The effects of various degrees of chronic renal failure on serum and urinary thyroid hormones were studied in 10 patients with a mean creatinine clearance (Cr.Cl.) of 23 ml/min (group A), in 11 patients with a Cr.Cl. of 5.7 ml/min (group B), and in 60 healthy euthyroid subjects with normal renal function. We found a significant decrease (P < 0.01) of serum total thyroxine (T4) (5.3 ±1.9 (sd) μg/100 ml in group A and 4.1 ± 1.5 in group B), serum total triiodothyronine (T3) (65.4 ± 17.4 ng/100 ml ~57.4 ± 13.9), serum free T4 (5.60 ± 1.74 arb.U ∼ 4.45 ± 1.61), and serum free T3 (69.51 ± 21.22 arb.U ∼ 62.09 ± 12.39). T3 uptake test and basal thyroid stimulating hormone (TSH) values were normal in both groups of renal patients. No statistical significance was found in T4 excretion in urine. Urinary T3 excretion was significantly reduced (P < 0.01) in group A (27 ± 44 ng/24 h), and undetectable in terminal renal failure. Urinary protein excretion was non-selective and low (median 0.2 g/24 h and 0.7 g/24 h, respectively). Conclusively we have found reduced levels of serum total and free T3, and in contradiction to most investigators substantially reduced levels of serum total and free T4. Urinary excretion of T4 and T3 reflects the low levels of free serum hormones and the tubular impairment.
Abstract. The results of 131I treatment in combination with pre- and post-treatment with carbimazole (n = 122) were compared to the results of 131I used as the only antithyroid treatment (n = 203). The two groups of patients were fully comparable in regard to age, size of goitre and time of observation, and the same diagnostic criteria and dosage regimen of 131I were used. The incidence of early myxoedema in patients with diffuse goitre was significantly reduced after combination therapy, 5 per cent, compared to 16 per cent after 131I as the only antithyroid therapy (P < 0.05). The incidence of late myxoedema was 6 per cent in both groups 3 years after the last treatment, and fully compensated myxoedema was found in 13 and 22 per cent (n.s.). No severe acute side effects were observed after 131I therapy in any of the two groups. It is concluded that - in diffuse toxic goitre - a lower early incidence of myxoedema was obtained on the combined regimen because of either a possibly lower absorbed radiation dose or a more fractionate therapy. A major advantage of the combination therapy is also, that the patients are rendered euthyroid shortly after the diagnosis and remain so during the prolonged period of treatment. 131I treatment in combination with carbimazole is advocated in all patients with diffuse and nodular toxic goitre if the patient is above fertile age and thyroidectomy is not indicated.
Abstract. A simple and accurate method for estimation of the free fractions (FFT) of T4, T3, rT3, 3,3'-diiodothvronine (3,3'-T2) and 3',5'-diiodothyronine (3',5'-T2) in serum is presented. The method is based on ultrafiltration of serum pre-incubated with tracers of high specific activity, followed by purification of the ultrafiltrate on small Sephadex columns. The addition of tracer only dilutes serum negligible (about 5%) and the ultrafiltration procedure only removes about 7% of the volume of serum, thus probably not disturbing the equlibrium between the free and protein bound fraction of iodothyronine. Progressive reduction of tracer to less than 10% of the amount usually used did not reduce the FFT of any of the iodothyronines. In contrast, addition of T4 to serum led to an increase of all FFTs except that of 3',5'-T2. These data suggest that FFT of T4, T3, rT3 and 3,3'-T2 primarily is determined by the amount of T4 present in serum and that significant amounts of these iodothyronines are bound to TBG, whereas 3',5'-T2 possibly primarily is bound to albumin. The median FFT of T4, T3, rT3, 3,3'-T2 and 3',5'-T2 in serum from euthyroid subjects (n = 38) was: 0.030, 0.29, 0.14, 1.10 and 1.07%, respectively. The corresponding median free concentrations in pmol/l were: 30, 4.79, 0.59, 0.44 and 0.77, respectively. Pregnant women in 3rd trimester had normal levels of free T4, free T3 and free rT3, wheras the median free 3,3'-T2 was reduced in contrast to elevated median free 3',5'-T2. Using the present method free T4 and free T3 discriminated almost completely hyper- and hypothyroid patients from controls, whereas some overlap to normal range was found concerning free rT3, free 3,3'-T2 and free 3',5'-T2. Patients with liver cirrhosis or chronic renal failure (CRF) had profound changes in total serum concentrations of all iodothvronines studied, possibly due to the somatic disease. Despite this, almost all had unchanged free T4 and free T3 levels indicative of euthyroidism. The median free rT3 and free 3',5'-T2 were elevated in cirrhosis but unchanged in CRF, whereas median 3,3'-T2 was unchanged in both groups.
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