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Biomedical subjects

I B Hales

Publications and source records attributed to I B Hales.

At least 19 recordsLinked to original sources
PubMed1992

Does Graves' disease or thyrotoxicosis affect the prognosis of thyroid cancer.

Twenty-one patients who underwent surgical treatment for thyrotoxicosis and who were found at operation to have thyroid cancer are presented. Sixteen had Graves' disease and 5 had toxic nodular goiter. The group with Graves' is compared with 110 euthyroid patients with thyroid cancer who underwent their initial surgery in the same time period and who were of the same age (+/- 1 yr) and sex as the patients with Graves' disease. None of the thyrotoxic patients died during follow-up of 2-24 yr or developed subsequent metastases. The 1 patient with a local lymph node metastasis has not shown evidence of recurrence. Hypoparathyroidism appeared as a complication in only 1 patient. The size of tumors in the patients with Graves' disease was significantly smaller than in the euthyroid group. The course of the disease in both the patients with Graves' disease and the thyrotoxic group as a whole was relatively benign. This series does not support the recent suggestions that thyroid cancer in patients with Graves' disease is more aggressive than in either patients with toxic nodular goiter or euthyroid subjects. Patients with Graves' disease and thyroid cancer should be treated identically to other patients with thyroid cancer. Therapy should consist of total thyroidectomy followed by a postoperative 131I scan. Residual tissue or metastases found on the scan should be ablated with 6 GBq 131I. The patient should receive a suppressive dose of T4.

Adult↗
PubMed1987

The effect of o,p'-DDD on adrenal steroid replacement therapy requirements.

Two patients with adrenal carcinoma treated with 2,2-bis (2-chlorophenyl-4-chlorophenyl)-1,1-dichloroethane (o,p'-DDD) as adjuvant therapy were studied. Both patients developed hypoadrenalism while on o,p'-DDD and apparently adequate dexamethasone replacement therapy. The hypoadrenalism was overcome by increasing steroid replacement therapy. Dexamethasone levels were measured in the serum by radioimmunoassay and shown to be lowered by o,p'-DDD therapy. A study of the absorption and disappearance of dexamethasone from the circulation in response to a (1 mg oral dose indicated that the steroid was absorbed normally but was cleared more rapidly from the circulation of these two patients than from normal controls. This may be due to a change in the type of metabolites excreted. It is suggested that many of the reported side-effects of o,p'-DDD may be due to hypoadrenalism and may be controlled by greatly increasing the steroid replacement dose. The adequacy of corticosteroid replacement therapy may best be assessed by monitoring the levels of ACTH.

Adrenal Gland Neoplasms↗
PubMed1985

The assay for thyroid stimulating immunoglobulins using cultured human thyroid cells.

Recent reports have shown that thyroid-stimulating immunoglobulins (TSI) may be detected by measuring cyclic AMP increases in cultures of isolated thyroid cells in response to added patient immunoglobulins (Ig). We have compared the frequency that TSI may be detected in the Ig fraction of 114 sera from 112 patients with a variety of thyroid disorders, to the presence of thyrotrophin binding inhibitor Ig (TBII). Whereas the sera of 46 out of 48 (95.6%) patients with untreated thyrotoxic Graves' disease had detectable TSI, only 26 out of 48 (54.2%) had detectable TBII. We did not find any significant correlation between TSI and TBII for these patients but there was a significant correlation between TSI and both serum T3 (r = +0.55, P less than 0.01) and T4 (r = +0.50, P less than 0.01). Twelve patients were studied at the time of relapse of thyrotoxicosis due to Graves' disease. All sera contained detectable TSI whereas only one contained detectable TBII. Of the sera from 20 patients in remission after antithyroid drug therapy three were positive for TSI. One of these samples as well as two others had detectable TBII. The two samples with TBII in the absence of TSI came from patients who had developed hypothyroidism. TSI were detected in the serum of one out of nine patients with Hashimoto's thyroiditis but not in the sera of 20 other patients with a variety of non-autoimmune thyroid disorders including five patients with thyrotoxicosis not due to Graves' disease. However TSI was found in the sera of three out of five patients with exophthalmos and no history of hyperthyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)

Cells, Cultured↗
PubMed1981

Thyroid stimulating immunoglobulin in Graves' disease.

There is excellent presumptive evidence that an IgG plays an aetiological role in the development of hyperthyroidism in Graves' disease but available methods for detecting thyroid stimulating immunoglobulins (TSI) are still far from satisfactory. They show considerable variation in specificity, sensitivity and precision, and comparison of the experimental data, obtained with these various methods, is difficult. A need exists for an in vitro TSI assay which is based upon the propensity of IgG molecules to stimulate the thyroid gland. Because a complex chain of biochemical events is involved, including binding to IgG to the cell membrane receptor, release of cyclic AMP, organification of iodide, hydrolysis of iodoproteins and secretion of thyroid hormones, it is not yet clear which step should be monitored to obtain the best index of thyroid stimulating activity. Although TSI and related assays appear to be of limited value in the primary diagnosis of Graves' disease, they offer some assistance to the clinician in the following situations: 1. Prediction of relapse in Graves' disease patients who have been rendered euthyroid with antithyroid drugs. 2. Identification of patients with ophthalmic Graves' disease. 3. Prediction of neonatal hyperthyroidism in thyrotoxic pregnancies.

Animals↗