The management of thyroid disease in pregnancy.
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The management of hyperthyroidism and hypothyroidism in pregnancy is discussed and illustrated with appropriate cases. The dangers of the usage of high doses of antithyroid drugs and of propranolol are described. (+info)
Single dose, "block-replace" drug therapy in hyperthyroidism.
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In 30 consecutive hyperthyroid patients with diffuse goitre divided dose therapy with carbimazole 40 mg and triiodothyronine 80 mug daily was shown to produce total or subtotal block in thyroid hormonogenesis. Once produced, this block could be invariably maintained with an equivalent single daily dose for periods up to three years. Its notable acceptability to patients, a more stable degree of euthyroid control, ease of assessing suppressibility of trapping, and ability to treat patients in remote areas all support a wider use of this mode of therapy. (+info)
Thyroid function in patients treated with radioactive iodine for thyrotoxicosis.
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A series of 105 patients treated at least two years earlier with radioactive iodine for thyrotoxicosis have been surveyed. Eighty-five patients (81%) were euthyroid clinically and on the basis of routine thyroid function tests. Of the euthyroid patients 46 (54%) had normal thyroid-stimulating hormone (TSH) levels and 39 (46%) had raised TSH levels. There was no difference in serum triiodothyronine levels between these two groups but the serum protein bound iodine and serum thyroxine, though still well within the normal range, were significantly lower in the group with raised TSH levels. The serum cholesterol was also significantly higher in this latter group.Most of the euthyroid patients were seen again a year later. None had become hypothyroid and neither those with normal nor those with raised TSH levels showed any evidence of a decline in the level of serum thyroxine.It is concluded that raised serum TSH levels in patients treated with iodine-131 are not necessarily indicative of hypothyroidism. There is no indication that patients who have this abnormality become overtly hypothyroid over a 12-month follow up. (+info)
Use of 99 Tc m for the routine assessment of thyroid function.
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(99)Tc(m)-pertechnetate is concentrated in the thyroid in the same way as iodide but it does not become organically bound. The uptake of (99)Tc(m) is a measure of the thyroid trap, and this measurement is satisfactory as a routine test in the diagnosis of thyrotoxicosis. The reproducibility of the method is such that suppression tests can be carried out when necessary even when uptake is within the normal range of 0.4-3%. (99)Tc(m) gives a low radiation dose to the thyroid and has certain other advantages over radioactive isotopes of iodine for early thyroid uptake measurements. It is particularly suitable when serial tests of thyroid function are required during treatment with an antithyroid drug. (+info)
Symptomatic hypercalcaemia in thyrotoxicosis.
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In three patients with thyrotoxicosis and with symptomatic hypercalcaemia antithyroid therapy restored the plasma calcium concentration to normal, though initially in one case intravenous and oral neutral phosphate solution were required to curtail intractable vomiting.Nine cases have been recorded in which the plasma calcium concentration returned to normal after antithyroid treatment was started; all but one became normocalcaemic within eight weeks. It is suggested that in hypercalcaemic thyrotoxicosis a second pathological condition should be considered only if the plasma calcium concentration fails to return to normal within eight weeks. (+info)
Control of hypercalcaemia in thyrotoxicosis.
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Two thyrotoxic patients with significant hypercalcaemia are described. The hypercalcaemia failed to suppress with hydrocortisone, propranolol and calcitonin but serum calcium fell rapidly to normal with carbimazole treatment. Both patients were subsequently treated surgically and at operation no evidence of parathyroid disease was found. Thyroid disease must be controlled before co-existing parathyroid disease is diagnosed in hypercalcaemic thyrotoxic patients. (+info)
Radioimmunoassay of human serum thyrotrophin.
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The double antibody radioimmunoassay of serum thyroid-stimulating hormone (TSH) allows measurement of circulating levels of the hormone in most normal subjects. The serum TSH level in normal subjects is 1.6 +/- 0.8muU/ml. Patients with non-toxic goitre and acromegaly have normal TSH levels. Values are always raised in hypothyroid patients (with primary thyroid disease) and are significantly lowered in those with hyperthyroidism. Of the many stimuli used in an attempt to raise TSH levels in normal adult subjects only three-synthetic thyrotrophin-releasing hormone, ethinyloestradiol, and carbimazole plus iodides-have been effective. The major clinical application of the TSH immunoassay lies in the diagnosis of minor degrees of hypothyroidism. An impaired response of serum TSH to synthetic thyrotrophin-releasing hormone should also help in the diagnosis of hypopituitarism affecting TSH production. (+info)
Mitotic rate of thyroid follicular cells in untreated and goitrogen-treated rats: variation with time of day.
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The paper presents the results of investigations into the mitotic rates of thyroid follicular cells of adult male rats maintained under controlled conditions of temperature, photoperiod and handling. The mitotic rate in eight successive 3 hour periods of the day showed a clear mitotic rhythm, with a maximum at 12.00--15.00 hours in untreated rats. The mitotic rate over the 24 hour period was 7.6+/-0.83(S.E.)metaphases/10000 cells/hour. Rats treated with the antithyroid drug, carbimazole, for three weeks were manifestly hypothyroid, as shown by decreases in oxygen consumption and rate of growth. With carbimazole the mitotic rate of the thyroid follicular cells was increased three-fold, and the mitotic rhythm was no longer detectable. In an experiment to test the efficiency of vincristine sulphate, the accumulation of metaphases after 1 mg/kg or 2 mg/kg vincristine was linear for 0.5--8 hours, although, at the higher dose, the number of metaphases was reduced after 8 hours. The mean daily mitotic rate in untreated rats was approximately commensurate with the rate of increase of body weight, which supports the classification of follicular cells as an 'expanding cell population'. (+info)