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J J Staub

Publications and source records attributed to J J Staub.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Intranasal TRH for the stimulation of hypophyseal and thyroid reserves. Preliminary report].

Intranasal, intravenous and oral TRH have been compared in 9 healthy volunteers. Intranasal administration of TRH leads to excellent stimulation of pituitary TSH secretion. Serum TSH levels are significantly higher than after intravenous TRH (p less than 0.005) and lower than after oral TRH (p less than 0.005). As with intravenous TRH, peak TSH response is reached at 20-30 minutes, but the stimulatory effect is prolonged and elevated TSH levels can be measured for up to 3 hours. Stimulation of T3 and free T4 at 3 hours is comparable in all three administration forms of TRH. The practical advantages of the intranasal route are that no intravenous injection is necessary, overnight fasting is not required and the duration of the test is short (30 minutes, in contrast to 3 hours in the oral test).

Administration, Intranasal↗
PubMed1985

[Therapy of differentiated thyroid carcinomas. Prospective study].

UNLABELLED: During an 11-year period (1973-1984) a consecutive series of papillary (n = 30) and follicular (n = 38) thyroid carcinomas was prospectively selected, on the basis of a clinico-pathologic and prognostic classification, for 1) non-total thyroidectomy (n = 20), 2) total thyroidectomy (n = 13), or 3) total thyroidectomy and radioiodine (n = 35), together with exogenous suppressive thyroxine therapy in most patients. Patients with an occult papillary carcinoma and patients under 40-50 years of age with an intrathyroidal, single papillary carcinoma without nodes, and microangioinvasive follicular carcinoma were often treated by non-total thyroidectomy or without radioiodine. Some patients refused adequately radical therapy (completion of thyroidectomy or radioiodine). RESULTS: a half-year to 11 (5 +/- 3) years following treatment no recurrences or deaths occurred in occult papillary and in microangioinvasive follicular tumors (treated by total thyroidectomy and radioiodine in 1 of 9 and in 2 of 9 patients respectively); 1 death and 1 curable recurrence occurred in the intrathyroidal papillary carcinoma group (treated by total thyroidectomy and radioiodine in 7 of the 15 patients); 3 patients died and there were 4 recurrences (3 locoregional, 1 systemic) in the patients suffering from extrathyroidal papillary or angioinvasive follicular carcinoma (treated by total thyroidectomy and radioiodine in all of the 6 and in 19 of 29 patients respectively). Patients who died (all had pulmonary metastases at the time of diagnosis) and those with a recurrence had total thyroidectomy with radioiodine as the primary treatment. In lethal papillary carcinomas, large follicular and solid areas, squamous cell metaplasia or anaplastic transformation were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1985

Intranasal thyrotrophin releasing hormone is a potent stimulus for TSH release in man (comparison with intravenous and oral TRH).

Intranasally administered TRH was tested and compared to i.v. and oral TRH in respect to its efficacy of TSH stimulation and thereby the stimulation of thyroid reserve. TSH release after nasal application is as prompt as after the i.v. route, reaching a peak at 20 to 30 min. After that, however, compared to the i.v. administration its stimulatory effect is prolonged, lasting over 3 h. At the dose used in this study the peak TSH response after intranasal TRH administration was 14.7 +/- 1.6 mU/l compared to 8.4 +/- 1.4 and 23.1 +/- 4.4 mU/l after i.v. and oral administration respectively (P less than 0.005). Intranasal application of TRH is as potent as i.v. or oral TRH for the stimulation of thyroid reserve. At 3 h a marked increase of T3 and a smaller elevation of FT4 is observed (delta T3 = 48.4%, delta FT4 = 31.6%). The nasal peptide was well tolerated locally and systemic side effects were comparable to those of i.v. TRH. This form of application offers a practical advantage by avoiding intravenous injections. Its diagnostic potential in investigation of thyroid disease and its possible therapeutic application have yet to be elucidated.

Administration, Intranasal↗
PubMed1985

[Malignant struma: changes in the clinical picture and treatment strategy].

In the Alpine countries of Switzerland and Austria iodized salt prophylaxis has greatly reduced the incidence of disease of the thyroid gland and substantially altered the pattern of malignant goitre: the previously dominant follicular carcinoma has diminished in number whereas there has been a corresponding increase in the papillary type. The number of highly malignant tumours has dwindled quite markedly within a few decades. Improved preoperative diagnosis and broader indications for surgery have been instrumental in causing most thyroid carcinomas to be treated today at an early stage. In papillary and follicular carcinomas cure rates are very gratifying if optimal advantage is taken of present strategies of treatment and aftercare. The otorhinolaryngologist should familiarize himself with modern thyroid medicine. He must realize first and foremost that thyroid malignancy today presents with much milder symptoms than the older medical literature led him to believe. Thyroid carcinoma is by no means rare in our outpatient departments.

Adenocarcinoma↗
PubMed1984

[Thallium scintigraphy of the thyroid as an alternative procedure for the demonstration of functionally silent thyroid tissue].

The efficacy of 201-thallium thyroid scintigraphy in nonvisualization of one or both thyroid lobes on 123I scan was evaluated prospectively in 38 patients with benign thyroid disease. In 17 of the 18 patients with autonomous toxic adenoma (Plummer's disease) the suppressed thyroid tissue was visualized by 201Tl scintigraphy. In one patient this method failed. A further 7 patients had partially decompensated adenomas demonstrated by both 123I and 201Tl scintigraphy. Homogeneous 201Tl uptake was observed in all 9 patients with bilateral subacute thyroiditis and depressed iodine uptake. Likewise, visualization of the thyroid was possible in the 3 patients with iodine blockade. 201Tl scintigraphy of the thyroid has substantial advantages over TSH stimulation and can be performed in all cases with diminished or suspended iodine metabolism.

Humans↗
PubMed1984

[Free thyroxin as a determinant for thyroid function. Evaluation of direct determination of fT4 compared to the oral TRH test].

The diagnostic value of a direct assay of free thyroxine has been evaluated by comparing the concentration of free T4 with the results of an oral TRH test. 147 patients were referred to an endocrine outpatient department because of suspected thyroid dysfunction. Based on clinical investigation and on the results of an oral TRH test, 75 patients were euthyroid, 12 hyperthyroid and 12 hypothyroid. Preclinical hypothyroidism (3 h- TSH value above 35 mE/l and euthyroid peripheral thyroid hormone levels) was found in 25 patients. In 23, preclinical hyperthyroidism (3 h- TSH value after TRH below the sensitivity of the assay, i.e. less than 1 mE/l) together with euthyroid peripheral thyroid hormone values was found. Free thyroxine was assayed using the solid phase technique (Clinical Assay); intraassay coefficients of variation varied between 4.5 and 7.6% and interassay coefficients of variation between 8 and 13%. A normal range for free thyroxine was found between 8.4 and 26.4 pmol/l, the log mean being 14.9 pmol/l. In 12 hyperthyroid patients the free T4 concentration was above 49.4 pmol/l, while the mean of 12 hypothyroid patients was below 4.4 pmol/l. The mean free T4 concentrations in the syndromes of preclinical hypo- and hyperthyroidism, which by definition are only recognizable by the TSH increase in response to TRH, were within the normal range. Using the sensitive TRH test as a comparison, the present investigation thus confirms the reliability of direct assay of free T4 for the diagnosis of thyroid function in clinical practise.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1984

Influence of thyroid function on theophylline kinetics.

Theophylline kinetics were examined in five patients with hyperthyroidism before and after treatment with carbimazole. Theophylline clearance fell after carbimazole, but the apparent volume of distribution did not change. There was a correlation between reduction in theophylline clearance and decreased thyroxine serum concentration. Data suggest that maximum induction is reached at a specific level of thyroxine beyond which no further increase in drug metabolizing activity takes place. In 15 subjects treated with aminophylline for acute bronchial obstruction, there was a positive correlation between thyroxine concentration and total body theophylline clearance (r = 0.72 for nonsmokers; r = 0.44 for smokers and nonsmokers).

Adult↗
PubMed1983

[Evaluation of the optimal thyroxine dose with the TRH test for replacement and suppression therapy].

53 patients with overt hypothyroidism (group 1), 17 patients with "preclinical hypothyroidism" (group 2), 22 patients with a euthyroid goiter (group 3) and 13 patients who had undergone total elimination of the thyroid gland for thyroid cancer (group 4) were treated with thyroxine. Basal levels of T4, T3, TSH and the TSH-response to 40 mg oral TRH were measured during treatment. For replacement therapy in hypothyroid patients of group 1 and 2 the dose was adjusted until the TSH response to TRH was within the normal range (3.5-38 mU/l). In groups 3 and 4 the thyroxine dose was increased to suppress the TSH response to TRH in the presence of euthyroid T4 and T3 levels (suppressive dose). Average thyroxine replacement doses were 128 micrograms per day in overt hypothyroidism and 101 micrograms/day in preclinical hypothyroidism. Suppressive doses of thyroxine were on average 119 micrograms/day in patients with euthyroid goiter and 183 micrograms thyroxine per day in patients with total thyroid ablation. In all 4 groups of patients a wide interindividual variation of the optimal thyroxine dose was found.

Goiter↗
PubMed1983

[Comparison between the intravenous TRH-test and the T4-thyroid suppression test for the diagnosis of borderline hyperthyroidism].

In a prospective study of 60 patients with T3 and/or T4 values within +/- 10% of the upper limit of normal, the suppressibility of thyroid storage values before and after oral administration of 3 mg L-thyroxine was tested and compared with the results of an intravenous TRH test. In 46 patients the results of the two methods agreed (77%): in 31 patients (52%) radioiodine uptake could not be suppressed nor TSH stimulated in the TRH test. Physiological suppression of the storage values in normal TSH stimulation after TRH as a sign of completely euthyroid function was present in 15 (25%). In the remaining 14 patients, 13 had a suppressed TRH test. In all patients radioiodine uptake could be suppressed either normally (above 50%) or partially (20-30%). A normal T4 suppression test in the absence of TSH rise after TRH indicates that biologically active TSH is circulating, even though not demonstrated by radioimmuno-assay. A normal T4 suppression test is an important argument against treating a given case of hyperthyroidism. The T4 suppression test reveals smooth gradation between euthyroid and hyperthyroid states. If the TRH test is normal one can assume a physiological T4 suppression test and no further tests are needed. If the TRH test is negative and there is only slight elevation of the thyroid hormones, the T4 suppression test is indicated before definitive treatment of hyperthyroidism is initiated.

Adult↗
PubMed1983

[Profile of autoimmune antibodies in idiopathic hypothyroidism and hypothyroidism following radio-iodine treatment in Basedow's disease: comparison with a group of normal subjects from the female population of Switzerland].

Prevalence of thyroid microsomal antibodies (MCHA) and thyroglobulin antibodies (TGHA), as well as frequency of other autoantibodies (parietal cell antibodies [PZA], adrenal antibodies [NNA], islet cell antibodies [IZA], smooth muscle antibodies [SMA], mitochondrial antibodies [MitA] and antibodies to nuclear antigens [ANF]), are reported for three different female groups in Switzerland in 91 euthyroid controls (group A), in 58 patients with idiopathic hypothyroidism (group B) and in 55 patients with hypothyroidism after administration of radioactive iodine for Graves' disease (group C). Prevalence of MCHA in the three groups was 14.5%, 90%, and 72%, respectively, and TGHA were positive in 6.5%, 56%, and 28%, respectively. Simultaneous occurrence of both thyroid antibodies and their appearance in higher titers were significantly more frequent in group B than in the other two groups. Goitrous forms of idiopathic hypothyroidism show higher MCHA titers than the atrophic forms. There was no association between thyroid antibodies and the presence of endocrine ophthalmopathy in group C. PZA were frequently found in groups B and C (26% and 13.6%, respectively; 4.7% in controls). The higher frequency of other autoantibodies was even more pronounced for ANF (52.1% in group B, 29.7% in group C, and 12.5% in controls). NNA and SMA were also more frequent, but not to a statistically significant degree. Two patients (both in group B) had positive islet cell antibodies. MitA were equally distributed in the three groups. These results suggest a relatively high proportion of asymptomatic autoimmune thyroiditis in the female population of Switzerland, with possible progression to overt hypothyroidism. Determinations of PZA and NNA are mandatory in both Graves' disease and idiopathic hypothyroidism. Cases with positive PZA must be closely monitored in view of the association with autoimmune atrophic gastritis and pernicious anemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Autoantibodies↗
PubMed1983

[Increase of circulating thyroid hormones following oral administration of TRH in preclinical hyperthyroidism. Biological efficacy of minimal TSH stimulation].

In patients with multinodular goiter and preclinical hyperthyroidism (euthyroid values of free T4-index, free T3-index, free T4, absent TSH response to oral TRH (40 mg), i.e. TSH after TRH less than 1.0 microU/ml) a statistical increase in the serum-T3 (free T3-index), serum-T4 (free T4-index) and free T4 was observed after oral TRH. No thyroid response to oral TRH occurred in multinodular goiter patients with hyperthyroidism or in preclinically hyperthyroid +athyrotic patients under T4. The thyroid response in patients with a preclinically hyperthyroid goiter was significantly lower than the response in goiter patients with a normal TSH reserve and in controls. The results demonstrate that (1) in euthyroid TRH-TSH unresponsiveness the pituitary TSH-reserve may not be completely suppressed; (2) very small variations in TSH not detectable by the available radioimmunologic assay may be of biological importance. In euthyroid TRH-TSH-unresponsive patients under T4 (simple goiter, differentiated thyroid carcinoma) thyrotropic function may not be completely suppressed. In euthyroid TRH-TSH-unresponsive patients with an autonomously functioning adenoma, additional exogenous suppression should be evaluated for protection of paranodular tissue before ablative radioiodine is given.

Administration, Oral↗
PubMed1983

[Thyroglobulin as a tumor marker and thallium scintigraphy for the course control of differentiated thyroid cancer].

The usefulness of measurement of serum thyroglobulin (TG) concentration and whole body 201-thallium scintigraphy for follow-up were evaluated prospectively in 80 patients with differentiated thyroid cancer. All patients had undergone thyroidectomy and 131-iodine ablation. In 74 patients without residual thyroid tissue and a negative whole body thallium and/or iodine scan, the TG concentration in plasma was undetectable. In 5 of the remaining 6 patients, TG was measurable while the patient was receiving T3 therapy and undetectable in one. After 1 and 2 weeks off T3, TG increased in all 6 patients in parallel with TSH. Of 5 patients with abnormal 201Tl scintigraphy, 2 have residual local tissue and 3 distant metastases. Of these cases, 131I scintigraphy detected metastases in only one and local tissue in 2 patients. It is concluded that 1. TG is TSH-dependent and increases after withdrawal of T3 replacement therapy. 2. TG measurements under T3 replacement therapy are less sensitive than measurements made after withdrawing T3. 3. 201Tl scintigraphy can replace 131I scintigraphy in follow-up controls. 4. The combination of serum TG and 201Tl scintigraphy seems to be superior to either one alone and can be performed while patient is on replacement therapy.

Humans↗
PubMed1983

[Uremic arteriopathy and ischemic skin changes].

The syndrome of uremic arteriopathy with ischemic skin manifestations--livedo reticularis, skin infarction and ulcerative necrosis--is described in a series of 6 patients. In all patients (3 female and 3 male, age 53-73 years) the syndrome occurred after slowly progressive renal failure and in 5 cases during temporary exacerbation of chronic renal failure and after alkalinizing treatment for marked metabolic acidosis. All patients had evidence of secondary hyperparathyroidism. In 4 the Ca X P product was in excess of 4.90, but only once above the critical product of 5.60 (greater than 70 when conventional units are used). Diagnosis was based on the clinical appearance of the skin involvement and the finding of vascular calcifications (x-ray and skin biopsy). The secondary hyperparathyroidism appears to play an important role in the pathogenesis of the syndrome. An increase in plasma phosphate or Ca X P product, calciphylaxis and/or alkalinizing therapy may release the precipitation of calcium salts in the interstitium or in the vessel walls. Therapy is confined to decreasing plasma phosphate and therewith the Ca X P product by means of phosphate binders or a diet low in phosphate. The unpredictable, often rapid success of parathyroidectomy awaits further clarification.

Aged↗
PubMed1983

The relationship of serum thyrotropin (TSH) to the thyroid hormones after oral TSH-releasing hormone in patients with preclinical hypothyroidism.

Serum thyroid hormone and TSH concentrations were measured before and after oral TRH (40 mg) administration in 46 women with preclinical hypothyroidism. Preclinical hypothyroidism was defined as serum T4 in the normal range, a normal or elevated basal serum TSH, and an exaggerated serum TSH response to TRH, in the absence of clinical manifestations of hypothyroidism. The results were compared to those in 22 normal women of the same age and body mass index. Overall, the patients had significantly lower mean values for basal T4 [total T4, free T4 index (FT4 index), and free T4] but not for T3; all indices of T4 were lower in those with an elevated basal TSH, but only the FT4 was lower in patients who had normal basal TSH levels and exaggerated TSH responses to TRH. Thyroid reserve, or the increase in serum thyroid hormones after TRH (delta T4, delta FT4, and delta T3) showed an inverse correlation with basal TSH (for delta T4, r = -0.518 and P less than 0.001; for delta FT4, r = -0.442 and P less than 0.05; for delta T3, r = -0.645 and P less than 0.001). Thyroid reserve was lower than normal in those with elevated basal TSH levels, but was normal in those with exaggerated TSH responses to TRH who had normal basal TSH levels. Thus, an elevated basal TSH level, even with basal serum T4 and T3 levels in the normal range, indicates deficient thyroid reserve.

Administration, Oral↗
PubMed1982

[TRH-TSH regulation in the aged and in patients with senile dementia].

TRH-TSH-thyroid regulation has been studied in clinically euthyroid elderly patients (average age 80 years) with senile dementia (27 women, 35 men) and normal controls (18 women, 10 men). TRH (40 mg) given by mouth did not stimulate TSH in one third of all subjects. Both sexes were equally affected. No relation to senile dementia or to goiter could be established. All groups, including the group without measurable TSH response (1 mE/1) showed an increase in peripheral thyroid hormone concentration after TRH. It is suggested that the low TSH response to TRH is a consequence of diminished pituitary responsiveness to TRH. Evaluation of thyroid function and diagnosis of hyperthyroidism in the elderly after TRH should be carried out with great caution.

Aged↗