Osamu Fukino

Serum thyrotropin (TSH) responses to thyrotropin-releasing hormone (TRH) in patients with anorexia nervosa and bulimia: Influence of changes in body weight and eating disorders

Serum thyrotropin (TSH) responses to thyrotropin-releasing hormone (TRH) were studied in 47 women with anorexia nervosa (AN) (group I) and in 11 bulimic patients of normal weight (group II). In group I, TSH responses were low in nine patients, delayed in 32 and normal in six. Patients with a normal TSH response had a lesser degree of anorexia than those with a delayed TSH response. Bulimia and vomiting were more frequently observed in the low response group. The maximum increase in TSH concentrations following TRH administration in the group I patients with vomiting (4.0 +/- 0.90 microU/ml, mean +/- S.E.) was significantly lower than that in the group I patients without vomiting or in normal controls (11.2 +/- 0.82 microU/ml and 11.1 +/- 2.34 microU/ml, respectively). Twenty-five patients with abnormal TSH responses in group I were retested after weight gain. Initially, TSH responses were low in six and delayed in 19. Following weight recovery, responses continued to be abnormal in five of the six and in eight of the 19, respectively. The symptoms of eating disorders continued in all patients with abnormal TSH responses even after weight recovery, whereas patients with normal responses after weight gain recovered from all symptoms. Of 11 patients in group II, six had abnormal TSH responses to TRH; the responses were delayed in four and low in two. Patients with normal responses had a lesser degree of eating disorder, compared with abnormal responders. These observations suggest that abnormal TSH responses in patients with AN were not necessarily due to weight loss alone; rather, they may be related to the eating disorder itself.

A Long-term Follow-up Study of Patients with Chronic Lymphocytic Thyroiditis

: It is generally believed that in the long-term observation of chronic thyroiditis, the goiter decreases in size with thyroid hormone therapy and the thyroid function drops gradually. On the other hand, the histological changes in so-called Hashimotos thyroiditis have been recognized to show progressive loss of epithelium and increased fibrosis. In this study, goiter size, thyroid function, thyroid microsomal and thyroglobulin antibodies and histology in needle biopsy were investigated in 75 patients with chronic thyroiditis during an interval of more than ten years. Among 75 cases, 8 (11%) were hypothyroid at the first medical examination. Among 21 cases who received no treatment, 7 (33%) became hypothyroid during the period of more than ten years. Among 54 cases with thyroid hormone therapy, 16 (30%) showed a remarkable reduction in size of goiter, but among 21 cases without thyroid hormone therapy only 3 (14%) showed a remarkable reduction. This paper discusses changes in titers of thyroidal antibodies in 47 cases. Among these 47 cases, 21 increased titer of thyroglobulin antibody during the period of more than ten years. 10 (48%) out of these 21 cases showed a remarkable reduction in size of goiter. But among 11 cases with a decrease of titer of thyroglobulin antibody, only one (9%) showed a remarkable reduction in size of goiter. On the other hand, titer of thyroid microsomal antibody increased in 33 cases. 9 (27%) out of these 33 cases showed a remarkable reduction in size of goiter. Only one (13%) of 8 cases, which decreased titer of thyroid microsomal antibody, showed a remarkable reduction in size of goiter.(ABSTRACT TRUNCATED AT 250 WORDS)

[A long term follow-up study of patients with Graves' disease: the correlation between thyroid functions and histological findings].

Yoshihiko HIROTA, Hajime TAMAI, Yoshio HAYASHI Osamu FUKINO and Noriyuki. OHSAKO* Fumio MATSUZUKA and Kanji KUMA** Shoichi KATAYAMA*** Shigenobu NAGATAKI**** *Department ofPsychosomatic Medicine , Faculty of Medicine, Kyushu University, Fukuoka **Kuma Hospital , Kobe * * *Department ofPathology , Faculty of Medicine Osaka University, Osaka ****Department of Internal Medicine Faculty of Medicine, Nagasaki University, Nagasaki

A Study of Thyroid Function in Patients with Graves' Disease after 5 to 10 Years of Subtotal Thyroidectomy

Among 281 patients who underwent subtotal thyroidectomy forhyperthyroidism five to ten years ago, recurrent hyperthyroidism was found in 30 (10.7%), T3-toxicosis in 17 (6.0%) and hypothyroidism in 18 (6.4%). The remaining 216 subjects were clinically euthyroid, but a raised level of serum thyroid-stimulating hormone (TSH;>9/..tU/m1) was found in 100 (35.6%). On 65 of the 216 euthyroid patients, the TRH test, T3 suppression test and measurement of antithyroid antibodies were performed. The results revealed that 37 of the 65 cases (56.9%) showedan abnormal response to TRH. Nine of these (13.8%) showed either a non-or hyporesponse (peak value of TSH was less than 4.9 pU/ml), and 28 cases (43.1%) revealed a hyper-response (peak value of TSH was more than 35 μU/ml). For the T3 suppression test, 18 ofthe 65 cases (27.7%) were