To compare the prediction of hip fracture risk of several bone ultrasounds (QUS), 7062 Swiss women ≥70 years of age were measured with three QUSs (two of the heel, one of the phalanges). Heel QUSs were both predictive of hip fracture risk, whereas the phalanges QUS was not.Introduction: As the number of hip fracture is expected to increase during these next decades, it is important to develop strategies to detect subjects at risk. Quantitative bone ultrasound (QUS), an ionizing radiation-free method, which is transportable, could be interesting for this purpose. Materials and Methods:The Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk (SEMOF) study is a multicenter cohort study, which compared three QUSs for the assessment of hip fracture risk in a sample of 7609 elderly ambulatory women Ն70 years of age. Two QUSs measured the heel (Achilles+; GE-Lunar and Sahara; Hologic), and one measured the heel (DBM Sonic 1200; IGEA). The Cox proportional hazards regression was used to estimate the hazard of the first hip fracture, adjusted for age, BMI, and center, and the area under the ROC curves were calculated to compare the devices and their parameters. Results: From the 7609 women who were included in the study, 7062 women 75.2 ± 3.1 (SD) years of age were prospectively followed for 2.9 ± 0.8 years. Eighty women reported a hip fracture. A decrease by 1 SD of the QUS variables corresponded to an increase of the hip fracture risk from 2.3 (95% CI, 1.7, 3.1) to 2.6 (95% CI, 1.9, 3.4) for the three variables of Achilles+ and from 2.2 (95% CI, 1.7, 3.0) to 2.4 (95% CI, 1.8, 3.2) for the three variables of Sahara. Risk gradients did not differ significantly among the variables of the two heel QUS devices. On the other hand, the phalanges QUS (DBM Sonic 1200) was not predictive of hip fracture risk, with an adjusted hazard risk of 1.2 (95% CI, 0.9, 1.5), even after reanalysis of the digitalized data and using different cut-off levels (1700 or 1570 m/s). Conclusions: In this elderly women population, heel QUS devices were both predictive of hip fracture risk, whereas the phalanges QUS device was not.

Thyroid function was studied for 42 days in 58 patients, 28 of whome had euthyroid goiter, after urography (diatrizoic acid), cholangiography (ioglycamic acid), and cholecystography (Naiopanoate). After urography and cholangiography short-lived increases of the serum thyroxine occurred in a few patients, but the mean thyroxine and triiodothyronine concentration did not change. By contrast, 7 days after oral cholecystography serum thyroxine had risen consistently by 22% with a concomittant rise of the free thyroxine, while triiodothyronine declined by 15%. The thyroxine metabolite 3,3',5'-triiodo-1-thyronine (reverse T3) rose by 50% and serum thyrotropin concentration doubled. After 42 days thryoxine and triiodothyronine had returned to baseline, and none of the 58 patients developed clinical hyperthyroidism. In patients with severe myxoedema kept on a constant replacement dose with 1-thyroxine NA-iopanoate produced similar changes with the exception of the rise of the serum thyroxine. The primary event after Na-iopanoate seems to be a fall of the serum triiodothyronine, which in turn augments thyrotropin and indirectly thyroxine secretion. the marked and sometimes sustained rose of serum thyroxine after cholecystography may lead to the erroneous diagnosis of hyperthyroidism.

The decrease in resting oxygen consumption induced by starvation was found to occur not only in euthyroid rats but also in hypothyroid and even in hypothyroid animals treated with triiodothyronine. Furthermore, the effectiveness of triiodothyronine was decreased when given to hypothyroid animals.

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under intensive care observation may be a safe alternative to mechanical ventilation in patients with severe pneumatosis cystoides and chronic respiratory insufficiency.

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The increment of serum TSH after thyrotrophin-releasing hormone (TRH) is usually considered an extremely sensitive thyroid test, particularly useful in borderline disturbances. We evaluated 195 patients by measuring serum TSH before and 3 h after 40 mg TRH po, and by various other thyroid tests. We found a very tight correlation between the TSH\x=req-\ increment and the 3 h TSH. Thus the TSH-increment can reliably be estimated from the 3 h TSH. The Mann\x=req-\ Whitney test confirmed that the 3 h TSH identified thyroid dysfunction as well as the TSH-increment. The basal TSH can therefore be omitted and we propose the measurement of the 3 h TSH as an initial screening test. This single measurement economically excludes the many euthyroid patients sent for thyroid evaluation from further costly tests.The usual laboratory investigation of suspected hyperthyroidism starts with measurements of thyroxine and triiodothyronine together with some test of binding capacity in serum. If the thyrotoxic patient suffers from another severe illness, or if thyrotoxicosis is due to an autonomous nodule or occurs in an elderly patient, these tests are not uncommonly within the normal range or only marginally elevated (Pohl et al. 1973 ;Birkhäuser et al. 1977;Chopra et al. 1980;Köbberling et al. 1981). Further tests are then ordered, including a scintiscan and a stimulation test with thyrotrophinreleasing hormone (TRH). If the latter is normal, the patient is proved to be euthyroid and the previous tests appear wasteful in retrospect. We suggest that it is more economical to start evalua¬ tion with the TRH-test and that with the oral modification of the test (Staub et al. 1976(Staub et al. , 1979, TSH needs to be measured in one single serum specimen only. Further thyroid tests are necessary only in patients with an abnormal TRH-test. Patients and MethodsWe analyzed 195 unselected patients from our in-and out-patient department (47 men, 148 women, age 17-92 years) who had had an oral TRH-test with one 40 mg tablet TRF (Roche) after an overnight fast (Staub et al. 1976(Staub et al. , 1978(Staub et al. , 1979. Serum TSH was measured before and 3 h after TRH by radioimmunoassay (Ria-mat from Byk-Mallinckrodt, lower and upper limits of detection 0.6 and 80 mU/1, respectively, interassay variation 6.7%). The following additional tests were available: serum thyroxine (110 patients, normal range 5.0-11.5 ug/dl), serum triiodothyronine (70 patients, normal range 80-190 ng/dl), both by Amersham radioimmunoassay kits; T3-resin-uptake (110 patients, normal range 89-112% of control pool serum) by Thyopac Amersham kit; and thyroid scan (51 patients). The thyroid status of the patients was judged by one of us (H.B.), using all available clinical and laboratory information. Fig. 1 shows the very tight statistical correlation between the 3 h TSH and the TSH-increment, suggesting that the 3 h TSH provides as much diagnostic information as the TSH-increment. Results

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