Investigation and treatment of hypothyroidism.
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Biomedical subjects
Publications and source records attributed to D Evered.
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Sebum excretion rates (SER) were measured before and after treatment in patients with hypothyroidism and thyrotoxicosis. The mean SER in the former was significantly less than that in normal controls but there was no correlation between SER and the severity of the disease as indicated by serum thyroid-stimulating hormone levels. After treatment with L-thyroxine the SER increased but remained subnormal. By contrast the SER was not increased in patients with thyrotoxicosis and it was unaffected by treatment. The human sebaceous gland seems to respond to thyroid hormone mainly in the hypothyroid range.
The effect of graded doses of thyroxine (T4) and triiodothyronine (T3) separately on the pituitary-thyroid axis has been studied in normal subjects. It has been demonstrated that small doses (50 mug T4 or 20 mug T3) cause significant suppression of the pituitary-thyroid axis. There was a strong negative correlation between the TSH value 20 min after TRH and the dose of thyroid hormone. T4 supplements led to a progressive dose-related rise in serum T4 and no significant change in T3 until high daily doses (greater than 200 mug) were administered. T3 supplements led to a progressive reduction in serum T4 and there was no change in T3 until substantial supplements were given (greater than 50 mug/day). Concurrent administration of 6 PTU had no effect on the pattern of pituitary suppression or thyroid hormone concentrations in contrast to its reported effect in hypothyroid subjects.
Triiodothyronine (T3) suppression and thyrotropin-releasing hormone (TRH) tests were used to study thyroid function in 50 patients with thyroid disease. The results of the thyroid function tests were compared with the levels of serum thyroid-stimulating immunoglobulins (TSI) measured by a radio-receptor assay. In euthyroid and hyperthyroid patients, the presence of TSI corresponded with the absence of TSH control of thyroid function. However, in two hypothyroid patients with serum TSI levels readily detectable in the receptor assay, T3 suppression and TRH tests indicated that thyroid function was under TSH control.
Among 76 patients who had had a subtotal thyroidectomy for hyperthyroidism from one to seven years previously recurrent hyperthyroidism was found in three and hypothyroidism in 13. The remaining 60 subjects were clinically euthyroid but a raised level of serum thyroid-stimulating hormone (TSH; greater than 5-0 mu U/ml) was found in 39. Analysis of the data showed that their serum thyroxine was significantly lower than in the subjects with a normal TSH. The serum triiodothyronine (T-3) was similar in both groups. It is concluded that subjects with a raised TSH remain clinically euthyroid by maintaining a normal serum T-3 concentration. There was no evidence of any long-term progressive deterioration of thyroid function after subtotal thyroidectomy.
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