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Biomedical subjects

A D Toft

Publications and source records attributed to A D Toft.

At least 109 records · Page 6Linked to original sources
PubMed1981

Morphological studies in a case of thyrotoxicosis complicated by lithium therapy for bipolar depression.

The histological and ultrastructural features of the thyroid in a case of thyrotoxicosis complicated by lithium therapy (for bipolar depression) are described. Despite the bizarre and disturbing pathological appearances, it is proposed that their interpretation should be modified in view of the biosynthetic block imposed by lithium administration. The cellular appearances are considered to reflect a hyperplastic state with coincidental impairment of synthetic activity, and not to represent a neoplastic process. The use of lithium in the management of psychiatric illness is increasing. It is important to be aware of the possible effect of the drug not only on thyroid function but also on the histopathological appearances of the thyroid when interpreting any associated or incidental lesion of the gland.

Adult↗
PubMed1981

Plasma exchange in conjunction with immunosuppressive drug therapy in the treatment of endocrine exophthalmos.

We describe three patients who developed severe endocrine ophthalmopathy at 3, 12 and 18 months after treatment with iodine-131. In two cases with congestive ophthalmopathy steroids alone and plasma exchange alone failed to produce a satisfactory response, but the combination of plasma exchange with steroids or steroids plus cyclophosphamide was followed by resolution of papilloedema and return of visual acuity to normal as well as definite improvement in the other signs of ophthalmopathy. In the remaining case, which did not have papilloedema the signs of ophthalmopathy were progressive despite treatment with steroids. Combined treatment with plasma exchange, steroids and cyclophosphamide resulted in improvement in visual acuity and resolution of periorbital oedema and diplopia. Plasma exchange may be a useful adjunct to immunosuppressive therapy in the treatment of acute progressive endocrine exophthalmos.

Aged↗
PubMed1980

Combination of potassium iodide and propranolol in preparation of patients with Graves' disease for thyroid surgery.

We assessed the efficacy of the combination of propranolol and potassium iodide in the preparation of patients with Graves' disease for thyroid surgery. Potassium iodide was given orally in a dose of 60 mg three times a day for 10 days before operation in 10 patients who were already receiving propranolol. In contrast to previous experience with either drug used singly, the combined regimen caused a significant fall in mean serum total thyroxine and triiodothyronine to levels in the euthyroid range before operation (P less than 0.001). There was also a significant fall (P less than 0.05) before operation and transient rise after operation in serum reverse triiodothyronine. These preliminary results suggest that the combination of potassium iodide and propranolol may prove to be the optimum preoperative preparation for patients with Graves' disease.

Adult↗
PubMed1980

Paracetamol pharmacokinetics in thyroid disease.

The absorption, distribution and elimination of oral paracetamol have been studied in patients before and after treatment of thyrotoxicosis (n = 7) and hypothyroidism (n = 4). Absorption was faster in patients with untreated thyrotoxicosis than when subsequently euthyroid. The peak paracetamol concentration, however, was lower in thyrotoxic patients due to an apparent increase in the total body clearance and a shorter plasma half-life. Both absorption and elimination rates were reduced in hypothyroid patients, but were not significantly different from the euthyroid results. When estimated using a two compartment model the total volume of distribution and the hybrid distribution rate constants were unrelated to thyroid status, but the apparent volume of the central compartment was significantly greater in the thyrotoxic group. These changes in drug disposition may contribute to differences in drug response seen in thyroid disease.

Acetaminophen↗
PubMed1980

Transient hypothyroidism after iodine-131 treatment of thyrotoxicosis.

Thirty consecutive patients with thyrotoxicosis were followed up at monthly intervals for 6 months after treatment with iodine-131. Serum total T4, serum total T3, and serum TSH response to TRH were measured at each review. Biochemical evidence of hypothyroidism (low T4 raised basal TSH) developed in 18 patients 1-4 months after treatment. In 5 of these patients, symptoms and signs of hypothyroidism remained absent or minimal and spontaneous recovery of thyroid function occurred during the ensuing 2 months. If biochemical hypothyroidism occurs during the first 6 months after radioiodine therapy, it is recommended that T4 replacement be withheld for 2 months unless the severity of symptoms demands treatment.

Adult↗
PubMed1980

Influence of thyroid status on dopaminergic inhibition of thyrotropin and prolactin secretion: evidence for an additional feedback mechanism in the control of thyroid hormone secretion.

Serum TSH and PRL concentrations were measured after the randomized oral administration of either metoclopramide, L-dopa, or placebo on 3 consecutive days to five patients with overt primary hypothyroidism (low serum total T4 and raised serum TSH) and to five patients with subclinical hypothyroidism (normal serum total T4 and raised serum TSH). In both groups there was a rise in serum TSH and PRL concentrations after metoclopramide and a fall after L-dopa when compared with the effect of the placebo. However, the rise in serum TSH and PRL concentrations was significantly greater in patients with subclinical hypothyroidism compared to that in patients with overt hypothyroidism. It was not possible to show any significant difference in the degree of fall of these pituitary hormones after L-dopa administration in the two groups. These results suggest that in addition to the established negative feedback of thyroid hormones at the level of anterior pituitary thyrotropes, there is a previously unrecognized effect of thyroid hormones at the hypothalamus, resulting in increased dopaminergic inhibition of TSH release. Stimulation of hypothalamic dopamine by thyroid hormones also inhibits PRL secretion.

Feedback↗
PubMed1980

TSH response to TRH in substantial obesity.

TSH response to TRH stimulation was studied in 40 non-obese control females and in 40 obese female subjects 40-148 per cent in excess of their ideal weight prior to receiving dietary advice. One patient was found to be hypothyroid and was excluded from further study. There was no significant difference between the basal serum TSH concentration in the subjects and controls. Obese subjects however had significantly greater serum TSH concentrations at 20 and 60 min following TRH stimulation. The implciations of these findings are at present unexplained.

Adult↗
PubMed1979

Occult thyrotoxicosis: a correctable cause of "idiopathic" atrial fibrillation.

Serum total thyroxine, triiodothyronine and thyrotropin response to thyrotropin-releasing hormone were measured in 75 consecutive patients presenting to a cardiology clinic with atrial fibrillation with no obvious cardiovascular cause. A lack of response of serum thyrotropin to thyrotropin-releasing hormone, indicative of thyrotoxicosis, was found in 10 patients (13 percent), not all whom had raised serum thyroid hormone levels. These 10 patients were predominantly male, had no clinical signs of thyrotoxicosis and a relative excess of nonpalpable autonomous thyroid nodules demonstrated with scintigraphy. Eight of the 10 patients had reversion to stable sinus rhythm after treatment with iodine-131 or carbimazole, either spontaneously or after direct current cardioversion. It would appear that clinically occult thyrotoxicosis can be identified consistently only with the thyrotropin-releasing hormone test and is the cause of "idiopathic" atrial fibrillation in a significant proportion of patients.

Aged↗
PubMed1979

Failure of the TRH test to predict the clinical course of patients in remission after antithyroid drug therapy for Graves' disease.

In an attempt to assess the predictive value of the TRH test in patients in remission after stopping antithyroid drugs for thyrotoxicosis, 11 euthyroid patients with a subnormal (group I) and 23 euthyroid patients with a normal serum TSH response to TRH (group II) were followed-up for one year. The mean +/- SE intervals since the withdrawal of drug therapy were 23.2 +/- 1.6 and 20.4 +/- 0.7 months, respectively, at the outset of the study. Five patients (45%) from group I and 7 patients (30%) from group II relapsed during the period of observation. In addition, a change from a subnormal TSH response to TRH and vice versa occurred in some patients. It is not possible to predict by means of the TRH test the subsequent clinical course of patients in remission following antithyroid drug therapy.

Adult↗
PubMed1978

How often should patients be reviewed after treatment with iodine-131 for thyrotoxicosis?

Six to 18 years after treatment with iodine-131 for thyrotoxicosis 69 euthyroid patients with raised serum thyrotrophin (TSH) concentrations (mean 25.0 +/- SE 2.0 mU/l) and 61 with normal concentrations (mean 4.0 +/- 0.2 mU/l) were included in a prospective five-year follow-up study beginning in 1972. During this period 13 patients from the original group with raised serum TSH concentrations became hypothyroid. In contrast it was five years before hypothyroidism developed in a single patient from the group with normal serum TSH concentrations in 1972, although raised concentrations were recorded in 19 of these patients during the study.

Aged↗
PubMed1978

Thyroid function after surgical treatment of thyrotoxicosis. A report of 100 cases treated with propranolol before operation.

We assessed thyroid function for 12 months after subtotal thyroidectomy in 100 tyrotoxic patients treated with propranolol alone before and immediately after operation. The operation proved safe, with low morbidity. Suppression of the hypothalamic-pituitary-thyroid axis, present in the majority one month after operation, was evidenced by normal or low levels of serum total tri-iodothyronine and thyroxine, but absent or subnormal serum thyrotropin response to thyrotropin-releasing hormone. Eighty patients were euthyroid at 12 months. Three patterns of thyroid function were observed in this group between the first and 12th months: normal serum total tri-iodothyronine, thyroxine and thyrotropin levels at all stages (20 patients); normal serum total tri-iodothyronine and thyroxine, but raised thyrotropin levels on one or more occasions (40 patients); and temporary hypothyroidism (20 patients). Of the remaining 20 patients, permanent hypothyroidism developed in 14, and six relapsed. Postoperative thyroid function was related to the estimated weight of the thyroid remnant.

Adult↗
PubMed1977

Familial studies of type-I and type-II idiopathic diabetes mellitus.

A study of 296 diabetics demonstrated an association between the type of diabetes in the propositi and their first-degree relatives (aged 40 to 89 yr), the type of diabetes being defined as insulin-dependent (type I) or insulin-independent (type II). This association was significant at the 1% level and was still maintained when only the propositi in whom the diabetes was diagnosed at the age of 30 years or later were considered. The findings also suggest that there is a greater genetic independence between these two types than was previously supposed and that the disease should be subdivided into type according to the treatment needed rather than by the age of onset.

Administration, Oral↗
PubMed1977

Spectrum of thyroid function in patient's remaining in remission after antithyroid drug therapy for thyrotoxicosis.

Thyroid function was assessed in 110 patients who were in remission for a period of 7-6 +/- 0-6 years (mean +/- S.E.) (range 0-25--25 years) after the withdrawal of antithyroid drug therapy for thyrotoxicosis. On the basis of clinical examination and on the results of thyroid-function tests, the following group of patients were identified: (I) euthyroid with normal plasma-total thyroxine (T4) and triiodothyronine (T3) concentrations, but an absent or subnormal response of plasma-thyrotrophin (T.S.H.) to thyrotrophin-releasing hormone (T.R.H.) (16%); (II) euthyroid with normal concentrations of plasma total T4 and T3 and a normal plasma-T.S.H. response to T.R.H. (59%); (III) euthyroid with normal concentrations of circulating thyroid hormones and a normal basal plasma-T.S.H., but an exaggerated plasma-T.S.H. response to T.R.H. (13%); (IV) euthyroid with normal plasma total T4 and T3 concentrations, but a raised basal plasma-T.S.H. concentration and an exaggerated plasma-T.S.H. response to T.R.H. (6%); (V) hypothyroid (6%). Although the need for short-term follow-up to identify those patients treated with antithyroid drugs who will relapse is well recognised, 16% of all patients in remission for longer than 4 years (10-8 +/- 0-7 years) in the present study showed some degree of thyroid failure. Evidence of hypothyroidism was associated with an increased frequency of thyroid microsomal antibodies. If the morbidity of the late development of hypothyroidism is to be avoided, patients who have been treated with antithyroid drugs should have long-term follow-up, as do patients treated surgically or with radioiodine.

Antithyroid Agents↗
PubMed1976

Temporary hypothyroidism after surgical treatment of thyrotoxicosis.

Mild clinical hypothyroidism associated with low levels of serum total thyroxine (T4) and tri-iodothyronine (T3) and raised levels of serum thyroid-stimulating hormone (T.S.H.) has been observed in 14 of 40 patients (35%) in the early months after a subtotal thyroidectomy for thyrotoxicosis under cover of propranolol. In 10 of the patients, however, the hypothyroidism was temporary and at 6 months after operation the thyroid hormone levels were normal and the serum T.S.H. levels had fallen. In 4 of the patients in whom clinical and biochemical evidence of hypothyroidism persisted 6 months postoperatively, long-term T4 replacement therapy was instituted. It is concluded that the diagnosis of permanent hypothyroidism should not be made with confidence before 6 months have elapsed after operation and that the incidence of hypothyroidism following the surgical treatment of thyrotoxicosis may have been overestimated in the past.

Adult↗
PubMed1976

Simple solid-phase radioimmunoassays for total tri-iodothyronine and thyroxine in serum, and their clinical evaluation.

1. Simple solid-phase radioimmunoassay methods for total tri-iodothyronine and thyroxine in serum or plasma are described. By using antibodies that are covalently coupled to microcrystalline cellulose, virtually identical assay procedures can be used for the determination of both hormones. An alkaline sodium glycinate buffer provides better assay conditions than the buffers often recommended for thyroid hormone radioimmunoassay. 2. Assay results are unaffected by moderate sample haemolysis. Plasma samples stored at room temperature for more than nine days often show an apparent increase in concentration of both thyroid hormones. 3. Serum tri-iodothyronine and thyroxine concentrations in healthy euthyroid subjects, and in euthyroid pregnant women are reported. In a series of 100 consecutive patients referred to a thyroid clinic the tri-iodothyronine assay discriminated better than the thyroxine assay between hyperthyroid and euthyroid patients. The thyroxine assay was much better than the tri-iodothyronine assay in discriminating between hypothyroid and euthyroid patients.

Anilino Naphthalenesulfonates↗
PubMed1976

Assessment by continuous cardiac monitoring of minimum duration of preoperative propranolol treatment in thyrotoxic patients.

The effect of the beta-blocker, propranolol (40 mg 6-hourly orally) has been studied on the tachycardia of six patients with untreated thyrotoxicosis. Heart rate was monitored continuously using a light portable ECG recorder which allowed the patients to undertake normal activities during the recording periods. The most marked reduction in heart rate was evident at 24 h after starting propranolol treatment. In three of the patients there was only a minor further fall in heart rate despite continued propranolol administration, but in the remaining patients the reduction in heart rate with each successive day of treatment was more marked. These results suggest that if propranolol were to be used alone in the preparation of patients before partial thyroidectomy for thyrotoxicosis, a dose of 40 mg 6-hourly for 3-4 days might be sufficient.

Adult↗