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Biomedical subjects

P G Walfish

Publications and source records attributed to P G Walfish.

At least 19 recordsLinked to original sources
PubMed1992

Prevalence and characteristics of post-partum thyroid dysfunction: results of a survey from Toronto, Canada.

In order to determine the prevalence of post-partum thyroid dysfunction in our region, 1,376 randomly selected mothers were enrolled immediately post-partum and followed prospectively over a 2 year period in a large single-center survey. Beginning at delivery, sequential clinical and laboratory assessments were conducted at 6-8 week intervals up to 1 year post-partum and a questionnaire was administered at 3 months post-partum. Among the 1,376 mothers who qualified for entry into this study, 495 (36%) completed at least 3 months follow-up and 300 (22%) completed at least 1 year of follow-up. Abnormalities in post-partum thyroid function (PTD) were detected in 82 of the 1,376 enrolled mothers for an overall minimum prevalence rate of 6.0%. Hyperthyroidism confirmed to be associated with a low 24h radioactive iodine thyroid uptake (RAIU), compatible with the post-partum painless thyroiditis syndrome (PPT) was documented in 44 (3.2% minimum prevalence of typical PPT) of which 39 (89%) had a typical biphasic (hyperthyroid to hypothyroid) PTD while 5 (11%) had only a hyperthyroid phase with a suppressed RAIU without a subsequent hypothyroid phase. Another 17 (1.2%) had transient hyperthyroidism likely due to PPT but were not confirmed by an RAIU test and did not evolve to a detectable hypothyroid phase; and, 17 mothers (1.2%) had hypothyroidism between 5-7 months post-partum without preceding hyperthyroidism, resulting in an overall minimum prevalence of 5.7% for all variants of PPT. Graves' hyperthyroidism occurred in 3 (0.2%) and toxic nodular goiter was present in 1 (0.07%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Intrathyroidal activated (Ia+) T-lymphocyte CD+ subsets and B cells in Graves' hyperthyroidism respond rapidly to propylthiouracil therapy: demonstration using fine needle aspirates and two-colour laser flow cytometry.

Using a rapid (whole blood lysis) single laser microfluorocytometric technique that permitted the simultaneous analysis of two monoclonal antibody surface markers tagged with different fluorescent dyes, the intrathyroidal (IT) and peripheral blood (PB) activated [Ia+ = DR+] T-lymphocyte CD3+ subsets and [F(ab')2+] B cells were studied in hyperthyroid patients with Graves' disease (GD) before and after 1-4 months of propylthiouracil (PTU) therapy. IT lymphocytes were obtained by serial fine needle aspiration. In untreated patients a marked quantitative (approximately < 10 fold) increase in activated (Ia+ CD3+) T-lymphocytes as well as CD4+ and CD8+ subsets, for IT compared to PB sites, was found. The percentages of Ia+ CD4+ and Ia+ CD8+ within Ia+ CD3+ were not significantly different between the two sources of T cells. F(ab')2+. B cells were significantly increased (approximately 2-3 fold) in IT compared to PB. In hyperthyroid GD patients, PTU therapy induced rapid and specific changes within the Ia+ CD3+ subsets, namely a reduction in the Ia+ CD4+ subset and an increase in the Ia+ CD8+ subset, resulting in a marked decrease in the Ia+ CD4+/Ia+ CD8+ ratio. These changes occurred in association with a reduction in serum T4 and T3 concentration. No significant changes could be detected within the total (predominantly non-activated) CD3+, CD4+ or CD8+ lymphocyte subsets within PB and only a small decrease in the CD4+/CD8+ ratio was demonstrated in IT, following PTU treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1979

A rapid double antibody non-equilibrium serum thyrotropin radioimmunnoassay suitable for primary neonatal hypothyroidism screening.

An improved double antibody radioimmunoassay for measuring human thyrotropin (h-TSH) in serum, suitable for neonatal primary hypothyroidism screening is described. The assay employs a non-equilibrium double antibody technique performed at an initial 37 degrees C followed by incubation at room temperature. Studies on the effects of various reaction parameters including time, temperature, antigen and antibody concentrations and the effect of various carrier proteins on the performance of standard curves were also performed. Using a 100-microliter serum sample for analysis, the assay sensitivity is routinely between 3 and 6 microU/mol of h-TSH (MRC 68/38) with interassay and intra-assay coefficient of variation values ranging from 6 to 14% over a wide range of control values. The incubation and phase separation is completed after 26 h with data available following automated counting and computation. Such a rapid assay facilitates a neonatal screening program for the early detection and treatment of primary neonatal hypothyroidism using either cord blood serum or early follow-up serum sampling in infants suspected on initial screening tests of an abnormality.

Cold Temperature↗
PubMed1979

Screening for congenital hypothyroidism: results of screening one million North American infants.

Pilot programs for screening of newborn infants for congenital hypothyroidism began in North America in 1972. To date, the five oldest programs (Quebec, Pittsburgh, Toronto, Oregon Regional, and New England Regional) have screened 1,046,362 infants. A total of 277 infants with congenital hypothyroidism have been detected and seven have been missed, resulting in a total of 284 affected infants in the screened population and an overall incidence of one in 3,684 live births. Of the affected infants, 246 were determined to have primary hypothyroidism, an incidence of one in 4,254 births. Ten infants with secondary-tertiary hypothyroidism were detected in Quebec, Oregon, and Toronto, an incidence of one in 68,200 births. Of all the infants with primary hypothyroidism who were adequately studied, 63% were determined to have aplastic or hypoplastic glands, 14% normal or enlarged glands, and 23% ectopic thyroid tissue. The estimated minimum incidence of infants with TBG deficiency is one in 8,913 births. Only 8 of the 277 detected infants were suspected clinically to have congenital hypothyroidism prior to the time of confirmation of the diagnosis at 4 to 8 weeks of age. The cost of screening varied from $0.70 to $1.60 per infant, depending on which costs were included in the estimate. Preliminary evidence from Quebec suggests that infants treated in the program have normal developmental testing scores at 18 months of age.

Alpha-Globulins↗
PubMed1979

The ultrasound of thyroid masses.

Ultrasonography of the thyroid gland permits differentiation between cystic, solid, and mixed lesions, allowing conservative management of cystic lesions, which constitute 20% of hypofunctioning nodules. The combination of ultrasonography and fine needle aspiration cytology appears to be a great advance in the preoperative diagnosis of nontoxic goiter and permits individualized treatment in as precise a manner as is possible at present.

Adenoma↗
PubMed1979

Results of a regional cord blood screening programme for detecting neonatal hypothyroidism.

Our regional cord blood screening programme for detecting neonatal hypothyroidism using initial cord blood thyroxine (T4) determinations, with supplemental thyrotropin (TSH), and triiodothyronine resin uptake (T3U) measurements, gave an incidence of thyroid abnormalities of 1/3000 births, with 1/5000 infants having severe primary hypothyroidism. No hypothyroid infant detected in the programme had been suspected clinically before the screening and, in retrospect, only a few babies had any signs of hypothyroidism. Supplemental TSH and T3U determinations were required on 8-12% of the population screened initially with a T4 test to avoid missing affected cases. With an initial T4 and supplementary TSH and T3U testing on cord blood serum, recalls to exclude primary hypothyroidism were reduced to 0.16% of the screened population. The incidence of abnormalities detected in this cord blood screening programme was comparable with that reported by others using neonatal dried blood screening methods, indicating that cord blood screening can be effective provided the appropriate recall criteria and transport conditions are used. Nevertheless, for several practical reasons, neonatal dried blood methods are recommended as the screening test of choice for surveying large populations over extensive geographical areas.

Female↗
PubMed1979

Serum triiodothyronine and other clinical and laboratory indices of alcoholic liver disease.

Admission serum triiodothyronine (T3) values in 124 patients hospitalized for alcoholic liver disease were correlated with clinical and laboratory indices of liver function and commonly used determinants of thyroid function. Patients with low admission serum T3 levels had significant alterations in serum albumin, bilirubin, prothrombin time, and alkaline phosphatase associated with clinical signs of portal hypertension and collateral circulation, with little difference in serum glutamic-oxaloacetic transaminase, serum gamma glutamyl transpeptidase, or serum ornithine carbamyl transferase. This group also had a significant decrease in free T3 index despite an increase in T3 uptake; the slight reduction in total thyroxine (T4) was associated with an increase in free T4 index and no change in serum thyrotropin (TSH). For patients with alcoholic liver disease, low admission serum T3 and free T3 index values when accompanied by normal serum T4, free T4 index, and TSH levels appear to be indicative of severe liver dysfunction and increased mortality risk.

Humans↗
PubMed1979

Thyroid hormones in alcoholic liver disease. Effect of treatment with 6-n-propylthiouracil.

The relationship between alcoholic liver disease and circulating thyroid hormones was investigated in 124 hospitalized patients treated with placebo or propylthiouracil (PTU) for a maximum of 46 days in a double-blind study. Serum triiodothyronine (T3) levels on admission were significantly (P less than 10(-6) and inversely correlated with the severity of alcoholic liver disease. After hospitalization, changes in T3-levels in patients with low admission T3 significantly correlated (P less than 0.001) with the degree of spontaneous improvement of liver function (placebo group). Treatment with 300 mg of PTU daily (Orrego et al. Gastroenterology 76:105--115, 1979) markedly increased the rate of improvement in severely ill patients with low T3 on admission. In this group, serum T3-levels were also increased after PTU, but this increase did not correlate with the change in the patient's condition. It is suggested that the known inhibitory effect of PTU on peripheral deiodination of T4 to T3 is marked by a more marked improvement in liver function in this group. PTU treatment in this group reduced the free T4-index and increased TSH levels markedly (16%; P less than 0.02) toward levels found in hypothyroidism. PTU did not improve the condition of mildly ill patients with normal admission T3-levels, nor did it alter free T4-index or serum TSH levels in these patients. Serum T3-levels provide a sensitive indicator of the severity of alcoholic liver disease and of its response to conventional treatment. Serum T3-levels also distinguish between a group of patients, in whom low-dose PTU administration results in a beneficial effect, and another group, in whom no therapeutic effect of PTU is observed.

Humans↗
PubMed1978

Parathyroid cysts. Medical diagnosis and management.

Two patients had asymptomatic neck masses that proved to be cystic. In each case, the lesions resolved after needle aspiration of 25 ml of clear, colorless fluid. Serum thyroid indexes and calcium levels were normal. Cyst fluid parathyroid hormone (PTH) levels were 0.56 and 1.50 ng/ml, respectively. The serum PTH level in case 1, determined at the same time, was less than 0.05 ng/ml (normal, 0 to 0.3 ng/ml). These observations indicate that (1) clear, colorless cyst fluid may indicate a parathyroid cyst, (2) serum and cyst fluid PTH levels can confirm the diagnosis, and (3) needle aspiration may be appropriate therapy for the benign, nonfunctioning parathyroid cyst.

Adult↗
PubMed1978

Sellar enlargement with hyperprolactinemia and a Rathke's pouch cyst.

A woman with secondary amenorrhea was found to have hyperprolactinemia without clinical galactorrhea. Radiological findings of an enlarged sella turcica with displacement of the pituitary stalk were considered consistent with a prolactin macroadenoma. Treatment with bromocriptine corrected the amenorrhea and hyperprolactinemia, and the patient inadvertently became pregnant. However, no complications to the mother or fetus occurred during pregnancy or postpartum. On transsphenoidal surgery three months postpartum, the unexpected presence of a large Rathke's pouch cyst with a microadenomatous or nodular hyperplasia type of prolactin-secreting tumor was observed to account for the preoperative clinical and radiological findings.

Adult↗
PubMed1978

Metastasis of cancer of the thyroid gland as a cause of goitre.

In three cases of cancer (arising in the pancreas, the breast and the lung) that had metastasized to the thyroid an unusual primary thyroid lesion was the presenting problem. While reputedly rare, metastases in the thyroid gland are not infrequently encountered at necropsy. These cases illustrate the varied causes of goitre, the value of needle aspiration and cytologic study in thyroid disease and the need for histologic vigilance. Worthwhile palliation by simple means can be obtained in such cases.

Adenocarcinoma↗
PubMed1978

Malignant pseudothyroiditis: a new clinical entity.

Six patients with thyroid cancer presented with clinical and, in most cases, biochemical features of subacute or chronic thyroiditis. Pathologic study revealed all types of cancer, including metastatic and neighborhood parathyroid malignancy. Confusion in diagnosis lead to a delay of diagnosis of one month to ten years. When thyroiditis is diagnosed, the patient should be followed carefully, including the use of needle aspiration biopsy. Where doubt exists as to diagnosis or response to treatment, open biopsy or operation may be indicated.

Adenocarcinoma↗