摘要:

SUMMARYEuthyroid Graves' ophthalmopathy (EO) is an ophthalmic disorder without persistent hyperthyroidism. To elucidate genetic differences among EO, Graves' disease (Gr) and Hashimoto's thyroiditis (H), we analysed HLA‐A, B, C, DR, DO, D and DP types in 23 Japanese EO patients, 88 Gr patients, 46 H patients and 186 control subjects utilizing assays of lymphocyte cytotoxicity and restriction fragment length polymorphism (RFLP). When compared with the control subjects, EO patients showed significant associations with HLA B40 (w61), DR9, DQw3, and Dw15 (P>0.01) and with HLA B12 and Cw1 (P>0.05). When allowance was made for the number of antigens tested, only DQw3 was significant. Significant differences were found between EO and Gr (DPw2), and between EO and H (Cw1) even after correction ofPvalues. Comparisons between EO and related subgroups of Gr confirmed the heterogeneity of EO again. It is concluded from these results that EO is associated with different HLA types from Gr and

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb01736.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYKetoconazole, an imidazole derivative which Inhibits adrenal steroidogenesis, has been used with success for the metabolic control of Cushing's disease. Few data are available about the use of ketoconazole in the management of the ectopic ACTH syndrome. We have used ketoconazole in eight patients: four patients with Cushing's disease, two patients with overt and two with occult ectopic ACTH syndrome. Among patients with Cushing's disease, reversible hypoadrenalism occurred once. All had full clinical and biochemical regression of the disease for more than 6 months with 400–1200 mg ketoconazole per day. Patients with ectopic ACTH syndrome received 1200 mg ketoconazole per day for at least 2 months. Partial biochemical regression was observed in two and a secondary escape to adrenal blockade in two others. These findings further indicate that ketoconazole is a valuable tool for the metabolic control of Cushing's disease. On the contrary, in ectopic ACTH syndrome, this aim can be impossible to reach with ketoconazole although the reasons for its ineffectiveness remain to be determine

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb01737.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYIn view of continuing debate regarding the best definitive therapy for thyrotoxicosis, we examined the long‐term outcome of radiolodine (131I) or surgical treatment of 1918 thyrotoxic patients divided into three groups: those given131I at a dose calculated from thyroid size,131I uptake and effective half‐life to administer a fixed radioactivity dose to the thyroid; those treated with a dose of131I (110,185 or 370 MBq) chosen empirically; and those treated by partial thyroidectomy. A minimum 10‐year follow‐up was achieved for 1119 patients treated with a calculated131I dose; a single dose resulted in control of disease in 90.5|X%. At 5 years, 18|X% were hypothyroid, the prevalence rising to 42|X% at 20 years. Of 504 patients treated with an empirical131I dose and followed for at least 5 years, thyrotoxicosis was controlled by a single dose in 89.7|X%. The rate of hypothyroidism at 5 years (38.5|X%) was higher than that found in the calculated dose group. A minimum 10‐year follow‐up was achieved for 295 surgically treated patients; thyrotoxicosis was controlled in 89.2|X%. The prevalence of hypothyroidism (2|X% at 5 years, 27.5|X% at 20 years) was lower than that found after131I, whether given by calculated or empirical dose. Each of the treatments employed resulted in an acceptable rate of cure of thyrotoxicosis. If maintenance of euthyroidism is the major objective, our findings suggest that surgery represents the treatment of choice. Furthermore, calculated dose131I administration has advantages in terms of risk of hypothyroidism over empirical dose treatment. In choosing treatment, these apparent advantages of partial thyroidectomy and calculated131I doses over empirical doses of131I must be weighed against surgical morbidity, cost and patient in

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb01738.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYIncreasing use of assays for TSH with improved sensitivity as a first‐line test of thyroid function has raised questions regarding prevalence and clinical significance of abnormal results, especially values below normal. We have assessed the thyroid status of 1210 patients aged over 60 registered with a single general practice by measurement of serum TSH using a sensitive assay. High TSH values were more common in females (11.6|X%) than males (2.9|X%). TSH values below normal were present in 6.3|X% of females and 5.5|X% of males, with values below the limit of detection of the assay present in 1.5|X% of females and 1.4|X% of males. Anti‐thyroid antibodies were found in 60|X% of those with high TSH but only 5.6|X% of those with subnormal TSH. Eighteen patients were hypothyroid (high TSH, low free thyroxine) and one thyrotoxic (low TSH, raised free thyroxine) at initial testing. Seventy‐three patients with elevated TSH but normal free T4 were followed for 12 months; 13 (17.8|X%) developed low free T4 levels and commenced thyroxine, TSH returned to normal in four (5.5|X%) and 56 (76.7|X%) continued to have high TSH values. Sixty‐six patients with TSH results below normal were followed. Of the 50 subjects with low but detectable TSH at initial testing, 38 (76|X%) returned to normal at 12 months; of those 16 with undetectable TSH followed, 14 (87.5|X%) remained low at 12 months. Only one subject (who had an undetectable TSH) developed thyrotoxicosis. In view of the marked prevalence of thyroid dysfunction in the elderly, we suggest that screening of all patients over 60 should be considered. It is important that those with high TSH are followed in view of the risk of progression to overt hypothyroidism, but the risk of thyrotoxicosis in those with TSH values below normal appear

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb01739.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYThis study was designed to assess the response of growth hormone (GH) to growth hormone releasing hormone (GHRH) and the possible interaction of acutely administered recombinant human erythropoietin (rhEPO) on GH response to GHRH in a group of uraemic patients. Eight patients on maintenance haemodialysis, not previously treated with rhEPO, and six healthy controls were tested with GHRH (100 μg i.v. in bolus), and with GHRH (100 μg i.v. in bolus) plus rhEPO (40 U/kg in constant infusion for 30 min) on different days. GHRH injection provoked a GH release in five out of eight uraemic patients; the overall mean response did not differ significantly from the GH response obtained in controls (P = 0.30). Erythropoletin infusion significantly increased GH release after GHRH (P>0.01 at 15, 30, 45, 60 min after GHRH injection) in uraemic patients; in controls, on the contrary, stimulation with GHRH plus rhEPO did not induce a greater increase of OH release compared with that observed after GHRH alone (mean GH peak 37.66 |Mp 7.68 mU/I after GHRH; and 38.0 |Mp 9.18 mU/I after GHRH plus rhEPO; P<0.5). In this study acutely administered rhEPO significantly potentiated the GH response to GHRH in uraemic patients whereas the same effect was not demonstrable in subjects with normal renal functio

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb01740.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb01741.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Book review in this ArticleThyroid Eye Disease. Second edition. D. H. Char.Controlof the Onset ofPuberty. Edited by M. M. Grumbach, P. C. Sizonenko&M. L. Aubert. Williams&WilkinsMolecular Endocrinology and Steroid Hormone Action. Edited by Gordon H. Sato&James L. Stevens. Alan R. Liss.Control of the Thyroid Gland. Regulation of its Normal Function and Growth. Volume 261. Advances in Experimental Medicine and Biology. Edited by R. Ekholm, L. D. Kohn&S. H. Wollman.Pediatric Endocrinology: A Clinical Guide. Edited by F. Lifshitz.Endocrine Function and Aging. Edited by H. J. Armbrecht, R. M. Coe&N. Wongsurawat.Smoking and Hormone‐Related Disorders. Edited by N. Wald&J. Baro

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb01742.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1991.tb01743.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY