Serum thyroglobulin (Tg) levels were measured during thyroid-hormone suppressive therapy in 291 patients who had been treated for well-differentiated thyroid carcinoma. The findings were compared with those of a subsequent total body scan (TBS) and with Tg levels measured after thyroid-hormone withdrawal. Of the patients with low Tg levels during suppressive therapy, 91.6% were subsequently shown to be free of disease or to have only remnants in the thyroid bed, whereas 8.4% had metastases (false-negative). Of the patients with false-negative findings, 89.3% had nodal metastases; 60.8% of the patients with nodal metastases exhibiting radioiodine uptake and only 23% of those with nonfunctioning nodal metastases had low Tg levels during suppression therapy. After thyroid-hormone withdrawal, all but 1 of the patients with nodal metastases had high Tg levels. All but 2 of the patients with distant metastases had high Tg levels during suppression therapy; 1 of these 2 patients exhibited high Tg levels after T3 withdrawal. No differences between Tg levels in patients with functioning and non-functioning metastases were found. Our study indicates that Tg assays performed during suppressive therapy have a fairly good predictive value and can be used as a general guide in the follow-up of thyroid cancer. However, since most differentiated metastases produce Tg only when stimulated by thyroid-stimulating hormone, measurements of Tg levels after the discontinuation of suppressive therapy would also seem to be necessary.

Adolescent↗

PubMed1986

Sexual activity after coronary bypass surgery.

Although successful rehabilitation of coronary artery bypass surgery (CABS) patients should include consideration of their sexuality, there is a paucity of data regarding their sexual activity (SA). One hundred thirty-four patients were interviewed in regard to the impact of surgery on their sexuality and the relation of SA to their work status. Eighty-four of the 92 previously sexually active patients and two of the inactive ones resumed SA. Sexual dissatisfaction prior to surgery was a negative factor (p less than .05), while return to work, in the group that was working before, was positive (p less than .05) for resumption of SA. The average time before resumption of SA after CABS was 7.8 weeks. Thirty-nine percent of patients decreased the frequency of SA. Seventeen percent of patients and 35 percent of their partners expressed fear of resumption of SA. Twenty-three percent of patients had symptoms during intercourse. The couples who resumed sexual activity had a closer emotional relationship (p less than .02). Two-thirds of the patients received sexual instructions, but in only 20 percent of the cases did the physician himself initiate discussion. Although after CABS patients fare much better in regard to SA when compared to myocardial infarction patients reported in other studies, CABS does not provide a net gain in SA and sexual functioning. Comprehensive sexual counseling is still not being adequately addressed.

Adult↗

PubMed1985