摘要:

SUMMARYThe thyroid hormone secretory response to TSH was studied in twenty‐eight patients undergoing thyroid and parathyroid surgery. Eighteen patients received bovine or human exogenous TSH by injection into a thyroid artery, and 10 received TRH to stimulate endogenous TSH secretion. Thyroid secretion rates of T4, T3, and rT3 were determined directly from measurement of blood flow and the hormone gradient across the gland. A significant secretory response was seen for all three hormones following TSH increase. T3 secretion accelerated more rapidly than that of T4 and rT3, thus reducing the T4/T3 and rT3/T3 ratios. The T4/rT3 ratio fell during the first 30 min but then increased. The responses correlated with the area under the curve of the TSH serum concentration, and were similar after administration of bovine and human exogenous TSH, and TRH. Conclusions regarding preferential secretion ought to be made by comparing ratios of thyroid hormone secretion with those of the hormone content of the gland, but our results indicate that TSH induces preferential secretion of triiodothyronines in ma

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1983.tb03180.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

SUMMARYTwo euthyroid subjects with high total concentrations of T4 in their sera have been studied (J.D.: T4, 170; T3, 1·90; rT3, 0·54 nmol/1. E.T.: T4, 185; T3, 1·63; rT3, 0·37 nmol/1). Concentrations of all three T4‐binding proteins were within normal limits in both cases. However, on reverse‐flow electrophoresis an abnormally large amount of thyroxine was found to travel with albumin. The three T4‐binding proteins in the sera of both patients were separated from each other by a novel affinity chromatographic method using dye‐Sepharose conjugates. Affinity constants for T4 binding to TBG and to prealbumin from both patients were normal. The albumin preparations were further purified and shown by physical and immunochemical techniques to be uncontaminated by other proteins. Scatchard plots of the binding of T4 to each of these pure albumins revealed two components, one having a normal affinity constant (J.D., 1·8 ± 105lmol−1and E.T., 2·3 × 105lmol−1), the other having a raised affinity constant (J.D., 5·4 × 106lmol−6and E.T., 5·8 × 106lmol−1). Extrapolation of the plots showed that the high affinity components comprised 66% (J.D.) and 54% (E.T.) of the total purified albumin. The raised affinity and high concentrations of the variants thus account for the raised total T4 concentrations in the patients. The presumed amino acid substitution in the albumins may be different in the two patients since the affinities for rT3 differ. Some methods for the estimation of free T4 levels give misleading results in the presence of these albumin variants. In the course of two episodes of illness, patient J.D. manifested large falls in serum T4 levels which could only be accounted for by reduced carriage of T4 by the abnormal and conventional binding proteins. Many cases reported in the literature as partial peripheral resistance to thyroid hormone may be examples

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1983.tb03181.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

SUMMARYUrinary levels of the glucuronides of androsterone, aetiocholanolone, 5α‐androstane‐3α, 17β‐diol and 5β‐androstane‐3α, 17β‐diol, were determined in twenty‐two‐post menopausal women both in spring and in autumn–winter. In sixteen women dehydroepiandrosterone sulphate plasma levels were also measured. Plasma DHAS levels as well as urinary metabolite excretion values were significantly higher in autumn–winter than in spring. This seasonal variability should be taken into account in long‐term studies involving adrenal hormone levels, excretion or metabolism. Moreover this seasonal variability might be of relevance for the cyclical growth rate of hormone dependent tu

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1983.tb03182.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

SUMMARYTo investigate a possible association between the β‐cells and the cells secreting pancreatic polypeptide (PP), the response of PP to insulin‐induced hypoglycaemia was investigated in seven insulin‐dependent diabetics with and seven without residual β‐cell function, all without signs of autonomic neuropathy. The mean concentrations of PP was significantly greater from 15 to 60 min after symptoms of hypoglycaemia in patients with residual β‐cell function than in patients without (P<0·05) despite similar blood glucose concentrations in the two groups. Also the total integrated areas beneath the response curves as well as the incremental integrated areas were significantly greater in patients with β‐cell function (216 + 36 pmol/l × min and 188 ± 34 pmol/l X min, respectively) than in patients without β‐cell function (125 ± 26 pmol/1 × min and 102 ± 26 pmol/l × min) (P<0·05 for both). The mean maximal concentrations of adrenaline (1±53 ± 0·28 ng/ml v. 1·29 ± 0·12 ng/ml) and noradrenaline (0·56 ± 0·16 ng/ml v. 0·45 ± 0·04 ng/ml) were not statistically different in the two groups. No well established explanation for an association between residual insulin secretion and capacity for PP‐response to

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1983.tb03183.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

SUMMARYAn insulin‐dependent diabetic presenting with thirst, polyuria and weight loss was noted to be hypertensive and shown subsequently to have a right adrenal phaeochromocytoma. Pre‐operative control of both diabetes and hypertension was achieved with propranolol and phenoxybenzamine, but not with propranolol alone. Full recovery with restoration of normal glucose tolerance and blood pressure followed successful surgery. Analysis of this patient's response to medical therapy provides further evidence that α2receptors inhibit insulin release in man. Since as many as one‐third of phaeochromocytomas are not detected during life, this diagnosis should be considered as an uncommon cause of carbohydrate intolerance in patients with diabetes mellitus, especially if accompanied by continuous or paroxysmal hypert

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1983.tb03184.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

SUMMARYBioassayable plasma ACTH and corticosteroid levels were measured during constant infusions of low doses of cortisol (3–15 mg/h) into normal subjects and into two patients with Cushing's disease. Plasma ACTH levels decreased significantly in all subjects within 60 min from the start of the infusion. The rate of rise of plasma corticosteroid levels concomitant with this feedback suppression were considerably higher in the patients with Cushing's disease (>13 nmol/l/min) than in normal subjects (3–6 nmol/l/min). In one of the Cushing's patients, ACTH secretion resumed in spite of the corticosteroid levels rising at a rate of>20 nmol/l/min. It is concluded that cortisol‐induced suppression of ACTH secretion may be operational in Cushing's disease but that the mechanism is less sensitive than in normal sub

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1983.tb03185.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

SUMMARYThis study compares salivary and total plasma levels of testosterone and androstenedione in healthy controls and chromatin positive patients with Klinefelter's syndrome. The mean plasma testosterone level in fifteen Klinefelter patients was significantly lower than in ten control subjects, but the mean androstenedione levels were similar. Saliva of the normal men and patients with Klinefelter's syndrome did not differ significantly in binding potency for testosterone or androstenedione. The mean salivary testosterone level in the Klinefelter patients was significantly lower than in the controls but again salivary androstenedione levels were similar. Although testosterone as well as androstenedione showed a fair correlation between the salivary and plasma concentrations, preliminary data suggested that salivary testosterone levels better characterize the clinical state of androgenicity than do plasma levels. When salivary testosterone and androstenedione were expressed as a percentage of total steroid levels in plasma, the ratios for both steroids were similar in Klinefelter patients and healthy controls and closely approximated to the reported percentages of free steroid levels in plasma. The absolute salivary testosterone concentrations also were almost identical to the reported free plasma hormone levels.Together the data provide indirect evidence that in Klinefelter patients testosterone and androstenedione binding in plasma and saliva does not differ from that in normal men, and measurement of salivary steroids, by reflecting their free hormone concentration in plasma, may be useful in evaluating endocrine function in both health and disease.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1983.tb03186.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

SUMMARYCirculating thyroid autoantibodies, T lymphocyte sensitization and suppressor T lymphocyte function were examined in thirty‐nine patients who had been treated for a mean of 10±2 years previously for hyperthyroid Graves’disease. Nineteen had been treated with radioactive iodine (131I), two with subtotal thyroidectomy, and eighteen were in long‐term remission after previous propylthiouracil (PTU) therapy. Sensitization of T lymphocytes to human thyroid antigen was studied by means of a modified migration inhibition factor test, using T lymphocyte enriched preparations, and antigen‐specific suppressor T lymphocyte function was assessed by the ability of T lymphocytes to suppress the production of migration inhibition factor by sensitized T lymphocytes of patients withactiveGraves’disease in response to human thyroid antigen. Despite effective correction of the hyperthyroid state in all patients, T lymphocyte sensitization to human thyroid antigen was still demonstrable in twelve of nineteen patients treated with131I (63%), in nine of eighteen patients in remission after PTU treatment (50%) and in one of two patients after thyroidectomy. All those showing such sensitization also manifested a suppressor T lymphocyte defect. In three of the patients (all after131I therapy) showingnosuch sensitization, there was nevertheless evidence of a suppressor T lymphocyte defect. On the other hand, thirteen patients (nine in the post‐PTU group, four in the post‐131I group) showed evidence of complete immunological remission. There was no correlation between the abnormal immunological findings and the number of years after treatment of the hyperthyroidism.The present study indicates that T lymphocyte sensitization and the underlying defect in suppressor T lymphocyte function are persistent in the majority of patients with Graves’disease years after131I destructive therapy, and occur independently of the hyperthyroid state. These findings are consistent with the concept that an inherited defect in suppressor T lymphocyte function plays a primary role in the pathogenesis of Graves’disease. In addition, long‐term remissions following non‐ablative antithyroid drug therapy appear to be of two types, namely, those in which immunoregulation has been restored, and those with remission in spite of a continuingly active

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1983.tb03187.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

SUMMARYTreatment of thyrotoxicosis in pregnancy with antithyroid drugs plus supplementary T4 is controversial. Data are presented on twenty consecutive pregnancies treated by this method. The mean birth weights of the babies and their gestation did not differ from those of normal controls. Cord blood mean T4 and free T4 index (FT4I) were not significantly different from controls and total T3 and free T3 index (FT3I), though significantly lower than the controls, were all within the normal range. In five babies in whom they were measured, FT3, FT4 and rT3 levels were not significantly different from controls. Cord TSH was significantly higher in the babies of thyrotoxic mothers than in the control babies. One baby had a goitre at birth which disappeared after a few days. Another baby, born euthyroid, developed neonatal thyrotoxicosis the day after birth. Data collected from the literature on this method of treatment are compared with similar data from women treated with antithyroid drugs alone.

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1983.tb03188.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

SUMMARYThe thyroid functional parameters of 102 children with protein–calorie malnutrition (PCM) classified as undernourished, marasmic, kwashiorkor and marasmic–kwashiorkor were studied by measuring the serum T4, T3, T3 percentage uptake (T3%UT), free thyroxine index (FTI), and (in a few subjects) TSH. Total plasma proteins, albumin and globulin were also estimated. T4 was increased markedly in the undernourished children and significantly decreased in kwashiorkor and marasmic–kwashiorkor groups. There was a consistent and significant fall in T3 levels of all PCM children. From normal values, the fall in T3 levels was progressive in the order of undernourished, marasmic, kwashiorkor and the marasmic–kwashiorkor states. The T3%UT was increased above normal in the marasmic, kwashiorkor and marasmic–kwashiorkor conditions. The FTI decreased somewhat in marasmus and kwashiorkor groups and was very low in marasmic–kwashiorkor. Total protein and albumin levels were above normal in the undernourished but became markedly depressed in the marasmic–kwashiorkor children. The changes in the levels of both T4 and T3 in our observations are well correlated with the levels of plasma proteins in the undernourished, marasmic and kwashiorkor states but not in the marasmic–kw

ISSN:0300-0664    

DOI:10.1111/j.1365-2265.1983.tb03189.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY