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Biomedical subjects

S I Sherman

Publications and source records attributed to S I Sherman.

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

Augmented hepatic and skeletal thyromimetic effects of tiratricol in comparison with levothyroxine.

A thyroid hormone analog with organ-selective effects could have therapeutic application for disorders such as hyperlipidemia and osteoporosis. We performed a randomized clinical trial to determine the specific thyromimetic effects of tiratricol. Twenty-four athyreotic patients underwent detailed metabolic and physiological evaluation after a 2-month baseline period, taking TSH-suppressive doses of L-T4. They were then randomized to blinded treatment with either tiratricol (24 micrograms/kg twice daily) or L-T4 (1.9 micrograms/kg daily). The dose of hormone was increased until the TSH level was less than 0.1 mU/L, and the metabolic and physiological testing was repeated. Comparing the change from baseline to the study drug periods, when serum TSH levels were equivalently suppressed, there were no significant differences between the two groups in resting metabolic rate, weight, urea nitrogen excretion, or symptom score. Plasma total and low density lipoprotein cholesterol levels declined 13 +/- 4% and 23 +/- 6% in the tiratricol group compared with 2 +/- 2% and 5 +/- 3% in the L-T4 group (P = 0.015 and P = 0.0066, respectively). Serum sex hormone-binding globulin levels increased 55 +/- 13% with tiratricol compared with a 1.7 +/- 4% decline with L-T4 (P = 0.0006), indicating an augmented hepatic response to tiratricol. Skeletal metabolic activity was enhanced, with increased levels of serum osteocalcin and urinary excretion of calcium and pyridinium cross-links. Tiratricol and L-T4 had comparable effects on cardiovascular function. Tiratricol has distinct augmented hepatic and skeletal thyromimetic actions of potential therapeutic value.

Adult↗
PubMed1996

Clinical and socioeconomic predispositions to complicated thyrotoxicosis: a predictable and preventable syndrome?

PURPOSE: To identify the clinical, demographic, and hormonal features that characterize and place patients at greater risk for complicated thyrotoxicosis. PATIENTS AND METHODS: Fifty-nine patients with documented thyrotoxicosis complicated by cardiovascular, neuropsychiatric, gastrointestinal, or thermoregulatory dysfunction, were retrospectively identified among 498,000 hospital admissions between 1979 and 1992. Clinical, demographic, and hormonal information were obtained from these charts, as well as from the charts of 118 randomly selected thyrotoxic outpatients. RESULTS: Age distribution of complicated thyrotoxicosis patients was bimodal, with a median of 41 years. Forty-nine percent of patients had been previously diagnosed with thyrotoxicosis, but most had been noncompliant with prescribed medication. Cardiovascular complications were among the primary causes for admission in 46% of patients, followed by neuropsychiatric indications in 42%, fever in 34%, and gastrointestinal dysfunction in 17%. Only 8% had primary involvement of > 2 organ systems. There was high correlation between organ systems with pre-existing dysfunction and those with a complication of thyrotoxicosis (P < 0.0001). Compared to uncomplicated controls, patients with complicated thyrotoxicosis were more likely to be uninsured or covered by Medicaid (OR, 2.64; 95% CI 1.78 to 3.91); to be < 30 or > 50 years old (OR, 1.93; 95% CI 1.23 to 3.03); and to have serum T4 concentrations greater than twice the upper limit of normal (OR, 1.67; 95% CI, 1.15 to 2.44). CONCLUSIONS: Certain thyrotoxic patients are at greater risk for developing complications. By addressing the medical needs of these patients, it may be possible to reduce the likelihood of complications requiring hospitalization.

Adult↗
PubMed1994

Follicular variant of papillary thyroid carcinoma. A clinicopathologic study.

BACKGROUND: A retrospective clinicopathologic study was performed to identify the influence of diagnostic and therapeutic procedures on the outcomes of patients with the follicular variant of papillary thyroid carcinoma (FVPTC). METHODS: The results of 37 patients with FVPTC were compared with those of 37 randomly selected patients with papillary carcinoma and 22 patients with follicular carcinoma. Diagnostic, therapeutic, and follow-up data were obtained by review of clinical and histologic materials. RESULTS: Median follow-up was approximately 3 years in all groups. Fine-needle aspiration had a sensitivity of 75% for FVPTC, which was similar to that for papillary carcinoma. Frozen section evaluation had a sensitivity of only 27% for FVPTC but 94% for papillary carcinoma and 44% for follicular carcinoma. All patients for whom the fine-needle aspiration specimen contained cytologic features of papillary carcinoma and frozen section suggested a follicular lesion proved to have FVPTC: Consequently, hemithyroidectomy was performed three times more often among patients with FVPTC than among those with papillary carcinoma. FVPTC tumors were modestly, but significantly, smaller than papillary carcinoma tumors (1.2 versus 1.6 cm). Metastases to cervical lymph nodes occurred least often in patients with FVPTC and usually were detected within 3 months of diagnosis. The frequency of distant metastases within this limited period of follow-up did not differ between FVPTC and papillary carcinoma. CONCLUSIONS: Fine-needle aspiration appears to be superior to frozen section for identification of FVPTC, although the number of aspirations performed was limited. Greater use of aspiration may permit more appropriate surgical management of this disease. Local and distant metastases of FVPTC do not occur more often than do those of papillary carcinoma.

Adenocarcinoma, Follicular↗
PubMed1994

Sucralfate causes malabsorption of L-thyroxine.

PURPOSE: To determine if sucralfate causes malabsorption of L-thyroxine. PATIENTS AND METHODS: Five healthy volunteers ingested L-thyroxine, 1,000 micrograms, administered orally (1) without sucralfate, (2) with sucralfate, 1 g, and (3) 8 hours after sucralfate, 2 g. The amount of L-thyroxine absorbed was calculated from the peak increase in serum T4 levels within 6 hours of hormone ingestion multiplied by the volume of distribution for the hormone. RESULTS: Peak absorption of L-thyroxine in the absence of sucralfate was 796 micrograms (95% confidence interval (CI): 515-1,074 micrograms). Coadministration of sucralfate, 1 g, with L-thyroxine reduced thyroid hormone absorption to 225 micrograms (95% CI: 151-299 micrograms) (P = 0.0029 compared with control). Peak hormone absorption was delayed 2 hours by simultaneous sucralfate ingestion. Separation of administered L-thyroxine and sucralfate doses by 8 hours returned hormone absorption to control values. Maximum T3 levels did not differ, regardless of drug regimen, but suppression of thyroid-stimulating hormone (TSH) by L-thyroxine was reduced by coadministration of sucralfate. CONCLUSIONS: Sucralfate causes malabsorption of L-thyroxine, presumably by intraluminal binding of hormone.

Adult↗
PubMed1994

Clinical utility of posttreatment radioiodine scans in the management of patients with thyroid carcinoma.

A retrospective comparison was performed of whole body scans obtained before and after 143 131I treatments in 93 patients with thyroid carcinoma. Pretreatment scans were performed with 74-185 megabecquerel 131I, and posttreatment scans were performed 5-12 days after dosing with 1.1-7.4 GBq. In 38 (27%) treatment cycles, the results of posttreatment and pretreatment scans differed. Only 14 (10%) posttreatment scans detected new locations of metastatic disease. Seventeen posttreatment scans demonstrated metastatic locations that were already known from previous studies but not seen on the pretreatment scan. Among parameters evaluated (including demographic and histological characteristics), only the combination of age at diagnosis less than 45 yr and history of previous 131I therapy contributed to the likelihood of a new finding on posttreatment scan (relative risk, 3.8). Five of the 14 new posttreatment scan findings were subsequently corroborated by other radiographic studies or thyroglobulin elevations, all in patients with extrathyroidal extension of the primary tumor. Seven (5%) posttreatment scans were unable to detect a focus of uptake seen on the corresponding pretreatment scan. In conclusion, posttreatment scans were most likely to reveal clinically important new information in young patients who had previously received 131I therapy. In older patients and those without previous 131I therapy, posttreatment scans rarely yielded new information that would potentially alter the patient's prognosis.

Adult↗
PubMed1992

Reversible alterations in myocardial gene expression in a young man with dilated cardiomyopathy and hypothyroidism.

Thyroid hormone effects on myocardial gene expression have been well defined in animal models, but their relationship to the pathogenesis of cardiac dysfunction in hypothyroid humans has been uncertain. We evaluated a profoundly hypothyroid young man with dilated cardiomyopathy. Before and during 9 months of thyroxine therapy, serial assessment of myocardial performance documented substantial improvements in the left ventricular ejection fraction (16-37%), left ventricular end-diastolic diameter (7.8-5.9 cm), and cardiac index (1.4-2.7 liters.min-1.m-2). Steady-state levels of mRNAs encoding selected cardiac proteins were measured in biopsy samples obtained before and after thyroxine replacement. In comparison with myocardium from nonfailing control hearts, this patient's pretreatment alpha-myosin heavy-chain mRNA level was substantially lower, the atrial natriuretic factor mRNA level was markedly elevated, and the phospholamban mRNA level was decreased. All of these derangements were reversed 9 months after restoration of euthyroidism. These observations in an unusual patient with profound myxedema and cardiac dilatation permit correlation between the reversible changes in myocardial function and steady-state mRNA levels in a cardiomyopathy. They suggest that alterations in gene expression in the dilated myopathic heart may be correctable when a treatable cause is identified.

Actins↗
PubMed1992

Octreotide therapy of growth hormone excess in the McCune-Albright syndrome.

We report a patient with the McCune-Albright syndrome and growth hormone excess. Biochemical evaluation demonstrated characteristic changes typical of acromegaly, and an unusual pattern of delayed somatotropin response to hGHRH40, not previously described in this syndrome. Therapeutic trial of low-dose octreotide successfully reversed his growth hormone excess, whereas bromocriptine failed to reduce growth hormone levels. Previous reports of acromegaly and McCune-Albright syndrome are reviewed, and the unique features of this case discussed.

Bromocriptine↗
PubMed1992

Organ-specific effects of tiratricol: a thyroid hormone analog with hepatic, not pituitary, superagonist effects.

Tiratricol has been used to suppress pituitary TSH secretion, with reported attenuation of extrapituitary thyromimetic effects. A randomized, double-blind trial was performed to define precisely the tissue-specific thyromimetic actions of tiratricol. Ten athyreotic patients, treated for thyroid carcinoma, were randomly assigned to receive L-T4 sodium 0.7 micrograms/kg daily and either tiratricol 10 micrograms/kg or placebo twice daily. The daily dose of L-T4 was increased by 25-50 micrograms increments until the TRH-stimulated TSH level was less than 0.1 mU/L. After measurement of biochemical and physiological parameters of thyroid hormone actions, patients crossed treatment groups. Patients required 46% less L-T4 to achieve equivalent TSH suppression when taking tiratricol. Hepatic effects were enhanced by tiratricol administration, with significant increases in sex hormone binding globulin and ferritin concentrations, 14% and 37%, respectively. Levels of serum cholesterol, LDL cholesterol, and apolipoprotein B were reduced by 7%, 10%, and 13%, respectively, during tiratricol therapy. Triglyceride levels also declined, but there were no changes of high density lipoprotein cholesterol or apolipoproteins AI and AII. Resting metabolic rate, body weight, urea nitrogen excretion, and symptoms did not differ between the two treatment regimens. Cardiovascular function, as reflected by mean arterial pressure and pulse wave arrival time, was not different during tiratricol therapy. Skeletal metabolic activity was affected by tiratricol, with marked elevation of osteocalcin without significant change in serum calcium, PTH, and urinary calcium and hydroxyproline excretion. Tiratricol has increased hepatic and skeletal actions of potential therapeutic value, but does not have enhanced thyromimetic activity specific to the pituitary gland.

Adult↗
PubMed1991

Percutaneous transluminal coronary angioplasty in hypothyroidism.

PURPOSE: To determine the risks of percutaneous transluminal coronary angioplasty (PTCA) in hypothyroid individuals. PATIENTS AND METHODS: In a retrospective cohort study, 13 patients with primary hypothyroidism were identified among 382 consecutive PTCA cases in 1987. Twenty-two euthyroid PTCA control subjects and 13 hypothyroid patients who underwent coronary artery bypass surgery (CAB) were identified for comparison. RESULTS: Hypothyroid and euthyroid PTCA patients had similar mean ages, numbers of prior and recent acute myocardial infarctions, diseased coronary arteries, coronary arteries dilated, and serum cholesterol levels. There were no significant differences in procedure-related mortality (0% versus 0%); coronary artery dissection (23% versus 23%); reocclusion (8% versus 5%); bradycardia (0% versus 0%); heart failure (0% versus 5%); hypotension (31% versus 27%); myocardial infarction (8% versus 0%); gastrointestinal dysfunction (0% versus 0%); neuropsychiatric disturbance (15% versus 9%); hyponatremia (23% versus 23%); hypothermia (0% versus 0%); or fever (15% versus 5%). Hematoma formation tended to be more frequent in the hypothyroid group (38% versus 18%, p = 0.18). Similar results were obtained when the subgroup of more severely hypothyroid patients (thyrotropin level more than 20 mU/L, n = 7) was examined. Compared to hypothyroid CAB patients, hypothyroid PTCA patients had less incidence of heart failure (0% versus 31%, p less than 0.025); neuropsychiatric disturbance (15% versus 54%, p less than 0.025); hyponatremia (23% versus 62%, p less than 0.05); gastrointestinal dysfunction (0% versus 23%, p less than 0.025); and fever (15% versus 62%, p less than 0.001). CONCLUSION: PTCA can be performed in hypothyroid patients without increased mortality or major morbidity, and when appropriate, may be preferred to bypass surgery for coronary revascularization in patients intolerant of full thyroid hormone replacement.

Angioplasty, Balloon, Coronary↗
PubMed1980

[Medullotherapy in hematopoietic depression].

Many-year observations, made by the authors, indicated that the main mechanism of medullotherapy is healing of histocompatible allogenic bone marrow, transplanted against the background of immunosuppressive therapy. In patients with hyperplastic anemia bone marrow transplantation results in a persistant clinico-hematologic remission. Observations, made by the workers of the Leningrad Institute of Hematology and Blood Transfusion, have demonstrated that transplantations of the preserved autologous bone marrow to patients with malignant neoplasms contribute to the restoration of hemopoiesis, suppressed by high doses of chemical drugs and associated radiotherapy.

Bone Marrow Transplantation↗
PubMed1979

[Clinical morphological, cytogenetic and genealogical studies of patients with chronic monocytic leukemia].

The introduction in clinical practice of modern methods of cytogenetic assays offers new opportunities in studying the nature of leukemia. Up to date, however, no due attention was given to the recognition of chromosome disorders in patients with chronic monocytic leukemia (CML). Study on the karyotype in 20 patients with chronic monocytic leukemia indicated that chromosome anomalies lie in both the changed chromosome number and their structure, in the phase of marked clinical manifestations these changes being increased, while in the stage of remission--being reduced. A rather high incidence of malignancies in near relations of patients with CML supports a suggestion of the related pathogenetic mechanisms underlying leukemia and malignant tumors.

Diagnosis, Differential↗