ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02779.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02780.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02781.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02782.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02783.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVE Many textbooks claim that radioIodine (131I) treatment should be given with care to a goitre with substernal extension, for fear of acute swelling of the gland and thus respiratory problems. Since131I Is used increasingly in the treatment of non‐toxic as well as toxic goitre we have evaluated the acute changes in thyroid volume following131I therapy.DESIGN Evaluation of potential acute changes in thyroid volume and function after131I treatment in patients with non‐toxic goitre treated because of compression symptoms or for cosmetic reasons, as well as In patients with toxic goitre.PATIENTS Out‐patients with multinodular goitre, either non‐toxic (n= 20) or toxic (n= 10). Excluded were patients with a substernal goitre.MEASUREMENTS Ultrasonically determined thyroid volume and standard thyroid function variables were Investigated before and 2, 7, 14, 21, 28 and 35 days after treatment.RESULTS In non‐toxic goitres the thyroid volume did not increase significantly, the maximum increase in the median volume being 4% on day 7. Serum levels of free T3 and free T4 Indices increased by 20% (day 7) and 13% (day 14) (P= 0·002), respectively.Likewise thyroid volume in toxic nodular goitre did not change significantly after131I treatment (maximum median increase was 2%). None of the patients presented symptoms of tracheal compression.CONCLUSIONS131I treatment of non‐toxic as well as toxic multinodular goitre does not seem to increase th

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02784.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVE The management of cystic lesions in the thyroid remains controversial. We examined the efficacy and safety of ultrasound guided percutaneous ethanol injection for the treatment of benign cystic thyroid nodules in euthyroid patients.STUDY DESIGN (A) Preliminary randomized trial: 20 patients with predominantly cystic thyroid nodules were randomized in two groups and followed up for 1 month. Group 1 underwent fine needle aspiration of the fluid component of the nodules; Group 2 underwent percutaneous ethanol injection at the end of fine needle aspiration of the cyst fluid. (B) Prospective study: 32 patients with the same clinical characteristics (Group 3) were treated by fine needle aspiration and percutaneous ethanol injection, and followed up for 12 months.METHODS Groups 1 and 2: clinical evaluation, thyroid ultrasonography, thyroid scintiscan and serum thyroid hormone profile were performed before treatment and one month later. Group 3: clinical evaluation, thyroid ultrasonography and serum thyroid hormone profile were performed in basal conditions and 1, 3, 6, 9, 12 months after treatment. Thyroid scintiscan was performed before treatment and 3–6 months later.RESULTS (A) Randomized study: one month after treatment, nodule volume decrease in Group 2 was significantly higher than In Group 1 (Group 2 median 14·75 range 6–29·9 ml; Group 1: median 3·65 range 0·2–18·5 ml;P<0·01). Nodule volume reduction was greater than 50% versus baseline in 8 (80%) patients in Group 2 and in 3 (30%) patients in Group 1 (P<0·01). (B) Prospective study (Group 3): a significant nodule volume reduction (P<0·01vspretreatment) was observed 1 and 12 months after percutaneous ethanol injection (pretreatment: median 14·5, range 1·5–65·8 ml; 1 month: median 3·5, range 0·4–38·9 ml; 12 months: median 2·5, range 0·4–34·5 ml). Nodule volume reduction greater than 50% was recorded in 24 (80%) patients. Groups 1–3: recurrence of cyst fluid was demonstrated by ultrasonography in 8 patients of Group 1, in 3 patients of Group 2 and in 1 patient of Group 3. No relevant adverse effects or significant biochemical changes were observed.CONCLUSIONS Ultrasound guided percutaneous ethanol injection of cystic thyroid nodules is a safe, low‐cost and effective therapeutic procedure in patients with benign thyroid cystic nodules. Indeed, nodule volume reduction was significantly greater and more frequent in patients treated by percutaneous ethanol Injection than in those patients who underwent fluid aspiration alone. These results were confirmed in a long‐term prospective trial and only one fluid recurrence was obse

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02785.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVE There are large variations in the circulating concentrations of thyroglobulin. The purpose of this study was to explore the possibility of a genetic basis for the variability of serum concentration of thyroglobulin (Tg) in euthyroid individuals.DESIGN The serum concentration of thyroglobulin (Tg) varies several‐fold in euthyroid individuals. Other circulating proteins also show wide normal ranges of concentration and these variations have been shown to have a genetic as well as an environmental basis. To explore the possibility of a genetic bash for variability in serum Tg levels, an analysis was made of serum Tg levels in 44 pairs of identical twins and 66 nuclear families who were euthyroid and thyroid autoantibody negative (thereby eliminating subclinical autoimmune thyroid disease and Tg autoantibody Interference with the Tg assay).RESULTS Each pair of identical twins tended to have a similar Tg level and the overall correlation was highly significant (r= 0·734,P<0·001). There was no relation between Tg and TSH levels In the twins (r= 0·119;P= 0·366). Segregation analysis of the 66 families showed that where both parents had Tg levels above the overall median for the subjects (males, 19 μg/l; females, 33 μg/l), 73% of the offspring also had concentrations above these levels, compared with 30% of the offspring when one parent had a high Tg level and only 16% in families where neither parent had a high Tg level.CONCLUSIONS Complex segregation analysis using the computer program Pointer suggested that variability in Tg levels was the result of a major dominant‐like gene effect (accounting for 80% of the variability) combined with a multifactorial component. Thyroglobulin, a template for thyroid hormone production, is also a major thyroid autoantigen and inherited variations in serum Tg levels may have implications for the pathogenesis of auto‐Immune thyr

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02786.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVE The Sick euthyroid syndrome is a poorly understood hallmark of critical illness. Dopamine is a natural catecholamine with hypophysiotrophic properties, that is used as an inotropic agent of first choice in intensive care medicine. We explored the effect of dopamine infusion (5μg/kg/min) on the sick euthyroid syndrome of critically ill patients.PATIENTS AND DESION In a prospective, randomized, controlled and open‐labelled study of critically ill, adult polytrauma patients (n= 12), we evaluated the effect of prolonged (83–296 hours) dopamine Infusion (5 μg/kg/min i.v.) on the thyroid axis. The effect of brief (15–21 hours) dopamine administration was documented in an additional randomized, controlled, cross‐over study involving 10 patients. The median age of the studied patients was 29 (16–83) years.MEASUREMENTS Serum TSH concentrations were measured by IRMA. The TSH profiles were obtained by blood sampling every 20 minutes for 9 hours during two consecutive nights. Serum T4, T3 and reverse T3 concentrations were measured by RIA once per study night.RESULTS Withdrawal of prolonged dopamine infusion was found to elicit a tenfold increase of serum thyrotrophin concentrations, a 57 and 82% rise of T4 and T3 respectively, and an Increase of the T3/rT3 ratio, resulting in virtual normalization of the thyroid axis within 24 hours. The brief dopamine infusion was documented to have a suppressive effect on the thyroid axis within 24 hours.CONCLUSIONS Dopamine infusion appears to induce or aggravate the sick euthyroid syndrome in critical illness. As a consequence, the sick euthyroid syndrome of severely ill patients receiving dopamine may be not an adaptive mechanism, but a condition of latrogenic hyp

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02787.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryBACKGROUND AND OBJECTIVES A worldwide trend towards increasing life expectancy has meant that osteoporosis is emerging as an important public health problem. The loss of bone mineral density and its restoration in association with a premenopausal but physiological hypo‐oestrogenic state may serve as an important model for research into the pathogenesis and prevention of osteoporosis. With this in mind we have undertaken a longitudinal study of changes in bone mineral density over one year in women after childbirth.DESIGN Observational study of 31 women in the first year following childbirth; 11 intending to breast‐feed and use barrier methods of contraception, 9 Intending to breastfeed and to use the progestogen‐only pill and 10 intending to artificially feed and to use barrier methods.PATIENTS Recruitment was from the antenatal clinics of the Simpson Memorial Maternity Pavilion. Only non‐smokers who had regular menstrual cycles prior to conception were included.MEASUREMENTS Bone mineral density was measured at the lumbar spine within 3 weeks of childbirth and repeated at 6 and 12 months post partum. Plasma oestradiol, prolactin and osteocalcin concentrations were measured at each visit.RESULTS Breast‐feeding women using barrier methods lost a mean ± SE of 4·9 ± 1·5% of bone mineral density In the first 6 months following delivery. This was however reversible since by one year the bone mineral density was no different from that measured immediately post partum. Breast‐feeding women using the progestogen‐only pill lost a significantly smaller percentage of bone mineral density in 6 months and by one year bone mineral density war 2·95 ± 0·75% higher than post partum. Artificially feeding women had a steady Increase in bone mineral density In the first year and bone mineral density was on average 4·3 ± 1·2% higher.CONCLUSION Breast‐feeding results in a reversible reduction in spinal bone mineral density. The small amounts of gestagen in the progesterone‐only pill would appear to protect against this loss. The mechanism of this loss in bone mineral density and the potentially bone protective effects of gest

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb02788.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY