Björn Sjögren

Thyroid hormone resistance in a 35-year old man with recurrent goitre

Without firm diagnosis a 16-year old boy was submitted to subtotal thyroidectomy because of a diffuse goitre and emotional instability. No definite improvement was obtained in the alleged toxic symptoms and the goitre recurred. During subsequent years increased serum concentrations of thyroid hormones have repeatedly been observed in the absence of clear-cut hyperthyroid symptoms. Judging from clinical examination and a normal basal metabolic rate the patient, now 35 years old, was euthyroid at the present study. Basal serum-TSH concentration was normal to slightly elevated; it was definitely abnormal in relation to the high serum concentration of free T4. Serum T4, T3 and rT3 concentrations were also abnormally high in the face of normal levels of TBG and prealbumin. Agarose gel electrophoresis revealed normal binding pattern for T4. After 200 micrograms of TRH intravenously there was an abnormally high rise of serum TSH. Concentrations of prolactin and glycopeptide-hormone alpha subunit as well as the pituitary-gonadal and adrenocortical functions were normal. Sella turcica was seemingly normal. During oral administration of T3, 160 micrograms daily for 5 days, the circulating T4, free T4 and rT3 concentrations decreased and the response to TRH was suppressed to that found in normal, untreated individuals. However, no clinical response to the drug was seen and the metabolic rate was unchanged. The patient had poor performance at school but acceptable performance at routine manual work. He had defective colour vision, a refractory anomaly, neurogenic auditory damage but no skeletal abnormalities. Laboratory investigation revealed features characteristic of partial thyroid hormone resistance in the pituitary and the peripheral tissues.

The electrocardiogram and potassium metabolism during administration of ACTH, cortisone, and desoxycorticosterone acetate.

Abstract The electrocardiogram and the potassium metabolism were studied in cases of rheumatoid arthritis during administration of ACTH, cortisone and desoxycorticosterone acetate. ACTH protein (Li) was given in daily doses of 13 to 80 mg. for ten to twenty-two days, 200 mg. of cortisone per day was given for twenty-eight and seventy-six days, and desoxycorticosterone acetate in daily doses of 20 and 30 mg. for forty-three, sixty and thirty-four days. A significant decrease in the plasma potassium level to hypokalemic values was obtained. The change of intracellular potassium, not accounted for by changes in protoplasm, was not larger than 10 per cent of total body potassium. No typical hypokalemic electrocardiograms were observed. There was no correlation between changes in the electrocardiograms and the plasma potassium level.

Renal Function in Primary Hyperparathyroidism: A Follow-up Study Two to Eleven Years after Surgery Comprising 139 Patients

Out of 160 consecutive patients operated upon for primary hyperparathyroidism, a follow-up study on renal function could be performed in 139. Clearances of inulin (CIN) and paraaminohippurate (CPAH) were determined before and after surgery in 75 of the patients. The average length of postoperative observation was 4.8 years (range 2-11 years) in this group. On average, CIN and CPAH were well maintained at the follow-up compared to the preoperative findings. This was true even for the group of patients with abnormal renal function before surgery. Only in two patients was an unequivocal decrease of CIN demonstrated. In two other subjects, however, serum creatinine showed an increase in the face of equivocal changes in CIN and CPAH.In 64 patients kidney function was evaluated only from the serum creatinine level. The average postoperative period of observation was 5.4 years (range 2-9 years). Renal function had deteriorated in two patients, one of whom suffered from chronic nephritis. Among 13 deceased patien...