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Biomedical subjects

W A Sadler

Publications and source records attributed to W A Sadler.

10 recordsLinked to original sources

A screening programme for congenital hypothyroidism: preliminary results.

Highly sensitive and precise radioimmunoassays for thyroxine (T4) and thyrotropin (TSH) in dried blood spots on filter paper cards have been developed and are used to screen newborn infants for congenital hypothyroidism. Blood spot TSH levels are measured in samples for which blood spot T4 levels fall in the lower 10 to 15 percent. There was a low recall rate of approximately one infant in every 550 screened. During a 17-month period 5225 infants have been screened for congenital hypothyroidism and two cretins have been detected. Due to very early diagnosis, both infants were commenced on T4 replacement therapy before the age of three weeks.

Congenital Hypothyroidism

Blood-spot thyrotropin radioimmunoassay in a screening program for congenital hypothyroidism.

We describe a highly sensitive and precise radioimmunoassay for thyrotropin in dried blood spots on filter paper cards. In a screening program for congenital hypothyroidism, blood-spot thyrotropin concentrations are measured in infants whose blood-spot thyroxine concentrations are in the lower 10%, and this strategy has reduced the recall rate from 1.7% (thyroxine assay alone) to 0.17%. Thyrotropin assay samples consist of discs 4.5-mm in diameter, containing about 6 microL of blood, punched from blood spots. By appropriate attention to assay conditions, a mean least-detectable thyrotropin concentration equivalent to 2.5 milliunits/L plasma has been achieved. Concomitant measurement of thyrotropin by plasma and blood-spot assays in 91 subjects yielded a Spearman rank correlation coefficient of 0.9732. An analysis of variance of the distribution volume of thyrotropin in blood spots and a covariance analysis of factors affecting blood-spot thyroxine results are presented.

Birth Weight

Low dose lithium-carbimazole in the treatment of thyrotoxicosis.

Fifteen patients with thyrotoxicosis were treated with low dose sustained release lithium carbonate 400 mg, combined with carbimazole 40 mg daily, and the therapeutic response was followed over a two week period. This response was compared with that obtained in a similar group of patient treated with carbimazole alone. Li-carbimazole treatment brought about a fall in the mean total serum T4 of 57.4% compared with a drop of 32.8% in patients treated with carbimazole alone. The mean serum T3 fell by 69.4% in the Li-carbimazole group compared with 47.3% in the group treated with carbimazole only. No lithium adverse effects were encountered.

Antithyroid Agents

Lithium associated thyroid disease--a report of 14 cases of hypothyroidism and 4 cases of thyrotoxicosis.

Thyroid function was assessed in 80 patients receiving long-term lithium therapy. Three of the 80 patients were biochemically hypothyroid and a further patient was receiving thyroxine for lithium associated hypothyroidism. A further eight patients had elevated TSH levels and eight patients had subnormal serum triiodothyronine levels. After a 24 month follow up period seven of the 80 patients have developed clinical hypothyroidism. One patient had elevated thyroid parameters and clinical features of mild hyperthyroidism. Additional clinical and laboratory data are included from seven patients with lithium associated hypothyroidism and three patients with lithium associated thyrotoxicosis who were not included in the survey population.

Adolescent

An evaluation of lithium as an adjunct to carbimazole treatment in acute thyrotoxicosis.

The rate of control of thyrotoxicosis during the first 2 weeks of treatment was documented in 63 patients. Twenty-three patients received carbimazole 40 mg plus lithium carbonate 750 mg daily and a comparable group of 20 patients were given carbimazole 40 mg plus potassium iodide 120 mg daily. In the lithium treated patients the mean percentage fall of serum T4 after 2 weeks treatment was 49% and the fall in serum T3 57%. The results were similar in the iodide treated patients; the mean falls in serum T4 and T3 being 47% and 64%, respectively. Serum lithium values varied between 0.1-1.25 mEq./l; lithium side effects were minor. In a companion study 20 patients were treated with carbimazole alone. The responses in this group were less impressive; the mean falls in serum T4 and T3 at 2 weeks being 18% and 36%, respectively. It is concluded that lithium is a safe adjunct to conventional antithyroid drug therapy in the initial treatment of acute thyrotoxicosis.

Acute Disease

Triiodothyronine radioimmunoassay in the assessment of thyroid function.

This report describes the development of a sensitive, precise, radioimmunoassay for the measurement of triiodothyronine in unextracted serum, documents serum levels of triiodothyronine in various states of thyroid dysfunction, and assesses the role of the triiodothyronine radioimmunoassay as a routine test of thyroid function.

Adolescent