Primary Thyroid Disease Research Articles

46 ELEVATED SERUM THYROTROPIN (TSH) IN IDIOPATHIC HYPOPITUITARISM

Numerous reports have confirmed the occurrence of elevated serum TSH in idiopathic hypopituitarism, suggesting association with primary thyroid disease or production of an abnormal TSH. Eight hypopituitary children with high baseline TSH concentrations between 6.6 and 33uU/ml (Normal: X ± SD=2.30 ± 1.13) were evaluated. TSH response to TRH were exagerated, prolonged and/or delayed. Serum T4 were normal in 6/8 and low in 2. bTSH (Bovine TSH) stimulation showed increase above baseline values in T4 (range 81-158%) and T3 (range 135-340%) similar to the responses obtained in the control group (n=4, T4 = 64-183%, T3=59-441%). Antithyroid antibodies were negative in 7/8. Elevated TSH levels were suppressed following either thyroxine treatment in 2/2 patients and bTSH in 3/3. The normal T4 and T3 responsiveness to TSH stimulation and the suppression of elevated TSH suggest a normal response to thyroid gland and an intact feedback mechanism. Elevated TSH levels associated with normal or low T4 in the presence of a normally TSH responding thyroid gland suggests that the TSH detected in serum had poor biological activity.

Hypothyroidism: Clinical features and complications

Hypothyroidism may be defined as the clinical state which results from decreased production of thyroid hormones, or, very rarely, from their decreased action at a tissue level. Virtually every tissue in the body is affected to a greater or lesser extent by thyroid hormone deficiency. The clinical picture which results depends on a variety of factors -- the rate of onset of the deficiency and its severity. Though there are great individual differences in response to diminished levels of thyroid hormone, gross deficiency may sometimes be associated with only minor clinical features of the disease. Hypothyroidism occurs most frequently in women, the sex ratio of symptomatic hypothyroidism being about 10:1. Although the disease can occur at any age, most patients present between 30 and 60 years. The great majority of patients who present with hypothyroidism are suffering from primary thyroid disease. Pituitary hypothyroidism is rare and will not be considered in this chapter. It should be suspected if there is other clinical evidence of primary pituitary disease, e.g. acromegaly, Cushing's syndrome or some visual defect. The presence of circulating thyroid autoantibodies, found in the majority of patients with thyroid failure, is usually accepted, along with elevation of the serum TSH, as sufficient evidence for primary thyroid disease. The clinical syndrome of hypothyroidism was first described by Gull in 1874. The term 'myxoedema' was coined by Ord four years later, and, although Haliburton pointed out in 1893 that 'myxoedema' was not a constant feature of hypothyroidism, the terms were considered to be synonymous for many years. It was widely accepted during the early years of this century that hypothyroidism was an 'all or none' phenomenon. However, the advent of more precise diagnostic techniques has demonstrated that hypothyroidism is a graded phenomenon (Evered and Hall, 1972). The term 'myxoedema' should be reserved for that particular presentation of advanced hypothyroidism in which there is undue swelling of the skin and subcutaneous tissues.

Serum thyrotropin (TSH) in pituitary and-or hypothalamic hypothyroidism: normal or elevated basal levels and paradoxical responses to thyrotropin-releasing hormone.

ABSTRACT Using a highly sensitive and specific radioimmunoassay for thyroid-stimulating hormone (TSH), basal serum TSH levels and the response to synthetic thyrotropin-releasing hormone (TRH) were evaluated in 21 patients with unequivocal hypothyroidism resulting from pituitary or hypothalamic lesions. Baseline TSH concentrations were undetectable in only 2, being normal (n = 9) or slightly elevated (n = 10) in the rest. Three of those with elevated levels had evidence of associated primary thyroid disease. Excluding these, the mean serum TSH concentration in the remaining 18 patients (3.4 ± 0.8 (sem) μU/ml) was significantly higher (p < 0.0005) than the mean of 75 euthyroid control subjects (1.0 ± 0.1 μU/ml). Patients with hypothalamic lesions generally had higher basal TSH levels than those with pituitary lesions. Treatment with thyroxine 0.1–0.3 mg/day led to suppression of the measured TSH values. Dilutions of sera containing normal and elevated TSH levels, showed parallelism with the standard curve (...

Understanding Electrocardiography; Physiological and Interpretive Concepts

Part 1 Reproductive Physiology: Genetics/Molecular Genetics Embryology & Sexual Differentiation Hypothalamus & Reproductive Disorders Puberty Ovarian Follicular Growth & Maturation Pharmacology of Reproductive Hormones. Part 2 Dislocated Intraocular Lenses: Primary Amenorrhea Dysfunctional Uterine Bleeding Hyperprolactinemia Hyperandrogenism Polycystic Ovary Syndrome Thyroid Disease Adrenal Disease. Part 3 Contraception: Overview Metabolic Effects of Oral Contraceptives Oral Contraceptive Use & Neoplasia The Future. Part 4 Infertility Evaluation: Evaluation of the Infertile Couple Cervical Factors in Infertility Male Factor Infertility Immunologic Infertility Sperm Antibodies Diagnosis of Ovulatory Defects Luteal Phase Defects Unexplained lnfertility Emotional Aspects of Infertility Hysterosalpingography Endoscopy/Laparoscopy Semen Evaluation. Part 5 Therapy of Infertility: Induction of Ovulation Monitoring of Ovulation Induction of Ovulation with Clomiphene Induction of Ovulation with Gonadotropins Induction of Ovulation with GnRH Ovulation Hyperstimulation Adhesions Medical Treatment of Endometriosis Surgical Treatment of Endometriosis Leiomyomata Surgery of the Male Reproductive Tract. Part 6 Assisted Reproductive Technologies AIH/IUI AID Cryopreservation of Sperm Gamete Intrafallopian Transfer Oocyte Assessment In Vitro Fertilization Cryopreservation of Eggs/Embryos Donor Eggs. Part 7 Problems with Pregnancy: Reproductive Pregnancy Wastage Endocrinology of Early Pregnancy Ectopic Pregnancy Lactation and Its Disorders. Part 8 Menopause: Menopause Overview Premature Ovarian Failure Menopause and Osteoporosis Menopause and Atherosclerosis. Part 9 Specialized Procedures: Ultrasound Hysteroscopy and Endometrial Ablation Laser Surgery Microsurgical Tubal Reconstruction & Reversal of Sterilization Mullerian Duct Anomalies Radioimmunoassays.

THYROTROPHIN-RELEASING HORMONE AS A THYROID-FUNCTION TEST

The increase in serum thyroid-stimulating-hormone (T.S.H.) levels recorded twenty and sixty minutes after the intravenous administration of 200 μg. of synthetic thyrotrophin-releasing hormone (T.R.H.) can be used as a test of thyroid function. The normal range of serum-T.S.H. (95% confidence limits) at twenty minutes is 3·5-15·6 μU per ml. for men and 6·5-20·5 μU per ml. for women, and at sixty minutes 2·0-11·5 μU per ml. for men and 4·0-15·6 μU per ml. for women. Women show a significantly greater response to T.R.H. at both the times. Patients with hypothyroidism due to primary thyroid disease exhibited an exaggerated and prolonged T.S.H. response to T.R.H. Patients with hyperthyroidism did not respond at all. It is suggested that, in the absence of pituitary or hypothalamic disease, the response of serum T.S.H. to T.R.H. provides a simple, safe, sensitive, and reliable test of thyroid function.

Pituitary Enlargement Resulting from Primary Thyroid Disease

Pituitary Enlargement Resulting from Primary Thyroid Disease

Primary Hyperparathyroidism and Associated Thyroid Disease.

s1 May 1969Primary Hyperparathyroidism and Associated Thyroid Disease.V. O. Laing, M.D., Boy Frame, M.D., F.A.C.P., M. A. Block, M.D.V. O. Laing, M.D.Search for more papers by this author, Boy Frame, M.D., F.A.C.P.Search for more papers by this author, M. A. Block, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-70-5-1063_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAmong 72 (53 female and 19 male) patients with primary hyperparathyroidism 29 (40%) were found to have concomitant pathologic changes in the thyroid. The prevalence of thyroid carcinoma was 5.5%; toxic multinodular goiter, 1.4%; thyroiditis, 4.2%; and gross thyroid nodules, 29.3%. The above figures were compared with the prevalence of thyroid disease found in a random survey of 100 consecutive autopsies (60 females and 40 males) at this hospital, which showed the following: thyroid carcinoma (1%), thyroiditis (1%), and gross thyroid nodules (14%). Possible mechanisms that could help explain the occurrence of combined thyroid-parathyroid disease are discussed. It is felt... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Detroit, Michigan PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1969Volume 70, Issue 5Page: 1063-1063KeywordsAutopsyHyperparathyroidismThyroidThyroid carcinomaThyroid diseases Issue Published: 1 May 1969 PDF downloadLoading ...

De Quervain's subacute granulomatous thyroiditis: histological identification and incidence.

The histological features of de Quervain's subacute granulomatous thyroiditis are described, on the basis of a study of six specimens. This condition, unlike Hashimoto's disease, rarely causes permanent hypothyroidism; its histological identification is thus of practical importance. Areas of thyroid affected by the disease show intrafollicular cellular infiltration, with partial or complete loss of colloid from infiltrated follicles, partial or complete disruption of their lining epithelium, and abnormalities of the basement membrane. These changes tend eventually to lead to replacement of the damaged follicle by a granuloma-like structure devoid of colloid content and without a recognizable epithelial lining. The disease also causes interfollicular fibrosis and an interstitial inflammatory cell reaction. The histological pattern is typically multiform. Formative follicle lesions present a striking appearance, aiding recognition of the disease. Some follicles contain numerous giant cells, often grouped around a central pool of residual colloid; others may contain a considerable proportion of neutrophil polymorphs or show radially aligned spindle-shaped cells.A study has also been made of the incidence of de Quervain's thyroiditis in surgical material in Sheffield during the seven year period 1955-61. Only two examples were found in a total of 1,282 cases of primary thyroid disease, an incidence of 1.6 per 1,000 (0.16%); there is, however, reason to believe that the overall clinical incidence is higher than that indicated by the surgical figures.