Biomedical subjects
R Hoffenberg
Publications and source records attributed to R Hoffenberg.
Thyrotoxicosis and stress.
There have been many attempts to incriminate stress as a precipitant of both physical and psychiatric illness. An inventory of life events made on 100 patients attending the thyroid clinic of a general hospital for the first time showed a slight excess of stressful events in the histories of the thyrotoxic patients. Their timing in relation to the onset of symptoms did not support a causal relationship.
The Biko case: an appeal.
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Measurement of free thyroxine and free triiodothyronine in thyrotoxicosis and hypothyroidism.
Free T4 and free T3 concentrations in thyrotoxic and hypothyroid patients at presentation differentiated those with thyroid disease from euthyroid control subjects and were closely correlated with T4/TBG ratio. A further group of thyrotoxic patients was followed serially during treatment with carbimazole. Measurements of free T4 and free T3 against closely reflected thyroid status with changes in the hormone measurements being paralleled by changes in T4/TBG ratio.
Measurement of free thyroxine and free triiodothyronine in asymptomatic subjects with high concentrations of serum TSH and a history of radioiodine therapy.
Total and free thyroid hormones were measured in a group of asymptomatic subjects with high circulating TSH concentrations and a previous history of radioiodine therapy. Subjects in the high TSH group all fell within the normal range for measurements of total T4, total T3 and T4/TBG ratio. Concentrations of free T4 or free T3 were below the normal range in more than half (9 out of 17) of the high TSH group suggesting that these measurements are more sensitive indices of thyroid failure than measurement of total hormones or T4/TBG ratio.
Control of thyroglobulin secretion from the rat thyroid gland.
Serum thyroglobulin (Tg), measured by radioimmunoassay, was high in 6-propylthiouracil (PTU)-treated rats but low in thyroxine (T4)-treated animals compared with euthyroid controls. Thyroid-stimulating hormone (TSH) stimulated Tg release in vitro from enzymatically dispersed normal rat thyroid cells in a dose-dependent manner. Thyroid cells prepared from T4-treated animals behaved similarly to cells from control rats, whereas in vitro basal release of Tg from thyroid cells prepared from PTU-treated animals was high and the response to TSH was lost. Our data confirm the TSH dependency of Tg release in vivo and in vitro and our system provides a means of studying the control of Tg secretion in vitro.
Serum free thyroxine concentrations in normal euthyroid subjects and ones with high serum thyroxine binding globulin concentration.
Serum free thyroxine (fT4) was assayed by a commercial fT4 method in 30 normal euthyroid subjects, 19 pregnant females, 13 euthyroid subjects with high thyroxine binding globulin (TBG) and three with low or undetectable serum TBG concentration. In a number of these fT4 was also calculated on the basis of the application of the law of mass action to the binding situation. In states in which TBG was altered for congenital reasons both the experimentally determined and calculated fT4 were not significantly different from their respective means in the normal euthyroid population. Pregnant females had both lower experimental and theoretical free T4 concentrations. It is inferred from these data that TBG concentration per se is without effect on serum fT4 concentration.
The actions of thyroid hormones mediated via the cell nucleus and their clinical significance.
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The transport of thyroid hormones.
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Should one measure serum thyroglobulin in the presence of anti-thyroglobulin antibodies?
Thyroglobulin auto-antibodies (anti-Tg) may affect measurement of serum thyroglobulin (Tg). We have assayed sera for Tg by RIA regardless of presence or absence of anti-Tg, and this study was designed to assess the influence of anti-Tg on the results. Binding of human anti-Tg by the second antibody in our RIA (sheep anti-rabbit immunoglobulin) is very low and sera containing anti-Tg of varying titres do not systematically affect assay of Tg regardless of concentration. In our follow-up study of patients with thyroid cancer, correlation between clinical state and Tg concentration is greater than 97% whether anti-Tg is present or absent. These results indicate that in our assay anti-Tg positive sera do not need to be excluded.
Detection of thyroid tumours using radio-labelled anti-thyroglobulin.
IgG antibody to human thyroglobulin was labelled with 131Iodine (131I) and used to locate deposits of thyroid follicular and papillary tumours with a gamma camera. Of twelve patients studied a total of 40 tumour 'areas' were detected by a variety of clinical and radiological techniques. Sixteen of these were detected using conventional 131I uptake scans whereas 34 were positive on the antibody scans. The difficulty of assessing diffuse pulmonary lesions (3 areas) and the possibility that free 131I from labelled antibody may have contributed to the antibody scan results in six areas left 31 definite areas for scan comparison. Twenty seven (87%) areas were positive on the antibody scan, nine (29%) were positive on conventional 131I scans whilst 24 (77%) areas were detected by a combination of clinical and other radiological criteria. Five areas were positive on the antibody scan alone but there was evidence, albeit indefinite, that these areas contained tumour. Four of the 31 areas were not detected by the antibody scans. The results indicate that anti-thyroglobulin scanning is more sensitive than conventional 131I-iodide scans and may contribute to the staging and management of thyroid cancer.
Free triiodothyronine and free thyroxin in sera of pregnant women and subjects with congenitally increased or decreased thyroxin-binding globulin.
Concentrations of free thyroxin (T4) and free triiodothyronine (T3) were measured in sera from pregnant women, in subjects with congenitally increased or decreased thyroxin-binding globulin (TBG), and in euthyroid controls. Measured free hormone concentrations were compared with calculated values for free hormone derived from concentrations of total T4, total T3, and binding proteins. Measured and calculated concentrations of free T4 and free T3 were below normal in the pregnant subjects but were normal in subjects with congenital increases of TBG. The low concentrations of free hormone in pregnancy are at variance with the euthyroid status of these subjects. Measured free T4 was normal, but concentrations of free T3 were less in the euthyroid congenitally low-TBG group.
Thyroglobulin and thyroid cancer.
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Serum thyroglobulin in normal and hypothyroid neonates.
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Radiation-induced thyroid tumours in man: discussion paper.
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Mediastinal benign cystic teratoma.
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Serum thyroglobulin in thyroid cancer.
Serum thyroglobulin (Tg) was measured in 274 patients with differentiated thyroid cancer; 266 had previous thyroidectomy, which had been followed by ablative iodine-131 in 183 cases. Neither the presence nor the titre of anti-Tg antibodies appeared to affect Tg assays. Serum Tg reflected the presence or absence of cancer in 83% of 164 patients not receiving thyroxine (T4). This concordance improved to 97.5% in 158 patients tested while receiving T4. 34 patients in remission were tested both on and off T4 therapy; in all these patients the Tg level when receiving T4 was less than 5 micrograms/l. In 19 of 21 patients with cancer T4 treatment did not suppress Tg. Serum Tg thus provides an excellent marker for the presence or absence of thyroid cancer in patients taking T4, even if anti-Tg antibodies are present. It is proposed that monitoring of patients by assay of serum Tg should supplant routine assessment by radioactive-iodine scans of the neck or whole body.
Long-term evaluation of thyroidal response to partial calorie restriction in obesity.
Twenty obese patients were treated as out-patients with a 3.35 MJ (800 Kcal) per day diet, and, by the double-blind method, ten of the patients were prescribed 40 micrograms of triiodothyronine (T3) daily and the other ten placebo. Body weight and serum thyroxine (T4), T3 and reverse T3 (rT3) concentrations were measured before treatment, then monthly over 6 months. No significant difference in mean weight loss was found between the patients receiving T3 and those on placebo. Serum T3 concentration decreased slightly in patients on placebo and increased in those on T3 but these changes were not statistically significant. However, patients on T3 maintained a significantly higher concentration of T3 in serum than those on placebo. Mean serum T4 and rT3 concentrations remained essentially unchanged in the patients on placebo, whereas both decreased significantly in patients receiving T3. We conclude that changes in serum T3 during dietary treatment of obesity are of minor significance in limiting the expected weight loss in the patients.