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Biomedical subjects

D S Cooper

Publications and source records attributed to D S Cooper.

At least 37 records · Page 2Linked to original sources
PubMed1997

Comparison of administration of recombinant human thyrotropin with withdrawal of thyroid hormone for radioactive iodine scanning in patients with thyroid carcinoma.

BACKGROUND: To detect recurrent disease in patients who have had differentiated thyroid cancer, periodic withdrawal of thyroid hormone therapy may be required to raise serum thyrotropin concentrations to stimulate thyroid tissue so that radioiodine (iodine-131) scanning can be performed. However, withdrawal of thyroid hormone therapy causes hypothyroidism. Administration of recombinant human thyrotropin stimulates thyroid tissue without requiring the discontinuation of thyroid hormone therapy. METHODS: One hundred twenty-seven patients with thyroid cancer underwent whole-body radioiodine scanning by two techniques: first after receiving two doses of thyrotropin while thyroid hormone therapy was continued, and second after the withdrawal of thyroid hormone therapy. The scans were evaluated by reviewers unaware of the conditions of scanning. The serum thyroglobulin concentrations and the prevalence of symptoms of hypothyroidism and mood disorders were also determined. RESULTS: Sixty-two of the 127 patients had positive whole-body radioiodine scans by one or both techniques. The scans obtained after stimulation with thyrotropin were equivalent to the scans obtained after withdrawal of thyroid hormone in 41 of these patients (66 percent), superior in 3 (5 percent), and inferior in 18 (29 percent). When the 65 patients with concordant negative scans were included, the two scans were equivalent in 106 patients (83 percent). Eight patients (13 percent of those with at least one positive scan) were treated with radioiodine on the basis of superior scans done after withdrawal of thyroid hormone. Serum thyroglobulin concentrations increased in 15 of 35 tested patients: 14 after withdrawal of thyroid hormone and 13 after administration of thyrotropin. Patients had more symptoms of hypothyroidism (P<0.001) and dysphoric mood states (P<0.001) after withdrawal of thyroid hormone than after administration of thyrotropin. CONCLUSIONS: Thyrotropin stimulates radioiodine uptake for scanning in patients with thyroid cancer, but the sensitivity of scanning after the administration of thyrotropin is less than that after the withdrawal of thyroid hormone. Thyrotropin scanning is associated with fewer symptoms and dysphoric mood states.

Adult↗
PubMed1996

Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association.

A set of minimum clinical guidelines for use by primary care physicians in the evaluation and management of patients with thyroid nodules or thyroid cancer was developed by consensus by an 11-member Standards of Care Committee (the authors of the article) of the American Thyroid Association, New York, NY. The participants were selected by the committee chairman and by the president of the American Thyroid Association based on their clinical experience. The committee members represented different geographic areas within the United States, to reflect different practice patterns. The guidelines were developed based on the expert opinion of the committee participants, as well as on previously published information. Each committee participant was initially assigned to write a section of the document and to submit it to the committee chairman, who revised and assembled the sections into a complete draft document, which was then circulated among all committee members for further revision. Several of the committee members further revised and refined the document, which was then submitted to the entire membership of the American Thyroid Association for written comments and suggestions, many of which were incorporated into a final draft document, which was reviewed and approved by the Executive Council of the American Thyroid Association.

Adenocarcinoma, Follicular↗
PubMed1996

Hyperthyroidism caused by an ectopic TSH-secreting pituitary tumor.

A woman developed what appeared to be typical Graves' disease in 1965 at the age of 45 years. After 9 years of antithyroid drug therapy, she was treated with radioiodine. Ten years later (1985) she developed postablative hypothyroidism. Despite replacement doses of thyroxine that resulted in thyroid hormone levels that were in the hyperthyroid range, TSH levels remained elevated. Initial biochemical studies, including a high alpha-subunit to TSH ratio, suggested a pituitary TSH-secreting tumor, but a CT scan of the sella turcica was normal. In 1994, while undergoing an otolaryngologic examination, the patient was found to have a nasopharyngeal mass lesion, which was ultimately shown histologically and immunohistochemically to be an ectopic pituitary tumor. Resection of the mass restored TSH and alpha-subunit levels to normal. This patient probably represents the first ectopic TSH-secreting pituitary tumor to be reported.

Adenoma, Pleomorphic↗
PubMed1995

Treatment guidelines for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association.

OBJECTIVE: To develop a set of minimum clinical guidelines for use by primary care physicians in the evaluation and management of patients with hyperthyroidism and hypothyroidism. PARTICIPANTS: Guidelines were developed by a nine-member ad hoc Standards of Care Committee of the American Thyroid Association (the authors of this article). The participants were selected by the committee chair and the president of the American Thyroid Association on the basis of their clinical experience. The committee members represented different geographic areas within the United States, in order to take into account different practice styles. EVIDENCE: Guidelines were developed on the basis of expert opinion of the participants, as well as on available published information. CONSENSUS PROCESS: Input was obtained from all of the participants, each of whom wrote an initial section of the document. A complete draft document was then written by three participants (P.A.S., D.S.C., and E.G.L.) and resubmitted to the entire committee for revision. The revised document was then submitted to the entire membership of the American Thyroid Association for written comments, which were then reviewed (mainly by P.A.S., D.S.C., and E.G.L.). Many of the suggestions of the American Thyroid Association members were incorporated into the final draft, which was then approved by the Executive Council of the American Thyroid Association. The entire process, from initial drafts to final approval, took approximately 18 months. CONCLUSIONS: A set of minimum clinical guidelines for the diagnosis and treatment of hyperthyroidism and hypothyroidism were developed by consensus of a group of experienced thyroidologists. The guidelines are intended to be used by physicians in their care of patients with thyroid disorders, with the expectation that more effective care can be provided, and at a cost savings.

Antithyroid Agents↗
PubMed1994

Dynamic properties of the posterior cricoarytenoid muscle.

The aim of this research was to investigate the contractile properties of the posterior cricoarytenoid (PCA) muscle. Simultaneous measurements were made of the isometric force, temperature, and electromyographic activity of the dorsal cricoarytenoid muscle of anesthetized dogs during supramaximal stimulation of the recurrent laryngeal nerve for twitch and tetanic contraction. The conduction delay between stimulation of the recurrent nerve at the level of the larynx and the onset of the muscle action potential averaged 2.0 +/- 0.2 milliseconds (ms), and the latent period between the onset of electrical activity of the muscle and the onset of contraction had a mean duration of 3.3 +/- 0.8 ms. The mean of isometric contraction times found was 33.3 +/- 2.0 ms, shorter than most previous studies of canine PCA muscle. Tetanic frequency defined as smooth contraction was higher than previous estimates. Considerations of scaling of physiological time based on animal mass were applied to analysis of the experimental findings to make possible systematic comparison of previous findings across species and animal size.

Animals↗
PubMed1993

Thyroarytenoid intramuscular pressures.

The aim of this research has been to investigate the measurement of laryngeal intramuscular fluid pressures as a technique for assessment of laryngeal muscle activity for diagnostic or experimental purposes. Simultaneous measurements of contractile force, intramuscular fluid pressure, and electromyographic signals were made under isometric conditions in the vocal fold muscles of anesthetized dogs during supramaximal stimulation of the recurrent laryngeal nerve. Covariation of force and pressure was studied in twitch and tetanic contractions, over a range of stimulation frequencies. Tetanic pressure rises were usually smaller than in human limb muscles, but were of sufficient magnitude that effects on blood flow and muscle metabolism are probable. Analysis of relations between pressure and force records demonstrated that intramuscular pressure variations correlated closely to isometric force in their time course. This finding suggests the potential significance of this measure as a relatively nonintrusive indicator of the level of force of muscles involved in laryngeal function, and as a physiological measure of importance.

Animals↗
PubMed1993

The thyroid status of the Yanomamö Indians of southern Venezuela: 1992 update.

Previous reports described an apparent paradox in the clinical expression of endemic iodine deficiency in Amazonian Indians, who were severely iodine deficient but had no goiter and were clinically euthyroid. To confirm and explain this unique observation, we estimated the iodine intake and evaluated the functional and structural thyroid status of an isolated population of Yanomamö Indians (n = 104) in southern Venezuela. Twenty-six children, 32 adolescents, and 46 adults were studied with serum thyroid function tests, spot urinary iodide concentration determinations, and sonographic measurement of thyroid gland volume. A subset of adolescents and adults (n = 35) had 24-h fractional thyroidal 131I uptake determinations. No individual with goiter, clinical hypothyroidism, or cretinism was observed. Children had higher mean serum T4 (114.5 vs. 102.9 nmol/L; P < 0.02) and serum T3 (2.96 vs. 2.46 nmol/L; P < 0.02) concentrations than adults, with 2% and 50%, respectively, of children having levels more than 2 SD above the mean for a North American reference population. Serum TSH concentrations were also higher in children than adults (3.3 vs. 2.3 mU/L; P < 0.02), with 25% of the subjects above the reference range. Mean urinary iodide was 61 +/- 29 micrograms/L (range, 10-178 micrograms/L), reflecting borderline iodine sufficiency. Thyroidal 131I uptake values were 28 +/- 7%, with 33% above the upper limit of normal (30%). Compared to an iodine-replete Swedish population, the thyroid gland volume was above normal (> mean + 2 SD) in 71% of the study children. We conclude that the Yanomamö have borderline iodine deficiency, associated in children with predictably higher serum T3 and TSH concentrations and a high prevalence of small goiters. The basis for the apparent change in their dietary iodide intake over the past 30 yr is unclear, as is the explanation for their previously postulated resistance to goitrogenesis with more profound iodine deficiency.

Adolescent↗
PubMed1992

Autoimmune thyroid disease, left-handedness, and developmental dyslexia.

Autoimmune thyroid disease (ATD) (Graves' disease and Hashimoto's thyroiditis) has been one of a number of autoimmune diseases possibly associated with left-handedness, mixed dominance, and learning disability. In the present study, 74 men with ATD were compared to 24 control men with non-ATD. An increased frequency of mixed dominance and traits suggestive of dyslexia were observed in the patients with ATD. These data are consistent with a link between the development of ATD and cerebral dominance.

Adult↗