Falsely low blood glucose readings by a blood glucose meter system.
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Aged↗
Biomedical subjects
J S Sawers
Publications and source records attributed to J S Sawers.
Hyperandrogenism, insulin resistance, acanthosis nigricans, and systemic lupus erythematosis associated with insulin receptor antibodies.
We report a young woman with systemic lupus erythematosis (SLE) who developed diabetes secondary to extreme insulin resistance, associated with severe hyperandrogenism and acanthosis nigricans. Her insulin resistance was found to be associated with high titers of insulin receptor antibodies. The hyperandrogenism has been favourably influenced by cyclical treatment with cyproterone acetate and ethinyl oestradiol, but the insulin resistance and acanthosis nigricans have remained unmodified after 15 months of follow up.
Acanthosis Nigricans↗
Problems of anticoagulation with warfarin in hyperthyroidism.
From clinical observation it would appear that hyperthyroid patients are particularly sensitive to the anticoagulant effects of warfarin. A study was made of clotting factors prothrombin (II), VII, procoagulant VIII (VIIIC), IX and X and of prothrombin ratio (PTR) and partial thromboplastin time with kaolin (PTT-K). These parameters and warfarin levels were measured before and following a single dose of warfarin given to five patients when hyperthyroid and again when euthyroid. Hyperthyroidism was associated with lower activity of factor II and a shorter PTT-K. Warfarin produced a greater fall in factors II and VII and a greater increase in PTR and PTT-K in the hyperthyroid state than in the euthyroid state. The enhanced response to warfarin in hyperthyroidism was, however, relatively greater for the PTR than for the PTT-K. In order to produce adequate protection against intravascular thrombosis by a suitable prolongation of the PTT-K, it may be necessary in hyperthyroid patients to extend the PTR beyond the normal therapeutic range.
Aged↗
The effect of minor increments in plasma thyroxine on heart rate and urinary sodium excretion.
We studied day/night (D:N) patterns of urinary sodium excretion and the 24 hour ambulatory electrocardiogram in seven normal subjects before and during the administration of T4. Thyroxine increased thyroid hormone levels within the normal range and inhibited the plasma TSH response to TRH. This was associated with a significant decrease in D:N sodium excretion (P less than 0.01) and D:N urine flow (P less than 0.01), a significant increase in mean nocturnal heart rate (P less than 0.01), and a lesser increment in mean daytime heart rate (P less than 0.05). These responses to small changes in thyroid hormone levels suggest that the anterior pituitary is not alone in recognising minor thyroid hormone excess. The clinical implication is that some patients with a normal T3 and T4 but an impaired TSH response to TRH might benefit from antithyroid treatment.
Adult↗
Does calcitonin cause hypocalcaemia after thyroidectomy?
Plasma calcitonin, parathyroid hormone, total thyroid hormones and calcium were measured in 6 patients before, during and after thyroidectomy for hyperthyroidism. In 4 patients, plasma calcium fell postoperatively by 0.23--0.46 mmol/l, but there was no change in calcitonin or parathyroid hormone levels. In one patient, in whom there was a postoperative fall in plasma calcium of 0.55 mmol/l, thyroid hormones rose to a peak at 1 h and calcitonin to a peak at 12 h after resection. However, the rise in calcitonin occurred 8 h after the initial decrease in plasma calcium. In this patient, parathyroid hormone levels showed a slight rise only. It is concluded that, while thyroid hormones and calcitonin may leak from the damaged thyroid remnant after surgery, it is unlikely that calcitonin is important in the production of postoperative hypocalcaemia. However, impaired parathyroid hormone secretion may be a contributing factor.
Adolescent↗
Nocturnal natriuresis in hyperthyroidism.
We measured urine flow and the renal excretion of total solute, sodium, potassium and calcium in eleven patients with hyperthyroidism before and after treatment. Mean nocturnal sodium excretion was significantly greater (P less than 0.05) during hyperthyroidism and was unaccompanied by any significant alterations in day time or 24-h values. As a result of this nocturnal natriuresis in hyperthyroidism significant changes were noted in the ratios of day/night sodium excretion (P less than 0.005) and urinary flow (P less than 0.05). The change in ratio of day/night sodium excretion resulting from treatment of hyperthyroidism was shown to correlate significantly with the change in plasma total triiodothyronine (r=0.73, P less than 0.01). Twenty-four hour urinary calcium output was significantly greater (P less than 0.02) in hyperthyroidism but there was no significant alteration in the day/night pattern of excretion.
Adult↗
What is the significance of raised plasma TSH levels after thyroid surgery?
Thyroid function was assessed prospectively for five years in 73 patients treated surgically for Graves's disease. No patient developed hypothyroidism after the sixth postoperative month, despite the presence of raised plasma TSH levels in 70 per cent of euthyroid patients at the end of the first year. Indeed, in those with evidence of temporary hypothyroidism (low T4, raised TSh at 3 months but normalisation of T4 at 6 months) plasma TSH continued to fall for up to three years. The majority (6) of patients developing recurrent hyperthyroidism did so within the first year, but in one of three patients who relapsed subsequently, plasma TSH had been elevated at one year. Plasma TSH cannot be used to predict thyroid status following surgery for Graves' disease. Although regular review remains necessary, it should not include measurement of TSH unless this is needed to confirm the validity of a low thyroxine level after the third postoperative month and before starting permanent replacement therapy.
Adult↗
Prolactin response to metoclopramide in hyperthyroidism.
The response of PRL to the oral administration of the dopamine receptor-blocking agent metoclopramide and the effect of metoclopramide on the TRH-induced release of PRL and TSH were measured in eight patients with hyperthyroidism and in eight age- and sex-matched euthyroid controls. As expected from the known direct inhibitory influence of thyroid hormones on pituitary TSH secretion, there was no TSH rise in response to metoclopramide in either group. PRL levels, on the other hand, rose significantly after the administration of metoclopramide in both the hyperthyroid and euthyroid subjects (P less than 0.0005 at 60 and 120 min). However, the increase in PRL at 120 min was significantly less in the hyperthyroid subjects than in the euthyroid controls (P less than 0.0025). Furthermore, the administration of metoclopramide failed to reestablish normal responsiveness of either PRL or TSH to TRH in the hyperthyroid subjects. We have previously suggested that thyroid hormones inhibit PRL secretion by stimulating the hypothalamic secretion of dopamine. These results suggest, however, that elevated levels of thyroid hormones also inhibit PRL release directly at the anterior pituitary level.
Administration, Oral↗
Plasma exchange in conjunction with immunosuppressive drug therapy in the treatment of endocrine exophthalmos.
We describe three patients who developed severe endocrine ophthalmopathy at 3, 12 and 18 months after treatment with iodine-131. In two cases with congestive ophthalmopathy steroids alone and plasma exchange alone failed to produce a satisfactory response, but the combination of plasma exchange with steroids or steroids plus cyclophosphamide was followed by resolution of papilloedema and return of visual acuity to normal as well as definite improvement in the other signs of ophthalmopathy. In the remaining case, which did not have papilloedema the signs of ophthalmopathy were progressive despite treatment with steroids. Combined treatment with plasma exchange, steroids and cyclophosphamide resulted in improvement in visual acuity and resolution of periorbital oedema and diplopia. Plasma exchange may be a useful adjunct to immunosuppressive therapy in the treatment of acute progressive endocrine exophthalmos.
Aged↗
Galactorrhoea after withdrawal of bromocriptine.
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Adult↗
Combination of potassium iodide and propranolol in preparation of patients with Graves' disease for thyroid surgery.
We assessed the efficacy of the combination of propranolol and potassium iodide in the preparation of patients with Graves' disease for thyroid surgery. Potassium iodide was given orally in a dose of 60 mg three times a day for 10 days before operation in 10 patients who were already receiving propranolol. In contrast to previous experience with either drug used singly, the combined regimen caused a significant fall in mean serum total thyroxine and triiodothyronine to levels in the euthyroid range before operation (P less than 0.001). There was also a significant fall (P less than 0.05) before operation and transient rise after operation in serum reverse triiodothyronine. These preliminary results suggest that the combination of potassium iodide and propranolol may prove to be the optimum preoperative preparation for patients with Graves' disease.
Adult↗
Transient hypothyroidism after iodine-131 treatment of thyrotoxicosis.
Thirty consecutive patients with thyrotoxicosis were followed up at monthly intervals for 6 months after treatment with iodine-131. Serum total T4, serum total T3, and serum TSH response to TRH were measured at each review. Biochemical evidence of hypothyroidism (low T4 raised basal TSH) developed in 18 patients 1-4 months after treatment. In 5 of these patients, symptoms and signs of hypothyroidism remained absent or minimal and spontaneous recovery of thyroid function occurred during the ensuing 2 months. If biochemical hypothyroidism occurs during the first 6 months after radioiodine therapy, it is recommended that T4 replacement be withheld for 2 months unless the severity of symptoms demands treatment.
Adult↗
Influence of thyroid status on dopaminergic inhibition of thyrotropin and prolactin secretion: evidence for an additional feedback mechanism in the control of thyroid hormone secretion.
Serum TSH and PRL concentrations were measured after the randomized oral administration of either metoclopramide, L-dopa, or placebo on 3 consecutive days to five patients with overt primary hypothyroidism (low serum total T4 and raised serum TSH) and to five patients with subclinical hypothyroidism (normal serum total T4 and raised serum TSH). In both groups there was a rise in serum TSH and PRL concentrations after metoclopramide and a fall after L-dopa when compared with the effect of the placebo. However, the rise in serum TSH and PRL concentrations was significantly greater in patients with subclinical hypothyroidism compared to that in patients with overt hypothyroidism. It was not possible to show any significant difference in the degree of fall of these pituitary hormones after L-dopa administration in the two groups. These results suggest that in addition to the established negative feedback of thyroid hormones at the level of anterior pituitary thyrotropes, there is a previously unrecognized effect of thyroid hormones at the hypothalamus, resulting in increased dopaminergic inhibition of TSH release. Stimulation of hypothalamic dopamine by thyroid hormones also inhibits PRL secretion.
Feedback↗
Effect of a coronary care unit on mortality from acute myocardial infarction.
The mortality from acute myocardial infarction was compared for 2 years before the introduction of a coronary care unit (C.C.U.), and three and a half years after. The difference was not significant statistically (18% before, and 15% after). There was no reduction in the incidence of cardiac arrest in the C.C.U. period, but resuscitation from cardiac arrest was more successful. The results are considered in the light of previous studies, and the current status of coronary care in district general hospitals is discussed.
Adult↗
The value of islet cell antibody in predicting secondary failure of oral hypoglycaemic agent therapy in Diabetes mellitus.
The sera of 160 diabetics who were well controlled by oral hypoglycaemic agents (OHA) for at least three months after diagnosis were tested for pancreatic islet cell antibodies (ICAb) either at diagnosis or within two years after diagnosis. 129 were non-obese at diagnosis and of these ICAb was detected in the sera in 20 (16%). 31 were obese at diagnosis and of these ICAb was detected in the sera in three (10%). All of the 160 diabetics were insulin independent at the time of testing the serum for ICAb. The presence of ICAb was associated with a high probability of becoming insulin dependent, calculated from actuarial statistics. 86% of ICAb positive patients initially controlled on OHA may be expected to be insulin dependent at five years from diagnosis as compared to 18% of ICAb negative patients. Obesity at diagnosis did not significantly affect the probability of becoming insulin dependent. ICAb positive diabetes controlled by OHA can be regarded as a less severe form of insulin-dependent (Type I) diabetes.
Administration, Oral↗
Bacteriuria and autonomic nerve function in diabetic women.
Significant bacteriuria (viable count greater than or equal to 10(5)/ml) was found on single testing in 10% of 400 consecutive diabetic women aged 15-65 yr routinely attending a diabetic clinic. Twenty patients with and 21 without significant bacteriuria were then randomly selected for measurement of cardiovascular autonomic reflexes, bladder ultrasound, and mictiography. There were no significant differences between these two groups in age, duration and type of diabetes, glycosylated hemoglobin, blood urea, and creatinine. Abnormalities of cardiovascular autonomic function were more common in the bacteriuric group (P less than .01). Although the bacteriuric group voided a smaller volume of urine, none had evidence of increased residual bladder volume of urine on ultrasound. Diabetic women with cardiovascular autonomic neuropathy appear to be at increased risk of developing bacteriuria. However, age is probably the most important factor influencing the prevalence of bacteriuria in diabetic and in nondiabetic women.
Adolescent↗