore goiter indicates a diminution in the rate of transfer of I<SUP>131</SUP> the more heavily iodinated compounds. Similar abnormal patterns had, however, been demonstrated in various thyroid disorders. It is, therefore, unlikely that such increase in the MIT/DIT radio and decrease in the proportion of T<SUB>4</SUB> + T<SUB>3</SUB> are peculiar to this goiter.<BR>In summary, these data would appear to support in part our thesis that the excessive and longstanding intake of dietary iodine is the most important goitrogenic factor of the seashore goiter in Hokkaido.

著者

小原 孝雄 中川 光二 慶松 元興 伊藤 宜人 国田 晴彦 嘉手納 成之 畑 俊一 大滝 幸哉 鈴木 邦治 中川 昌一 深津 亮 松浦 侯夫 大橋 晃

出版者

The Japanese Society of Internal Medicine

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.65, no.9, pp.906-912, 1976

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"Periodic hormonogenesis"を示し,ヒステリー発作を契機に寛解したGushing病,およびreserpine投与下でのmetyrapone試験直後より,急性副腎不全症状を呈し,寛解に到つたCushing病の2症例を報告する.症例1. 16才,女性.軽度の肥満・頬部紅潮・〓瘡・皮膚線条を認めた.尿中17-OHCSは, 4~46mg/日の間を約10日間の周期で変動し,血中corticosteroidsもこれに並行. ACTHには明らかな過剩反応を示したが,他の負荷試験は変動のため判定困難.副腎シンチグラムでは両側過形成像,頭部X線検査でトルコ鞍正常,他臓器に異常なく, periodic hormonogenesisを示すCushing病と診断した.この周期性変動はdexamethasone 8mg/日18日間投与で抑制された.経過中ヒステリー発作を生じ,その直後から尿中17-OHCSは3~8mg/日となり,周期性も消失.その後はACTHには過剰反応を示したが,抑制試験・metyrapone試験は正常となつた.症例2. 21才,女性.無月経で,中心性肥満・満月様顔貌・〓瘡・皮膚線条・高血圧を認めた.尿中17-OHCSは20~40mg/日で血中corticosteridsも高値.抑制試験は少量では非抑制, 8mg/日4日間投与で抑制された. metyraponeには過剩反応,副腎シンチグラムでは両側過形成像. reserpine投与下でのmetyrapone試験直後より副腎不全症状を呈し,尿中17-OHCSは1~5mg/日となり, Cushing病の諸症状改善.寛解後は, ACTHに過剩反応, metyraponeには無反応であつたが,他のホルモン系には障害はなかつた.