The recommendations for the dietary allowance of iodine are 150 micrograms per day for adolescents and adults. Thyrotropin (TSH) and thyroglobulin (Tg) can be used as surveillance indicators for assessing iodine deficiency disorders. We compared the relation between TSH and Tg, free triiodothyronine, and thyroxine serum levels with urinary iodine excretion in 2311 untreated euthyroid patients using our modified cericarsenite method. An adequate iodine intake may be assumed when TSH and Tg values are at the lower end of the normal range. Patients were grouped according to urinary iodine excretion and goiter size. In the group with an iodine excretion between 201 and 300 micrograms of iodine per gram of creatinine, the lowest TSH values and even low Tg levels could be shown. We conclude that an iodine intake of approximately 250 micrograms/day is associated with the lowest TSH stimulation to thyrocytes. In the groups separated according to thyroid size, significantly higher Tg levels were found in the patients with uninodular and multinodular goiter as a result of longstanding iodine deficiency, whereas actual urinary iodine excretion did not differ significantly. Additionally, iodine excretion of 39,913 euthyroid patients between 1984 was 1996 was examined. In Austria iodized salt (10 mg KI/kg) was introduced by law in 1963 and increased to 20 mg KI/kg salt in 1990. An initial increase of iodine excretion until 1993 was followed by a decrease in 1994 and 1995 without further changes in 1996. These results show that iodine intake has improved since 1984; however, in 1996 iodine excretion in one-third of the investigated patients was under 100 micrograms per gram of creatinine and more than 80% had less than 200 micrograms per gram of creatinine.

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Relapsing polychondritis (RP) is a relatively rare disorder, with a high death rate that affects cartilaginous structures. RP can be either primary or secondary as part of autoimmune syndromes. We present a case of RP in a 49-year-old man suffering from cytoplasmic antineurophil cytoplasmic antibodies (cANCA) positive vasculitis, admitted to our hospital with red swollen left ear and painful sternoclavicular joint and larynx. The patient was in remission from the vasculitis but manifested a high cANCA titre indicating vasculitis activity. With his high cANCA titre vasculitis, full manifestation of RP concomitantly occurred. After a successful cortisone treatment for RP, the patient received cyclophosphamide treatment for his vasculitis that resulted in a decrease in cANCA titre and full remission of his RP symptoms.

Familial Mediterranean fever (FMF) is an autosomal recessive hereditary disease. FMF-related arthritis affects large joints, especially in the lower extremities. It starts with acute pain and swelling and affects one joint at a time. Fever is the most common symptom in FMF. Monoarthritis as the sole symptom is relatively rare and thus delayed diagnosis of the disease in a patient who had been suffering from monoarthritis for several years. Genetic analysis showing typical mutations in the patient eventually resulted in correct diagnosis, although classical clinical diagnostic criteria were not met. The patient received appropriate therapy with colchicine, which led to remission of the symptoms.

Seasonal variations in the frequency of thyrotoxicosis are known for a long time. Both, variations in the temperature and in the iodine supplementation are believed to affect the incidence of the diagnosis of hyperthyroidism. Seasonal variation of the incidence of hyperthyroidism was investigated before and after increase of salt iodination in 1990/1991. In the period from January 1987 to December 1995 hyperthyroidism was diagnosed for the first time on 4711 patients in our department. This population was subdivided according to etiology (Graves' disease, autonomous nodular goiter) and grade of hyperthyroidism (preclinical or clinical form). The so formed groups were divided according to the month of diagnosis into further 12 subgroups. Significant differences in month to month variation were found in the patients suffering from Graves' disease and autonomous nodular goiter with preclinical hyperthyroidism after increased iodine supplementation. The peak incidence of the diagnosis occurred in June, July, and August. Our results indicate that improved iodine supplementation may be the main cause of seasonal variations in the incidence of thyrotoxicosis.