A detailed comparison was made over 18 months of the serial mean 20 min 132I uptake behavior between 15 Graves' disease patients whose hyperthyroidism ultimately remitted (Group E) and 20 in whom it persisted (Group R). All were treated with carbimazole and T3. There were not qualitative differences in uptake between the 2 groups. In both, the uptake fell with time, and the slopes were parallel. The fact that the mean uptake started lower in Group E patients was sufficient to explain why it became normal much earlier than that of Group R, which had not normalized by 18 months. In both groups, over half the overall fall in uptake occurred during the first month of treatment with carbimazole. We conclude that, while time remains the most important determinant of outcome in Graves' disease, some possible immunosuppressive action of carbimazole can shorten the cycle length to a major degree.

Adult↗

PubMedDate not supplied

The influence of subtotal thyroidectomy on the thyroglobulin binding capacity of thyrotoxic serum.

It has been shown previously that large amounts of thyroglobulin are released into the circulation by the trauma of thyroid surgery. In order to characterize the response to this challenge in patients with and without autoimmune disease, serial estimations of thyroglobulin binding capacity (AgBC) using a sensitive double antibody technique were made on 105 patients undergoing partial thyroidectomy for thyrotoxicosis (70 patients prepared medically) and nontoxic goiter (35 patients). Samples were measured the day before, the day of, and on eight subsequent occasions during the first 14 days after surgery. Three distinct patterns of change in AgBC were observed in the thyrotoxic patients: i) when elevated before surgery, it fell acutely within 48 h of operation and rose again within the first 7-10 days (8 patients); ii) it rose briskly, though transiently, when low (less than 10%) before surgery (4 patients); iii) when elevated before surgery, it rose or fell gently afterwards without sudden change (7 patients). The AgBC in 51 of the Graves' disease patients never exceeded 10% during the perioperative period, and was immeasurably low in all nontoxic goiter patients. Autoimmune thyroid disease results from a disturbance of normal tolerance to thyroid antigens, and thyroid surgery provides an in vivo model in which the response to an acute antigenic challenge may be studied. Patients with Graves' disease showed varying degrees of intolerance to the challenge, while those with nontoxic goiter and no evidence of autoimmune disease were uniformly unresponsive.

Adult↗

PubMedDate not supplied

The variations in thyroid function tests compatible with clinical euthyroidism after medical and surgical treatment for Graves' disease.

Eight widely used tests of thyroid function (clinical and biochemical) were performed simultaneously on 46 thyrotoxicosis patients who were clinically well at a standardised interval after medical or surgical treatment. The aim was to establish the range of thyroid function compatible with clinical normality. While clinical scoring systems gave broadly similar results between surgically and medically-treated patients, thyroid biochemistry showed major differences. Thus while 87% of medically-treated and 74% of surgically-treated patients were classified clinically euthyroid by the clinical indices devised by Crooks and Billewicz, the TRH test was exaggerated in 77% of the latter group but in only 13% of the former. On the other hand, half of the 26% of surgical patients with a clinical index suggesting hyperthyroidism had normal thyroid hormone levels and exaggerated TRH tests. No patient was categorised as clinically hypothyroid despite basal TSH levels as high as 21 mU/L (N : less than 5 mU/L) and T4 levels as low as 42 nmol/L (N: 70.150 nmol/L). Substitution of FT4 index for total T4 did not significantly alter the classification or ranking of patients in either treatment group. The early (20-minute) 132I uptake was normal in all but one case. We conclude that abnormal laboratory tests of thyroid function are found frequently after treatment in thyrotoxicosis patients with few or no clinical features of thyroid disturbance.

Graves Disease↗

PubMedDate not supplied

Meningitis: public health issues.

This paper describes a case-note review of 25 cases of meningococcal disease which occurred in the six months following distribution of pre-admission antibiotic treatment packs and prophylaxis advice packs. The data showed that while these interventions had improved some aspects of public health, and management of cases and their contacts, further action was needed

Adolescent↗