To determine the cytodiagnostic accuracy rate and pitfalls of Hashimoto's thyroiditis (HT), the files and smears prepared from the thyroid needle aspirates of 146 patients with suspected HT and/or clinically and serologically confirmed HT were reviewed. Of those patients, 105 presented with a diffuse and rubbery thyroid enlargement, and 41 with one or two prominent nodules. For the first group (105 patients), the needle aspiration biopsy (NAB) was performed on one or two thyroid lobes during their initial endocrinologic consultation, and for the second group (41 patients), the NAB was performed on and around the predominant nodules that were found either at initial physical examination or during the patients' routine follow‐ups. In 134 cases, a cytodiagnosis of HT was made on the first NAB. Among the 41 patients with a prominent thyroid nodule, a thyroid neoplasm was suspected clinically in four because their thyroid nodules increased in size. In the other 12 patients, a cytodiagnosis of follicular neoplasm (FN) was made in five cases, and a Hürthle cell tumor (HCT) was diagnosed or suspected in seven patients. All 16 patients had thyroid surgery, and a HT was histologically confirmed in all cases. In the first four patients, no tumor was found. Among five patients with a cytodiagnosis of FN, one had a hyperplastic follicular cell nodule (HFCN), two had follicular adenomas, and two had papillary carcinomas of follicular variant. For the seven patients with a cytodiagnosis of HCT, HCT was confirmed in three, three were found to have hyperplastic Hürthle cell nodules (HHCN), and one showed a benign colloid nodule with Hürthle cell changes and remote hemorrhagic necrosis. It is concluded that NAB is highly sensitive in diagnosing HT, with a diagnostic accuracy rate of 92% by the first biopsy attempt. The cytologic differential diagnosis between an HFCN and a follicular neoplasm and between an HHCN and an HCT is impossible in some cases. Diagn. Cytopathol. 16:531–536, 1997. © 1997 Wiley‐Liss, Inc.

Normal women have alterations in carbohydrate metabolism during pregnancy and when taking oral contraceptives, and clinical observations suggest that diabetic women need more insulin during menstruation. We, therefore, studied insulin action in normal women during the menstrual cycle in the follicular, luteal, and menstrual phases. Glucose tolerance was similar at all three times. Specific insulin receptor binding to monocytes did not change during the menstrual cycle. Euglycemic insulin clamp studies at four different insulin infusion rates (15, 40, 120, and 240 mU/M2 X min) showed no differences in insulin sensitivity or responsiveness throughout the menstrual cycle, and hepatic glucose output did not change. These studies suggest that if insulin action is impaired during menstruation in diabetic women it is because of factors that are not detected in normal women.

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A double antibody adaptation of the glucagon radioimmunoassay is described in detail. Guinea pig antiserum allowing the assay of 2,500 unknowns per milliliter of undiluted serum was induced by biweekly immunization. Glucagon was iodinated with I-125 and purified by elution from a cellulose column, maximal immunoprecipitibility approximating 80 per cent. Standard curves in buffer were sensitive to purified glucagon in amounts of less than 100 μμg. Rapid degradation of labeled glucagon added to human blood was demonstrated. Trasylol was confirmed as an effective inhibitor of this degradation. Endogenous plasma immunoreactive glucagon (IRG) appeared less labile and may have interfered with the quantitative detection of unlabeled exogenous beef-pork glucagon in plasma recovery studies. The hypothesis is offered that plasma IRG, herein measured at 400 ± 220 (S.D.) μμg./ml., may be composed of a pancreatic and an extrapancreatic fraction of similar but not identical immunological activity. The cross-reactivity of the two components remains a problem in the interpretation of the glucagon immunoassay as applied to plasma.