Sheldon S. Waldstein

A CLINICAL STUDY OF THYROID STORM

Excerpt INTRODUCTION Thyroid storm or crisis is a severe, often fatal exacerbation of the manifestations of hyperthyroidism, which requires prompt recognition and energetic treatment if the patient...

Free Thyroxine Concentrations in Thyroid Storm

Total serum thyroxine concentrations, the dialyzable fractions of total thyroxine, and absolute free thyroxine concentrations were measured in six patients with thyroid storm, in 15 patients with uncomplicated thyrotoxicosis, and in 19 normal subjects. Total thyroxine concentrations were similar in both thyrotoxic groups. However, the mean dialyzable fraction of thyroxine and the mean free thyroxine concentration was significantly higher in patients with thyroid storm than in patients with uncomplicated thyrotoxicosis (0.060 +/- 0.017% versus 0.026 +/- 0.006% and 10.9 +/- 3.8 ng/dL versus 4.7 +/- 1.4 ng/dL, respectively). These findings suggest that events precipitating thyroid storm may act with thyrotoxicosis to decrease thyroxine binding markedly and result in a sharp increase in free thyroxine concentration. These phenomena may play a role in the pathogenesis of thyroid storm.

Hypophysial tuberculoma with hypopituitarism

Abstract In this patient with a caseating pituitary tuberculoma the diagnosis of hypopituitarism was established antemortem by modern tests of pituitary function. Pituitary tuberculoma is rare and may resemble pituitary adenoma. Tuberculoma should be considered in patients with hypopituitarism or enlargement of the sella turcica, or both, who have or have had tuberculosis of any site. Antituberculous therapy should be instituted in such patients, especially when surgery is contemplated.

Idiopathic, episodic inappropriate secretion of antidiuretic hormone

Abstract For five years, a fifty-one year old man has had recurrent episodes of confusion, hiccoughs, convulsions and profound hyponatremia. He has been well between attacks. During an observed episode, a balance study demonstrated the abnormal response to water loading typical of the syndrome of inappropriate secretion of antidiuretic hormone (ADH). Following administration of ACTH and 9α-fluorohydrocortisone a normal response to water occurred, suggesting that these drugs may be useful for therapy of this condition. In contrast to previously reported examples of the syndrome, the patient is without evidence of other disease. Inappropriate secretion of ADH thus may be primary, idiopathic, intermittent and compatible with good health in other respects.

Measurement of hepatic blood flow by clearance methods; a review and a theoretical basis for a new noncatheterization method.

SummaryThe estimation of hepatic and splanchnic blood flow in humans by clearance methods has been reviewed (Part I). Methods based on the Fick principle and hepatic vein catheterization employ BSP, Rose Bengal, urea, or galactose as the test substance. Methods based on the disappearance of particulate material after injection use P32-labeled colloidal chromic phosphate, Au198-labeled colloidal gold, or I131-labeled denatured human serum albumin as the test substance.The hypothetical behavior of a substance after intravenous injection for which the liver has a removal rate maximum and which is lost otherwise only into the urine is developed (Part II). Equations are derived from these considerations by which to estimate the liver removal maximum and hepatic blood flow from the peripheral disappearance curve and urine collection alone, without resort to hepatic vein catheterization. The actual behavior of galactose after single intravenous injection suggests it may be a suitable test substance for the application of the proposed noncatheterization method to humans.

Idiopathic juvenile myxedema and myasthenia gravis: A case with circulating thyroid and skeletal muscle antibodies

Abstract Idiopathic juvenile myxedema developed in a Negro boy when he was fourteen years old. One year later he experienced a transient episode of generalized myasthenia gravis. The diagnosis of myxedema was not made until he was eighteen years old. Two years later, while euthyroid on thyroid replacement therapy, ocular myasthenia gravis intervened and was resistant to drug therapy. Six months later thyroid therapy was inadvertently discontinued, and myxedema recurred. Thyroid replacement therapy made him euthyroid but the myasthenia continued to respond poorly to therapy. Immunologic studies demonstrated circulating antibodies to the thyroid gland and skeletal muscle, as well as antibodies to gastric parietal cells, although there was no evidence of achlorhydria or pernicious anemia. The patients clinical course fluctuated between cholinergic and myasthenie crises. He died at the age of twenty-one. The autopsy findings were meager. The medical literature relating to the concurrence of myasthenia gravis, myxedema and pernicious anemia is reviewed. There is evidence which suggests that these diseases may have in common a defect of the immune process.

THE EFFECT OF OTHER LIPOTROPIC SUBSTANCES ON THE FATE OF CHOLINE AFTER ORAL AND INTRAVENOUS ADMINISTRATION

1. In vitro degradation of choline to trimethylamine (TMA) by fecal bacteria is unchanged in the presence of methionine, inositol, or both. 2. Rats fed methionine and inositol together with choline excreted the same amount of TMA in the urine as rats fed choline alone. Human experiments duplicated the experience in animals. 3. Humans excrete the same amount of choline in the urine following the intravenous injection of methionine, inositol and choline together as they do following the injection of choline alone. 4. The intravenous injection of methionine, inositol, and choline in relatively large amounts is well tolerated and appears to be without danger. 5. The presence of the lipotropic agents methionine and inositol does not appear to influence the degradation or excretion of choline after oral or intravenous administration, again pointing to the differences in the lipotropic action of these substances. We wish to thank Dr. Hans Popper for this generous advice during the conduct of tliis investigation.