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Biomedical subjects

F D Rosenthal

Publications and source records attributed to F D Rosenthal.

At least 19 recordsLinked to original sources
PubMed1991

Changes in circulating thyroid hormone levels and systolic time intervals in acute hypothyroidism.

OBJECTIVE: We have previously reported that, in thyrotoxic patients treated with carbimazole, serum T4 and T3 levels are the first parameters to return to normal, followed by the systolic time interval (STI, a marker of thyroid function at tissue level) and then the serum TSH. The aim of this study was to compare the rate of change of thyroid hormones, TSH and STI in treated hypothyroid patients after the sudden withdrawal of thyroxine. DESIGN AND PATIENTS: Serum T4, T3 (free and total) and TSH were measured in 12 patients taking thyroxine for primary hypothyroidism; seven were biochemically euthyroid and five were over-replaced, as defined by an elevated free T4 and a sub-normal TSH. Thyroxine was withdrawn and the measurements repeated three times a week until the STI rose above the euthyroid range (0.26-0.32). RESULTS: After stopping thyroxine, the serum TSH and STI left the normal range, in advance of the free T4 and T3, after 9.5 +/- 0.95 and 12.2 +/- 1.5 days respectively (mean +/- SEM). The TSH was the first parameter to leave the euthyroid range in all subjects except one in whom the serum TSH was fully suppressed (less than 0.05 mU/l) initially. In the euthyroid group the TSH and STI increased rapidly after stopping thyroxine (time to leave euthyroid range 7.4 +/- 0.8 and 9.4 +/- 0.7 days respectively). In contrast, in the over-replaced group serum TSH and STI became elevated after 12.4 +/- 1.0 days (P less than 0.005 vs euthyroid group) and 16.0 +/- 2.7 days (P less than 0.05 vs euthyroid group) respectively. There was no delay in the fall in serum T4 or T3 in the over-replaced group when compared with the euthyroid group. CONCLUSIONS: In the evolution of primary hypothyroidism, markers of thyroid function at a tissue level (TSH and STI) become abnormal in advance of thyroid hormones. After stopping thyroxine therapy in treated hypothyroid patients, there is a delayed rise in STI and serum TSH levels in subjects with a subnormal TSH level, as compared with those with a normal TSH on treatment. This suggests mild tissue thyrotoxicosis in these individuals.

Acute Disease↗
PubMed1989

Low serum TSH with normal total thyroid hormone levels: an indicator of free T4 excess.

We have studied 18 patients with low serum thyrotrophin (TSH) levels accompanied by normal thyroxine (T4) and triiodothyronine (T3) levels in order to clarify whether or not they are thyrotoxic. Serum T4, T3, free T3, free T4 and TSH were estimated three times weekly for 3-4 weeks. Thyroxine binding globulin (TBG) levels were estimated on one occasion only. Thyroid hormone data were expressed as the cumulative probability of having at least one result above the relevant normal range by the nth sample (Pn). For free T4 this probability was 61% by the 10th sample. Free T4 values were confined to the upper half of the normal range or above throughout the study. In contrast, free T3 values were distributed evenly within the normal range (P10 = 12%). For total T4 and total T3, P10 was 34 and 11% respectively. Thus, subjects with subnormal TSH levels but normal T4 and T3 levels have been shown to have elevated serum free T4 levels, an indicator of biochemical hyperthyroidism.

Adult↗
PubMed1988

Higher than conventional doses of carbimazole in the treatment of thyrotoxicosis.

In order to ascertain whether higher than conventional doses of carbimazole achieve more rapid control of thyrotoxicosis, 30 thyrotoxic patients were alternately allocated into two groups, group 1 (15 subjects) receiving a conventional starting dose of 45 mg orally daily and group 2 (15 subjects) a dose of 100 mg orally. In addition to weekly estimations of serum T4, T3, free T4, free T3 and TSH, the systolic time intervals ratio (STI), a measure of left ventricular contractility, was calculated as an accurate measure of peripheral thyroid hormone activity, the study end-point being a normal STI (0.26-0.32). None of the individuals studied experienced side-effects during the study period. Mean pre-treatment STI values for the two treatment groups were the same at entry (0.20). The mean recovery times for STI was 4.4 weeks (SE 0.3) in the high dose group and 5.9 weeks (SE 0.4) in the low dose group (P = 0.0037). There was a definite trend towards a shorter recovery time for free T3 in the higher dose group (P = 0.057) but no apparent differences for T4, T3 and free T4. Higher than conventional doses of carbimazole may be advisable in the initial treatment of severe thyrotoxicosis.

Administration, Oral↗
PubMed1987

Aldosterone responsiveness to metoclopramide in hyperprolactinaemia.

Basal serum aldosterone levels in 13 hyperprolactinaemic females did not differ significantly from those of nine control individuals. There was increased responsiveness of circulating aldosterone levels to the long acting dopamine antagonist metoclopramide (10 mg intravenously) in the hyperprolactinaemic patients as compared with the controls. Prolactin responsiveness to metoclopramide was reduced in the patients as compared with the controls, such being considered characteristic of a prolactinoma. Basal serum thyrotrophin (TSH) levels, although within the euthyroid range, were increased in the patients as compared with the controls. There was no significant difference in the TSH responsiveness to metoclopramide between the study groups. However, in the five patients with exaggerated responses of TSH to metoclopramide, basal TSH levels were significantly higher than in the other patients. One explanation for these results is that prolactin can directly or indirectly modulate the aldosterone response to metoclopramide.

Aldosterone↗
PubMed1987

Long-term suppression of a testosterone-producing ovarian tumour by oestrogen/progestogen therapy.

A 44-year-old lady presenting with hirsutism was found to have a testosterone-secreting Leydig cell tumour of the right ovary. Serum testosterone levels were adequately suppressed for 8 years by combined oestrogen/progestogen preparation (Microgynon 30, Schering, West Sussex). The fall in gonadotrophin and testosterone levels during therapy and their rise after stopping therapy suggests that the tumour was gonadotrophin dependent.

Adult↗
PubMed1986

Acute sulphasalazine hepatotoxicity.

We describe a case of severe sulphasalazine hepatotoxicity. The features described are those of an acute hypersensitivity reaction which responded to drug withdrawal alone as steroids were withheld. Supportive treatment only is recommended for this potentially fatal condition.

Adult↗
PubMed1985

Sensory thresholds and motor responsiveness in thyroid disease: their responses to treatment and warming.

It has been our clinical observation that patients with hypothyroidism are relatively insensitive to the discomfort of venepuncture, whereas thyrotoxic patients seem to have a heightened sensitivity. In an initial study we have measured the sensory thresholds of perception along with motor responsiveness in hypothyroid, thyrotoxic and euthyroid subjects, employing a simple and readily reproducible technique. Sensory thresholds were elevated and motor responsiveness impaired in hypothyroid subjects as compared to euthyroid controls. In thyrotoxic subjects, motor responsiveness was significantly enhanced, but sensory thresholds did not differ from control values. In a subsequent study the threshold abnormalities of thyroid dysfunction were corrected by rendering the patients euthyroid with appropriate therapy. Warming a further group of untreated hypothyroid patients produced a similar improvement in motor responsiveness to that seen in the L-thyroxine-treated group, thus implying that this parameter is at least, in part, temperature dependent. Sensory thresholds would seem to be reliable reflectors of tissue thyroid status in hypothyroidism, whereas motor responsiveness seems the better guide to thyroid status across the whole spectrum of thyroid function.

Carbimazole↗
PubMed1985

Reversible abnormalities of myocardial relaxation in hypothyroidism.

Fifteen selected hypothyroid patients without symptoms or signs of cardiovascular disease and an equal number of matched control subjects underwent simultaneous recording of electrocardiogram and phono-, apex-, and echocardiography to assess dynamic systolic and diastolic left ventricular function. Both the systolic preejection period and the isovolumic relaxation period were significantly increased in the hypothyroid group. However, whereas the rate of myocardial contraction, assessed from the echocardiograph of the left ventricular posterior wall, was identical in patients and control subjects, the diastolic thinning rate of the muscle was markedly slowed in the hypothyroid individuals. The abnormalities demonstrated were in the main completely reversed after 3 months of T4 therapy. These results demonstrate a relatively selective and readily reversible disturbance of the rate of myocardial relaxation in hypothyroidism, suggesting an intrinsic abnormality of cardiac muscle. This allows an intriguing parallel to be drawn with the delayed relaxation phase of voluntary muscle contraction, long recognized as a direct measure of tissue thyroid function in hypothyroidism. The abnormality of diastolic function we have described is of similar character to that found in patients with other cardiomyopathies and which has been shown to be a major cause of disturbance of global cardiac action.

Adult↗
PubMed1979

Bone lesions in systemic acne (acne fulminans).

An 18-year-old West Indian male presented with severe sternal pain and an exacerbation of facial acne. Radiographs of the sternum revealed several lytic lesions which appeared as hot areas on successive technetium bone scans. Painful areas over the right iliac crest and left greater trochanter likewise appeared as transient hot areas on successive scans. Histology of affected bone revealed reactive changes only. High dose prednisolone provided rapid alleviation of pain, which recurred on reducing the dose to less than 10 mg daily. Auto-immune complex disease has been considered the most likely aetiological mechanism of systemic acne (acne fulminans), but lytic lesions of bone have never previously been reported in auto-immune disorders.

Acne Vulgaris↗
PubMed1979

Gilbert's syndrome: evidence of morphological heterogeneity.

Hepatic ultrastructure was examined by electron microscopy in 25 patients with Gilbert's syndrome and the changes in the smooth endoplasmic reticulum quantified by grid technique. Thirteen patients showed gross hypertrophy of the smooth endoplasmic reticulum (SER). These were designated Gilbert's EM Positive. The remaining 12, designated Gilbert's EM Negative, did not differ significantly from normal controls. The EM Positive group showed a significantly greater percentage response to caloric restriction (P less than 0.01) and an exaggerated response to nicotinic acid stimulation when compared with the EM Negative group and normal controls. These results suggest that SER hypertrophy is not, as previously suggested, a constant feature of Gilbert's syndrome but rather a characteristic of a distinct subpopulation.

Adolescent↗
PubMed1978

Felty's syndrome.

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Felty Syndrome↗
PubMed1978

The association of HLA-B8 with visceral disease in systemic sclerosis.

Seventy-one patients with systemic sclerosis (SS) were typed for twenty-seven HLA alleles of the A and B loci, and the findings were related to both the extent of visceral disease and tests of cellular immune competence in a subgroup of fifty-two of these patients. Nineteen pa;ients with widespread visceral involvement and more rapidly progressive disease had an increased frequency of HLA-B8 (relative risk = 4.14; P less than 0.05) when compared to thirty-three less severely affected patients and 3000 controls. Patients with severe and progressive disease also had defective cell-mediated immunity with reductions in both the numbers of circulating thymus-dependent (T) lymphocytes and in the lymphocyte transformation response to phytohaemagglutinin. These findings suggest that a genetic factor, such as an abnormal immune response gene, may be involved in the progression of the disease.

Adult↗
PubMed1977

Secondary pituitary hyperplasia in Addison's disease.

In patients with Addison's disease, whether treated or untreated for the previous 24 hours, hydrocortisone produced only a partial suppression of their elevated adrenocorticotrophic-hormone (A.C.T.H.) levels. This is comparable to untreated myxoedema, in which administration of triiodothyronine fails to inhibit secretion of thyrotrophin (T.S.H.). In myxoedema, however, continued treatment produces normal T.S.H. levels. Inadequate A.C.T.H. suppressibility in patients with Addison's disease while on treatment may be due to the maintenance of a secondary pituitary hyperplasia by inadequate replacement therapy. This may be clinically important, especially in the genesis of Nelson's syndrome.

Addison Disease↗