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Biomedical subjects

H Bürgi

Publications and source records attributed to H Bürgi.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Therapy of euthyroid goiter].

In regions of iodine deficiency TSH-suppressive therapy with L-thyroxine is quite successful: 50-60% of euthyroid goitres shrink (almost) totally and an additional 15-20% undergo a clinically useful reduction in size. 100 micrograms L-thyroxine daily suppresses TSH secretion in 75% of patients and 150 micrograms daily in 95%. Reduction of goitre size takes four to six months' treatment, which must be continued on a lifelong basis. In regions of sufficient iodine supply (such as Switzerland today) treatment of euthyroid goitre is less successful because TSH-independent factors (thyroid stimulating immunoglobulins and possibly other yet unknown growth factors) assume relatively greater importance. In Denmark, for example, L-thyroxine reduces the size of only about 50% of goitres by only about 20% of their sonographic volume. In nonendemic regions goitres generally are not only less prevalent but also of smaller size. The indication for surgery therefore more rarely arises from pressure symptoms or cosmetic reasons, but rather from concern over potential malignancy. Cytologic examination of fine-needle aspirates is the most important method of ruling out malignant lesions and is far more important than scintigraphy or sonography. The general consensus is that surgery should be advised in all cytologically suspect lesions, in addition, of course, to the frankly malignant lesions.

Biopsy↗
PubMed1988

Can serum thyroglobulin predict the effect of thyroid hormone therapy on goitre growth?

Serum thyroglobulin and goitre size were followed in 22 patients with simple goitre or single thyroid nodules during 9 months of thyroxine therapy, to see whether alterations in serum thyroglobulin correlated with changes in goitre size. In the case of such a correlation serum thyroglobulin could be used to predict which goitres respond to thyroxine therapy and which require surgery. Pretreatment serum thyroglobulin was elevated in 11 patients. It normalized in one of 7 patients whose goitre did not shrink and in none of the 4 patients whose goitre shrank during thyroxine treatment. Thus no simple correlation exists between alterations in serum thyroglobulin and goitre size during short-term thyroxine therapy. Since other studies suggest that increased serum thyroglobulin indicates ongoing goitre growth, thyroxine treatment might have been unsuccessful in all patients with persistently elevated serum thyroglobulin with a longer follow-up. The presence of predominantly thyroxine responsive tissue together with some autonomously growing, thyroglobulin-releasing areas in the same goitre could explain the failure of serum thyroglobulin to normalize in patients whose goitre shrank during therapy. The study shows that after eradication of iodine deficiency, thyroxine treatment is rarely successful in the Swiss goitre population and that surgical treatment is usually required.

Adult↗
PubMed1987

[New aspects in the surgical treatment of hyperparathyroidism].

As a result of routine serum calcium determinations an increasing number of primary hyperparathyroidism (pHPT) cases are detected. While surgical treatment of the symptomatic patient with pHPT is generally accepted, this may not be the case in asymptomatic and especially elderly patients. The value of preoperative localization of parathyroid tumors has not been clearly established. In our experience dual parathyroid imaging with thallium and technetium has provided the best results. With the growing number of dialyzed patients, secondary (sHPT) and tertiary hyperparathyroidism (tHPT) are assuming increasing importance. Patients suffering from symptomatic sHPT or tHPT should undergo parathyroid surgery. After respective follow-up of 3.8 years (pHPT) and 2 years (sHPT and tHPT), all the cases with pHPT showed a relevant fall in serum calcium levels and PTH.

Biopsy↗
PubMed1986

[Radioiodine therapy in hyperthyroidism: reliability of a long-term follow-up scheme for the diagnosis and treatment of hyperthyroidism based on the family physician and on a central registry].

We assessed the reliability of a follow-up scheme for radioiodine-treated patients which involved the general practitioner after the first year, leaving to the center only the operation of a central recall registry and the analysis of mailed blood samples and simple questionnaires. The analysis of 238 patients followed up for 3-6 years showed that the scheme was equal or superior to follow-up rates of published systems in Switzerland which rely on regular recalls of the patients to the center. However, the excellent follow-up rates published with similar systems in Great Britain were not quite achieved and efforts will be needed to diminish the number of patients lost to follow-up. Contrary to the experience of other authors, our laboratory results did not allow us to single out a group of patients with low likelihood of developing hypothyroidism and in whom follow-up examinations could be spaced at longer intervals. Reversing our current practice, we now recommend that hypothyroid patients be left on our registry once they are on replacement therapy with thyroxine. Examination of this patient group has revealed that 27% are undersubstituted, albeit only to a borderline degree in most cases.

Aged↗
PubMed1986

[The treatment of Basedow's disease. The agony of selection].

The treatment mode of Graves' disease should be chosen individually for each patient. This requires a thorough knowledge of the advantages and disadvantages of the various methods, and also bias-free interdisciplinary cooperation. Surgery reestablishes euthyroidism in about 80%, with 10% becoming hypothyroid. In centers practising more radical surgery hypothyroidism has developed in up to 49% and there is now evidence of occurrence of late hypothyroidism in the same way as after radioiodine. Radioiodine is cheap and causes minimal inconvenience to the patient. Because prevalence of hypothyroidism rises in a cumulative way over decades, lifelong follow-up is necessary with an examination every 1 to 2 years. The genetic risk and the danger of thyroid carcinoma have been shown to be negligible by gonadal dose calculations and by longterm prospective follow-up. Antithyroid drugs inhibit incorporation of iodide into thyroglobulin and produce rapid clinical improvement. It seems probable that, in longterm treatment, they also specifically suppress the synthesis of thyroid-stimulating immunoglobulins. The significance of "allergic" reactions such as skin rash, leukopenia and agranulocytosis is usually overestimated. The hematologic side effects are rare, dose-related and reversible in most cases. The major drawback of antithyroid drugs is the high recurrence rate (50%) of hyperthyroidism after cessation of therapy. It is still undecided whether a long course of treatment (one year or longer) produces better longterm results than short courses.

Antithyroid Agents↗
PubMed1984

[Blood glucose determination at the bedside with test strips and reflection photometer: comparison of 2 instruments with a standard method].

The accuracy of blood glucose measurements was evaluated with two different test strip-reflection photometer systems (Reflolux and Reflocheck). Two experienced technicians took 92 measurements in capillary blood at the bedside and the results were compared with a reference value obtained from the same capillary blood sample by a standard automated glucose oxidase method. Both test strips agreed well with the reference value, with high correlation coefficients and with total errors of less than 25%. It remains to be established whether the two methods are as reliable when performed by patients themselves.

Blood Glucose↗
PubMed1984

Effects of fluoride on thyroid hormone biosynthesis. Studies in a highly sensitive test system.

In view of the recommendation that fluoride supplements via drinking water or table salt prevent dental caries, we analyzed whether fluoride had antithyroid properties in a sensitive experimental model. Rats were given either 60 or 200 micrograms/ml fluoride in the drinking water. This raised the serum fluoride concentration from 0.165 to 0.246 in the first and to 0.576 micrograms/ml in the second instance. Although the higher fluoride dose was near the toxic range, no antithyroid effect was observed. Neither organification of iodine, nor any subsequent step of thyroid hormone biosynthesis (transformation of monoiodotyrosine to diiodotyrosine and then to thyroxine) were affected. Fluoride had no effect on thyroglobulin content of the thyroid gland or on the degree of iodination of thyroglobulin.

Animals↗
PubMed1984

Fluorine and thyroid gland function: a review of the literature.

The increasing use of fluoride for prevention of dental caries poses the problem as to whether this halogen has antagonistic properties towards iodine, whereby it could hamper the success of iodine prophylaxis of endemic goitre. Review of the literature shows that some authors have found an inhibition by fluoride of various steps of thyroid hormone biosynthesis in animal experiments. By and large, the inhibition was only slight and it was elicited only with fluoride doses greatly in excess of those recommended for caries prevention. The inhibition was not consistently present and other authors could not confirm it in comparable experiments. There is no convincing evidence that fluoride produces true goitres with epithelial hyperplasia in experimental animals. There are some reports based on casual observations that fluoride is goitrogenic in man. On the other hand, several good studies with adequate exposed and control populations failed to detect any goitrogenic effect of fluoride in man. It is noteworthy in particular that fluoride does not potentiate the consequences of iodine deficiency in populations with a borderline or low iodine intake. Published data failed to support the view that fluoride, in doses recommended for caries prevention, adversely affects the thyroid.

Adult↗
PubMed1983

Thyroglobulin-rich colloid goitres: a result of the combined action of lithium and methimazole on the rat thyroid.

Naturally occurring euthyroid goitres in man and goitres produced in experimental animals by iodine deficiency or goitrogen feeding both have in common a thyroglobulin of low iodine content. The latter experimental goitres are always depleted of colloid and thyroglobulin. In contrast, natural goitres often contain excessive amounts of colloid which may accumulate because of endocytosis becoming refractory to TSH. We tested the hypothesis that minute doses of goitrogens could lower the iodine content of thyroglobulin without colloid depletion. We then examined whether such a low-dose 'classical' goitrogen could induce excessive colloid storage rather than depletion if acting in concert with lithium, a cation which blocks endocytosis. Rats on an adequate iodine intake were fed minimal doses of methimazole either alone or combined with lithium chloride. Chronic minimal-dose methimazole treatment lowered the iodine content of thyroglobulin without changing thyroglobulin content and thyroid weight. In contrast, addition of lithium to methimazole, produced goitres containing supranormal amounts of poorly iodinated thyroglobulin. We conclude that borderline doses of goitrogens can lower iodination of thyroglobulin without causing hyperplasia and colloid depletion. Thyroglobulin-rich goitres can be obtained by adding a second goitrogen which inhibits endocytosis. As an alternative to Marine's hypothesis of colloid goitre formation we suggest that inhibition of endocytosis, e g by goitrogens of the lithium type, could cause colloid and thyroglobulin accumulation in human iodine deficiency goitre.

Animals↗
PubMed1982

[Use of plasma calcitonin levels in the detection of Sipple syndrome in siblings (clinicopathological conference)].

In a 22-year old man plasma calcitonin was normal in the basal state but elevated to 2.6 ng/ml after stimulation with calcium and pentagastrin. Two other family members had had bilateral pheochromocytoma accompanied by medullary carcinoma of the thyroid in one case and by adenomas of the parathyroid glands in the other. The literature of Sipple's syndrome, the value of calcitonin assay and the grounds for screening in affected families are reviewed. Surgery (total thyroidectomy) confirmed the clinical suspicion of C-cell hyperplasia and medullary microcarcinoma of the thyroid gland. Hyperplasia of the parathyroid glands was also found.

Adult↗
PubMed1982

[Thyroid other endocrine and disorders in a general internal medicine group practice].

Retrospective analysis of 3397 patients of a general group practice revealed thyroid disease in 5.8% and other endocrine disease (including diabetes) in 2%. Of the total of 6629 diagnoses, one out of 25 was an endocrinopathy. Every 35th practice patient had an endocrine disease which required treatment. Endocrine laboratory tests were ordered in every 7th patient. Diabetes mellitus (1.7%), hyperthyroidism (0.38%), hypothyroidism (0.53%) and euthyroidism after goiter operation (1.4%) were the most frequent endocrine problems recorded. Euthyroid goiter was relatively rare (4%), probably because it was often considered an irrelevant finding and not coded for. The thyroid gland was therefore the most frequently affected endocrine organ and diabetes mellitus the most prevalent endocrine dysfunction. Compared with other diseases, endocrine problems were of intermediate prevalence. The analyzed group practice had relatively young patient population, which may account for the surprisingly low prevalence of diabetes mellitus. On the whole, however, the prevalence of various diseases in this group practice compared well with statistics in representative samples of Swiss medical practices.

Adolescent↗
PubMed1982

Use of a single TSH-measurement after oral thyrotrophin releasing hormone: an economical and highly sensitive thyroid screening test.

The increment of serum TSH after thyrotrophin-releasing hormone (TRH) is usually considered an extremely sensitive thyroid test, particularly useful in borderline disturbances. We evaluated 195 patients by measuring serum TSH before and 3 h after 40 mg TRH po, and by various other thyroid tests. We found a very tight correlation between the TSH- increment and the 3 h TSH. Thus the TSH-increment can reliably be estimated from the 3 h TSH. The mann-Whitney test confirmed that the 3 h TSH identified thyroid dysfunction as well as the TSH-increment. The basal TSH can therefore be omitted and we propose the measurement of the 3 h TSH as an initial screening test. This single measurement economically excludes the many euthyroid patients sent for thyroid evaluation from further costly tests.

Adolescent↗
PubMed1981

Neutropenia after penicillins: toxic or immune-mediated?

Eight patients treated with a total of 220-550 million U penicillin-G developed neutropenia. These cases have been compared with eight patients receiving a similar dose of pencillin-G with no adverse reactions and with eight untreated subjects. All penicillin-treated patients showed raised levels of anti-IgG antibodies and lymphocyte culture stimulation indices. These values were highest in the neutropenia group. Both of the two tests significantly discriminated the three groups. Antineutrophil antibodies could be detected in four of seven neutropenic patients with a staphylococcal-slide-assay while indirect immunofluorescence and microcytotoxicity tests failed to reveal these antibodies. The literature dealing with neutropenias induced by penicillin-G and its congeners is reviewed. We conclude that (1) penicillin-G in doses exceeding a total of 200 million U frequently induces neutropenia, (2) an immune-mediated pathogenesis a highly probable, (3) neutropenia after penicillins is different from two hither-to accepted types of this side effect, (4) sufficiently high amounts of penicillin-G intravenously always induce sensitization against this drug.

Adolescent↗