PubMed Health⌕ Search

Biomedical subjects

M L England

Publications and source records attributed to M L England.

5 recordsLinked to original sources
PubMed1986

Serum TSH concentration as an aid to monitoring compliance with thyroid hormone therapy in hypothyroidism.

To monitor the compliance of patients taking levothyroxine as replacement therapy for primary hypothyroidism, the authors measured serum thyroid-stimulating hormone (TSH), free thyroxine index (FT4I), and free triiodothyronine index (FT3I) in patients attending the endocrine clinic. During a 6-month period, there were 159 visits by 132 patients with treated hypothyroidism. Five of the 132 patients had TSH levels greater than 12 microU/ml (normal, 0.3-5.7 microU/ml), with FT3I greater than 85 (normal, 70-160) and FT4I greater than 7 (normal, 4.2-11). Four others had TSH greater than 6 microU/ml with normal FT3I and normal FT4I. These nine patients had normal thyroid tests documented on replacement therapy in the past. Five of the nine admitted to discontinuing their medicine for more than 1 week or taking it erratically. Two untreated hypothyroid patients had daily thyroid function tests after they were started on full replacement doses of levothyroxine. Both achieved FT4I greater than 4.2 by day 8 and FT3I greater than or equal to 70 by day 18, but serum TSH concentration did not fall consistently below 20 microU/ml until day 23 in one patient and day 21 in the other and did not fall to the normal range by discharge at day 37 in one patient or day 42 in the other. Thus, although treatment with levothyroxine will normalize serum T4 and T3 concentrations within 3 weeks, normalization of serum TSH may take several more weeks. This prospective study in a large out-patient clinic shows that 4% of patients with treated primary hypothyroidism may have elevation of serum TSH to more than twice the upper limit of normal, while serum T4 and T3 are clearly normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Glyburide does not alter thyroid function.

Goiter and hypothyroidism have been reported as side effects of sulfonylurea therapy. To test the effects of glyburide, a new generation sulfonylurea drug, on thyroid function, we studied 15 male Type 2 diabetic patients before and after 6 weeks of treatment with this drug, and we repeated the studies on 9 of these patients who remained on the drug for at least 24 weeks. All hypoglycemic agents were discontinued for 1 week before the study. Patients had a baseline thyroid examination, serum T4, free T4 index (FT4I), T3, and free T3 index (FT3I), fasting serum glucose (FSG), HbA1c and a TRH test of TSH reserve. The dose of glyburide was adjusted at 2 weeks, and the tests were repeated after 6 weeks and after at least 24 (24-32) weeks of glyburide therapy. Compared to baseline, there was a significant decrease in FSG at 6 weeks and again at 24-32 weeks. Body weight, thyroid size, serum FT4I, FT3I, and TSH did not change significantly. After 6 weeks of therapy, there was no significant correlation of FSG or HbA1c with FT4I, FT3I, basal or peak TSH or TSH response area. The integrated area under the TSH response curve decreased significantly in 8 patients at 24 weeks (p less than 0.05). There was a positive correlation between FSG and the area under the TSH response curve using the combined baseline and 24 week data in these patients (r = 0.73, p less than 0.01). In this study with patients acting as their own controls, there was no effect of glyburide on thyroid function or size.

Aged↗
PubMed1985

Comparison of a new ultrafiltration method for serum free T4 and free T3 with two RIA kits in eight groups of patients.

We measured serum free thyroxine (FT4) and free T3 (FT3) concentrations by a newly developed ultrafiltration (UF) method and by the Diagnostic Products Corporation (DPC) and Amersham Corporation (Amerlex) RIA methods in 173 patients divided into eight groups: 1) normal controls, II) normal elderly subjects, III) hyperthyroidism, IV) hypothyroidism, V) pregnancy, VI) critically ill, VII) chronic renal failure, and VIII) heparin therapy. The results were also compared with the free T4 index and free T3 index. FT4 (UF) and FT3 (UF) were generally normal in the elderly subjects. All methods showed elevated values in hyperthyroid patients. FT4 was normal in 7-23% of hypothyroid patients (depending on the method), and FT3 was normal in 15-27% of hypothyroid patients. Mean FT4 (UF) and FT3 (UF) were increased in pregnancy; in contrast the Amerlex RIA results were reduced in pregnancy. In critically ill patients, mean FT4 and FT3 were reduced by all methods. In heparinized patients, FT4 (UF) and FT3 (UF) were normal, but the RIA kits, especially Amerlex, gave very low values. Although the various methods gave considerably different absolute values of FT4 and FT3, there was a high degree of correlation between the ultrafiltration FT4 and FT3 and the results by the other methods.

Adult↗