Takeo Kuroda

Reversible primary hypothyroidism with blocking or stimulating type TSH binding inhibitor immunoglobulin following recombinant interferon‐α therapy in patients with pre‐existing thyroid disorders

OBJECTIVE Treatment with recombinant interferon‐α (rIFN‐α) may induce autoimmunity. We have evaluated the effect of rIFN‐α on pre‐existing thyroid disease with special reference to changes in TSH receptor antibody.

Immunological and chemical types of reversible hypothyroidism; clinical characteristics and long‐term prognosis

OBJECTIVE Spontaneous improvement occurs in about one‐half of patients with primary hypothyroidism who reside in an iodine‐sufficient area of Japan, but the pathogenetic factors related to reversible hypothyroidism are still not fully understood. We therefore investigated the clinical features and prognosis of patients with reversible hypothyroidism with or without iodine excess and antithyroid antibodies.

Risk factors for brain infarction in patients with Cushing's disease. Case reports.

Two women aged 51 and 52 years old, respectively, developed a brain infarction before and after undergoing treatment for Cushings disease. A biochemical remission was obtained more than ten years after the onset of signs or symptoms of Cushings disease. The arteriosclerotic changes of the cerebral vessels progressed even during replacement therapy for posttreatment hypopituitarism after they underwent either ablative surgery or radiotherapy. One patient, who showed the signs of Nelsons syndrome, demonstrated severe progressive cerebrovascular sclerotic changes, especially around the irradiated site. It is thus suggested that hypercortisolemia, external pituitary irradiation, and post treatment hypopituitarism may be risk factors for brain infarction. The early diagnosis and adequate treatment are therefore important to prevent cerebrovascular complica tions in patients with Cushings disease.

Atrial natriuretic peptide in hyperthyroidism: Effect of Β-adrenergic blockade

The hypersecretion of atrial natriuretic peptide (ANP) in hyperthyroidism is still in controversial [2, 3]. We measured the plasma concentrations of ANP in untreated patients with hyperthyroidism, and sutdied the effect of p-adrenergic blockade before treatment with antithyroid drugs to evaluate the role of tachycardia in the ANP secretion. The venous samples were obtained from 20 untreated hyperthyroidism patients without congestive heart failure and 13 euthyroid controls. Metoprolol (120 mg/d as a standardized dose for Japanese patients with tachycardia) was given to the thyrotoxic patients for two weeks. The last venous blood sampling was obtained from 2 to 4 hours after taking metoprolol. Venous blood was collected from the subjects in a supine position at morning after resting for 30 min, and placed in EDTA tubes containing aprotinin, and then stored at 7 0 C after centrifugation. The plasma ANP levels were assayed in triplicate by direct radioimmunoassay method (Eiken, Tokyo, Japan). The minimum detectable level of ANP was 3.5 pmol/L. All the samples were determined in a single test to eliminate the interassay variation. The intraassay coefficients of variation with 2 samples were 3.3 and 5.1 (n=5, each). Total T4, total T3, and free T4 were determined with RIA (total T4 and T3; Dainabot, Tokyo, Japan, free T4; Amersham, Japan). The results were expressed as the mean + standard deviation. The statistical analysis was performed with paired or non-paired Students t-test. The ANP level in hyperthyroidism patients was high compared to that in controls (20.0+13.7pmol/L, n=20, vs.