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Osteoporosis in one of the most common diseases among the elderly individuals. Bone hardness is reduced to the critically low level. Even the smallest trauma makes previously healthy individual severely ill patient. In the USA, 1.6 million people sustain fractures due to osteoporosis each year, while approximately 14 billion dollars is spent on their treatment. The costs of osteoporosis treatment exceed the costs of prevention. The studies on the incidence, prevalence and socioeconomic aspects of osteoporosis, its prevention and treatment are expected to be carried out in our country in the future. Prevention of osteoporosis is not an individual problem, but it has wide social implications. Osteoporosis may be prevented and further loss of bone substance may be discontinued.

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BACKGROUND: Ample evidence has proven that the functional property of cells decreases over the years. Nevertheless, although it has taken decades to convince ourselves that elderly people belong to a specific age group both biologically and medicinally, and in whom special criteria have to be taken into consideration, it seems that even they themselves do not present an homogenous group. OBJECTIVE: Today we often hear of authors of studies speaking of two subpopulation groups--one group that ages by all the laws of aging that we have encountered and accepted thus far, and the other group that seems to postpone aging due to 'programmed death', or more specifically due to low mastery/low emotional support or because of additional reasons; however, the existence of the two groups seems eminent. METHODS: The identification of these two groups would allow us to find more realistic results in studies, and therefore a more efficient therapy for certain diseases. RESULTS: This hypothesis does not contradict the theories of aging that we have accepted (at least not the majority) and also does not contradict the fact that there is a large interindividual variability. This hypothesis doubts and claims there are exceptions to the initial assumption of geriatrists and gerontologists that 'parallel to the aging process, the functions of all organs and organ systems lessen.' CONCLUSION: The identification of these two groups would allow us to find more realistic results in studies, and therefore more efficient therapy for certain diseases.

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In contrast to numerous studies of the activity of the supraglottic voice resonator and its acoustic effect, little is known about the subglottic resonator and its function. In the present investigation the phonatory behavior of the lower airway (the "chest resonator") was studied and the quality of its acoustic output analyzed. Echo-tomographic analysis was used to study the tracheal diameter during various phonatory tasks. Acoustic analysis was also used, based on acoustic separation between the supra- and subglottic airways (including perceptual testing, sound pressure levels, and long-time spectral analysis). Evidence is presented of chest resonator activity having both perceptual and spectral effects.

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A retrospective analysis of the thyroid gland carcinoma in children, cured at the Institute of Oncology, was more frequent in girls (76%) than in boys. The changes were analysed according to TNM classification using the protocol for diagnostic and treatment procedures. The approach of the protocol was the same for children and adult population. In children the primary process ecpanded very fast in regional lymph nodes. Surgery of different size with or without the functionally neck dissection, proved the pathohistological verification. After the surgery, in 10 of 29 children, 131-I was applied. Spreading of the disease in lungs was observed in four of 29 children. The parameters of the successful therapy of the thyroid gland carcinoma in childhood were the general status, local status, the concentration of thyroglobulin value (Tg), and the serum titres of antithyroglobulin antibodies.

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Using the rat and guinea-pig as an experimental animal model, the effect of amiodarone (Cordarone) on normal of hyperplastic thyroid was investigated in eu- or hypothyroid animals. Following short- or long-term treatments with different doses of amiodarone (5-50 mg/day) and amiodarone-equivalent amounts of stable iodine, serum thyroid hormones were assayed, followed by determination of thyroid uptake of radioiodine, the weight of the thyroid gland and its histological structure. Having received amiodarone chronically, euthyroid rats showed decreaed levels of serum T3 and T4, in contrast to euthyroid guinea-pigs in which no appreciable differences between amiodarone-treated and untreated animals were observed. However, the weight of the thyroid decreased in both species after amiodarone treatment. A similar effect was seen after the treatment with excessive iodine, but only in euthyroid rats, while the guinea-pigs showed increased gland weight and activation of the follicular epithelium, as seen on histological sections. These differences obeserved in thyroid glands of rats and guineapigs were probably associated with the facts that the normal dietary iodine intake was lower in guinea-pigs and their thyroid glands were more sensitive to excess of iodine than that of rats. After chronic amiodarone treatment, hypothyroid rats with hyperplastic thyroids showed a much greater increase of serum T4 than the control rats, while the T3 increase was appreciably smaller. After several months (5 and 6.5) of amiodarone treatment, the appearance of various lesions was observed in the thyroid follicular epithelium of these animals. These microlesions probably resulted in a direct toxic effect of amiodarone on the hyperplastic gland. The results of the present investigation suggest that amiodarone effects on the thyroid may not be associated with excessive iodine exclusively, but also with the specific effects of amiodarone on this gland.

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The parameters of 125I-bTSH binding to plasma membrane as well as serum thyroglobulin (Tg) level in 13 euthyroid females, suffering from scintigraphically functioning thyroid nodule, were investigated. Thyroid tissue samples of five euthyroid patients were obtained by surgical reintervention, which was done because of scintigraphically functioning nodular goitre relapse (Group 1). Data were compared with two control groups. One of them (Group 2) consisted of 5 euthyroid females in whom partial thyroidectomy was done because of solid functioning thyroid nodule. Long-term follow-up during postoperative period confirmed normal morphofunctional status in them. The second control (Group 3) is consisted of 3 patients suffering from goitre relapse now. The percent of specific 125I-bTSH binding and the affinity of its binding to plasma membranes from nodular goitre relapse were lower (2.05% +/- 0.82; Kd1: 0.56 +/- 0.34 10(-9) M; mean and S.D., resp.) than to the membranes obtained from surrounding perinodular tissue (0.32 +/- 0.89; Kd1: 0.20 +/- 0.77 10(-9) M, resp.). However, the level of high affinity TSH receptors in plasma membranes prepared from nodular goitre relapse was higher than that in perinodular, assumed to be normal tissue (11.21 +/- 0.87 fmol/mg prot. versus 6.29 +/- 2.24 fmol/mg prot., mean and S.D.). Plasma membranes obtained from goitre relapse were characterised by high total number of receptor and binding sites (N1 + N2) for TSH. In Group 1 and 3 elevated serum Tg levels were confirmed during follow-up period with no correlation with TSH, which characterises a normal physiological status of regulation.

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Increased thyroglobulin (Tg) serum level in females (n = 49) suffering from scintigraphically "cold" thyroid nodule (395 +/- 168, micrograms/l, mean +/- SD) is significantly higher (p less than 0.001) in comparison with the data obtained from euthyroid healthy persons (28 +/- 10, n = 15) or those diagnosed with scintigraphically functional thyroid nodule (72 +/- 14, n = 15). No correlation between Tg and TSH serum levels has been seen before surgical removal of "cold" nodule (rxy = +0.34). In 49 out of 75 cases (65.3%) struma colloids were confirmed pathohistologically. After surgery, "cold" thyroid nodule was removed, serum Tg level decreased progressively within several days and three months afterwards, Tg level in most patients was mainly within the normal range for a healthy subject. The positive correlation between Tg and TSH was established three months after surgical removal of the nodule (rxy = +0.90). An elevation of serum Tg level was found in 16 out of the 49 patients during different postoperative periods (from 2 to 9 years). Under thyroxine treatment, in most of these patients a significant decrease of serum Tg level was observed. However, in a few treated patients, no change in Tg level was seen. Further clinical control in thyroxine-nonsuppressive patients discovered a compensatory hypertrophy of thyroid tissue and the appearance of a new thyroid nodule later. Present data and clinical experience suggest that long-term follow-up of serum Tg level in patients after surgical removal of "cold" thyroid nodule, brings about to early diagnosis of thyroid tissue postoperative hypertrophy before the appearance of thyroid gland nodule relapse.

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This study analysed the changes in serum thyroglobulin levels in euthyroid female patients, suffering from diffuse and scintigraphically functional nodular goiter, after therapeutic administration of two preparations of stable iodine: dried bovine thyroid, containing 100 mcg of iodine in one dragee (Thyral, Yugoslav Pharmacopea) and synthetic Na-salt L-thyroxine (Vobenol, with 100 mcg of iodine, too), for relatively short time of following-up, 8 weeks only. Having in mind the key role of TSH in regulation, all aspects of thyroid gland function, the interrelationship between TSH and thyroglobulin concentrations in those patients were also investigated. Prior to the therapy females had elevated thyroglobulin serum concentrations, caused by existence of diffuse and nodular goiter, which reflected an increase in intraglandular turnover of thyroglobulin (192 +/- 140 mcg/L in GROUP A further treated with Thyral and 121 +/- 14.80 +/- mcg/L in GROUP B, whose patients received Vobenol, mean +/- SD). Positive linear correlation between TSH and Tg levels was not established before therapy. Our data indicate that administration of two different preparations containing stable iodine in doses of 100 mcg every second day, during a two months period, resulted in significant decrease in the size of diffuse and nodular goiter, with diminished complains in a great number of patients. In thyroid humoral status, significant decrease of thyroglobulin concentrations was evident in both analysed groups (62 +/- 48 mcg/L, and 60 +/- 66, respectively). Presented results confirmed positive linear correlation between TSH and thyroglobulin in serum samples, after therapy, especially strong in the group treated with dried bovine thyroid.

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In 52 geriatric patients, average age of 74 years (range from 65 to 89) suffering from generalised arteriosclerotic disease and hospitalized at the Clinical Institute for Geriatrics, we found normal thyroid gland function, in basal condition. Our data showed that 19.42% of the patients had low triiodothyronine (T(3)) concentrations. Basal serum T(3) level was higher (P < 0.01) in males (1.88 +/- 0.44 nmol/l) in comparison to values in females (1.75 +/- 0.28). Serum thyroxine (T(4)) level was lower in males (P < 0.01), but the concentrations of thyreo stimulating hormone (TSH) was lower in females. The value of thyroid reserve in elderly people, estimated by measuring T(3) and T(4) incretion shortly after thyreotropin releasing hormone (TRH) was done, is sufficient to maintain cuthyroid function, although it is, as a whole, significantly lower if compared with T(4) and T(3) response after TRH tests in middle-aged subjects (n = 26), acting as a control group (P < 0.001). Thyroxine excretion from follicular cells in elderly female patients was faster and amplitude was higher, up to the maximal possible level 93 nmol/l (+/- SD) in 25 min after an injection of TRH. In elderly male patients the maximum of T(4) excretion was 78 nmol/l (P < 0.01) at 60 min.

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Ophthalmopathy of Graves-Basedow disease appears in 20-50% of patients suffering from thyreotoxicosis. It is usually bilateralophthalmopathy with different degrees of severity. Many noninvasive diagnostical methods are used today. In diagnostic procedure, and especially in therapy, multidisciplinary approaches are compulsory. Although therapeutical effects vary from person to person, only a long follow-up can offer some clinical data about therapeutical success. The authors describe a 39-year-old woman with thyrotoxic bilateral ophthalmopathy. Thyrostatics, such as MMi and PTU, gave no satisfactory therapeutical results. Therefore a therapeutic dose of 131J was administered after which egsophthalmometry (Hertel) revealed regression of thyrotoxic ophthalmopathy, while the ocular signs were more pronounced after the partial thyroidectomy which had had to be carried out because of the existing thyroid functional nodule. The patient responded to corticosteroid therapy by showing a reduction in periorbital oedema, chemosis and hyperemia as well as by lowering the antibody titre against thyroglobulin and disappearing the serum immune complexes.

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TSH receptors in plasma membranes of thyroid nodular and perinodular tissue and the concentration of thyroid hormones and thyroglobulin in serum were estimated in patients with Hashimoto's thyroiditis (HT) and in six persons with scintigraphically cold thyroid nodules (AFN). In perinodular tissue of HT patients specific binding of 125I-bTSH was found to be significantly decreased (1.50 +/- 0.13%; mean +/- S.E.) as compared with AFN patients (2.79 +/- 0.53%), whereas any significant difference in hormone binding to nodular tissues between both examined groups was not detected. Scatchard analysis of TSH binding revealed two kinds of binding sites for both thyroid tissues of all examined patients. The capacity of high affinity binding sites in both thyroid tissues of HT patients was found to be decreased (3.92 +/- 0.86 fmol/mg protein in nodular tissue and 5.93 +/- 1.16 fmol/mg protein in perinodular tissue) in comparison with these tissues of AFN patients (18.80 +/- 18.36 and 32.24 +/- 33.38, respectively). Any differences in dissociation constant and capacity of low affinity binding sites between analysed groups were not observed. Serum TSH levels of HT patients were higher than these in AFN patients and were not significantly changed after surgical treatment. Any difference in triiodothyronine (T3) levels between analysed groups was not detected, while the concentration of thyroxine (T4) was lower in HT than in AFN and significantly decreased after the excision of thyroid gland. Thyroglobulin levels were significantly changed after surgical treatment in both analysed groups.

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This study analysed the concentrations of thyroid binding globulin (TBG) in the serum as well as the level of triiodothyronine (T3), thyroxine (T4), thyreostimulating hormone (TSH), thyroglobulin (Tg) and T4/TBG coefficient, before therapy and on the fifth day of therapy in 27 patients of both sexes suffering from neoplasia. The patients were treated with cytostatic antibiotics, alkylating agents and podophyllines derivates, by protocol. Serum T3 gains in concentration already after 5 days since the beginning of treatment (from 1.65 +/- 0.20 to 1.73 +/- 0.18 nmol/l), but it is retained within physiological ranges as well as TSH, rT3 and Tg. Thyroxine remains within the permitted ranges, but slightly decreased after therapy (64.00 +/- 11.00 nmol/l, mean +/- SEM) in comparison to the value before (71.00 +/- 19.00), p(F) less than 0.1. A reduction of concentrations in total serum proteins at an average 7.88% was found. The level of inter-alpha globulin, TBG, in patients with proved malignancy is low before therapy (14.97 +/- 4.73 micrograms/l, mean +/- SEM, in males and 14.83 +/- 3.70 in females) but, with application of cytostatics it decreases considerably to the level of 11.68 +/- 4.46 (p less than 0.05) in males and to 13.68 +/- 3.89 in females (NS). In view of these facts, T4/TBG coefficient remains normal and contributes to the maintenance of euthyroid gland function.

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Thyroid function parameters (triiodothyronine, thyroxine, reverse triiodothyronine, thyroid stimulating hormone, thyroglobulin) and thyroid binding globulin (TBG) were determined in sera of 64 women who had carried a normal pregnancy and delivered at term, as well as in sera of their newborns. Obtained results were compared to the findings of the same parameters in 28 women who delivered at term, but had been receiving gestanges 1 to 5 months prior to the delivery, and in their babies. In both groups, serum triiodothyronine (T3) levels were normal both in mothers and in their babies. Foetal serum reverse triiodothyronine (rT3) levels were higher (1.58 +/- 0.14, means +/- SEM) as compared to serum levels (0.36 +/- 0.04) of the mothers treated with gestagens; similar results were obtained in the mothers with normal pregnancy (0.41 +/- 0.03) and their babies (1.65 +/- 0.15, means +/- SEM). In 13 out of 64 (20%) women with normal pregnancy serum thyroxine (T4) was elevated in delivery at term, with no impact on the clinical course. Of 28 women who were treated with gestagens for 1 to 5 months only 4 had elevated serum T4 on the delivery. Using gestagens, according to our results, contributes to an increase of the newborn TBG levels (27.00 +/- 2.65; means +/- SEM) in a significant way (p less than 1.001) as compared to TBG of the newborn delivered after a normal pregnancy (21.40 +/- 2.55).

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TSH receptors of plasma membrane fractions of human cold thyroid adenoma and perinodular thyroid tissues (PTT), assumed by pathohistological analysis to be normal, were examined. In perinodular thyroid tissues (PTT) obtained by partial thyroidectomy from twelve euthyroid female patients 125I-TSH binding (as determined by equilibrium binding analysis on particulate plasma membrane preparations) was found to be significantly increased as compared with scintigraphically cold thyroid nodular tissues (CTN). In all examined thyroid tissues Scatchard analysis of TSH binding revealed two kinds of binding sites: these with high affinity showed a significantly increased dissociation constant (Kd1), while these with low affinity showed a decreased dissociation constant (Kd2) in PTT as compared with CTN. The capacity of low affinity binding sites in PTT was found to be decreased in comparison with CTN tissues. These results suggest that the changes in affinity of TSH receptors sites as well as iodine deficiency of thyroid tissues may be an important events in functional status of analysed perinodular and cold nodular thyroid tissues.

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The Teffect of haemodialysis on the level of TBG and thyroid hormones in the serum of patients, suffering from terminal form of kidney insufficiency, were investigated. It was established that in the majority of patients euthyroid function of the thyroid gland was preserved. According to our results this preservation of euthyroid function results from the decreased concentration of sera TBG, which follows the decrease of total sera proteins as well as increased peripheral conversion of thyroxine mostly in rT3.

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The proteolytic activity of lysosomes isolated from solitary "cold" thyroid nodule and morphologically normal perinodular thyroid tissue was examined in parallel in an in vitro system using 125I-labelled rat Tg as substrate. Lysosomes were isolated by centrifugation of the tissue homogenates between 800 and 20,000 x g. The optimal proteolytic activity of acid proteases from human thyroid tissue was observed between pH 3.6 and 4.8. The evident differences in the proteolytic activity of lysosomal acid proteases between nodular and perinodular tissues were observed. It was found that the activity of lysosomal proteases from "cold" nodule in both the same amount of wet weight thyroid tissue and the same amount of lysosomal proteins was significantly lower (29-54%) than in the morphologically normal perinodular tissue used as a control. The reduced proteolytic activity of lysosomes from patients with "cold" nodule provides further confirmation on the low metabolic activity of thyrocytes in non-functioning thyroid nodules.

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