[Early detection of congenital hypothyroidism with mass screening method].
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Biomedical subjects
Publications and source records attributed to K Enomoto.
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Activities and isozyme patterns of acid phosphatase and esterase were studied in rat liver at different intervals after partial hepatectomy to clarify the grade of immaturity of normal regenerating liver cells as a control for the unlimited proliferation of hepatoma cells. Acid phosphatase and esterase activities in the liver were elevated during a 12-hr period after hepatectomy, while their isozyme patterns did not change from those of immature liver. Similar findings were also observed in the liver of sham-operated rats. Eighteen hours after the operation, at the S phase before cell division, the isozyme pattern of these enzymes began to shift from an adult liver-type to an immature one resembling those of the infant liver 3 weeks after birth rather than those of newborn or fetal liver. Two or three days after partial hepatectomy, the isozymes characteristic of an immature liver type were more apparent. Although enzyme activities mostly returned to the normal adult level one week after the operation, the isozyme patterns did not completely return to those of an adult liver. These results indicate that despite the rapid proliferation of liver cells, the grade of cell differentiation of the regenerating liver after partial hepatectomy is much nearer to that of the normal adult liver rather than that of the fetal liver.
Blood TSH (Thyroid Stimulating Hormone) was successfully measured by radioimmunoassay in a dried blood spot on filter paper which is obtained in newborn screening for metabolic disorders. By this method, the minimal detectable level of blood TSH was about 10 muU/ml, which is the approximate upper limit of normal values of blood TSH. Good correlation was found between the TSH values obtained from this specimen and from liquid serum samples from the same subjects. The duplication of assay of a single sample was not necessary. A screening program using the method described here was initiated and a 4 year old infant was found to have primary hypothyroidism, later verified by other testing methods. Since the technique is simple and adequately sensitive for the detection of hypothyroidism, it could be a valuable method for use in mass-screening of newborns for congenital hypothyroidism.
We present a successful clinical case (perhaps the first) of primary reconstruction of the breast after radical mastectomy by use of a free skin-fat-muscle flap.
Blood T.S.H. (thyroid-stimulating hormone) was measured by radioimmunoassay in dried blood spotted onto filter-paper and obtained during screening of the newborn for metabolic disorders. By this method, the detection limit for blood T.S.H. was 5--10 muU/ml, which is the approximate upper limit of normal for blood T.S.H. T.S.H. values obtained on dried blood correlated well with those obtained on serum from the same subjects. Duplication of the assay in a single sample is not necessary. This method picked up a case of primary hypothyroidism in a four-year-old girl with symptoms. Since the technique is simple and sensitive enough for the detection of hypothyroidism, it could be valuable in mass-screening for congenital hypothyroidism.
A study was performed to observe serum TSH response following TRH injection (TRH test) in 79 cases of Graves' disease (male 23, female 56, aged 16-70 years old), before and during treatment by antithyroid drug, in a total of 244 occasions. Treatment was mostly the daily administration of methyl-mercaptoimidazole (MMI), and in one case of propylthiouracil (PTU). TRH test was conducted by i.v. administration of 500 mug synthetic TRH, and subsequent 6 blood drawing until 2 hours. Serum TSH was measured by radioimmunoassay in each serum, and serum T4, T3, RT3U and cholestrol were measured in the serum before TRH injection. In some cases, the results of TRH test were compared with those of T3 131I thyroidal uptake suppression test, using the 131I uptake values at 20 min. and 24 hours. Results were obtained as follows: 1) Some cases showed positive TRH test at the early stage of treatment when the patients were in eumetabolic states, while many patients showed no TSH response in spite of their long maintenance at eumetabolic states. 2) When both serum T4 and T3 were high, all cases showed no response of TSH. When serum T4 alone was high, all cases except one case showed no response;whereas when serum T3 alone was high, 5 cases showed normal response. When both serum T4 and T3 were below normal, 2 cases showed no response. When serum T4 was low, all cases showed response; whereas when serum T3 alone was low, 6 cases showed no response. Thus, there was no positive correlation between TSH reactivity and serum concentrations of thyroid hormones. 3) No correlation was observed between TSH reactivity and the period after the onset of hyperthyroidism. 4) In 57 cases of Graves' disease, who were under treatment and in eumetabolic states, a comparison was made between TSH reactivity and the results of T3 suppression test. In T3 suppressed group, 19 showed response, and 3 showed no response; whereas in T3 non-suppressed group, 18 showed response and 17 showed no response. In the group of T3 non-suppression as well as in the group of T3 non-suppression plus TRH no response, there was a significant elevation of serum T3 compared with the control group. 5) TRH test does not appear to be an appropriate test as a predictive method to know the permanent remission of Graves' disease.
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