Subclinical hyperthyroidism due to a nodular goitre in postmenopausal women resulted in a continued loss of bone mass of about 2% per year. Radioiodine treatment resulting in normalization of serum TSH prevented this continued bone loss for at least 2 years. Our study supports earlier intervention in such patients.

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HLA typing of 86 patients with Graves' disease was performed for the A, B, C and D series antigens. An increased frequency of HLA-B8 (47 per cent) and Dw3 (51 per cent) compared with controls (23.7 and 21 per cent, respectively) was observed. The increase of B8 and Dw3 was almost exclusively found in a group of 48 patients with relapse of disease, whereas the frequency of B8 and Dw3 in patients without relapse did not differ significantly from that of the control group. No association with the presence of exophthalmos, thyroid antibodies, or antibodies to Yersinia enterocolitica serotype 3 could be found.

Abstract. Endogenous creatinine clearance, serum creatinine and urinary creatinine excretion have been determined in 368 patients hospitalized with various medical diseases, and without known renal disease. The patients were divided into 10‐year age groups and the results were analysed for age and sex differences. The average creatinine clearance in males showed a steady decline from 110 to 34 ml/min/1.73 m2 from the age group 20–29 to the age group 90–99 years. The mean serum creatinine values did not show any significant variations with age, but urinary creatinine (mg/kg b.wt./24 h) decreased from 23.8 in the age group 20–29 to 9.4 in the age group 90–99 years. In females creatinine clearance declined from 95 to 39 ml/min/ 1.73 m2, serum creatinine was without significant change and urinary creatinine (mg/kg b.wt./24 h) decreased from 19.7 in the age group 20–29 to 8.4 in the age group 90–99 years. The finding of considerably decreased creatinine clearance values without elevation of serum creatinine values in the elderly is probably explained by a great reduction with age in lean body mass and thereby in creatinine production. In a group of 106 patients with serum creatinine values between 1.4 and 5.0 mg/100 ml the urinary creatinine (mg/kg b.wt./24 h) was not significantly different from that of patients without renal disease. A risk of overestima‐tion of glomerular filtration rate seems to exist if serum creatinine is used as the only parameter of renal function in these patients and might lead to intoxication with drugs which are mainly excreted by the kidney. The authors suggest a nomogram for rapid evaluation of creatinine clearance in ml/min.

Cytokines are peptide hormones essential for cellular communication in the immune response. The purpose of this study was to investigate the influence of cytokines, especially recombinant interleukin 1 beta (rIL-1 beta), on human thyroid cells. Thyroglobulin (Tg) was measured by a double antibody radioimmunoassay, and cyclic AMP (cAMP) by a competitive protein binding assay. Supernatants from unstimulated and phytohaemagglutinin-stimulated blood mononuclear cells were added to human thyroid cells cultured in monolayers. A dose-dependent inhibition of the secretion of Tg and cAMP was demonstrated. Both subcultured and primary cultured cells incubated with rIL-1 beta at pharmacological levels (10(-1)-10(2) U/ml) exhibited an inhibition of Tg and cAMP secretion, while at physiological levels (10(-5)-10(-3) U/ml), the secretion of Tg was enhanced. The similar stimulation of cAMP was demonstrated in subcultures. These in vitro studies suggest that IL-1 beta may play a role in the pathogenesis of autoimmune thyroid diseases. Further, the stimulations at low concentrations indicate that IL-1 beta may regulate the function of the thyroid gland under physiological conditions.

SUMMARY The effect of a single dose of 131I upon thyroid stimulating immunoglobulins has been studied in twenty‐two patients with Graves' disease. The thyroid stimulating immunoglobulins were assessed by parallel measurements of thyrotrophin receptor binding inhibitory immunoglobulins (TBII) and of thyroid adenylate cyclase stimulating immunoglobulins (TACSI) in serum by radioreceptor assay and stimulation of adenylate cyclase respectively. Prior to 131I therapy TBII were present in fourteen and TACSI in sixteen patients; seventeen were positive in one of the assays and thirteen in both assays. After radioiodine the level of both TACSI and TBII increased in most patients, but in six patients 131I therapy appeared to lead to a dissociation between the TBII and TACSI. After 12 months, nine patients were still positive in both assays, and twenty‐one in one of the assays. In total, five patients developed hypothyroidism within 1 year after radioiodine. The TBII levels were significantly higher both before and 3 months after therapy in these patients than in those who remained euthyroid. Two of the hypothyroid patients developed non‐stimulatory TSH binding inhibitory antibodies. The present study thus confirms that radioiodine therapy is followed by an increase of TBII and TACSI in most patients with Graves' disease. The level of TBII can probably provide a marker for development of hypothyroidism following 131I therapy and might be involved in its pathogenesis.

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