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At least 919 records · Page 51Linked to original sources
PubMed1999

Review of investigation and management of severe hyponatraemia in a hospital population.

The purpose of this study was to assess retrospectively the prevalence of severe hyponatraemia in a hospital population and its laboratory investigation, treatment and clinical outcome. Over a 6-month period 47 patients (27 women and 20 men) were found to have a plasma sodium concentration of < or = 120 mmol/L (this number made up less than 0.17% of all plasma sodium requests over that time period). The mean patient age was 75 +/- 16 years and the average hospital stay was 37 +/- 45 days (1-179 days). Patient mortality was 51% (women 57% and men 43%). The mean initial plasma sodium concentration was 116 +/- 4.5 mmol/L, rising after therapeutic intervention to a mean of 130 +/- 4.2 mmol/L. The mean plasma sodium correction rate was 4.7 +/- 4.3 mmol/L/24 h (0.9-17.5 range). Twelve per cent of the patients had their plasma sodium raised at a rate of greater than 10 mmol/L/24 h after their initial presentation. Two patients may have had symptoms and signs suggestive of cerebral oedema/cortical dysfunction: in one patient the sodium concentration was raised at a rate of 9.5 mmol/L/24 h and in the other at 12.0 mmol/L/24 h. Sixty-one per cent of the patients had a chest infection, 44% were on diuretics, 28% had congestive cardiac failure, 28% were post-operative (9% orthopaedic procedures), 19% had carcinoma and 9% were on a selective serotonin re-uptake inhibitor. Regarding laboratory investigations, 56% had liver function tests, 41% had thyroid function tests, 36% had plasma osmolality determination, 36% had urinary electrolytes including urinary osmolality and < 2% had tests to exclude hypoadrenalism.

Adolescent↗
PubMed2003

An analysis of routine blood testing of British army pilots.

BACKGROUND AND OBJECTIVE: The purpose of the study was to ascertain what had been discovered in the 15 yr that the British Army has been conducting a program of routine blood testing on its pilot population. These results were to be analyzed with respect to the causes of medical retirement, change of flight status on medical grounds, accidents, incidents, and sudden incapacitation in flight. METHODS: Data were collected from the records of 408 aircrew and comprised 1213 records of test batteries. Each battery consisted of: complete blood count, erythrocyte sedimentation rate, urea and electrolytes, liver function tests, fasting glucose, thyroid function tests, and fasting lipids. Altogether 8,491 tests were considered. They were analyzed for degree of abnormality, subsequent action, resultant diagnoses, and therapeutic interventions. RESULTS: The positive predictive values for the tests ranged between 2% and 33%. The overall percentages of tests that resulted in a diagnosis were between 0.08% and 3.5%, and therapeutic intervention between 0.08% and 3.4%. CONCLUSIONS: No evidence to support the continuation of routine blood testing was found other than in the case of lipid estimation. Although this had the highest diagnostic yield, abnormal results were dealt with in an inconsistent manner. Further, the testing was shown to have no predictive value in any of the adverse pilot outcomes mentioned above. Recommendations to alter future practice have been made and accepted in full by the Aviation Medicine hierarchies of all three UK Services.

Adult↗
PubMed1975

Serum triiodothyronine concentration in the diagnosis of hyperthyroidism.

The serum triiodothyronine concentration is superior to the serum thyroxine concentration, the resin uptake test and the free thyroxine index in the diagnosis of hyperthyroidism. Over a 14 month period fifty-five patients attending an endocrine clinic with suspected thyrotoxicosis of all degrees of severity had blood taken on initial attendance and the serum was stored for routine thyroid function tests and triiodothyronine estimation. The patients were followed up and forty-six proved to be toxic and seven to be euthyroid; two could not be classified. Analysis of the initial serum showed that the serum triiodothyronine concentration was superior to the serum thyroxine concentration, the resin uptake test and the free thyroxine index in predicting the clinical outcome.

Adenoma↗
PubMed1984

The differential diagnostic problems in unilateral euthyroid Graves' ophthalmopathy.

Nine consecutive patients with unilateral ophthalmopathy with suspected endocrine pathogenesis were investigated with a TRH test, a T3 suppression-test, thyroid autoantibodies and a subsequent computerized tomography (CT)-scan. All patients were clinically and biochemically euthyroid. Seven of 9 patients had a normal TRH test and 6 of 7 had a normal T3 suppression test. Slightly to moderately elevated microsomal and thyroglobulin (determined with radioimmunoassay) autoantibodies were found in 5 of 8 patients and in 1 patient thyroid stimulating immunoglobulins (TSI) were found. Three of the patients had normal thyroid function tests and no detectable thyroid autoantibodies. The subsequent CT-scan revealed that one of these had a maxillary tumour protruding into the orbita. The remaining 8 patients had enlargement of one (3 patients) or more (5 patients) eye muscles. Two of the 8 patients had bilaterally enlarged eye muscles, one of which was the patient with positive TSI. The remaining 6 patients had unilateral extraocular muscle enlargement. Thus, 2 of 9 patients had ophthalmopathy without thyroid dysfunction so-called isolated autoimmune ophthalmopathy or Graves' ophthalmopathy. Thyroid function tests seem to be of limited value in the diagnosis between endocrine and non-endocrine eye disease, and we recommend the use of diagnostic imaging (e.g. CT-scan) in patients with unilateral exophthalmus in order to diagnose malignant processes.

Antibodies↗
PubMed1984

Diagnostic dosages of protirelin (TRH) elevate BP by noncatecholamine mechanisms.

While performing thyroid function tests, we noticed that protirelin (TRH) raised BP, and, therefore, we investigated the effect of diagnostic dosages of protirelin (500 micrograms) on plasma catecholamine levels and cardiovascular function in eight patients one day before, one day after, and four weeks following heart surgery. Mean arterial pressure (MAP), heart rate (HR), plasma norepinephrine (NE), epinephrine (EPI), dopamine (DA), thyroid hormone (triiodothyronine [T3], thyroxine), and thyrotropin (TSH) levels were measured before and after the intravenous injection of protirelin. Protirelin increased MAP transiently from 88 +/- 2 to 103 +/- 3 mm Hg (before surgery), 86 +/- 4 to 102 +/- 4 mm Hg (one day after surgery), and 86 +/- 4 to 104 +/- 5 mm Hg (four weeks after surgery). There were no notable changes in HR or plasma NE, EPI, or DA levels. The T3 and TSH response to protirelin was normal on all three study days. Protirelin raised MAP by an effect on systemic vascular resistance (SVR) rather than an increase in cardiac output. We conclude the following: (1) diagnostic dosages of protirelin transiently elevate MAP and SVR by a noncatecholamine mechanism, (2) clinicians who perform protirelin tests should be aware of protirelin's transient pressor effects.

Adult↗
PubMed1979

Sinemet and thyroid function in Parkinson disease.

Patients on chronic carbidopa-levodopa (Sinemet) therapy underwent thyroid function testing that included measurement of serum thyroxine (T4), triiodothyronine (t3), thyrotropin (TSH), T3 uptake (T3U), free T4 index (FT4I), and free T3 index (FT3I). The subjects were studied both in a random sampling and in a controlled manner, fasting and 2 hours after receiving the drug. All subjects were euthyroid by testing, and there was no significant difference in thyroid hormone levels of patients and controls or in fasting values and values 2 hours after the drug. However, there was a small but significant reduction in serum TSH levels after Sinemet. Therapeutic doses of Sinemet have no significant effect on thyroid function in euthyroid patients with Parkinson disease.

Carbidopa↗
PubMed1989

Testing for recovery of thyroid function after withdrawal of long-term suppression therapy.

Many persons are given thyroid hormone for long periods without sufficient justification. We selected 45 patients whose chart reviews did not demonstrate a clear need for thyroid replacement. Thyroid hormone was withdrawn and blood samples taken for free thyroxine index and TSH levels at 2, 4, 6, and 8 weeks after thyroid withdrawal. At 8 weeks, 30 of the 45 were normal. A single TSH test 8 weeks after thyroid withdrawal appears to be the most efficient way to separate euthyroid from hypothyroid patients.

Adult↗
PubMedDate not supplied

Familial dysalbuminemic hyperthyroxinemia: cumulative experience in 29 consecutive patients.

PURPOSE: The syndrome of familial dysalbuminemic hyperthyroxinemia (FDH), an inherited abnormality characterized by the presence of a variant serum albumin with preferential affinity for T4, is recognized with increasing frequency as a cause of elevated total and free T4 serum values in clinically euthyroid patients with normal TSH levels. Hyperthyroxinemia caused by this syndrome is occasionally confused with hyperthyroidism or thyroid hormone resistance syndromes, which may prompt unnecessary treatment. To better define the clinical and biochemical characteristics of patients with FDH, we undertook a retrospective analysis of the experience at our institution with this condition. PATIENTS: We reviewed our cumulative experience in 29 consecutive patients with FDH diagnosed between 1970 and 1991. RESULTS: FDH was diagnosed in 18 males and 11 females (mean age, 42.7 years) on the basis of clinical euthyroidism, increased total T4 and increased/normal free T4 serum values, normal T3 and TSH serum values, increased T4 binding to serum albumin, and low/normal T4 binding to T4-binding globulin and serum prealbumin. Clinical thyroid examination revealed no abnormalities except for goitre in five patients, and the results of radioiodine uptake studies were normal. Patients with subsequently documented FDH were referred for evaluation of "unusual" findings on thyroid function tests or FDH was detected on routine thyroid function tests or identified on family screening. Euthyroid hyperthyroxinemia in combination with a family history compatible with FDH correctly suggested FDH in seven patients. CONCLUSIONS: Clinical euthyroidism in conjunction with a normal basal sensitive TSH value in a hyperthyroxinemic patient differentiates euthyroid hyperthyroxinemia from thyrotoxicosis, obviating unnecessary therapy. Detection of excessive thyroxine binding to serum albumin establishes the diagnosis of FDH and allows it to be differentiated from thyroid hormone resistance syndromes. After a diagnosis of FDH has been established, family screening is advisable. Hyperthyroxinemia in clinically euthyroid patients ("euthyroid hyperthyroxinemia") is recognized with increasing frequency and should prompt a careful diagnostic evaluation. The differential diagnosis of this condition may be difficult because it includes various common and unusual syndromes, including quantitative or qualitative changes in thyroid hormone-binding proteins, circulating antibodies against thyroid hormones, resistance to thyroid hormones, influences from drugs, and acute somatic or psychiatric illness (1). The recently recognized syndrome of familial dysalbuminemic hyperthyroxinemia (FDH), an inherited abnormality with autosomal dominant transmission, is characterized by the presence of a variant serum albumin with preferential affinity for T4 (2-4). Typically, FDH is detected incidentally or patients are referred to endocrinologists on the basis of "unusual" results on routine thyroid function testing, revealing consistently elevated total T4 and elevated or normal free T4 values in a clinically euthyroid patient with normal TSH levels (1,5). Unfortunately, hyperthyroxinemia due to FDH may be confused with hyperthyroidism or thyroid hormone resistance syndromes, prompting repeated unnecessary laboratory testing and possibly even inappropriate treatment (1,3,6,7). Herein, we describe the clinical and biochemical characteristics of 29 consecutive patients with documented FDH.

Journal Article↗
PubMed1975

[Assay of serum creatine phosphokinase in primary hypothyroidism. Comparison with other thyroid gland function tests in 32 cases. Value of isoenzyme studies].

Serum-creatine phosphokinase levels were measured in 32 cases of primary hypothyroidism in adults and compared with the results of other thyroid function test. C.P.K. elevation appeared to be almost completely uniform (31 out of 32 cases) and marked, reaching six times the normal value. This elevation is more marked in 18 myxoedematous patients than in 14 with those with hypothyroidism of mixed aetiology. Close correlation does not seem to exist between the elevation of C.P.K. and the lowering of serum thyroxine. The elevation of C.P.K. above the upper limits of normal seemed more constant than lengthening of the achilles reflex time, a rise in serum cholesterol, or a rise in other enzymes of muscular origin, such as the glutampopyruvic and glutamo-oxalocetic transaminases, lactodehydrogenase and hydroxybutyric dehydrogenase. In 8 cases of hypothyroidism, the isoenzymic study of serum C.P.K. by electrophoresis on cellulose acetate confirmed that the molecular structure was of the muscle type MM. The advantage of such a study shows that a structure MB found in the case of myocardial infarction in a patient with hypothyroidism deserves to be stressed.

Adolescent↗
PubMed1982

Tests of thyroid function important to the ophthalmologist.

The most useful tests to establish a diagnosis of endocrine exophthalmos are the following: To prove that thyroid gland activity is increased: serum T3 and T4 assays. To demonstrate immunologic abnormalities: thyroid antibody testing and the TDA test. To demonstrate an abnormal hypothalamic-pituitary-thyroid axis: the TRH test. To demonstrate enlarged ocular muscles: orbital ultrasonography and computerized tomography.

Antibody Formation↗
PubMed1992

Pituitary resistance to thyroid hormone action with preserved circadian rhythm of thyrotropin in a postmenopausal woman.

We assessed the 24-h behavior of circulating TSH and the dopaminergic control on TSH release in a postmenopausal woman, who had elevated levels of serum thyroid hormones and an inappropriately high concentration of serum TSH, indicating pituitary resistance to thyroid hormone action. The patient was found to have a daily profile of serum TSH similar to that of normal subjects, except for the persistently elevated 24 h levels, suggesting that alterations in thyroid hormone negative feedback control did not affect substantially circadian TSH rhythm. The acute administration of a dopamine antagonist drug (metoclopramide) resulted in a markedly elevated peak of serum TSH, similar both in the morning and in the evening. The chronic administration of a dopamine agonist drug (bromocriptine) reduced basal and TRH-stimulated TSH, restored circadian TSH variations to lower levels, and normalized other thyroid function tests. Although the metoclopramide test results confirmed the existence of an increased dopaminergic inhibitory tone in nonneoplastic inappropriate secretion of TSH, the outcome of bromocriptine treatment indicated that the dopaminergic control over TSH release was not enough in this case of PRTH.

Circadian Rhythm↗