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Journal of Endocrinological... Sep 1991We herein describe a family with thyroid hormone resistance. Thyroid hormones and basal TSH were elevated. Pituitary tumor or abnormality in thyroid hormone binding...
We herein describe a family with thyroid hormone resistance. Thyroid hormones and basal TSH were elevated. Pituitary tumor or abnormality in thyroid hormone binding proteins were ruled out by appropriate tests. Mother and sister of the propositus presented similar abnormal hormonal features but no hyperthyroidism. Initially the patient was treated with carbimazole (30 mg/day): three months later a dramatic increase in the size of the thyroid gland and in TSH levels (12.5 to 28 mU/l) were noted. Thereafter, dextrothyroxine (D-T4) and 3, 5, 3'-triiodothyroacetic acid (TRIAC) were given consecutively and treatment was accompanied by a decrease of TSH levels (2 mU/l) but thyroid hormone remained elevated. The symptoms and signs of hyperthyroidism improved with the addition of propranolol (30-60 mg/day). In conclusion, the present report describes a new family with the syndrome of THR and variable degrees of involvement among relatives. We suggest the usefulness of TRIAC therapy to decrease TSH levels and propranolol to improve thyrotoxicosis due to pituitary resistance to thyroid hormone.
Topics: Adolescent; Child; Drug Therapy, Combination; Female; Humans; Hyperthyroidism; Pituitary Gland; Propranolol; Thyroid Hormones; Triiodothyronine
PubMed: 1774450
DOI: 10.1007/BF03347890 -
Magnetic Resonance in Medicine Mar 199131P NMR spectroscopy was used to monitor the cardiac energy metabolism in hypothyroid rat hearts. Differential alterations in phosphocreatine and inorganic phosphate... (Comparative Study)
Comparative Study
31P NMR spectroscopy was used to monitor the cardiac energy metabolism in hypothyroid rat hearts. Differential alterations in phosphocreatine and inorganic phosphate levels were observed upon treatment of hypothyroid animals with DT4 and LT4, while both agents were equipotent in reducing cholesterol. These results show potential for NMR spectroscopy as a technique to determine therapeutic selectivity.
Topics: Adenosine Triphosphate; Animals; Anticholesteremic Agents; Cholesterol; Dextrothyroxine; Energy Metabolism; Heart; Hypothyroidism; Magnetic Resonance Spectroscopy; Male; Myocardium; Phosphates; Phosphocreatine; Rats; Rats, Inbred Strains; Thyroxine
PubMed: 2062236
DOI: 10.1002/mrm.1910180125 -
European Journal of Clinical... 1991Niacin was one of the treatments compared in the Coronary Drug Project, a placebo-controlled, multicenter trial of lipid-lowering drugs in the secondary prevention of... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Niacin was one of the treatments compared in the Coronary Drug Project, a placebo-controlled, multicenter trial of lipid-lowering drugs in the secondary prevention of coronary heart disease. A total of 1119 men, aged 30-64 at entry, were randomized to niacin and 2789 to placebo by the end of recruitment in March 1969. Although side-effects interfered with adherence to the niacin regimen, it was the most effective agent in achieving cholesterol-lowering (10% overall); other agents in the trial were clofibrate, dextrothyroxine, and conjugated equine estrogens. At the scheduled conclusion of the trial in February 1975, the niacin-treated group exhibited a statistically significantly lower incidence of definite, non-fatal myocardial infarction (MI) than the placebo group. There was a trend toward improvement in the life-table mortality curve, but this was not statistically significant. In 1981 an extended follow-up was carried out concerning vital status for the 6008 men who were still alive at the end of treatment and active follow-up in the trial in 1975 (827 in the niacin group and 2008 in placebo groups). Vital status was determined for 99.1% of these men after a mean of 9 years from conclusion of the trial. In the group previously randomized to niacin, there were 69 (11%) fewer deaths than were expected on the basis of mortality in the placebo group. This difference was significant (z = -3.52; P = 0.0004). The data also suggested that patients with a higher baseline cholesterol experienced greater benefit from niacin therapy, as did those with the best response to the drug.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adult; Coronary Disease; Double-Blind Method; Follow-Up Studies; Humans; Male; Middle Aged; Niacin
PubMed: 2044644
DOI: No ID Found -
Padiatrie Und Padologie 1991This overview shows the present state of the art in the treatment of glycogen storage diseases (GSD) illustrated by some characteristic courses of glucose-6-phosphatase... (Review)
Review
This overview shows the present state of the art in the treatment of glycogen storage diseases (GSD) illustrated by some characteristic courses of glucose-6-phosphatase deficiency (GSD type I) and of phosphorylase b-kinase deficiency (GSD type VIa). In the majority of our patients suffering from GSD type I the combination of nocturnal gastric drip feeding (GDF) using oligosaccharides with frequent daytime meals using high amounts of glucose, it's polymers and low amounts of uncooked starch is better accepted and more effective than a round the clock diet using high amounts of uncooked starch without the use of GDF. In one of three patients suffering from GSD type VIa dextro-thyroxine has been shown to be very effective concerning linear growth velocity, liver size, hyperlipidaemia and hypertransaminasaemia. Finally, the need and availability of prenatal diagnosis is discussed in view of the rather limited therapeutical efficacy in most of the GSD.
Topics: Child, Preschool; Enteral Nutrition; Female; Glucose Solution, Hypertonic; Glycogen Storage Disease; Glycogen Storage Disease Type I; Humans; Infant; Infant, Newborn; Male; Pregnancy; Prenatal Diagnosis; Starch
PubMed: 1905390
DOI: No ID Found -
Hormone Research 199114 years ago, a 5.7-year-old healthy girl was treated with desiccated thyroid for a goiter and elevated TSH levels. The goiter disappeared and TSH levels were...
14 years ago, a 5.7-year-old healthy girl was treated with desiccated thyroid for a goiter and elevated TSH levels. The goiter disappeared and TSH levels were normalized. However, hyperthyroidism appeared. Without therapy, the goiter reappeared and hyperthyroidism aggravated. Based on hormone values, TSH-induced hyperthyroidism was diagnosed. After exclusion of neoplastic TSH secretion, treatment with dextrothyroxine (DT4) was initiated at age of 10 years and continued during the last 10 years (except for short periods). The girl became euthyroid, has no goiter and normal TSH values. Since thyrotrophs and peripheral tissues are probably normally sensitive to T4, we postulate that her hypothalamopituitary-thyroid control is operating on a higher set point level for T4.
Topics: Adolescent; Dextrothyroxine; Female; Growth Hormone; Humans; Hypothyroidism; Longitudinal Studies; Radioimmunoassay; Thyrotropin; Thyroxine; Triiodothyronine
PubMed: 1802825
DOI: 10.1159/000181905 -
European Heart Journal Dec 1990The Lipid Hypothesis, which states that lowering blood cholesterol levels should significantly reduce the incidence of coronary heart disease (CHD), has been repeatedly... (Review)
Review
The Lipid Hypothesis, which states that lowering blood cholesterol levels should significantly reduce the incidence of coronary heart disease (CHD), has been repeatedly tested in primary and secondary intervention trials. Viewed as a whole, it is apparent that the incidence of CHD in treated groups decreased in proportion to the degree of plasma cholesterol reduction. An early study at the Wadsworth Hospital in Los Angeles showed that a diet high in polyunsaturated fat and low in cholesterol reduced the incidence of CHD. The Oslo study of diet and smoking intervention demonstrated a significant decrease in CHD concomitant with a 13% reduction in serum cholesterol achieved through a low saturated-fat diet and cessation of smoking. In the World Health Organization primary prevention trial, clofibrate reduced serum cholesterol by 9% and first clinical episodes of myocardial infarction by 20%. There was a 37% rise in total mortality, but no causal link with clofibrate has been found, and this was not significant when corrected for age at death. A secondary trial, the Coronary Drug Project, demonstrated that oestrogen and dextrothyroxine were clearly toxic. In this trial, niacin produced a 10% fall in serum cholesterol and mortality was 11% lower than in the placebo group after long-term follow-up. The Lipid Research Clinics-Coronary Primary Prevention Trial (LRC-CPPT) found an 8% reduction in plasma cholesterol and a 19% reduction in the incidence of CHD in the group treated with cholestyramine compared with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Animals; Arteriosclerosis; Cholesterol; Clinical Trials as Topic; Coronary Disease; Humans; Primary Prevention; Risk Factors; Smoking; Smoking Prevention
PubMed: 2073909
DOI: 10.1093/eurheartj/11.suppl_h.15 -
JAMA Apr 1990Data from two pharmaceutical marketing research databases, the National Prescription Audit and the National Disease and Therapeutic Index, were used to study trends in...
Data from two pharmaceutical marketing research databases, the National Prescription Audit and the National Disease and Therapeutic Index, were used to study trends in outpatient use of cholesterol-lowering drugs in the United States from 1978 through 1988. Retail pharmacies dispensed an estimated 4.4 million prescriptions for cholesterol-lowering drugs in 1978. This declined to 2.6 million in 1983 and increased dramatically to nearly 13 million in 1988. This fivefold increase between 1983 and 1988 was accounted for primarily by the introduction and use of two new drugs, gemfibrozil and lovastatin, and, to a lesser extent, by the increasing use of some older drugs. In 1988, after 1 full year of marketing, lovastatin was the leading cholesterol-lowering drug, followed closely by gemfibrozil; both drugs are currently considered second-line agents. Clofibrate and dextrothyroxine, drugs that ranked first and second in 1978, declined to ranks of sixth and eighth out of eight in 1988. Cholestyramine, gemfibrozil, and lovastatin accounted for about 75% of all lipid-lowering prescriptions in 1988. From 1978 through 1988, an average 54% of individuals using cholesterol-lowering drugs were 60 years of age or older. The 13 million prescriptions for cholesterol-lowering drugs in 1988 represent a maximum estimate of 13 million treated individuals. This number compares with the 60 million Americans with high cholesterol levels who are candidates for dietary advice, and, if cholesterol levels do not improve, for combined diet and drug intervention.
Topics: Anticholesteremic Agents; Data Collection; Drug Utilization; Humans; Information Systems; Medicine; Outpatients; Practice Patterns, Physicians'; Specialization; United States
PubMed: 2319684
DOI: No ID Found -
Clinical Endocrinology Feb 1990Selective pituitary resistance to thyroid hormone (PRTH) is responsible for thyrotoxicosis due to inappropriate secretion of TSH. The TSH suppressive action of... (Clinical Trial)
Clinical Trial
Selective pituitary resistance to thyroid hormone (PRTH) is responsible for thyrotoxicosis due to inappropriate secretion of TSH. The TSH suppressive action of D-thyroxine (DT4) has been previously documented in euthyroid and hypothyroid subjects. This prompted us to treat with DT4 three patients with PRTH uncontrolled by anti-thyroid drugs (ATD) alone or supplemented with bromocriptine, and whose follow-up had been complicated by atrial fibrillation in two patients. Because of 100% cross-reactivity between the D and L isomers of T4 and T3 in our RIAs, thyroglobulin (Tg) was used as an index of thyroid secretion. Under ATD, TSH and Tg levels were respectively: 35 mIU/l and 670.5 pmol/l (patient 1), 87 mIU/l and 453 pmol/l (patient 2) and 110 mIU/l and 906 pmol/l (patient 3). When DT4 was added (patient 1, 3 mg daily; patients 2 and 3, 2 mg daily) to the same dose of ATD, plasma TSH and Tg levels fell but were still over the upper limit of normal and thyrotoxicosis persisted as illustrated by a recurrence of atrial fibrillation in one patient. When ATD were withdrawn and DT4 given alone (2 mg daily) all symptoms subsided within 1 month while TSH and Tg levels fell within the normal range. TSH normalization was documented within 1 week in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adult; Clinical Trials as Topic; Dextrothyroxine; Female; Humans; Male; Middle Aged; Pituitary Gland; Thyroglobulin; Thyroid Hormones; Thyrotoxicosis; Thyrotropin
PubMed: 2189602
DOI: 10.1111/j.1365-2265.1990.tb00858.x -
Experimental Parasitology Dec 1988The structure and concentration of sterol in a lipid-defined artificial medium affected the development of the entomogenous nematode, Steinernema feltiae (= Neoaplectana...
The structure and concentration of sterol in a lipid-defined artificial medium affected the development of the entomogenous nematode, Steinernema feltiae (= Neoaplectana carpocapsae). The nematode grew normally in vitro when the medium was supplemented with delta 5-desalkylsterol (cholesterol) or delta 5-desalkylsteryl ester (cholesterol oleate). The minimum amount of cholesterol in the medium that was necessary to support the development of S. feltiae to the climax population (i.e., dauer stage) was 0.0025%. The nematode also completed its life cycle normally when delta 0- or delta 7-desalkylsterols (cholestanol and lathosterol) were substituted for cholesterol. In contrast, development was inhibited when the medium contained delta 5,7-desalkylsterol (7-dehydrocholesterol); however, the nematode population reached the climax stage, in medium containing this sterol, when cholesterol was also present. S. feltiae was able to utilize delta 5- and delta 0-24 alpha-ethylsterols (sitosterol and sitostanol) as dietary sterols; however, when a delta 22-bond was introduced into the side chain (stigmasterol) the rate of development of the nematode slowed significantly. The growth of the nematode was also retarded when the medium contained delta 5,7,22-24 beta-methylsterol (ergosterol). The nematode population reached the climax stage in medium containing delta 8,24-4,14 alpha-trimethylsterol (lanosterol) only when cholesterol was also present. When S. feltiae was exposed to certain hypolipidemic agents, which are known to lower the level of lipids in human plasma (clofibrate, cholestyramine resin, niacin, and D-thyroxine), all but D-thyroxine affected the growth and development of the nematode in vivo (in Heliothis zea) and/or in vitro. Therefore further studies are warranted to determine how these drugs affect the lipid biochemistry of this nematode.
Topics: Animals; Anticholesteremic Agents; Caseins; Cholesterol; Cholestyramine Resin; Clofibrate; Culture Media; Dextrothyroxine; Female; Globulins; Hemin; Hydrogen-Ion Concentration; Male; Moths; Myoglobin; Nematoda; Niacin; Sterols
PubMed: 3191959
DOI: 10.1016/0014-4894(88)90073-2 -
The Journal of Clinical Endocrinology... Nov 1988A 15-month-old boy had clinical features of hyperthyroidism. In spite of elevated serum thyroid hormone levels (mean serum T4, 230 nmol/L; T3, 4.2 nmol/L), serum TSH...
A 15-month-old boy had clinical features of hyperthyroidism. In spite of elevated serum thyroid hormone levels (mean serum T4, 230 nmol/L; T3, 4.2 nmol/L), serum TSH levels ranged between 3.3-5.6 mU/L and rose to 35.4 mU/L after TRH stimulation. There was no abnormal serum thyroid hormone binding or any evidence of a pituitary tumor. The boy was treated with carbimazole for 6 months and became euthyroid. However, his thyroid size enlarged, and serum TSH rose to 45 mU/L. In an attempt to suppress TSH secretion, 3,5,3'-triiodothyroacetic acid was added to carbimazole in daily doses from 0.7-1.4 mg. This combined therapy failed to suppress TSH secretion (serum TSH, 10.2 mU/L) and led to recurrence of symptoms of hyperthyroidism. A trial using highly purified dextrothyroxine (contamination by L-T4, 0.05%) as sole therapy then was carried out. Serum TSH levels promptly declined to normal, both basally and after TRH stimulation (basal, 2.4 mU/L; peak, 13.8 mU/L). During a 24-month follow-up period, the boy remained euthyroid. Serum TSH levels remained in the normal range, as did his serum L-T4 levels (93 nmol/L). Complete remission was achieved using a 5-mg daily dose of D-T4. Temporary discontinuation of D-T4 led to prompt relapse of hyperthyroidism. Our patient's TSH hypersecretion appears to be due to selective pituitary resistance to thyroid hormones. Purified D-T4 effectively inhibited TSH secretion in this patient, without inducing significant side-effects, even when the daily dose was high. The cause of partial pituitary unresponsiveness to thyroid hormones is not known. We suggest that transport of thyroid hormones into the thyrotroph cells could be deficient in our patient.
Topics: Dextrothyroxine; Drug Resistance; Humans; Hyperthyroidism; Infant; Male; Pituitary Gland; Thyroid Hormones; Thyrotropin
PubMed: 3182960
DOI: 10.1210/jcem-67-5-1089