Forensic Science International90 (1997) 165–170

Thyreoglobulin and violent asphyxia

a , b c*¨E. Muller , W.-G. Franke , R. Kocha ¨ ¨ ¨Institut f ur Rechtsmedizin, Technische Universitat Dresden, Universitatsklinikum Carl Gustav Carus,

Fetscherstraße 74, D-01309 Dresden, Germanyb ¨ ¨ ¨Klinik und Poliklinik f ur Nuklearmedizin, Technische Universitat Dresden, Universitatsklinikum Carl

Gustav Carus, Fetscherstraße 74, D-01309 Dresden, Germanyc ¨ ¨ ¨Institut f ur Medizinische Informatik und Biometrie, Technische Universitat Dresden, Universitatsklinikum

Carl Gustav Carus, Fetscherstraße 74, D-01309 Dresden, Germany

Received 18 January 1996; received in revised form 26 August 1996; accepted 23 July 1997

Abstract

The concentration of thyreoglobulin (tg) was determined for death caused by hanging,strangulation by ligature, and throttling. Cases of sudden death (traumatic aortic rupture,penetrating wounds of the heart) were used for comparison. The mean values in cases of hanging(149.96202.3 ng/ml), strangulation by ligature (193.16173.3), manual strangulation(561.66173.9) are distinguishable from violent acute deaths (23.3627.6) and living healthyindividuals (17.3616.1). By means of statistical comparisons, significant differences were foundbetween throttling and strangulation by ligature and between throttling and hanging (adjustedP,0.001). In connection with examination of the bodies high tg values can be regarded as a vitalreaction in obstructive asphyxia. 1997 Elsevier Science Ireland Ltd.

Keywords: Thyreoglobulin; Vital reaction; Hanging; Strangulation by ligature; Throttling

1. Introduction

The present paper reports on the investigation of thyreoglobulin (tg) in the blood ofpersons who died by constriction of the neck. This form of violent asphyxia leaves moreor less characteristic external appearances. The extent of these signs depends on severalcircumstances, in particular the local violent forces. In some cases the signs of asphyxia

*Corresponding author.

0379-0738/97/$17.00 1997 Elsevier Science Ireland Ltd. All rights reserved.PII S0379-0738( 97 )00158-8

¨166 E. Muller et al. / Forensic Science International 90 (1997) 165 –170

may be very slight so that we tried to include the tg in the diagnosis of mechanicallycaused asphyxia (by hanging, strangulation by ligature and throttling).

The impulse that initiated the investigation came from Yada et al. [1–3]. By means ofthe qualitative antigen–antibody reaction, an increased tg content was found in the bloodof an infant who was throttled. The initial idea of having a forensically essentialparameter at one’s disposal with which violent action on the neck (thyroid) can berecognized, did not always prove correct so that further investigations into the matterstagnated. It was not until the quantitative determination of tg was introduced [4] that thetg was included in the investigation of certain forensically relevant death causes [5–8].As before, the results are not free of contradictions. The present paper describes anddiscusses the different concentrations of tg in cases of obstructive asphyxia, and theirinterrelations.

2. Materials and methods

All human samples were obtained from autopsies and kept at 2208C until analysis.The blood samples were mixed from the contents of both heart ventricles using anIRMA kit (DYNOtest tg Henning) in selected cases of persons who died of violentasphyxia caused by constricting the cervical vasculature and from persons who died inroad accidents without any agonal period (rupture of aorta, damage of the heart). Thelast were used as controls. In these cases the circulation stopped immediately, andtransport of tg from the thyroid to the heart could not take place. One can thereforeassume that these post-mortal reference values do not differ from the levels of a livinghealthy person.

3. Results

3.1. Statistics

The distribution of tg is significantly different (Kruskall–Wallis test: P,0.001).The multiple comparisons show significances (at least P,0.01) in the pairs:

• Hanging versus throttling and versus controls.• Strangulation by ligature versus throttling and versus controls.• Throttling versus controls.

The comparison between strangulation by ligature versus hanging is nonsignificant.

3.2. Tg-value

The result shows that the tg level of persons who died immediately after an accident(aorta rupture or damage of the heart) does not differ much from the standard levels ofhealthy persons; thus these values are suitable as reference material.

¨E. Muller et al. / Forensic Science International 90 (1997) 165 –170 167

Table 1Sample characteristics of measured concentration of tg (ng/ml) in cases of hanging, strangulation by ligature,throttling, controls and healthy living persons (number of cases, mean, standard deviation, minimum,maximum and median)

Causes of death n Mean Sd Min Max Median

Hanging 95 149.9 202.3 4.0 892.0 48.0Strang. by ligat. 11 193.1 173.3 2.0 628.0 140.0

aThrottling 14 561.6 173.9 252.0 853.0 540.5Controls 29 23.3 27.6 0.4 137.0 13.0

bLiving persons 122 17.3 16.1 0.3 85.0 13.0aTg value by throttling: 795, 738, 829, 853, 463, 551, 553, 530, 590; throttling and hanging: 448, 252;throttling and other causes of death: 442, 401, 417.bMEDIPAN DIAGNOSTICA (personal information).

The mean value of tg is significantly distinct for the causes of death described here(Table 1). The highest mean tg concentration can be observed in the case of death bythrottling (561.66173.9), and the smallest tg value in the case of ruptures of the aorta(23.3627.6).

The maximums of the tg values for hanging and throttling do not seem to differ much(Table 1), but the range by hanging (4–892 ng/ml) and by strangulation by ligature(2–628 ng/ml) was larger than in cases of throttling (252–853 ng/ml). The small valueof 252 ng/ml tg was measured in one combined case of throttling and hanging. Thelatter was the cause of death.

In the relative distribution (Fig. 1) when the tg value is subdivided into 100 and 200

Fig. 1. Percentage distribution of tg by hanging, strangulation by ligature, throttling and controls.

¨168 E. Muller et al. / Forensic Science International 90 (1997) 165 –170

ng classes it is shown that only in the case of death by throttling is there no overlappingwith the tg values of the controls.

The most pronounced tg values are found in the blood of throttled persons. In relationto the reference values, the average values are here almost 10 times higher.

4. Discussion

The goal of the investigation is the inclusion of the parameter into the spectrum ofvital reactions [9]; it goes without saying that the morphological signs of asphyxia mustnot be neglected in a diagnostic evaluation. However, they can only be rated as vitalwhen the change in the concentration

1. is the consequence of a response to a stressor;2. differs widely from controls.

If these conditions are met, one can speak of a vital process that may be considered theresponse to the violent action on the thyroid, although, in principle, it has not yet beenproven unambiguously that the change in the hormone level is caused exclusively by amechanical trauma of the thyroid.

The pathogenetic mechanism mentioned by Yada et al. [1–3], he says that tg gets intothe blood as a consequence of the thyroid tissue injury caused by the circular trauma ofthe neck—sounds very logical but is in general not applicable to all death causes. Inmore than 1000 investigations of forensically unselected material, several extremely hightg concentrations have been found in the blood of dead persons who obviously did notsuffer a neck trauma, but died of intoxication and craniocerebral trauma. Accordinglythere must be another control mechanism for the release of high tg concentrations intothe blood. Biosynthesis and secretion of the hormones are known to be subject to a stricthierarchic control of a self-regulating circulatory system which is controlled by centressuch as the hypothalamus and hypophysis. The central impulse is given here by thethyrotropin-releasing hormone (TRH). Its purpose is to stimulate TSH (thyrotropin,thyroid-stimulating hormone) secretion.

The tg is stored in the thyrocolloid. If necessary, tg is transported back into thethyroid cell by endocytosis [10,11]. The whole micro- and macropinocytosis processtakes place under TSH influence [12]. Experiments showed that macropinocytosis can beverified as early as 5 min after TSH injection [13]. In view of this metabolism, it can beassumed that the tg concentration in the blood increases after a stress situation withoutthe tissue of the thyroid being affected (within the meaning of a multiple controlcirculatory system with negative feedback). A certain time must elapse between thestimulus (e.g. circular trauma of the soft tissue of the neck) and the perceptible response(increased hormone secretion), before this second manner of hormone secretion takesplace. Studies [14] have confirmed the hypothesis that the level of the tg concentration inpersons who died in accidents correlates with the duration of agony.

Disregarding certain biological restrictions due to thyroid biopsies, X-ray treatment of

¨E. Muller et al. / Forensic Science International 90 (1997) 165 –170 169

the thyroid, TSH application, toxic hyperthyroidism and thyroid carcinomas [15], high tgconcentrations in the blood indicate a vital process. In connection with the morphologi-cal data of the body [16–19], they may contribute to the elucidation and sometimes alsoto the differentiation of the various types of mechanical asphyxia (Fig. 1). For the timebeing, experience shows that it is not advisable to use only the tg level to indicate a vitalreaction in obstructive asphyxia.

Acknowledgements

The authors thank Monika Jacob, Monika Leo and Gudrun Michael for their expertassistance.

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