James Crooks

Association of Thyrotoxicosis and Auto-immune Thyroiditis

Roitt and Doniach (1958) have demonstrated that circulating thyroid auto-antibodies are present in a large proportion of patients with auto-immune thyroiditis (Hashimotos disease). In this paper we show that the application of these immunological tests in patients with symptoms suggestive of thyrotoxicosis is of considerable practical importance, since we have been able to identify two groups in which the correct diagnosis could not otherwise have been made and where mismanagement might have occurred. In the first group evidence of auto-immune thyroiditis was found in patients with undoubted thyrotoxicosis. Only one fully documented case of this association has been previously described (Doniach and Hudson, 1959; Doniach et al., 1960). We were also able to define a second group of patients who had been referred to the clinic because of suspected thyrotoxicosis and in whom radioiodine tests had appeared to confirm this diagnosis. Further investigations, however, showed that these patients were in fact euthyroid and that the presence of auto-immune thyroiditis explained the abnormal laboratory findings.

Serum Proteins in Thyroid Disease

Abnormalities in the serum proteins have been described in several disorders of thyroid function (Man et al., 1940; Lewis and McCullagh, 1944; Lamberg and Grasbeck, 1955) and in particular in auto-immune thyroiditis, where a raised serum y-globulin has been found (Fromm et al., 1953; Luxton and Cooke, 1956; Skillern et al., 1956; Doniach and Hudson, 1957; Greene et al., 1958; Roitt et al., 1958 ; Hetz et al., 1959; Shulman et al., 1960). The diagnostic significance of these changes is difficult to evaluate because in most studies the number of patients has been small. Furthermore, the control series of normal subjects and of patients with other forms of thyroid disease has been inadequate for statistical evaluation. In this paper we report a detailed study of the serum protein abnormalities in 182 patients with different thyroid disorders and compare them with those found in 26 normal controls. In addition the diagnostic value of the serum flocculation tests and the erythrocyte sedimentation rate (E.S.R.) has been studied, since both have been suggested as diagnostic aids in auto-immune thyroiditis (Luxton and Cooke, 1956; Doniach and Hudson, 1957; Hubble, 1959).

The Sleeping Pulse Rate in Thyrotoxicosis

W I r H the development of many accurate tests for the diagnosis of hyperthyroidism, simple clinical methods have recently tended to become neglected. One such method is the recording of the sleeping pulse rate which, for many years, has been considered to provide useful diagnostic information. The practical application of the procedure has, however, been limited by the fact that those who recommend its use do not provide ranges of normality. The object of the present study has been to establish such ranges and to evaluate the use of the sleeping pulse rate as an aid to the diagnosis of thyrotoxicosis.