Alvin L. Schultz

Leydig-cell tumor of the testis with gynecomastia and elevated estrogen levels.

A normally-virilized 24-year-old white man who had gynecomastia was found to have a Leydig-cell tumor of the testis, without demonstrable metastases. Hormonal evaluation revealed negative serum and urine tests for human chorionic gonadotropin, and normal steroid excretion. Prior to orchiectomy, serum estradiol was elevated and serum testosterone depressed; postoperatively these values reverted to normal. Attempts to quantitative the estradiol content of the tumor failed to show a significant increase over normal testicular tissue, however. Histologically, the tumor showed classic Reinke crystalloids, the nature of which remains undefined. Electron-microscopic studies showed these crystals to have a regular hexagonal pattern.

The Effect of Dietary Fats on the Serum Lipoproteins of Normal Dogs

Summary The serum lipoproteins of normal dogs were studied while on different dietary regimens including low fat and various high fat diets containing coconut, olive, safflower, or menhaden oil. The serum low density (beta lipoprotein) fraction was increased nearly threefold by feeding coconut oil in contrast to the other diets which, except for a small increase with olive oil, showed little effect on the lipoproteins. High density lipoproteins, while constituting the major fraction in dogs, did not respond to the diets. Reasonably good separation into alpha and beta lipoprotein by ultracentrifugation was demonstrated by electrophoresis of the fractions on polyacrylamide gels.

Subacute Diffuse Thyroiditis: Clinical and Laboratory Findings in 24 Patients and the Effect of Treatment with Adrenal Corticoids

Because the natural course of subacute diffuse thyroiditis without treatment is extremely variable, it is difficult to evaluate therapy unless it consistently produces rapid, striking improvement; the effectiveness of cortisone and related steroids in this regard is established.Clinical and laboratory findings in 24 patients are presented. Treatment with adrenal corticoids in 15 patients (prednisolone in 14, cortisone in one) consistently produced rapid and dramatic responses. Relapses occurred in six cases, but permanent remission was achieved in every case.Therapeutic response to TSH in three cases and to antibiotics in seven cases was not impressive.

Alterations in thyroid I-131 uptake, basal metabolic rate and serum cholesterol following treatment of hyperthyroidisim with radioactive iodine:Value in early prediction of success or failure of therapy

Abstract Sixty-six hyperthyroid patients given eightynine therapeutic doses of radioiodine were evaluated before and serially after therapy in regard to clinical status, thyroid uptake, basal metabolic rate, serum cholesterol and proteinbound iodine as determined chemically. Three groups of patients—those showing failure, remission and myxedema—were distinguished by clinical criteria after adequate follow-up (average of twenty-one, seventy-seven and seventy-nine weeks, respectively). Differences in clinical severity were evident prior to treatment. Approximately two-thirds of the failure, one-third of the remission, and one-seventh of the myxedema groups were severely hyperthyroid initially. The basal metabolic rate was the only test differentiating significantly all three groups before treatment. The response groups were clearly distinguishable by the thyroid uptake as early as six to nine weeks following therapy and at each period of observation thereafter. The basal metabolic rate was almost as effective and the cholesterol somewhat less effective in differentiating failures from remissions. Though based upon very small samples, the protein-bound iodine appeared at least as effective as the basal metabolic rate. With one exception a combination of the variables was more effective than any single measure in separating the three groups at every time interval after therapy. Ninety-six per cent of those who were hyperthyroid clinically and whose uptake and basal metabolic rate were both either abnormally high or borderline at their first adequate posttherapy evaluation proved eventually to be treatment failures. Six of ten who were hyperthyroid clinically, but with either uptake or basal metabolic rate definitely normal, were treatment failures. Only 2 per cent of those who were (1) hyperthyroid clinically with uptake and basal metabolic rate both definitely normal, or (2) probably euthyroid clinically with either uptake or basal metabolic rate normal, or (3) definitely euthyroid clinically, were failures. The serum cholesterol was chiefly of corroborative value. As early as six to nine weeks, over one-half of the patients in the remission and myxedema groups but only one-twentieth of those in the failure group had non-palpable glands. At later intervals the group differences were even more striking.

Effect of coconut oil on serum lipids of normal and of thyroidectomized dogs.

Summary Thyroidectomized dogs respond to the addition of coconut oil to the diet with greater elevations of serum cholesterol concentration than do normal dogs. This greater elevation is not explained by the higher serum cholesterol level of the thyroidectomized dogs on the low-fat diet. Serum phospholipids are elevated by administration of coconut oil but there is no difference between the responses of normal and thyroidectomized dogs. Serum triglycerides are elevated in both groups of animals by coconut oil. The elevation tends to be greater in the thyroidectomized animals but the difference between normal and thyroidectomized dogs was not statistically significant.

Thyroid function tests. Selective use for cost containment.

Clinicians often obtain a variety of thyroid function tests in patients suspected of having thyroid disease when only a few are necessary to adequately establish a diagnosis and do follow-up. For hyperthyroidism and hypothyroidism, measurement of serum T4 is the best screening test. The serum T3 resin uptake test should be added with women suspected of being hyperthyroid because of the changes produced by pregnancy or estrogen-containing contraceptives. Various imaging techniques, including RAI, ultrasound, CT, and MRI, are often used for differentiating benign or cystic thyroid nodules from malignant or solid ones. Each of the available techniques has a different cost, and each is most suitable for a particular disorder. Special tests (eg, TRH testing and measurement of serum TBG) should be added to the basic screening tests only for questionable cases to differentiate diagnostic possibilities or confirm an uncertain diagnosis.