Oral Methyltestosterone and Jaundice

Abstract

THYROID AND THE HEART MBRTISH 259 unchanged; the B.P. had fallen to 170/95; and the cholesterol was 210 mg. per 100 ml. However, the patient did not feel so well. Treatment was then stopped, and after four weeks the tracing had returned almost to its original normal pattern, the B.P. had risen to 210/105, and the cholesterol to 300 mg. The patient felt better for a time but then deteriorated; she finally improved on a smaller dose of thyroid.The blood pressure, especially the diastolic, was slightly raised in mild cases. In the severe spontaneous cases it was very high in one half. Nearly always it fell to near normal as the myxoedema was corrected by thyroid hormone. The possibility that the disappearance of the electrocardiographic abnormalities under treatment could be due to fall in blood pressure might be put forward. This cannot be accepted, however, because the T-wave changes in myxoedema are more widespread than in hypertension; they can be corrected very much more quickly than in primary hypertension; and, moreover, they revert just as readily when an initially low blood pressure rises with treatment.To test the effect of thyroid hormone on the electrocardiogram of patients with normal thyroid function, nine subjects were given triiodothyronine in doses of 40 to 90 jug. daily. The results are given in Table V. In those with a left ventricular predominance pattern there was some lessening of the depression of the ST segment and increase in the voltage of T; there were similar effects on the tracings of two patients with old coronary thrombosis. In one with a normal tracing thyroid hormone had no effect beyond a slight increase in rate. These effects are in keeping with the usual high T voltage in toxic goitre, for when thyroid hormone is given to a subject whose thyroid is functioning normally a mild degree of hyperthyroidism is produced. This raises the T wave and, with it, lessens the depression of the ST segment. The changes are, however, trivial in comparison with what occurs in myxoedema using the same dose of hormone.Arrhythmia.-Abnormal rhythms are conspicuously absent. Apart from heart-block, the only one recorded was an occasional extrasystole, either ventricular or auricular. While an excess of thyroid secretion promotes auricular fibrillation, lack of this seems to prevent it. Heart Size.-There was no enlargement in 14 out of 36 cases. However, pulsation was small even in these. Enlargement when present varied from slight to very great. Its amount was not always proportional to the severity of the hypothyroidism as judged by clinical, cardiographic, blood pressure, or cholesterol findings. It is probable that great enlargement is always due to pericardial effusion (Figs. 8 to 13). This is suggested by the shape of the very large heart and by the rapid shrinkage with treatment; as the face and body lose their puffiness the heart goes down at the same time.Simulation of Congestive Heart Failure.-In a severe case with cardiac enlargement there is pitting oedema of the feet and legs and engorged c...

Jaundice in Severe Infections

“…The serum alkaline phosphatase values were normal or only slightly raised, but this finding is not incompatible with a diagnosis of cholestatic jaundice. For example, the alkaline phosphatase is not increased at the onset of the obstructive phase of infective hepatitis, and it is not increased in steroid jaundice (Foss and Simpson, 1959). Extrahepatic biliary obstruction was excluded by operation or necropsy in the first three cases, and there was no clinical reason to suspect it in the other two.…”

Systemic Distribution of Steroid Sulfatase and Estrogen Sulfotransferase in Human Adult and Fetal Tissues

“…Her et al (49) demonstrated that both EST and dehydroepiandrosterone sulfotransferase proteins are expressed in human jejunal mucosa. It is well established that orally administered E2 and testosterone are rapidly inactivated and do not necessarily enter the circulation to any significant degree in adults (50,51). In addition, in the fetus, large quantities of estrogens are present in the amniotic fluid (52); the estrogens may enter the fetal circulation in an excessive quantity by swallowing and absorption from the GI tract unless a means of degradation and/or inactivation of estrogens as described above is present in epithelial cells of the fetal GI tract.…”

Anabolic-Androgenic Steroid Therapy in the Treatment of Chronic Diseases

“…Studies have linked various abnormal liver function tests (elevated plasma alkaline phosphatase, aminotransferases, conjugated bilirubin, and plasma proteins) with the use of AAS (102)(103)(104). Jaundice occasionally occurs in patients with a previously normal functioning liver due to a hypersensitivity-type reaction.…”