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Biomedical subjects

H Bürgi

Publications and source records attributed to H Bürgi.

At least 55 records · Page 3Linked to original sources
PubMed1981

Prevalence of various degrees of hypothyroidism among patients of a general medical department.

We have measured basal thyrotropin (TSH) in 945 consecutive patients of a general medical department. Additional thyroid tests were carried out in patients with elevated TSH. Thirty patients (3.1%) had subclinical hypothyroidism, i.e. an elevated TSH with no clinical signs and with a normal free thyroxine index. A cause was found in only fifteen of these thirty patients. Thirteen additional patients (1.37%) had mild or overt primary hypothyroidism, three of which were already diagnosed. This prevalence is three times higher than that found in a retrospective survey at the same hospital. Of the ten newly-detected cases five were discharged on thyroid hormone replacement. In two patients the antithyroid drugs which were the cause of hypothyroidism were discontinued. The remaining three patients had severe non-thyroidal illnesses and thyroid hormone was not prescribed. A cause for the hypothyroidism (autoimmune thyroid disease, post-radioiodine, post-thyroidectomy or antithyroid drugs) was established in all but two cases. The data suggest that thyroid function tests (preferably a TSH) should be performed on any patient with prior treatment to the thyroid and, in addition with very broad indications, perhaps even routinely, in all women over 50 years of age.

Adult↗
PubMed1981

The effect of antipyrine, phenobarbitol and rifampicin on thyroid hormone metabolism in man.

The effect of three different live microsomal enzyme inducing drugs on thyroid hormone metabolism was investigated. Seven volunteers were randomly allocated in a crossover design to either antipyrine (1200 mg), phenobarbital (100 mg) or rifampicin (1200 mg) daily for 14 days. Before and after each treatment the following parameters of enzyme induction were measured: antipyrine clearance, gamma-glutamyltranspeptidase, d-glucaric acid and 6-beta-hydroxycortisol urinary excretion. In addition, thyroxine-binding globulin (TBG), T3-resin uptake (RT3U), thyroxine (T4), free thyroxine (FT4), triiodothyronine (T3), reverse T3 (rT3), and thyroid stimulating hormone were estimated. Following antipyrine and phenobarbital antipyrine clearance increased by about 45%, while with rifampicin an increase of 125% was observed. The indices of thyroid function did not change following phenobarbital and antipyrine, but after rifampicin T4, FT4 and rT3 decreased by about 14%, and T3 increased by 25%. In addition, the impact of rifampicin on the clearance of injected 125I-T4 was investigated in six additional volunteers by blocking thyroid iodine uptake. The 125I-T4 halflife decreased from 155 to 106 h and its clearance increased from 25 to 50 ml/h, while a fall in T4, FT4 and rT3 by about 40% and no rise but a decrease in T3 by 25% occurred. Therefore an increased clearance of T4 and rT3 but not of T3 seems likely following rifampicin, which might be due to enhanced hepatic metabolism and biliary excretion.

Adult↗
PubMed1981

Borderline low thyroid function and thyroid autoimmunity. Risk factors for coronary heart disease?

Assessments were made of 945 consecutive hospital patients with regard to a relation between borderline low thyroid function (recognised by a slightly raised thyroid stimulating hormone), thyroid autoimmunity, serum cholesterol, and coronary heart disease. Men and women with a thyroid autoimmunity, serum cholesterol, and coronary heart disease. Men and women with a thyroid stimulating hormone of 4.0 mU/l or over had a higher prevalence of coronary heart disease than did age-matched controls, and this difference was significant in women. The excess of coronary heart disease was not explained by an excess of other risk factors such as a high cholesterol, hypertension, smoking, and diabetes. Women with thyroid antibodies had a slightly higher prevalence of coronary heart disease despite the unexpected finding of a lower serum cholesterol. The data point to an association between borderline thyroid function and autoimmunity and coronary heart disease which is not mediated through a raised serum cholesterol.

Adult↗
PubMed1980

[When should stable maturity-onset diabetics be switched to insulin?].

All 11 maturity-onset diabetics (age 55 to 79 years) switched from oral hypoglycemics to insulin during one year in our department, even though metabolically stable, have been followed up. The main reason for the change was a diminished sense of well-being combined with relatively ill-defined symptoms such as declining physical performance, fatigue, dizziness and pain in the legs. None of the patients was ketoacidotic and the 24-hour glucosuria was less than 15 g, although the average fasting blood sugar was markedly elevated to 296 mg/dl. After 6 months on insulin the 24-hour glucosuria had not changed but the fasting blood sugar had dropped to 183 mg/dl. This was accompanied by an improved sense of well-being (as measured by an analog scale) and by disappearance of the symptoms mentioned above. Even though 9 of the 11 patients were initially reluctant to change to insulin, all 11 were still on this drug after 6 months. The authors recommend broadening the indications for insulin therapy in stable adult-onset diabetics, particular attention being paid to vague symptoms such as fatigue and decreased physical performance.

Aged↗
PubMed1980

[Iodine deficiency is still endemic in Switzerland].

To obtain information on the present state of iodine supply in Switzerland random urine samples have been collected from 770 individuals for the purpose of measuring iodine and creatinine excretion. As a first step the widely used method of measuring iodine concentration per gram creatinine in casual urine samples was validated by quantitatively collecting urines for 6 consecutive 4 h periods in 11 healthy volunteers. True ioduria could thereby be compared with that calculated from random samples. 83% of all values were found to be within +/- 30% of the true mean value. The mean iodine content of all 770 samples collected in the field study was 93.3 microgram per gram creatinine (I/Cr). This mean value is slightly below the adequate iodine supply. Of even more concern is the fact that less than 60 microgram I/g Cr was found in 20% of all samples. Therefore, in the population sample as a whole the mean ioduria is still clearly below that indicating a sufficient iodine supply, and in one out of five individuals iodine excretion was typical of marked iodine deficiency. Low ioduria correlated significantly with low natriuria in both male and female subjects. This finding indicates that iodized table salt is an important though inadequate source of alimentary iodine. The increase in iodine admixture to table salt already agreed upon appears to be an appropriate means of improving nutritional iodine availability. Iodine deficiency may still be an important cofactor in the high prevalence of goiter in Switzerland. The long established goiter prophylaxis by iodine admixture to table salt may have lost part of its efficiency due to the sharp decrease in per capita consumption of salt.

Creatinine↗
PubMed1979

[Experiences with an oral cocaine-morphine solution (Brompton mixture) in the treatment of severe pain in patients with neoplasms].

One year's experience is reported in the treatment of terminally ill cancer patients with an oral solution of morphine and cocaine on a fixed schedule. 36 consecutive patients were treated for an average of 51 days. Excellent or good pain relief was achieved with 26 patients (72%). The initial mean daily dose of morphine was 35 mg. After 12 weeks, the dose had to be raised to an average of 52 mg per day. Some patients received up to 180 mg morphine per day. Side effects were not uncommon but were without clinical consequences in most patients. Side effects caused discontinuation of treatment in only 2 patients. Terminally ill cancer patients often derive great benefit from this treatment.

Administration, Oral↗
PubMed1978

[Lithium acetate, a useful and well tolerated thyrostatic for selected cases of hyperthyroidism].

Lithium acetate treatment of 6 patients with hyperthyroid Graves' disease and 6 patients with toxic nodular goiter is reported. Lithium acetate was administered either as monotherapy (group A) or combined with 45 mg carbimazole or methimazole (group B). A control group of 8 patients received methimazole or carbimazole only (group C). Lithium either alone or combined with thionamide drugs consistently lowered serum thyroxine and triiodothyronine with marked clinical improvement. After 7 days of treatment thyroxine was reduced by 28% (group A), 43% (group B) and 36% (group C). The respective decrease in triiodothyronine was 42%, 50% and 46%. The differences between three groups were not statistically significant. We conclude that lithium is a useful antithyroid agent for selected patients, since it is safe and effective even in severe cases, does not interfere with radioiodine uptake for diagnostic or therapeutic purposes and provides an alternative for patients allergic to thionamides.

Acetates↗
PubMed1978

[Unrecognized hyperthyroidism in hospital patients. Analysis of clinical symptoms compared to aged euthyroid goiter patients].

During a 14-month period hyperthyroidism has been diagnosed in 39 of 2916 inpatients of a general medical service. Graves' disease was present in only 8 cases. 21 patients had solitary autonomous nodules or multiple autonomous nodules (toxic multinodular goiter). In 10 patients the type of hyperthyroidism could not be established. The referring practitioner suspected hyperthyroidism in all 8 patients with Graves' disease, but in only 5 of the 31 remaining cases. The relative rarity of Graves' disease in inpatients reflects the fact that this form of hyperthyroidism is easily recognized by the practitioner and treated on an out-patient basis. Graves' disease patients and those with autonomous solitary or multiple nodules were of comparable age and had an identical serum free-thyroxin. Thus, neither higher age nor lower thyroxin is responsible for the atypical clinical presentation of autonomous nodules. A comparison with age- and sex-matched carriers of euthyroid goiters identified weight loss, resting pulse rate over 90 and auricular fibrillation as reliable clinical features. A thyroid function test is therefore indicated in every patient with a goiter and one of the three above clinical findings.

Adenoma↗
PubMed1978

[Importance of thyroid diseases in internal medical hospital].

Retrospective analysis of 2627 and prospective analysis of 289 inpatients (mean age: 57 years) of the Department of Internal Medicine, University of Berne, disclosed euthyroid goiter in 33.9%. 65% of the patients had urinary iodine excretion below 100 microgram per gram creatinine. Thus, iodination of salt (raised to 10 mg potassium iodide per kg in 1962) is still inadequate. 1.4% of the inpatients had hyperthyroidism. Hypothyroidism was diagnosed in 0.5% of the inpatients, which is about three times less than in comparable prospective English studies. The finding raises the possibility that cases of hypothyroidism have been frequently missed. Antibodies against thyroglobulin and/or microsomal antigen were present in 8.5% of 105 goiter patients and 4.0% of 124 patients without goiter. This is a definitely lower incidence than has been reported in comparable English populations and confirms reports from other Alpine endemic goiter areas. Among the 2916 patients of the entire study only 3 cases (0.1%) of clear-cut chronic lymphocytic (Hashimoto) thyroiditis were found.

Autoantibodies↗
PubMed1978

[Indications and procedures in conservative goiter treatment].

A review of the literature shows that thyroid hormone therapy causes 13 to 40% of euthyroid goiters to disappear and brings about a reduction in goiter size in another 30 to 50%. The hormonal treatment is more successful with smaller goiters. Uninodular goiters respond on the average less well than diffuse and multinodular goiters. In Switzerland, about 33% of adult persons have goiters, albeit mostly of small size. This renders impracticable investigation or treatment of all goiters. It is recommended that only goiters which are esthetically disturbing or which cause pressure symptoms be treated. An operation must always be performed when there is suspicion of thyroid cancer or in the presence of threatening pressure symptoms. In all the other cases, thyroid hormone therapy may be tried. If an operation cannot be performed for cardiac or other reasons, radioiodine will relieve pressure symptoms due to goiter in over 65% of cases.

Goiter↗
PubMed1976

[How do hormones act?].

Hormones act via receptors, i.e. structures which contain specific binding sites for any given hormone. The transmission of information is accomplished by reversible binding of the hormone to the receptor. Steroid hormones and triiodothyronine act via receptors which are located in the nucleus and regulate the biosynthesis of specific proteins. Peptide hormones and catecholamines combine with receptors within the cell membrane, thereby regulating the membrane-bound enzyme adenyle cyclase. The product of this enzyme, cyclic AMP, acts as a transmitter of the action of these hormones in the interior of the cell.

Adenylyl Cyclases↗