Determination Of Basal Metabolic Rate Research Articles

Size matters in metabolic scaling: Critical role of the thermodynamic efficiency of ATP synthesis and its dependence on mitochondrial [formula omitted] leak across mammalian species

In this last article of the trilogy, the unified biothermokinetic theory of ATP synthesis developed in the previous two papers is applied to a major problem in comparative physiology, biochemistry, and ecology—that of metabolic scaling as a function of body mass across species. A clear distinction is made between intraspecific and interspecific relationships in energy metabolism, clearing up confusion that had existed from the very beginning since Kleiber first proposed his mouse-to-elephant rule almost a century ago. It is shown that the overall mass exponent of basal/standard metabolic rate in the allometric relationship P=P0Mb′+b is composed of two parts, one emerging from the relative intraspecific constancy of the slope (b), and the other (b′) arising from the interspecific variation of the mass coefficient, a(M) with body size. Quantitative analysis is shown to reveal the hidden underlying relationship followed by the interspecific mass coefficient, a(M)=P0M0.10, and a universal value of P0=3.23 watts, W is derived from empirical data on mammals from mouse to cattle. The above relationship is shown to be understood only within an evolutionary biological context, and provides a physiological explanation for Cope's rule. The analysis also helps in fundamentally understanding how variability and a diversity of scaling exponents arises in allometric relations in biology and ecology. Next, a molecular-level understanding of the scaling of metabolism across mammalian species is shown to be obtained by consideration of the thermodynamic efficiency of ATP synthesis η, taking mitochondrial proton leak as a major determinant of basal metabolic rate in biosystems. An iterative solution is obtained by solving the mathematical equations of the biothermokinetic ATP theory, and the key thermodynamic parameters, e.g. the degree of coupling q, the operative P/O ratio, and the metabolic efficiency of ATP synthesis η are quantitatively evaluated for mammals from rat to cattle. Increases in η (by ∼15%) over a 2000−fold body size range from rat to cattle, primarily arising from an ∼3−fold decrease in the mitochondrial H+ leak rate are quantified by the unified ATP theory. Biochemical and mechanistic consequences for the interpretation of basal metabolism, and the various molecular implications arising are discussed in detail. The results are extended to maximum metabolic rate, and interpreted mathematically as a limiting case of the general ATP theory. The limitations of the analysis are pointed out. In sum, a comprehensive quantitative analysis based on the unified biothermokinetic theory of ATP synthesis is shown to solve a central problem in biology, physiology, and ecology on the scaling of energy metabolism with body size.

Exposure to melamine cyanuric acid in adult mice caused motor activity and skeletal muscle energy metabolism disorder

Thyroid hormone has a variety of physiological functions and plays an important role in the development of central nervous system, skeletal muscle and lung, as well as body temperature regulation. Skeletal muscle is a key determinant of basal metabolic rate and systemic energy metabolism. It contains Myopsin (SLN) which plays an important role in muscle heat production and energy metabolism. Melamine cyanuric acid (MCA) is an important component of the new flame retardant, but also a chemical interfering substance that can affect the endocrine in the body. It is mainly distributed in nylon and other flame retardant substances. Therefore, in this study, male mice were exposed to MCA at 10, 20 and 30 mg/kg for four weeks. We explored the effects of MCA exposure on skeletal muscle morphology, thermogenic gene expression and motor activity to explore whether MCA exposure could induce skeletal muscle hyperthermia and energy metabolism disorders and its underlying mechanisms. The results showed that the motor activity of male mice exposed to MCA was decreased, the morphology of skeletal muscle tissue was impaired, and the levels of morphological and thermogenic genes in skeletal muscle were destroyed. These findings are intended to provide a preliminary reference for studying the effects of MCA exposure on thermogenesis and energy metabolism in adult mice.

HDAC11 is a novel regulator of fatty acid oxidative metabolism in skeletal muscle.

Skeletal muscle is the largest tissue in mammalian organisms and is a key determinant of basal metabolic rate and whole-body energy metabolism. Histone deacetylase 11 (HDAC11) is the only member of the class IV subfamily of HDACs, and it is highly expressed in skeletal muscle, but its role in skeletal muscle physiology has never been investigated. Here, we describe for the first time the consequences of HDAC11 genetic deficiency in skeletal muscle, which results in the improvement of muscle function enhancing fatigue resistance and muscle strength. Loss of HDAC11 had no obvious impact on skeletal muscle structure but increased the number of oxidative myofibers by promoting a glycolytic-to-oxidative muscle fiber switch. Unexpectedly, HDAC11 was localized in muscle mitochondria and its deficiency enhanced mitochondrial content. In particular, we showed that HDAC11 depletion increased mitochondrial fatty acid β-oxidation through activating the AMP-activated protein kinase-acetyl-CoA carboxylase pathway and reducing acylcarnitine levels invivo, thus providing a mechanistic explanation for the improved muscle strength and fatigue resistance. Overall, our data reveal a unique role of HDAC11 in the maintenance of muscle fiber-type balance and the mitochondrial lipid oxidation. These findings shed light on the mechanisms governing muscle metabolism and may have implications for chronic muscle metabolic disease management.

Low basal metabolic rate as a risk factor for development of insulin resistance and type 2 diabetes

IntroductionIdentification of physiological factors influencing susceptibility to insulin resistance and type 2 diabetes (T2D) remains an important challenge for biology and medicine. Numerous studies reported energy expenditures as one of...

Endokrin Bozukluğu Olan Hastalarda Bazal Metabolik Hızın Belirlenmesinde İndirekt Kalorimetre ile Diğer Enerji Denklemlerinin Karşılaştırılması

Amaç: Bu çalışma, endokrin hastalıklara sahip ve ayaktan tıbbi tedavi alan hastaların bazal metabolizma hızı hesaplanmasında kullanılan enerji denklemleri ile indirekt kalorimetre sonuçlarını karşılaştırarak, bu hasta grubunun enerji gereksinmesinin belirlenmesinde en doğru sonucu veren denklemlerin belirlenmesi amacı ile yapılmıştır.Bireyler ve Yöntem: Çalışma, Aralık 2016-Şubat 2017 ayları arasında Başkent Üniversitesi Ankara Hastanesi Endokrinoloji Bölümü’ne başvuran, 18-86 yaş arası, indirekt kalorimetre (IC) (COSMED, Fitmate GS) ile bazal enerji harcamaları ölçülen ve çalışmaya katılma konusunda gönüllü olan 150 hasta (%74 kadın, %26 erkek) üzerinde yapılmıştır. Bireylerin kişisel özellikleri ve yaşam tarzları anket formu ile sorgulanmıştır. Antropometrik ölçümleri ve vücut bileşimi analizleri ölçülmüş ve kaydedilmiştir. Ayrıca bireylerin antropometrik ölçümleri ve vücut bileşimleri enerji denklemlerinde kullanılarak bireylerin bazal metabolik hızları (BMH) 42 ayrı enerji denklemi ile hesaplanmıştır.Bulgular: İndirekt kalorimetre kullanımının mümkün olmadığı durumlarda endokrin hastası bireylerin BMH’nin belirlenmesinde, tüm bireylerde Harris-Benedict (HB) 1984, erkek bireylerde Lazzer (BC), yetişkin bireylerde Nelson (BC), yaşlı bireylerde HB 1984, HB 1919 ve De Lorenzo, hafif kilolu bireylerde Henry, obez ve morbid obez bireylerde ise Huang ve Japanese (sadeleştirilmiş) denklemlerinin kullanımının en doğru sonuçları vereceği belirlenmiştir. Kadın bireyler ile zayıf ve normal bireylerin BMH’lerinin belirlenmesinde ise IC ile yeterli uyuma sahip hiçbir denklem belirlenememiştir.Sonuç: Endokrin hastalığa sahip bireylerde IC kullanımının mümkün olmadığı durumlarda BMH’nin belirlenmesinde HB 1984 denkleminin kullanımının en doğru sonuçları vereceği belirlenmiştir.

The indicators of basal metabolism in inflammatory syndrome bacterial origin: predictors of prognosis or the need for timely correction?

The aim of the study was to determine the comparative significance of basal metabolism indicators and inflammatory process markers for the closest prognosis of patients in ICUs with systemic inflammation syndrome caused with infectious genesis. The paper presents the results of a retrospective analysis of the plan of treatment of 198 patients with confirmed clinical and laboratory signs of bacterial infection. The number of leukocytes, platelets, the percentage of lymphocytes, the concentration of procalcitonin, creatinine, bilirubin, C-reactive protein, acid-base balance values were determined in patients. Patients were assessed on a SOFA scale. The type of biomaterial for microbiological research was determined depending on the intended source of infectious inflammation. Identification of the isolated microorganisms was carried out using the MALDI ToF mass spectrometry method, followed by determination of antibiotic resistance. Empirical antibiotic therapy was prescribed upon admission of the patient to the ICU. Patients were switched to etiotropic antibacterial therapy after 48 hours, taking into account the results of a microbiological study. Determination of basal metabolic rate was carried out using the method of indirect calorimetry (CCM Express, Medical Graphics) with the calculation of basal metabolism, respiratory coefficient, absolute and relative amount of macronutrients. The calculation of the protein was made on the basis of the nitrogen level of the daily urine urea. Logistic analysis (ROC analysis) revealed that the antibacterial therapy strategy used, age, gender of patients, tinctorial properties of microorganisms isolated from patients, do not affect the nearest prognosis of the disease. On the contrary, SOFA score, the concentration of procalcitonin in the blood, and such parameters of the metabolic status as the need for kilocalories per kilogram of actual body weight and the percentage of protein calories significantly affect the nearest prognosis of the disease. The percentage of calories derived from protein metabolism, in the main exchange has a high reliable predictive value. The results of the study confirm the importance of adequate nutritional therapy in the treatment of patients with infectious inflammatory syndrome, including the calculation and correction of protein loss and total daily calorie.

Basal metabolic rate and energy expenditure or rural farmers in Magubike village, Kilosa district, Tanzania

Measurement of basal metabolic rate (BMR) provides an important baseline for the determination of an individual’s total energy requirement. The study sought to establish human energy expenditure of rural farmers in Magubike village in Tanzania, through determination of BMR, physical activity level (PAL) and total energy expenditure (TEE). In addition, the study intended to provide an indication of the level of energy requirement for the rural people of Tanzania. The objective of the study was to determine energy expenditure of farmers in comparison to the mean caloric intake per capita and the WHO/FAO recommended energy requirements for developing countries. A cross-sectional study design involving 33 male and 31 female farmers was conducted on randomly selected households. Basal Metabolic rate and household activities were measured by indirect calorimetry, using the Douglas bag technique. Physical activity Level was measured by twenty-four hour activity diary and TEE calculated as a product of BMR and PAL. Men’s BMR was 4.7 MJ/day while that of women was 4.3 MJ/day. Farmers mean PAL was 2.20 ± 0.25 in men and 2.05 ± 0.23 in females and TEE was 10.24 MJ/day in men and 8.57 MJ/day in women. Both BMR and TEE were higher in men than in women. The measured energy expenditure for digging and weeding were 1.57 ± 0.3 kJ/min; 1.36 ± 0.31kJ/min in men and 1.58 ± 0.3 kJ/min; 1.49 ± 0.33 kJ/min in women. It was revealed that total energy expenditure of farmers in Magubike village was high with the values being above the mean daily calorie requirement per capita for Tanzania (8.15 MJ/day) but within the WHO/FAO recommended energy requirements (11.26 MJ/day) for developing countries. High energy expenditure was attributed to high energy levels spent in farm activities which were manual and labour intensive. This is likely to be the situation in many rural areas of Tanzania. More work on measurement of costs of farm activities and farmers work capacity are necessary to provide recommendations on energy needs of rural farmers.

Post‐Metabolic Response to Exercise in Normobaric Hypoxia

The purpose of the study was to examine post‐metabolic response to constant workload exercise (CWE) under normobaric hypoxia. Seven active healthy males (age: 26±4 yrs; height: 176±4 cm; weight: 78±10 kg; BMI: 25±3 kg•m−2; VO2max: 4.0±0.3 L•min−1) randomly underwent normoxic and hypoxic (FiO2= 0.15) CWE. Each experimental session consisted of a basal metabolic rate determination (BMR), 60‐min of CWE, and 60‐min of post‐exercise metabolic rate measurement. For each condition, 24‐hr post‐treatment BMR was recorded. Absolute workload was determined during a graded cycling test in normoxia and set at 50% of participants’ peak power (314±26 W) for both conditions. There was a significant condition/time (0–20; 21–40, and 41–60‐min) interaction on post‐exercise lipid metabolism (p= 0.015). Fat contribution was 47±19%, 60±9% and 51±12% in normoxia; and 79±20%, 79±19% and 62±24% in hypoxia, for each epoch, respectively. Although not statistically significant, fat contribution 24‐hrs after the hypoxic intervention was elevated 3% above baseline. In conclusion, exercise in hypoxia contributed to an increase reliance on fat oxidation post‐treatment up to 24‐hrs. This result was explained by higher glycolytic flux during exercise under hypoxia compared to normoxia at the same absolute workload.

Correspondence on ‘‘Determination of Basal Metabolic Rate and Body Composition With Bioelectrical Impedance Method in Children With Cerebral Palsy’’

Correspondence on ‘‘Determination of Basal Metabolic Rate and Body Composition With Bioelectrical Impedance Method in Children With Cerebral Palsy’’

Effects of Measurement Duration on the Determination of Basal Metabolic Rate and Evaporative Water Loss of Small Marsupials: How Long Is Long Enough?

We examined the time course for measurement of basal metabolic rate (BMR; measured as O(2) consumption and CO(2) production) and standard evaporative water loss (EWL) for six species of small marsupial to determine the minimum time required to achieve basal/standard values. There was a highly significant effect of measurement duration on measured physiological variables with values for O(2) consumption, CO(2) production, and EWL decreasing with time for all species. The time required to attain values statistically indistinguishable from minimal differed significantly between species, but in general O(2) consumption rate reached basal values after 4.3 h, CO(2) production after 4.5 h, and evaporative water loss after 5.2 h. For 16 BMR measurements of small marsupial species in the literature, with experimental duration provided, 10 were for less than 4 h, suggesting that their BMR values might be overestimates. For EWL, three of the four published values for small marsupials may be overestimates. It is clear that appropriate experimental duration is an important component of the measurement protocol for both BMR and standardized water loss, which needs to be rigorously observed in future studies.

Determination of Basal Metabolic Rate and Body Composition With Bioelectrical Impedance Method in Children With Cerebral Palsy

This study uses the bioelectrical impedance method to assess the body composition, basal metabolic rate, and some other physical properties of children with cerebral palsy. In this study, 41 children with spastic cerebral palsy were assessed, and 56 normally developed children were included as control. Parameters such as body compositions, basal metabolic rate, body resistance, liquid compartment, and capacitance of patients and control group were measured and analyzed statistically. Basal metabolic rate, body mass index, extracellular liquid, intracellular liquid, body capacitance, and resistance differed significantly compared to the control group (P < .01), whereas extracellular mass, lean body mass, body cell mass, and fat mass did not differ significantly compared to the control group (P > .05). Parameters such as basal metabolic rate, body composition, and body resistance can be determined using the bioelectrical impedance method in children with cerebral palsy.

THE HEAT ASSOCIATED WITH EATING MEAT

![Figure][1] Physiologists have long been aware that body mass is the main determinant of basal metabolic rate (BMR) where BMR is the minimum metabolic rate of post-absorptive inactive endotherms in their rest phase and in a thermal neutral zone. Physiologists also realised that BMR scales as

A simple method of measuring total daily energy expenditure and physical activity level from the heart rate in adult men

To evaluate a simple method that uses only a heart rate monitor to predict total energy expenditure (TEE) and physical activity level (PAL) from 24 h heart rate (HR) measurements. The simple method involved the determination of the physical activity ratio (PAR) from corresponding heart rate ratios (HRR) (ratio of observed to resting HR), from an individualized calibration curve relating activities with known PAR to the HRR. Several curve fits were evaluated for this curve. The PAL was calculated from minute to minute PAR. The TEE was computed as the product of the PAL and the predicted basal metabolic rate (BMR). The accuracy of the simple method was assessed by within-subject comparisons of the simple method versus the oxygen consumption - HR method and a time and motion study. Bangalore City, India. In all, 17 healthy male subjects between 18 and 44 years were recruited for the study. None. The simple method correlated well with both the reference methods when using a calibration curve that involved the fitting of two straight lines at low and high PAR activities, respectively, to the PAR and HRR data. The mean error in TEE, as a product of BMR and PAL, was about 1%, but with limits of agreement between the methods that were about 20% of the TEE. However, the low mean error could have been due to a canceling of errors in the determination of BMR and PAL. The simple method is a relatively cheap, useful technique for evaluating TEE and PAL in resource-poor situations. It may particularly be of use in epidemiological investigations where population estimates of TEE and PAL are required.

Cost of living in free-ranging degus ( Octodon degus): seasonal dynamics of energy expenditure

Animals process and allocate energy at different seasons at variable rates, depending on their breeding season and changes in environmental conditions and resulting physiological demands. Overall total energy expenditure, in turn, should either increase in some seasons due to special added demands (e.g. reproduction) or it could simply remain at about the same level, in which case the animals must show compensatory rebalancing of other expenditures that can be reduced. To test for the alternative hypotheses of seasonal variability or compensation, we measured total daily energy expenditure (DEE) in free-living degus ( Octodon degus) at four seasons and followed this with determinations of basal metabolic rate (BMR) in the laboratory in the same individuals. DEE varied seasonally but was only significantly different (lower) in summer (non-breeding season), with a DEE:BMR ratio of only 1.6, whereas autumn, winter and spring DEE values were statistically indistinguishable from one another and showed DEE:BMR ratios ranging from 1.9 to 2.2. Our values of DEE in the field fall within the broad range of allometric expectation for herbivorous mammals in general, but the ratios of DEE:BMR are lower than expected. This, together with the lack of strong major shifts in total levels of DEE, suggests that degus are showing compensatory shifts among various categories of energy expenditure that allow them to manage their overall energy balance by minimizing total expenditure.

VALIDITY OF A LOW-FLOW PNEUMOTACH AND PORTABLE METABOLIC SYSTEM FOR MEASUREMENT OF BASAL METABOLIC RATE

The accurate measurement of physiologic variables at rest is essential for determination of basal metabolic rate (BMR). Advances in technology have led to development of portable metabolic measurement systems which allow researchers to take systems into homes for the determination of BMR. The low flow volume produced during BMR assessment has proved difficult for portable units to accurately measure. Recently a pneumotach was developed for a portable metabolic measuring system for measuring oxygen consumption (VO2), carbon dioxide production (VCO2) and minute ventilation (VE) at rest. PURPOSE The purpose of this study was to investigate the validity of the MedGraphics VO2000 portable metabolic measurement system with a Low Flow Pneumotach (Medical Graphics Corp., St. Paul, MN) for the determination of VO2, VCO2 and VE at rest. METHODS A MedGraphics VO2000 equipped with a Low Flow Pneumotach was arranged in series to a MedGraphics CPX/D metabolic system. This back to front series allowed for identical samples to be obtained by both systems thus limiting biological and environmental variability from multiple testing sessions. Twenty-two(10 M, 12 F) young(24±6 yrs) healthy participants volunteered for this study. Mean height and weight were 173.2 cm(±10.2) and 73.5 kg(±10.9), respectively. Protocol consisted of subjects arriving to the laboratory after a 12 hr fast and lying quietly in a comfortable supine position for 10 minutes before data collection began. Inspired and expired gases were collected for 60 min. RESULTS Student's T-test demonstrated no significant difference (p < .05) between VO2, VCO2, or VE. These findings coincide with significant (P < 0.05) correlation coefficients of 0.78, 0.78 and 0.71 for VO2, VCO2, and VE, respectively. Bland-Altman plots indicated good agreement between the systems for VO2, VCO2 and VE. CONCLUSION Results of this study indicate that the MedGraphics VO2000 fitted with a Low Flow Pneumotach produces comparable results for VO2, VCO2 and VE to that of the MedGraphics CPX/D unit for measures of BMR.

Does BMR represent BMR?: Overestimation in the BMR standards

An implicit assumption, that the post-absorptive resting metabolic rate (RMR) after light physical activity frequently permitted in the determination of basal metabolic rate (BMR) would not differ substantially from that measured upon awakening, was questioned as a possible factor of overestimation in the BMR standards. The supine RMRs measured with 15 overnight fasting subjects (males, aged 20–29) 10 and 20 min after awakening were 0.91 and 0.97 kcal/kg fat-free mass/h, indicating the rise of metabolic rate with time (a 7% increase in 10 minutes). After a 10-min walk, the RMRs increased by 20% as compared to the RMR taken 10-min after awakening and remained constant. The RMRs 1 to 3 h after breakfast were essentially the same as the Japanese BMR standards. All predicted basal energy expenditure from the Japanese BMR standards, Harris-Benedict equation, Robertson-Reid standards and Boothby-Sandiford standards overestimated the post-absorptive resting energy expenditure determined after a 10-min walk by 9 to 18%. Our findings suggest a possibility that the BMRs previously determined have not been rigorously standardized, and raise questions regarding the accuracy of widely used BMR standards in predicting basal energy requirements.

Studies on Human Adaptability to Climatic Conditions Reprt 7

This study was undertaken to investigate the level of basal metabolic rate (BMR) and its seasonal variation in people living in Okinawa. Determination of BMR was conducted in summer and winter during 1972 and 1973 on the same subjects consisting of 39 natives of Okinawa and 22 natives of the Japanese mainland. The results obtained were as follows:1) It was observed that the skinfold thickness and fat tissue mass were lower in the subjects native of Okinawa than in those native of the Japanese mainland (Table 1, 2). Whereas, BMR in natives of Okinawa was almost the same as that in natives of the mainland, and both were compatible with the Japanese BMR standard reported by the Ministry of Health and Welfare (Fig. 1).2) In agreement with the results of past experimental studies on Japanese, BMR of residents in Okinawa showed seasonal variations, being low in summer and high in winter (Fig. 1, Table 3). The mean variation rate of all the subjects in terms of the annual mean of BMR was 3.2%.3) Seasonal variation rate was higher in office workers with uncomplete cooling system than in those who worked and lived in airconditioned rooms (Maritime Self-Defence Force personnel) or in those receiving hard physical training (Police school students). (Table 6).4) The seasonal variation range of the outdoor temperature was about 27.99°C∼16.76°C in Okinawa and 27.16°C∼6.43°C in the Japanese mainland according to the data of the Weather Bureau. The seasonal variation range in the present study was compared to those obtained in mainland as follows;From the results reported recently in Sasebo and Nagasaki, both in mainland, by Yosida and Chen, respectively, the variation range of BMR in two months with the temperature comparable to the summer mean (27°C)and the winter mean (17°C) in Okinawa, was calculated by the present auther as ±2.6% This figure is almost the same as the value of 3.2% in summer and winter for the residents in Okinawa, obtained by the author.In view of the results of the present study, it is suggested that the range of seasonal variation of BMR for the Southwest Japanese people is controlled by the annual range of the outdoor temperature and their living environmental temperature, irrespective of Okinawa and the Japanese mainland.

Saline drinking and cloacal excretion of salt and water in the zebra finch.

ARTICLESSaline drinking and cloacal excretion of salt and water in the zebra finchE Skadhauge, and SD BradshawE Skadhauge, and SD BradshawPublished Online:01 Dec 1974https://doi.org/10.1152/ajplegacy.1974.227.6.1263MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByRenal and extrarenal regulation of body fluid compositionRe-evaluating model assumptions suggests that Australian birds are more tolerant of heat and aridity than predicted: a response to Conradie et al . 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MANAGEMENT OF HABITUAL ABORTION.

Examination of the habitual aborter should include, in addition to routine studies, a hysterogram, determination of basal metabolic rate, body temperature charting, and endometrial biopsy. Study of the husband is also recommended. Preconceptional management is aimed at improving health and nutrition, eliminating gynecologic abnormalities, and supporting an inadequate secretory endometrium. When pregnancy occurs, management calls for adequate rest, good nutrition, administration of progestogens, and frequent examination.

False diagnosis of hyperthyroidism.

An analysis is made of 228 cases in which surgery had been advised elsewhere on the basis of a misdiagnosis of hyperthyroidism. The corrected diagnosis was nervous tension and exhaustion in 112 cases; menopause, 30; physical exhaustion, 27; normal, 11; colloid goiter, 11; rheumatic endocarditis, 3; psychoneurosis, 8; hypothyroidism, 6; and miscellaneous, 20. It is believed that in the first (largest) group the most important single factor was the excessive use of coffee, tea, and tobacco; these were sometimes used in surprising amounts, sufficient to explain the nervous tension, tremor, insomnia, cardiovascular disorders, and weight loss. Determinations of basal metabolic rate gave useful information when repeated on different days with due care by experienced technicains; single determinations prove misleading. For a diagnosis of hyperthyroidism the basal metabolic rate, the proteinbound iodine test, and the radioatcive iodine test should all be significant. If the two lastnamed are not available, the iodine test should be done, consisting of the administration of 10 drops of strong iodine solution (Lugol's solution) three times a day for 10 days. Cautions in performing and interpreting this test are noted. Thyroidectomy is not an emergency operation, and needs to be justified by complete diagnostic information.