J. Grimley Evans

The spectrum of thyroid disease in a community: the Whickham survey.

A survey has been conducted in Whickham, County Durham, to determine the prevalence of thyroid disorders in the community. Two thousand seven hundred and seventy‐nine people (82.4% of the available sample) were seen in the survey. The prevalence of overt hyperthyroidism was 19/1000 females rising to 27/1000 females when possible cases were included, compared with 1.6–2.3/1000 males. The prevalence of overt hyothyroidism was 14/1000 females rising to 19/1000 females when possible cases were included, compared with less than 1/1000 males. The prevalence of spontaneous overt hypothyroidism (excluding iatrogenic cases) was 10/1000 females or 15/1000 females including unconfirmed cases. Minor degrees of hypothyroidism were defined on the basis of elevated serum thyrotrophin (TSH) levels in the absence of obvious clinical features of hypothyroidism. TSH levels did not vary with age in males but increased markedly in females after the age of 45 years. The rise of TSH with age in females was virtually abolished when persons with thyroid antibodies were excluded from the sample. TSH levels above 6 mu/1 were shown to reflect a significant lowering of circulating thyroxine levels and showed a strong association with thyroid antibodies in both sexes, independent of age. Elevated TSH levels (>6mu/l) were recorded in 7.5% of females and 2.8% of males of all ages. Thyroglobulin antibodies were present in 2% of the sample. Thyroid cytoplasmic antibodies were present in 6.8% of the sample (females 10.3%, males 2.7%) and their frequency did not vary significantly with age in males but increased markedly in females over 45 years of age. 3% of the sample (females 5.1%, males 1.1%) had thyroid antibodies and elevated TSH levels and the relative risk of a high TSH level in subjects with antibodies was 20:1 for males and 13:1 for females, independent of age. Small goitres (palpable but not visible) were found in 8.6% of the sample and obvious goitres (palpable and visible) in 6.9%. Goitres were four times more common in females than in males and were most commonly found in younger rather than older females. TSH levels were slightly but not significantly lower in those with goitre than in those without goitre. There was a weak association between goitre and antibodies in females but not males.

LIPID PROFILES AND CARDIOVASCULAR DISEASE IN THE WHICKHAM AREA WITH PARTICULAR REFERENCE TO THYROID FAILURE

The age and sex distribution of ischaemic heart disease (IHD), other vascular disorders and serum lipid concentrations and the possible association between these factors and thyroid failure have been examined in a community survey. A past history of IHD occurred in 7.5% of males and 4.8% of females.‘Chest pain on effort’was found in 7.4% of males and 7.8% of females and‘possible infarction’in 5.4% of males and 3.8% of females. Major ECG changes were found in 4.7% of both sexes and minor changes in 6.5% of males and 11% of females. Intermittent claudication was present in 4.8% and cerebrovascular accidents had occurred in 2% of the sample. Diastolic blood pressures greater than 100mmHg were found in 13% of all males and 11% of all females. Cholesterol concentrations were normally distributed. Mean cholesterol rose by approximately 0.25 mmol/1/decade in both sexes to reach a maximum in the 55–64 years age group and declined slightly thereafter. Trigly‐ceride values were skewed to the right and increased by 0.2 mmol/1/decade in males up to the 45–54 years age group and by 0.1 mmol/1/decade in females to a peak in the 65–74 years age group — and declined after these ages. Electrophoresis revealed Type IIa patterns in 3% of males and 9% of females, IIb in 1% of both sexes and Type IV in 13% of males and 3% of females. There was no association in males between IHD and thyroid antibodies or minor degrees of thyroid failure. There was a weak association between minor ECG changes and minor degrees of hypothyroidism (but not thyroid antibodies) in females which was independent of other variables. The significance of this observation depends upon the interpretation of the ECG abnormalities and will only be established by longitudinal studies. No association was noted between lipid concentrations and thyroid antibodies or minor degrees of hypothyroidism.

A prospective study of fractured proximal femur: Incidence and outcome

A prospective study was made of all cases of fractured proximal femur arising in a defined population of persons aged 65 and over in Newcastle upon Tyne. Incidence rates, which were higher than in other United Kingdom studies, showed a broadly exponential increase with age and were higher in women than in men. Comparison with a retrospective study for 1971 showed no evidence of a secular increase in incidence rate. The six month fatality proportion was 40·3% and only one-third of survivors classified themselves as fully mobile at six months from injury. Mean length of hospital stay was 59 days and 82% of patients underwent an operative procedure. There was evidence of a high incidence of proximal femur fractures among persons living in Residential Homes and Psychiatric Hospitals. Two-thirds of the injuries occurred in a domestic setting. There was no evidence of an association with use of barbiturates and comparison with survey data suggests that frequent falls by an elderly person would be a poor predictor of fractures in the community.

A prospective study of fractured proximal femur; hospital differences

Two teaching hospitals in Newcastle upon Tyne differ in the proportion of elderly patients admitted with proximal femoral fractures who survive six months. The hospital with the worse results receives a higher proportion of patients with a poorer prognosis in terms of mental function and residence in institutions and this reflects differences in catchment population and in referral policy. Patients admitted to the hospital with better results are more likely to be upper social class, to have been injured in public places, to be operated on by a Consultant and to wait a shorter time for operation. They probably receive more physiotherapy than do patients at the other hospital and have more nurses on their wards. Our analysis suggests the hypothesis that this last factor may be responsible for the differences in fatality rates between the two hospitals.

Age-Associated Change in QRS Axis: Intrinsic or Extrinsic Ageing?

Human ageing is most usefully conceptualised as an interaction between intrinsic and extrinsic processes. Comparison of age-associated trends in populations living under different environmental conditions provides a method of recognising the effects of extrinsic influences. This paper compares the age-associated trend in mean frontal plane QRS axis in the male adult population of Pukapuka with the trend observed in an age-matched sample from a British population. The Pukapukans show no rise in mean blood pressure with age and have other features placing them at low risk of coronary heart disease. Although the British population showed the shift to the left in mean QRS axis characteristic of economically advanced populations there was no change in mean QRS axis with age among the Pukapukans. The conclusion is drawn that the shift with age in QRS axis observed in advanced populations is extrinsic in origin but is not necessarily a manifestation of coronary heart disease.