[Hypercalcemia in lithium therapy--an underestimated complication?].
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Adult↗
Biomedical subjects
G Kallner
Publications and source records attributed to G Kallner.
Hypothalamic-pituitary-testicular axis in patients with hyperthyroidism.
To test whether chronic thyroid hormone excess influences the hypothalamic-pituitary-testicular axis, 8 hyperthyroid men were given two identical intravenous GnRH tests. The first test was performed before any treatment had been instituted, the second 6-13 months later, when medical treatment had made the patients euthyroid. Although basal serum luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone (T) levels were of similar magnitudes before and after the medical treatment, LH and FSH responsiveness to gonadotropin-releasing hormone (GnRH), as reflected by the hormone incremental areas (U/l X min), were significantly larger in the thyrotoxic state compared with the euthyroid state (LH incremental areas: 3,999 +/- 665 vs. 2,640 +/- 430, p less than 0.02; FSH incremental areas: 825 +/- 193 vs. 542 +/- 98, p less than 0.05). Furthermore, serum T increased significantly in response to GnRH when the patients were hyperthyroid (T incremental area: 162 +/- 51, p less than 0.02), but failed to do so when they were euthyroid (T incremental area: 92 +/- 53, NS). These results imply that chronic thyroid hormone excess makes the pituitary gonadotrophs 'hypersensitive' to exogenous GnRH. This may in turn explain why human Leydig cells respond more powerful to exogenous GnRH in thyrotoxic patients than in euthyroid subjects.
Blood Glucose↗
Recurrent factitious hypercalcemia.
Severe hypercalcemia recurred three times during an observation period of 15 years in a woman with anorexia nervosa. The patient displayed a factitious cheese-alkalosis syndrome similar to the iatrogenic milk-alkali syndrome.
Adult↗
Highly sensitive assays of serum-thyrotropin in the diagnosis of hyperthyroidism: assessment of performance and reference values.
The performance of three different highly sensitive immuno-assays for thyrotropin in serum (S-TSH) was compared. Specimens from 803 patients with suspected hyperthroidism or other thyroid disease were used. Hyperthyroid patients were identified and characterized by determining serum thyroid hormones and by clinical observation. The performance of the methods in discriminating between hyperthyroidism and euthyroidism was described in terms of diagnostic sensitivity and specificity. The performance was also assessed by systematically varying the reference values. If patients with treated hyperthroidism were eliminated, the three S-TSH assays performed equally well at a suggested lower reference value of 0.4 mU/l. A diagnostic efficiency of more than 0.95 was achieved at the observed prevalence of disease (0.12). A graphical model which allows an adjustment of reference values to favour sensitivity or specificity is presented. Reference values were also calculated from the euthyroid subjects using parametric and non-parametric approaches. The specificity, when using the recommended discrimination level, suggests that patients with low S-TSH values should be subjected to further investigation by biochemical or other methods.
Adolescent↗
S-T4 and S-T3 levels during the L-thyroxine suppression test.
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Aged↗
Immunoreactive somatomedin B (RIA-B) in the circulation of healthy adults and patients with endocrine disorders.
The serum and cerebrospinal fluid (CSF) levels of immunoreactive somatomedin B (RIA-B) were examined throughout life in healthy adult humans. A significant decline in serum RIA-B was observed in subjects over 60 years of age. No significant diurnal, daily, or monthly serum variation was observed in healthy subjects aged 20-60 years. However, women taking oral contraceptives had elevated RIA-B values. No significant decline in CSF RIA-B was observed in subjects over 60 years of age. A significantly lower level of RIA-B in CSF was observed in subjects sampled at 20.00 h compared to subjects sampled in the morning. A significant decline in serum RIA-B was observed in patients with hypopituitarism and diabetes mellitus and a significant elevation of serum RIA-B levels was observed in patients with hyperthyroidism. CSF RIA-B was significantly elevated in patients with Cushing's syndrome.
Adult↗
Hypoglycemia and low S-T3--an experimental study.
Ethanol-induced hypoglycemia after 44 hours of complete fasting was allowed to last for four hours. S-T3 decreased significantly (p less than 0.05), by 16.5%, S-rT3 remained unchanged and S-cortisol increased significantly (p less than 0.01). No correlation was found between S-T3 and S-cortisol. An association was found between S-T3 and blood glucose (p less than 0.05). An acute low S-T3 was achieved by depressing the peripheral availability and utilization of glucose. No association to a simultaneous increase in S-cortisol was found. An increase in S-rT3 failed to appear, probably also due to glucopenia.
Adult↗
An incident of bilateral mastodynia after the menopause.
A 54-year-old postmenopausal woman is described who quite suddenly experienced intense tenderness and tension in both breasts lasting for about 3 weeks. Subsequently she had a uterine bleeding. Excessively increased levels of estradiol (peak value 2325 pmol/l) were found during the period of mastodynia. Seven months previous to this event, hyperthyroidism had been diagnosed. She had, however, been treated with propylthiouracil and was euthyroid long before and during the period of mastodynia.
Breast↗
Assessment of thyroid function in chronic alcoholics.
The clinical manifestations in chronic alcoholics may sometimes mimic those of hyperthyroidism. However, diagnostic aids are somewhat contradictory in many cases. Ten chronic alcoholics with symptoms from the sympathoadrenal system were investigated. A significant increase (p less than 0.01) of T3 at 120 min after TRH stimulation was found despite a blunted TSH response (increment less than 3 mU/l) in some cases. This increase in T3 indicates a preserved thyroid function in chronic alcoholics despite generally low basal T3 levels. It is concluded that T3 determinations at 120 min in connection with TRH test may be an essential parameter in evaluating euthyroid function in chronic alcoholics.
Adult↗
Serum reverse-T3 determinations in the laboratory diagnosis of hyperthyroidism.
The relative discriminatory value of the estimation of the serum reverse-T3 levels for the laboratory diagnosis of hyperthyroidism was investigated in 47 patients with clinical signs or symptoms of hyperthyroidism. The results were compared with those from the determination of the total serum levels of T3 and T4 prior and after correction for the binding proteins. Twenty-three of the patients had normal thyroid function and 24 had hyperthyroidism. The estimation of the total serum T3 level was superior to both the determination of the total serum T4 and reverse-T3 levels even subsequent to correction for the binding proteins.
Humans↗
[Adrenal cortex insufficiency with an unusual genesis].
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Adrenal Insufficiency↗
Serum T3 and T4 determinations during the TRH test as a complement to improved discriminatory power in suspect hyperthyroidism.
The aim of the study was to determine whether the addition of T3 and T4 determination in connection with a routine TRH-test could increase the discriminatory power of the test. Thus, forty-one patients with suspect hyperthyroidism were examined and samples for T3 and T4 and TSH determinations were drawn prior to the administration of TRH and at 20 and 60 min thereafter. The results showed that the addition of these thyroid hormone estimations did not increase the clinical value of the TRH-test.
Adult↗
T4, T3 and reverse-T3 determinations in connection with the TRH test in the evaluation of possible hyperthyroidism.
One disadvantage of the TRH test is that an absent or blunted TSH response is seen not only in hyperthyroid patients but also in some normal subjects. The aim of the present study was to elucidate whether the discriminatory power between eu- and hyperthyroidism could be increased by determining the T3 and T4 levels before and after the TRH administration. The study population consists of 30 patients referred for evaluation of suspected hyperthyroidism. The results show that all but one of the patients (n=20) who had T3 levels within the normal reference limits increased these levels after TRH administration, whether their TSH response was normal or blunted. One patient's T3 levels decreased after TRH. All the patients (n=10) who had T3 levels within the hyperthyroid range showed a decrease after TRH. The decrease was significantly correlated (r=0.90) to the magnitude of the increase. No consistent T4 and no change in reverse-T3 response was obtained. The addition of T3, T4 or reverse-T3 determinations in connection with the TRH test does not seem to increase the discriminatory power of the test.
Adult↗
The role of endogenous cortisol in patients with non-thyroidal illness and decreased T3 levels.
The aim of the study was to elucidate if endogenous cortisol, as previously suggested, could be involved in the mechanism behind the reduced serum T3 levels seen in euthyroid patients with various non-thyroidal illnesses. The correlation between the serum levels of T3 and cortisol was investigated in 41 hospitalized patients with non-thyroidal illness during hyperpyrexia. The results showed a correlation coefficient of -0.94, indicating a close reciprocal association between the two hormones. Cortisol may thus be one factor associated with the decreased T3 levels seen in euthyroid patients with non-thyroidal illness. The results also indicate a close parallelism between the total and free T3 levels during hyperpyrexia.
Body Temperature↗
The effect of propranolol on serum levels of T4, T3 and reverse-T3 in hyperthyroidism.
The effect of propranolol (40 mg t.d.s.) on the peripheral levels of T4, T3 and reverse-T3 was studied in 26 patients with hyperthyroidism. The compounds were measured by specific radioimmunoassay techniques. The levels were followed for five weeks and compared with the levels before treatment. The results show that propranolol had no significant effect on the peripheral levels of T4 despite a rapid amelioration of clinical symptoms. A significant reduction of T3 levels was obtained during the first to fourth week of treatment. No significant decrease was obtained after the fourth week. A significant elevation in reverse-T3 levels was obtained during the second to fourth week of treatment. No significant change was obtained either during the first week or after the fourth week. Inconsistent fluctuations in hormone levels, both before and during treatment, could be seen in individual cases. The results suggest that the reduction of clinical symptoms must be caused by an extrathyroidal action of propranolol which does not seem to involve the pituitary gland.
Adult↗
Clinical value of total T4 and T3 determinations in patients with suspect hyperthyroidism before and after correction for binding proteins.
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Adolescent↗
Radioimmunoassay of triiodothyronine and thyroxine in capillary blood.
A radioimmunoassay technique for the estimation of T3 and T4 levels in capillary blood is described and evaluated in comparison to a simultaneously drawn and equally analyzed sample from the cubital vein. A total number of 236 samples thus received from the capillary and the vein from euthyroid, hypo- and hyper-thyroid patients were collected. For both T3 and T4 a good correlation (r = 0.94) was obtained. The clinical implication would especially be for paediatric practice.
Capillaries↗
Comparison between serum thyroxine and triiodothyronine estimation and the TRH test in the routine diagnosis of hyperthyroidism.
Serum T3 and T4 levels have been determined by a radioimmunoassay technique and the TRH test has been performed in 50 patients in whom hyperthyroidism could not be ruled out by the first clinical examination alone. Each patient was then further evaluated in order to establish the state of the thyroid function. The extent to which the determination of T3 or T4 could replace the TRH test in the routine diagnosis of hyperthyroisism was evaluated. The results showed that 26 of the 50 patients had normal thyroid function and 24 had hyperthyroidism. No patient in the normal groups and all but one in the hyperthyroid group had T3 levels above the upper normal limit (2 S.D.). Two of the patients in the normal group and 19 in the hyperthyroid group had T4 levels above the upper normal limit (2 S.D.). Twenty of the patients in the normal group showed a normal TSH response to TRH (increment is greater than 3.0 micronU/ml); the remaining 6 showed an impaired or absent response. Twenty of the hyperthyroid patients had no response and four had a slightly positive response to TRH. No hyperthyroid patient had a TSH response exceeding 3.0 micronU/ml. It is concluded that the determination of T3 is superior to both the determination of T4 and the TRH test for the laboratory discrimination between eu- and hyperthyroidism.
Adult↗