ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb03775.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.tb03776.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVE The aim of this study was to assess whether autoimmune thyroid damage in post‐partum thyroiditis was accompanied by a significant rise in the concentration of thyroglobulin in the serum and whether its measurement could be useful In the prediction of the risk and severity of an episode of post‐partm thyroid dysfunction.PATIENTS Fifty‐one women, who had taken part in a larger survey of post‐partum thyroiditis, were selected at random for this study. Fourteen women without elevated circulating thyroid autoantibodies and 21 with raised thyroid autoantibodies remained euthyroid throughout the post‐partum year. A third group of 14 women had raised thyroid autoantibody levels and showed one or more episodes of thyroid dysfunction during the course of the first year post partum.MEASUREMENTS Thyroid autoantibodies were measured by ELISA, free T3 and free T4 by the Amerlex M method and TSH by an immunoradiometrlc method. Serum thyroglobulin was measured by a method free from interference by circulating endogenous thyroglobulin autoantibodies. Thyroid ultrasonography was performed using a General Electric RT3600 scanner operating at 7.5 MHz.RESULTS Fourteen control women had a mean serum thyroglobulin concentration of 3.3 μg/l (SD 4.4; range<1–12jxg/l; 95% confidence interval up to 6.0μg/l). Twenty‐one thyroid autoantibody positive euthyroid women had a mean serum thyroglobulin level of 5.8 μgl I (SD 6.2; range<1–36 μg/l) which was not significantly different from that seen in the control group. Sixteen thyroid autoantibody positive women who showed one or more episodes of thyroid dysfunction during the postpartum period had a mean serum thyroglobulin of 31 μg/l (SD 24–8; range up to 88 μg/l) and this was significantly elevated compared with both the control and antibody positive groups (P<0.001). Serum thyroglobulin concentrations at 3 months post partum correlated with the degree of post‐partum hypothyroidism (as indicated by the maximum TSH and the minimum free thyroxine concentrations post partum) and, in those cases where thyroid ultrasound examinations were performed, with the degree of lymphocytic infiltration of the thyroid gland.CONCLUSIONS The data presented in this paper confirm the destructive nature of post‐partum thyroiditis and indicate that the measurement of serum thyroglobulin concentration could assist in the identification of those women at risk

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb03777.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVE Autoimmune thyroid diseases often occur after delivery. However, it has been difficult to predict who will develop Graves' thyrotoxicosis after delivery. We tried to establish a systematic method for predicting postpartum onset of Graves' thyrotoxicosis. DESIGN We followed up the pregnant women with antithyroid microsomal antibody (MCAb) from early pregnancy to the post‐partum period and analysed the relation between the activities of thyroid stimulating antibodies (TSAb) in early pregnancy and post‐partum occurrence of Graves' disease.PATIENTS Seventy‐one women with positive MCAb in early pregnancy were studied. They were randomly selected from 262 MCAb‐positive subjects found in 3405 consecutive early pregnant women who attended our maternity clinic during the last ten years.MEASUREMENTS MCAb was measured with a commercially available agglutination kit. For 71 MCAb‐positive subjects, TSH‐binding inhibitory immunoglobulin (TBII) and TSAb were measured in early pregnancy, and serially until 6 months after delivery for the subjects with either positive TBII or TSAb. Thyroid function and goitre size were recorded at every observation.RESULTS Among the 71 subjects, 7 showed positive TSAb in early pregnancy without any thyroid dysfunction; all 7 developed thyroid dysfunction in the post‐partum period. Five of them (70% of TSAb‐positive subjects) developed Graves' disease, two showing persistence and three transiently. None of 64 TSAb‐negative subjects developed Graves' thyrotoxicosis, though 44 developed various types of thyroid dysfunction as a result of postpartum autoimmune thyroiditis.CONCLUSION The Individuals at high risk of post‐partum onset of Graves' thyrotoxicosis can be found early in their pregnancy by the detection of TSAb. Overall occurrence of post‐partum Graves' disease in the general population is estimated above 0–54%, that is, one in 200 post‐partum women may develop Graves' thyrotoxicosis, although thyrotoxicosis may be transien

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb03778.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVE The amylin/lslet amyloid polypeptide (IAPP) gene is the third member of the calcitonin (CT)/calcitonin gene related peptide (CGRP) gene family, which includes the αCT/CGRP (CALC‐I) and βCGRP (CALC‐il) genes. CT is predominantly expressed in thyroid C cells, a and βCGRP (CGRP‐I and II) in neural tissue and amylin/IAPP in pancreatic β cells. Both the detailed tissue distribution and the physiological role of amylln are subjects of current research. We sought to characterize the RNAs transcribed from the IAPP gene In normal human pancreas and to investigate possible ectopic expression of this gene in neuroendocrine tumours.DESIGN AND TISSUES RNA was extracted from normal human pancreas, five phaeochromocytomas and 12 medullary thyroid carcinomas (MTCs) and studied by Northern blotting.RESULTS We found that in normal human pancreas the IAPP gene transcripts differ in size from those reported for human Insulinoma. Expression of the amylin/IAPP gene was detected In seven of the MTCs, while it was not detected in phaeochromocytomas. There were no apparent clinical or histological differences between IAPP positive and IAPP negative MTCs. The relative expression levels of the four mRNAs of the CT/CGRP gene family varied between the different tumours.CONCLUSIONS Our findings are consistent with the view that ectopic hormone production may occasionally be causally related to the common origin of related genes.The possibility that IAPP may constitute a minor component of MTC amyloid should be c

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb03779.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVE Heat intolerance is a well known symptom of Graves' disease. Therefore, it is possible that increased ambient temperature could influence the recognition of Graves' disease by unmasking or enhancing the symptom of heat intolerance. Our aim was to determine if there is a seasonal variation in the diagnosis of Graves' disease.DESIGN A retrospective study. SETTING A county hospital and clinic.PATIENTS Two hundred and seven patients with Graves' disease diagnosed from 1985 to 1992.RESULTS A high correlation was found between the temperature and the number of cases of Graves' disease diagnosed. A larger proportion of patients (68%) was diagnosed during the warmer half of the year, May‐October, than during the cooler half. The peak incidence of the diagnosis occurred in May, when 17–4% of the patients were diagnosed. Although the peak average monthly temperature occurs in July, the month of May corresponds to the time of the year when the temperature is making its largest positive change In the month‐to‐month variation. CONCLUSIONS Seasonal variations in the temperature can affect the incidence of the diagnosis of Graves' disease. The diagnosis is more common during the months of higher temp

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb03780.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVE We studied the macrolide antibiotic FK‐506, an immunosuppressive agent, in an attempt to ameliorate the lesion of autoimmune thyroid disease in human thyroid tissue xenografted into severe combined immunodeficient (SCID) mice. It was not felt appropriate to employ this agent directly in patients with autoimmune thyroid disease because adequate therapeutic modalities are available and the introduction of new, experimental agents could not be justified. Moreover, the study of the tissue before and after treatment could not have been undertaken directly in patients.DESIGN Human thyroid xenografts from four patients with Graves' disease and two normal persons were xenografted into SCID mice. Two weeks after xenograft‐ing, human immunoglobulin G (IgG) was detectable in all SCID mice xenografted with Graves' thyroid tissue. Mice were divided into two groups with human IgG levels similar to each other. Mice in the first group were treated with FK‐506 daily for 6 weeks; mice in the second (similar) group were given phosphate‐buffered saline (PBS) only (control group).MEASUREMENTS Blood samples were taken every 2 weeks from the tail veins for human IgG, thyroid stimulating antibody, thyroperoxidase antibodies, thyroglobulin antibodies, and interferon‐gamma (IFN‐7). After 8 weeks treatment, animals were sacrificed; thyroid tissue was examined histologically and for thyrocyte HLA‐DR expression. FK‐506 was also added to thyrocytes in in‐vitro tissue culture conditions. RESULTS After 4–6 weeks of FK‐506 therapy, human IgG, all thyroid antibodies and IFN‐7 were suppressed, while the levels remained elevated in the control group. Lymphocytic infiltration virtually disappeared in the human thyroid tissue of the FK‐506‐treated mice and thyrocyte HLA‐DR expression markedly declined; in the control mice, lymphocytic infiltration remained heavy and HLA‐DR expression remained high. On the other hand, FK‐506 added directly to thyrocytesin vitro(without lymphocytes) did not reduce thyrocyte HLA‐DR expression.CONCLUSIONS FK‐506 appears to suppress the activation of intrathyroidal lymphocytes, but not thyrocytes. From these observations, it is concluded that this agent, by its action on intrathyroidal lymphocytes, is able to ameliorate the immunologically mediated histological and serological disturbance in human autoimmune thyroid diseas

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb03781.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryBACKGROUND Urine calcium after an overnight fast is higher in osteoporotic than in normal post‐menopausal women. The question is whether this is the cause or effect of the bone‐losing state.OBJECTIVE To establish whether the elevated obligatory calcium loss In osteoporotic women is due to a raised filtered load of calcium or to reduced renal tubular reabsorption of calcium.DESIGN Covariance analysis using total plasma calcium and its fractions as the covariates.PATIENTS Eighty‐two untreated post‐menopausal women without vertebral compression and 137 untreated postmenopausal with vertebral compression all between the ages of 61 and 75 years.MEASUREMENTS After an overnight fast, calcium, albumin, globulins, anion gap and bicarbonate were measured in the plasma, and calcium, sodium and creatinine In the urine. The calcium fractions in plasma and the calcium/creatinine and sodium/creatinine ratios in urine were calculated. Bone density was measured in the distal forearm.RESULTS The ultrafiltrable and Ionized calcium in the plasma and the calcium/creatinine ratio in the urine were significantly higher in the women with vertebral compression than in those without. On covariance analysis, neither total plasma calcium nor any of the plasma calcium fractions made a significant contribution to the difference in fasting urine calcium between normal and osteoporotic women, whether bone status was defined by vertebral compression or by bone density.CONCLUSIONS The increased obligatory calcium loss in osteoporotic women is not due to an increase in the filtered load of calcium and must therefore reflect reduced renal tubular reabsorption. This implies that the calcium loss in the urine Is not theresultof increased bone resorption but ismorelikely to b

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb03782.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SUMMARYBACKGROUND In patients with mild or asymptomatic primary hyperparathyroidism a reliable index of bone resorption might be useful for appropriate management. Hydroxyproline is the most commonly used marker of bone resorption but its low specificity and sensitivity are known. Galactosylhydroxylysine, an aminoacid mainly represented in bone collagen, has been proposed as a more suitable index of bone resorption. In this study we evaluated the sensitivity of galactosylhydroxylysine and hydroxyproline assays in following the changes of their urinary levels in 12 patients with mild primary hyperparathyroidism before and after treatment with bisphosphonate and surgery.METHODS Serum and fasting urine specimens were obtained from 12 women with mild primary hyperparathyroidism before and after bisphosphonate treatment (2.5 mg daily for 5 days, intravenously) and after a further 25 days; in 7 patients biochemical tests were also performed 1 and 6 days after parathyroidectomy. Galactosylhydroxylysine was assayed by an HPLC method and hydroxyproline by a RIA commercial kit.RESULTS Baseline galactosylhydroxylysine urinary levels were far above the normal range in all the patients whilst in 8 of them baseline hydroxyproline levels were normal. Bisphosphonate treatment significantly decreased bone turnover as shown by a significant fall in serum calcium (from 2.9 to 2.6 mmol/l; P<0.001) and in galactosylhydroxylysine and hydroxyproline (−55 and −31% respectively). Twenty‐five days after the end of treatment, resorption increased again and serum calcium and galactosylhydroxylysine, but not hydroxyproline, rose significantly towards basal levels. One day after parathyroidectomy serum calcium, galactosylhydroxylysine and PTH showed reduction below normal ranges. PTH and galactosylhydroxylysine returned to normal values at day 6 after parathyroidectomy. No changes in hydroxyproline levels were seen. Galactosylhydroxylysine, but not hydroxyproline, correlated significantly with serum calcium and PTH.CONCLUSION Galactosylhydroxylysine appears to be a sensitive index of bone resorption, useful in the clinical assessment of bone involvement and in the management of patients with mild primary hyperparathyro

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb03783.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryOBJECTIVE The adrenal glands may be involved in tuberculosis. The exact frequency and extent of adrenal involvement in tuberculosis are not well known. Although there are some studies regarding adrenal gland involvement, they are not sufficient because of inadequate endocrinological tests and radiological procedures. The aim of this study was to assess the adrenal gland in acute and chronic pulmonary tuberculosis and to compare it with the findings obtained in healthy subjects.DESIGN AND PATIENTS We studied 20 patients with acute pulmonary tuberculosis, 41 patients with chronic pulmonary tuberculosis and 20 healthy subjects. Involvement of the adrenal gland was assessed by basal Cortisol level, Cortisol response to Synacthen and adrenal computed tomography.MEASUREMENTS Cortisol levels were measured before, 30 and 60 minutes after Synacthen (250 μg i.v.) injection. Computerized tomography of the adrenals was carried out in 61 patients with tuberculosis and 20 healthy subjects.RESULTS Mean basal Cortisol level and 60‐minute Cortisol response to Synacthen were significantly higher in acute pulmonary tuberculosis than in chronic pulmonary tuberculosis and healthy subjects. Two patients with Addison's disease were diagnosed among the chronic tuberculous patients. Both length and thickness of the right and left adrenal gland were greater in patients with acute tuberculosis.CONCLUSION Adrenal enlargement demonstrated by computerized tomography is common in patients with acute pulmonary tuberculosis, but our findings show that Cortisol reserve is normal, in contrast to previous suggestio

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1994.tb03784.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY