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Biomedical subjects

F D Rosenthal

Publications and source records attributed to F D Rosenthal.

17 recordsLinked to original sources
PubMed1991

Changes in circulating thyroid hormone levels and systolic time intervals in acute hypothyroidism.

OBJECTIVE: We have previously reported that, in thyrotoxic patients treated with carbimazole, serum T4 and T3 levels are the first parameters to return to normal, followed by the systolic time interval (STI, a marker of thyroid function at tissue level) and then the serum TSH. The aim of this study was to compare the rate of change of thyroid hormones, TSH and STI in treated hypothyroid patients after the sudden withdrawal of thyroxine. DESIGN AND PATIENTS: Serum T4, T3 (free and total) and TSH were measured in 12 patients taking thyroxine for primary hypothyroidism; seven were biochemically euthyroid and five were over-replaced, as defined by an elevated free T4 and a sub-normal TSH. Thyroxine was withdrawn and the measurements repeated three times a week until the STI rose above the euthyroid range (0.26-0.32). RESULTS: After stopping thyroxine, the serum TSH and STI left the normal range, in advance of the free T4 and T3, after 9.5 +/- 0.95 and 12.2 +/- 1.5 days respectively (mean +/- SEM). The TSH was the first parameter to leave the euthyroid range in all subjects except one in whom the serum TSH was fully suppressed (less than 0.05 mU/l) initially. In the euthyroid group the TSH and STI increased rapidly after stopping thyroxine (time to leave euthyroid range 7.4 +/- 0.8 and 9.4 +/- 0.7 days respectively). In contrast, in the over-replaced group serum TSH and STI became elevated after 12.4 +/- 1.0 days (P less than 0.005 vs euthyroid group) and 16.0 +/- 2.7 days (P less than 0.05 vs euthyroid group) respectively. There was no delay in the fall in serum T4 or T3 in the over-replaced group when compared with the euthyroid group. CONCLUSIONS: In the evolution of primary hypothyroidism, markers of thyroid function at a tissue level (TSH and STI) become abnormal in advance of thyroid hormones. After stopping thyroxine therapy in treated hypothyroid patients, there is a delayed rise in STI and serum TSH levels in subjects with a subnormal TSH level, as compared with those with a normal TSH on treatment. This suggests mild tissue thyrotoxicosis in these individuals.

Acute Disease↗
PubMed1989

Low serum TSH with normal total thyroid hormone levels: an indicator of free T4 excess.

We have studied 18 patients with low serum thyrotrophin (TSH) levels accompanied by normal thyroxine (T4) and triiodothyronine (T3) levels in order to clarify whether or not they are thyrotoxic. Serum T4, T3, free T3, free T4 and TSH were estimated three times weekly for 3-4 weeks. Thyroxine binding globulin (TBG) levels were estimated on one occasion only. Thyroid hormone data were expressed as the cumulative probability of having at least one result above the relevant normal range by the nth sample (Pn). For free T4 this probability was 61% by the 10th sample. Free T4 values were confined to the upper half of the normal range or above throughout the study. In contrast, free T3 values were distributed evenly within the normal range (P10 = 12%). For total T4 and total T3, P10 was 34 and 11% respectively. Thus, subjects with subnormal TSH levels but normal T4 and T3 levels have been shown to have elevated serum free T4 levels, an indicator of biochemical hyperthyroidism.

Adult↗
PubMed1988

Higher than conventional doses of carbimazole in the treatment of thyrotoxicosis.

In order to ascertain whether higher than conventional doses of carbimazole achieve more rapid control of thyrotoxicosis, 30 thyrotoxic patients were alternately allocated into two groups, group 1 (15 subjects) receiving a conventional starting dose of 45 mg orally daily and group 2 (15 subjects) a dose of 100 mg orally. In addition to weekly estimations of serum T4, T3, free T4, free T3 and TSH, the systolic time intervals ratio (STI), a measure of left ventricular contractility, was calculated as an accurate measure of peripheral thyroid hormone activity, the study end-point being a normal STI (0.26-0.32). None of the individuals studied experienced side-effects during the study period. Mean pre-treatment STI values for the two treatment groups were the same at entry (0.20). The mean recovery times for STI was 4.4 weeks (SE 0.3) in the high dose group and 5.9 weeks (SE 0.4) in the low dose group (P = 0.0037). There was a definite trend towards a shorter recovery time for free T3 in the higher dose group (P = 0.057) but no apparent differences for T4, T3 and free T4. Higher than conventional doses of carbimazole may be advisable in the initial treatment of severe thyrotoxicosis.

Administration, Oral↗
PubMed1987

Long-term suppression of a testosterone-producing ovarian tumour by oestrogen/progestogen therapy.

A 44-year-old lady presenting with hirsutism was found to have a testosterone-secreting Leydig cell tumour of the right ovary. Serum testosterone levels were adequately suppressed for 8 years by combined oestrogen/progestogen preparation (Microgynon 30, Schering, West Sussex). The fall in gonadotrophin and testosterone levels during therapy and their rise after stopping therapy suggests that the tumour was gonadotrophin dependent.

Adult↗
PubMed1986

Acute sulphasalazine hepatotoxicity.

We describe a case of severe sulphasalazine hepatotoxicity. The features described are those of an acute hypersensitivity reaction which responded to drug withdrawal alone as steroids were withheld. Supportive treatment only is recommended for this potentially fatal condition.

Adult↗
PubMed1979

Bone lesions in systemic acne (acne fulminans).

An 18-year-old West Indian male presented with severe sternal pain and an exacerbation of facial acne. Radiographs of the sternum revealed several lytic lesions which appeared as hot areas on successive technetium bone scans. Painful areas over the right iliac crest and left greater trochanter likewise appeared as transient hot areas on successive scans. Histology of affected bone revealed reactive changes only. High dose prednisolone provided rapid alleviation of pain, which recurred on reducing the dose to less than 10 mg daily. Auto-immune complex disease has been considered the most likely aetiological mechanism of systemic acne (acne fulminans), but lytic lesions of bone have never previously been reported in auto-immune disorders.

Acne Vulgaris↗
PubMed1979

Gilbert's syndrome: evidence of morphological heterogeneity.

Hepatic ultrastructure was examined by electron microscopy in 25 patients with Gilbert's syndrome and the changes in the smooth endoplasmic reticulum quantified by grid technique. Thirteen patients showed gross hypertrophy of the smooth endoplasmic reticulum (SER). These were designated Gilbert's EM Positive. The remaining 12, designated Gilbert's EM Negative, did not differ significantly from normal controls. The EM Positive group showed a significantly greater percentage response to caloric restriction (P less than 0.01) and an exaggerated response to nicotinic acid stimulation when compared with the EM Negative group and normal controls. These results suggest that SER hypertrophy is not, as previously suggested, a constant feature of Gilbert's syndrome but rather a characteristic of a distinct subpopulation.

Adolescent↗
PubMed1978

Felty's syndrome.

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Felty Syndrome↗
PubMed1978

The association of HLA-B8 with visceral disease in systemic sclerosis.

Seventy-one patients with systemic sclerosis (SS) were typed for twenty-seven HLA alleles of the A and B loci, and the findings were related to both the extent of visceral disease and tests of cellular immune competence in a subgroup of fifty-two of these patients. Nineteen pa;ients with widespread visceral involvement and more rapidly progressive disease had an increased frequency of HLA-B8 (relative risk = 4.14; P less than 0.05) when compared to thirty-three less severely affected patients and 3000 controls. Patients with severe and progressive disease also had defective cell-mediated immunity with reductions in both the numbers of circulating thymus-dependent (T) lymphocytes and in the lymphocyte transformation response to phytohaemagglutinin. These findings suggest that a genetic factor, such as an abnormal immune response gene, may be involved in the progression of the disease.

Adult↗
PubMed1977

Secondary pituitary hyperplasia in Addison's disease.

In patients with Addison's disease, whether treated or untreated for the previous 24 hours, hydrocortisone produced only a partial suppression of their elevated adrenocorticotrophic-hormone (A.C.T.H.) levels. This is comparable to untreated myxoedema, in which administration of triiodothyronine fails to inhibit secretion of thyrotrophin (T.S.H.). In myxoedema, however, continued treatment produces normal T.S.H. levels. Inadequate A.C.T.H. suppressibility in patients with Addison's disease while on treatment may be due to the maintenance of a secondary pituitary hyperplasia by inadequate replacement therapy. This may be clinically important, especially in the genesis of Nelson's syndrome.

Addison Disease↗
PubMed1976

Thyrotoxic vomiting.

In seven patients vomiting played an important part in the presentation of thyrotoxicosis. Vomiting does not always indicate severe thyroid disease, and the diagnosis in patients presenting with this symptom may be long delayed.

Adult↗