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Adrenal mass discovered during imaging for non-adrenal related causes is called incidentaloma. Adrenal masses can be asymptomatic or can have clinical manifestations related to hormone overproduction. The increasing number of discovered adrenal mass is by no doubt due to quick development of radiology procedures. The aim of study was determination of statistical frequency of different types of adrenal tumours and related clinical symptoms based on retrospective analysis of patients diagnosed in the Department of Endocrinology, Collegium Medicum, Jagiellonian University. There were 271 patients (184 female, 87 male) with incidentaloma confirmed in CT scan from January 2000 to June 2005. Mean patients' age was 56.8 +/- 12.7 years. The most common localisation was right adrenal gland (135 cases), bilaterally in 29 patients. Tumours less than 3 cm in diameter were observed in 58.5% of diagnosed persons, tumours from 3 to 6 cm in 33.3% of cases and tumours bigger than 6 cm in 8.2% patients. Hormone excess associated with adrenal mass was detected in 37 (13.6%) patients. Pheochromocytoma was diagnosed in 20 patients (7.4%). Subclinical hypercortisolism was found in 13 patients (4.8%). Primary hyperaldosteronism was diagnosed in 4 cases (1,4%). In patients with adrenal mass incidentaloma hormone tests should be performed before making therapeutic decisions despite no clinical symptoms.

Unlabelled: Regardless the autoimmune origin of Graves' disease, the preferred method of its treatment remains antithyroid drug administration. Use of immunosuppressive agents (mostly steroids) is still limited to the therapy of disease complications, such as proliferative ophthalmopathy. The aim of the study was to assess the influence of early immunosuppressive treatment of autoimmune thyrotoxicosis with azathioprine on the course of the disease and the incidence of its complications. The study comprised 64 patients (47 females and 17 males aged 20-43 years) for the first time diagnosed with Graves' disease. The subjects were randomised into two groups. Group I consisted of 28 patients treated only with antithyroid drugs, the remaining 36 subjects additionally receiving azathioprine were included into group II. The dose of both drugs was adjusted during the treatment according to metabolic status of each patients. The treatment was continued for 8-14 months, the follow-up duration after therapy withdrawal was 5 years. Euthyreosis was achieved in all patients 2-8 weeks after treatment initiation. No drug intolerance symptoms were observed in group I. In four patients additionally treated with azathioprine, gastrointestinal side effects or leucopenia were present. The disease relapse was observed during the follow-up period in 15 (53.5%) patients of group I and in 3 (8.3%) of group II, the difference was statistically significant (p<0.01). Only one patient receiving additionally azathioprine presented ophthalmic symptoms compared with seven subjects (25%) treated only with antithyroid drugs (p<0.001). The patients of group I were also more frequently referred to surgical treatment due to rapid goitre growth (accordingly 5 (17.8%) and 1 (2.7%) patients, p=0.07), the difference between both groups not being statistically significant., Conclusions: Additional early immunosuppressive treatment significantly decreased frequency of Graves' disease complications and thyrotoxicosis recurrence. The use of azathioprine may be advised in patients with contraindications to the radical Graves' disease treatment and in prophylaxis of its complications.

The thyroid fine-needle aspiration (FNA) is the decisive examination in the preoperative diagnostics of thyroid nodules. Different cytohistologic studies have revealed that the accuracy of FNA for thyroid nodules varied from 69% to 94%. The aim of our study was to compare the results of FNA with regard to final histopathological diagnosis among patients with follicular tumor, Hurthle cell tumor or papillary carcinoma in FNA. We retrospectively analyzed medical documentation of 51 patients (mean age 57.9 years, 49 women and 2 men) from the Endocrinology Department from 1997 to 2002 years. Based on FNA 29 patients were diagnosed as having follicular tumor, 10 as having Hurthle cell tumor and 12 as having papillary carcinoma. Carcinoma was detected histopathologically in 38% of patients with follicular tumor. Follicular carcinoma was detected histopathologically in 10% of patients with Hurthle cell tumor. Cytological diagnosis was confirmed histopathologically in 66.8% of all patients with papillary carcinoma in FNA. In accordance with our results the confirmation of malignant neoplasm can be expected in more than 80% of cases with papillary carcinoma in cytological examination. In case of follicular or Hurthle cell tumors the frequency of malignant neoplasm was less than 40% and 10% respectively.

Unlabelled: New imaging modalities and hormonal diagnostic improvement have markedly increased the number of newly recognized pituitary tumours. Introduction of immunohistochemical assays in histopathological diagnostics of pitutary adenomas resulted in better understanding of pathology and clinics of these neoplasms. The aim of the study was to correlate the hormonal status and hematoxylin-eosin staining results with immunohistochemical staining of pituitary tumours. The study included 40 patients aged 43.8 +/- 18.3 years, diagnosed with a pituitary tumour in the Department of Endocrinology Collegium Medicum UJ, who subsequently underwent trans-sphenoidal surgery in the Department of Neurosurgery Collegium Medicum UJ. The serum pituitary hormone levels were assessed by means of radioimmuno-assays. The surgically obtained tumour tissue was evaluated both by hematoxylin-eosin and immunohistochemical staining. Using traditional staining 33 patients were diagnosed with chromophobic adenoma, 1 with basophilic adenoma, and remaining 6 with eosinophilic tumour. Immunohistochemical assays were ACTH-positive in 16, TSH-positive in 7, GH-positive in 14 and PRL-positive in 17 cases. In 15 subjects immunohistochemical staining was positive for at least two pituitary hormones. In 34 of 54 patients with positive immunohistochemical staining results, no increase in corresponding pituitary hormone serum levels was observed. In 5 of 9 patients with negative immunohistochemical staining, no increase in serum hormone level was noted, remaining 4 were characterized by hyperprolactinaemia. Tumour cells were ACTH-positive in 5 of 6 patients with elevated serum ACTH levels and GH- or TSH-positive in all cases of increased levels of these hormones. Only 6 of 15 subjects with hyperprolactinaemia revealed positive PRL immunohistochemical staining., Conclusions: Positive immunohistochemical staining often do not correlate with elevated basal serum pituitary hormone levels, which may be related to either impaired synthesis or excretion of the hormones by tumour cells. Increased serum levels of ACTH, TSH or GH are usually connected with positive immunohistochemical staining results. Hyperprolacinaemia in cases of PRL-negative assays arises from PRL secretion defects caused by the tumour presence itself.

Poland has been known as an area with iodine deficiency. Surveys carried out in 1992/1993 and 1994 revealed that the voluntary model of iodine prophylaxis introduced in 1986 was ineffective. In 1997 a new model of iodine prophylaxis based on obligatory household salt iodization has been implemented. In order to assess its effectiveness new studies were undertaken in 1999-2001. The study involved 1471 school-children aged 6-15 years from 12 sites. In every subject thyroid volume by means of ultrasound and urinary iodine concentration were assessed. The results were compared with data obtained from the same schools in the 1992/1993 survey. Between 1992/93 and 1999/2001 goiter prevalence decreased from 14.5% to 5.2% (p<0.05) and median urinary iodine concentration increased from 56 microg/l to 103 microg/l (p<0.05). A decrease in goiter prevalence was observed in 6 sites with moderate goiter endemia, whereas the changes in goiter prevalence were statistically insignificant in other 6 sites. Three sites were characterized by goiter prevalence close to 5% before and after implementing the obligatory model of iodine prophylaxis. Goiter prevalence in the remaining three sites remained within the same limit of 7-10%, in spite of observed ioduria increase. The Authors conclude that the Polish model of obligatory iodine prophylaxis ensures efficient iodine supplementation and this is confirmed by a significant increment in ioduria. The effect of this model on thyroid volume is evident in moderate goiter endemia areas. Slight changes in goiter prevalence in mild goiter endemia regions need further monitoring and considering other factors affecting thyroid volume.

The aim of the study was to evaluate the correlation between thyroid cancer histotype and incidence rate (IR) and iodine nutrition level in two endemic goiter areas: the districts of Krakow and Nowy Sacz. The suspension of iodine prophylaxis in Poland in 1980 resulted in increased goiter prevalence in schoolchildren and adults and elevated TSH levels in newborns in the early 1990s. Since 1992 a rise in thyroid cancer IR was observed. Thyroid cancer IR in the Krakow population was 2.22 in 1986; 3.62 in 1995 and 6.02 in 2001; in Nowy Sacz: 1.52; 2.59 and 3.88 respectively. In 1986 papillary/follicular cancer ratio in both areas was about 1.0--the value typical of iodine deficient areas. After restoring the obligatory iodine prophylaxis in 1997, a significant decrease in elevated TSH concentration in newborns and urinary iodine concentration increase in schoolchildren were observed. A relative rise in the incidence of papillary thyroid cancer and decrease in follicular cancer, resulting in rise in papillary/follicular thyroid cancer ratio up to 5.9 in 2001 was also observed. Since 1999 no further thyroid cancer IR increase was noted. In conclusion, a significant increase in differentiated thyroid cancer IR was observed in association with the iodine prophylaxis suspension. Changes in thyroid cancer histotypes in 1986-2001 and a significant decrease in incremental rate of differentiated thyroid cancer probably reflect the influence of effective iodine prophylaxis. The significant difference between IR of thyroid cancer incidence in the districts of Krakow and Nowy Sacz may be related to differences in the exposure to radiation after the Chernobyl accident.

Unlabelled: Postprandial hypotension is commonly defined as the decrease in systolic blood pressure of 20 mm Hg and more, observed within 2 hours after meal ingestion. This phenomenon was described in subjects with comprised function of autonomic nervous system. However, the data on its prevalence in diabetic patients are scarce. The aim of the study was to assess the concordance of postprandial hypotension and autonomic cardiovascular neuropathy in diabetes mellitus. The study included 67 patients (26 males, 41 females, mean age: 47.5 +/- 16.2 years) with diabetes type 1 or 2 (mean disease duration: 13.3 +/- 8.8 years), treated with diet and insulin injections. Postprandial hypotension was diagnosed based on results of automatic blood pressure recordings performed within 90 minutes after test meal ingestion. Tests of Ewing's battery were used to evaluate autonomic cardiovascular neuropathy., Results: Mean postprandial decrease in systolic blood pressure of 17.7 +/- 11.7 mm Hg was noted at 48.0 +/- 13.7 min after meal ingestion. The study patients were divided into 2 groups based on results of systolic blood pressure recordings. In group A of 39 subjects (58.2%) the mean fall in systolic blood pressure of 8.9 +/- 4.4 mm Hg was observed. In group B of 28 (41.8%) subjects fulfilling the criteria of postprandial hypotension systolic blood pressure decreased after the meal of 30.0 +/- 6.2 mm Hg, the difference between groups was statistically significant (p < 0.001). Autonomic cardiovascular neuropathy was recognized in 41 (61.2%) of the study patients. The more advanced neuropathy was stated in group B (neuropathy scale score: group A--1.54 +/- 1.48 points, group B--5.11 +/- 1.93 points, p < 0.001). Statistically significant correlation between the magnitude of postprandial systolic blood pressure fall and cardiovascular neuropathy scale score was noted (Spearman's correlation co-efficient R: -0.612: p < 0.01). Postprandial blood pressure fall correlated significantly with orthostatic systolic blood pressure changes (correlation co-efficient R: 0.610; p < 0.001)., Conclusions: Postprandial hypotension is an important symptom of diabetic cardiovascular neuropathy. It is recommended to include postprandial blood pressure measurements in diagnostic algorithm of autonomic nervous system dysfunction in diabetic patients.

Ophthalmopathy, particularly its infiltrative form, is considered a characteristic feature of Graves' disease. However many other also life-treating conditions may be manifested as unilateral exophthalmos and lead to diagnostic problems. A case of a sixty six-year old patient with asymmetric exophthalmos and rapidly decreasing vision acuity is reported. Thyroid eye disease was suspected due to clinical symptoms (diplopy, impaired right eye motion) and thickening of extraocular muscles in ultrasound imaging. Further follow-up and orbits as well as head MRI imaging led to the final diagnosis of cavernous sinus thrombosis, complication of acute maxillary sinusitis.

Unlabelled: Postprandial hypotension is commonly defined as a decrease in systolic blood pressure of 20 mmHg and more within 2 hours after meal ingestion. It was described in autonomic nervous system failure of different origin, among others in diabetes mellitus. Pathomechanism of postprandial hypotension is not entirely understood. The rol of gastric emptying disorders is considered as an important factor. The aim of the study was to evaluate the concordance between gastric emptying and postprandial blood pressure changes in diabetic patients. The study involved 67 subjects (26 males, 41 females, mean age: 47.5 +/- 16.2 years) diagnosed either with diabetes mellitus type 1 or 2 (disease duration: 13.3 +/- 8.8 years) and treated with diet and insulin injections. Postprandial hypotension was recognised based on results of automatic blood pressure recordings within 90 minutes after test meal ingestion, according to the criterion mentioned above. Gastric emptying was assessed scintigraphically. The parameters evaluated were: gastric half emptying time (T1/2 max) and residual activity registered over stomach area at 45 minute of the study. Both blood pressure monitoring and gastric emptying were assessed concurrently. In investigated patients mean fall in systolic blood pressure of 17.7 +/- 11.7 mm Hg was recorded at 48.0 +/- 13.7 min of the study. Based on systolic blood pressure monitoring results patients were divided into two groups: group A of 39 patients (58.2%) without postprandial hypotension, and group B of 28 patients (41.8%) with pathological reaction of systolic blood pressure to meal. The average decrease in systolic blood pressure was 8.9 +/- 4.4 mm Hg in group A and 30.0 +/- 6.2 mmHg in group B, the difference was statistically significant (p < 0.001). Gastric emptying parameters in both groups did not differ significantly (T1/2 max: group A 68.4 +/- 31.1; group B 70.8 +/- 39.1 min, p = 0.96; residual activity over stomach area at 45 min of the study: 64.5 +/- 18.6% and 62.6 +/- 24.3% accordingly, p = 0.80). No statistically significant correlation between gastric emptying half time (T1/2 max) and magnitude of postprandial systolic blood pressure fall was noted (Spearman's correlation co-efficient R: -0.041, p = 0.74). Statistically significant correlation was found between T1/2 max value and time in which systolic blood pressure reached its nadir (Spearman's correlation co-efficient: 0.527, p < 0.0001)., Conclusions: Gastric emptying was not recognised as an important factor influencing the magnitude of postprandial hypotension in diabetic patients, however it may significantly change the dynamics of postprandial blood pressure decrease.

A case of the coexistence of nonfunctional pituitary adenoma and pulmonary sarcoidosis is reported. 39 years old female presented symptoms of a pituitary-gonadal axis insufficiency, visual deficit and dizziness. CT pituitary imaging revealed large intra and extrasellar tumour. Histological examination of the tissue obtained at transsphenoidal surgery showed chromophobic adenoma. Hypopituitarism and transient diabetes insipidus occurred after the surgery. The adequate replacement therapy with hydrocortisone and sex steroids was introduced. At the time of the pituitary tumour diagnosis enlargement of pulmonary lymph nodes was also observed. Based on histological examination of tracheal and bronchial epithelium specimens obtained during bronchoscopy the diagnosis of pulmonary sarcoidosis was made. No other systemic sarcoidosis localisation was confirmed. Histological re-evaluation of adenoma showed no noncaseating granuloma tissue. The overlapping symptoms of pituitary adenoma and other intrasellar masses may result in diagnostic difficulties, particularly in the presence of systemic disorders in which this gland may be involved.

A case of 34-year old female with incidentally diagnosed adrenal tumour is discussed. The patient complained only of mild headaches and heart palpitations and was not previously treated for hypertension. A diagnosis of pheochromocytoma was made. The diagnostic controversies arose because of subclinical course of the disease, slightly elevated biochemical markers of pheochromocytoma (catecholemines urinary excretion) and non-characteristic result of glucagon stimulation test results. The diagnosis was confirmed by histologic examination of tumour tissue. Presented case indicates the need for thorough clinical and hormonal evaluation of patients with incidentaloma (particularly, when adrenal tumour diameter is larger than 3 cm) to avoid serious complication of surgery treatment in case of misdiagnosis.

Unlabelled: The occurrence of autonomic neuropathy in patients with diabetes is associated with increased incidence of cardio-vascular events and increased mortality. The character of such process is not clear yet and the question if the damage to autonomic nerves equally involves particular organs and systems is open. The aim of the study was to assess the concordance of cardio-vascular neuropathy with diabetic gastropathy in type 1 diabetic patients. The study involved 42 subjects with type 1 diabetes mellitus (age 36.7 +/- 8.3 years; duration of the disease 14.8 +/- 33 years). Gastric emptying of solid food was assessed scintigraphically. T1/2 max and residual isotope activity (expressed as the percentage of initial value) at 45th minute of the study were estimated. Autonomic cardio-vascular neuropathy was assessed based on the Ewing battery tests results., Results: 11 of all subjects (group A) showed normal or increased gastric emptying of solid foods (T1/2 max 36.6 +/- 9.3 min, residual activity 39.6 +/- 12.1%) and 31 remaining subjects (group B) demonstrated delayed gastric emptying (T1/2 max 89.2 +/- 11.4 min, residual activity 74.6 +/- 5.2%), which was regarded as diabetic gastropathy symptom. 31 (74%) of all subjects were diagnosed with cardio-vascular neuropathy, 18 of them (43%) showed early autonomic neuropathy and remaining 13 (31%) presented decided cardio-vascular neuropathy. In group A2 (18%) subjects were diagnosed with early and 5 subjects (45%) with decided neuropathy. In group B early and decided autonomic neuropathy was present in 16 (51%) and 8 (26%) subjects. No statistically important difference between both groups was found., Conclusions: The results of the study support the thesis of a disseminated nature of the diabetic autonomic neuropathy and of not concomitant involvement of autonomic nervous system in particular organs and systems of the human body.

The aim of the study was to evaluate the correlation between incidence rate (IR) of thyroid cancer and severity of iodine deficiency. The influence of iodine prophylaxis on IR was also investigated. The suspension of iodine prophylaxis in 1980 resulted in goitre prevalence increase in schoolchildren (up to 60%) and elevated TSH levels in neonates observed in early 1990-ties. In 1990 rise in thyroid cancer IR was observed. IR of papillary and follicular carcinoma in 1995 were 1.6 and 1.5 respectively. Papillary to follicular ratio was about 1.0. Such a high prevalence of follicular cancer was specific for iodine deficient regions. In 1997, after introduction of mandatory model of iodine prophylaxis in Poland, increase in papillary thyroid cancer IR was observed, reaching in 1998 6.23 per 100,000 inhabitants. Papillary to follicular cancer ratio rose to 2.48. In 1999 no further increase in thyroid cancer IR was observed. Increase in papillary cancer incidence between 1990 and 1999 may be related to overlapping of iodine deficiency and other cancer risk factors i.e. radiation after Chernobyl accident.

Nowadays transsphenoidal surgery is the method of choice in most cases of pituitary adenoma treatment, both functioning and non-functioning. This method is considered to be safer than transcranial approach, as lower incidence of complications, particularly hypopituitarism, is observed. The aim of the study was to evaluate the pituitary function after transsphenoidal surgery. 20 patients (mean age 49.3 +/- 13.9 years) were included into the study. The anterior pituitary insufficiency was defined as an inadequate excretory response to metopirone, LH-RH and TRH stimulation. Diabetes insipidus was diagnosed based on clinical symptoms. Hypopituitarism was diagnosed after surgery in 7 patients, 3 cases had adrenal and gonadal insufficiency, 1 patient had insufficiency of the pituitary-thyroid and gonadal axis and 3 subjects panhypopituitarism. Diabetes insipidus was still present in 2 patients, 3 months after surgery. We conclude that transsphenoidal approach in pituitary adenoma surgery is connected with low risk of iatrogenic hypopituitarism.

A case of 40-year-old patient with glucagonoma associated with neurological and consciousness disturbances is reported. The diagnosis of the tumour was based on clinical manifestations (diabetes mellitus, anaemia, weight loss, distant metastases), visualisation (USG, CT of the abdomen) and immunohistochemical staining of the biopsy of tumour metastatis to the liver. During the progress of disease paraplegia, other neurological symptoms and three episodes of coma were observed. This should be associated with the neurologic paraneoplastic syndrome and hepatic failure due to diffuse metastases to the liver, especially when no metastases to the central nervous system were found in CT. Although patient was treated with chemotherapy, disseminated neoplasmatic process was the cause of the fatal outcome.

Thyroid size was evaluated by ultrasonography and palpation during a study performed in 1992 and 1993 by PCCIDD. Statistical analysis was carried out in 15774 cases with thyroid volume measured by trained teams of doctors. The results were evaluated in 5 age group: 6-8, 9-10, 11-12, and 13 years. The upper limit of the thyroid volume in each age group was defined as mean for stage 0 (WHO) + 1 SD. Our upper limits of thyroid volume in age groups were: 6.1, 7.2, 8.4 and 9.1 ml, respectively. The highest frequency of goitre (according to ultrasound criteria) were in the Sudeten endemia region (53.1%), the lowest in the Seaside area (14.3%). Significant influence of age, sex, height, weight, place of living, and thyroid hormone containing drugs on thyroid size was proved. The influence of iodine prophylaxis on thyroid volume was not significant.

The study was aimed at evaluation of applicability of 99mTc-labeled MIBI accumulation for early diagnosis of thyroid cancer. The investigated group included 16 patients with cold nodules of the thyroid in whom the presence of thyroid cancer or thyroid adenoma was diagnosed by means of a thin-needle biopsy. All the patients studied were subjected to surgical treatment. Prior to the operation, each patient was subjected to scintigraphic examination of the thyroid 10 minutes after intravenous administration of 185 MBq (5 mCi) 99mTc-MIBI. Scintigraphy was performed by using a ZLC Digitrac gamma camera of Siemens equipped with a Micro Delta computer. The accumulation of the tracer within the cold nodules was demonstrated in 11 patients with thyroid cancer (7 with follicular cancer, 2 with papillary cancer, 1 with anaplastic cancer and 1 with metastases to the thyroid) and in 2 patients with thyroid adenoma. This represents diagnostic accuracy of 0.85 in cases of thyroid cancer and 0.65 in cases of thyroid adenoma. Two conclusions can be formulated on the basis of the results obtained: first conclusion is that both thyroid cancer and thyroid adenoma do exhibit the ability to accumulate 99mTc-MIBI; the second conclusion is that 99mTc-labeled MIBI as used for scintigraphy of cold nodules of the thyroid is an useful marker of thyroid cancer in its early phase.

Low levels of iodine, observed in endemic goiter areas, decrease the synthesis of T3 and T4. This phenomenon is particularly dangerous during pregnancy when demand for thyroid hormones increases considerably. Iodine deficiency may cause brain tissue damage of varying degree, even cretinism in most severe cases. The aim of the study was to make an initial evaluation of TSH and thyroid hormone levels, thyroid volume, and urine iodine excretion in pregnant women. The group under study consisted of 46 women, inhabitants of Kraków region. Their mean age was 26.8 years, 18 were primiparas and 28 multiparas. All deliveries were physiologica, vaginal, within the biological norm of 281 +/- 22 days from the last menstrual period. The concentrations of T3, T4 and TSH were determined in maternal and umbilical blood. Urine iodine levels were measured in the patients. Mean body weight of the newborns was 3338 g, mean pregnancy duration 39.6 weeks, and mean Apgar score 9.9. The results for maternal blood were (mean, SD in parentheses): T3 1.5 ng/ml (0.4), T4 11.6 micrograms% (2.9), TSH 2.3 microU/ml (1.2), thyroid volume 27.8 ml (15.2), urine iodine level 34.99 micrograms/l (29.12), and for umbilical blood T3 0.59 ng/ml (0.1), T4 10.6 micrograms/dl (2.1), FT3 1.28 pm/l (1.1), FT4 15.6 pm/l (4.8), TSH 3.7 microU/ml (0.9). Urine iodine level in pregnant women was several times lower than normal. 80% of the women under study had enlarged thyroid glands. We conclude that investigations of the problem should be continued.

The main reasons to start investigations on IDD in Poland as a nationwide project of the Ministry of Health and Welfare sponsored by the State Committee For Scientific Research and Foundation for Polish Science were: cessation of iodizing of kitchen salt in Poland in 1980, increase of the incidence of goitre in the population and hyperthyrotropinemia in newborns, results of the survey undertaken after Chernobyl disaster indicating an increase of goiter incidence (Nauman et al.) and results of the pilot study (Gutekunst, Gembicki, Kinalska and Rybakowa) indicating an increase of thyroid volume and diminishing of iodine excretion in urine of children in Kraków, Białystok ad Poznań regions. Therefore the main goals of the project were as follows: to evaluate IDD in Poland on the population basis, to map goiter incidence and iodine deficiency in geographic areas, to evaluate a voluntary model of iodine prophylaxis in Poland (20 mg of KI/kg of salt). The investigations were carried out in 19330 children (48.7% of boys and 51.3% for girls) in age group 6-13 years, attending 111 coeducational randomly selected schools from all the country. This number represents 0.35% of children subpopulation in the above age-groups. For practical purposes local coordinating centers at the relevant Departments of Endocrinology and Board of Coordinators were set up. The programme of survey included: filling the questionnaire by children's parents, thyroid palpation and classification according to WHO and ICCIDD criteria, thyroid volume determination by means of ultrasonograph Kontron Sigma 1 L with linear transducer 7.5 MHz, determination of iodine in casual morning urine sample using Sandell and Kalthoff method. Determination of iodine concentration in urine was performed in each case of goiter and in the same number of children without goiter. The results were segregated according to coordinating centers and according to 6 geographical areas of the country. The results were calculated according to the descriptive statistics using Student's test, Chi-square test F-test and Leven's test. The results segregated according to geographic areas were tested by means of analysis of variance using the linear model. The final results of the programme are presented in the next papers.

The study included 4103 school children attending randomly selected schools localized in towns and villages of 3 geographically distinct regions: mountainous, (Carpathian endemia), upland, lowland. The children were divided into four age-related groups. The incidence of goiter as detected by palpation was 38.1% in all the children studied, the value being similar in all three regions (38.1, 37.3 and 38.6%, respectively). Goiter incidence differs slightly among urban and rural children, amounting to 40.5 and 34.5%, respectively, in the two groups. In about 60% of children urinary iodine excretion was lower than 50 micrograms/l, while in about 30% it was normal. In about 10% of children studied urinary iodine excretion was lower than 20 micrograms/l. The results obtained indicate the occurrence among children of the studied region of goiter endemy of moderate degree. It was found that the percentage of children excreting more than 50 micrograms/l of urinary iodine was higher among those consuming iodized salt as compared to those consuming non-iodized salt. The first effects of resumption of common salt fortification with iodide in southern Poland can already be noted. There is, however, a need for optimization and steady control over this prophylactic action.

Epidemiologic studies following the Czernobyl accident were performed in region Kraków, including Kraków, Nowy Sacz and Kielce district. 1426 males and 2495 females were selected according to the random sample on the whole population of Kraków and Nowy Sacz, as well as in some selected areas in Swietokrzyski Mountains, and in Kielcecity. The aim of the study was to assess the results of the prophylaxis with Kalium iodine after the radiation and the incidence of the goiter in the population. It was stated, that 19.2% of the population in Kraków district, 16.9% in Nowy Sacz and 20% in Kielce received the prophylactic dosis of K.J. 80% took mainly the Lugol solution, between May, the 1st and 5th, 1986. Among 18 of person showing side effects like gastrointestinal disturbances, 16 were of female sex. Goiter incidence according to WHO classification was 50.7%, 67.3% and 49.9% in Kraków, Nowy Sacz and Kielce respectively. The difference between the incidence of goiter in males and females was 1:3. In women it was rather Ist and IInd degree of goiter, in men OB and Ist. Nodules of thyroid gland in the rural region of Kraków, Nowy Sacz and Kielce were seen in women in 10.8%, 1.7%, add 12.3% consecutively. Hormonal studies i.e T3, T4, TSH serum concentration showed normal results in all groups studied. TSH concentration was the highest in the group OB. The microsomal and antithyroglobulin antibodies level was the same independently on the prophylactic dosis of Lugol solution. The high incidence of thyroid diseases not related to the accident was observed.(ABSTRACT TRUNCATED AT 250 WORDS)