The volume of infusion fluids correlates with treatment outcomes in critically ill trauma patients.

Background: Appropriate fluid management is essential in the treatment of critically ill trauma patients. Both insufficient and excessive fluid volume can be associated with worse outcomes. Intensive fluid resuscitation is a crucial element of early resuscitation in trauma; however, excessive fluid infusion may lead to fluid accumulation and consequent complications such as pulmonary edema, cardiac failure, impaired bowel function, and delayed wound healing.

How does levothyroxine therapy affect thyroid function studies?

Are thyroid function test results affected by the timing of the previous levothyroxine dose? To answer this question, the authors asked 101 consecutive patients when they took the last dose and then correlated the time elapsed with the results of thyroid assays. Their findings are discussed in this article.

Clinical evaluation of a thyroxine binding globulin assay in calculating a free thyroxine index in normal, thyroid disease, and sick euthyroid patients.

As assay for thyroxine binding globulin (TBG) that measures the thyroxine binding capacity of TBG and other proteins was used to calculate a free thyroxine index (FTI) in 108 consecutive thyroid patients, 2,559 normal patients, and 152 sick euthyroid patients. The TBG assay compared favorably with the triiodothyronine (T3) uptake test in producing a FTI for the clinical evaluation of thyroid patients. In addition, it did not suffer the disadvantages inherent in assays specific for only TBG.

Familial papillary carcinoma of the thyroid.

Of 226 consecutive papillary carcinoma patients, 14 indicated that at least one other relative was similarly affected. Pathology confirmation was obtained in 8 of the 14 families. Of the eight families with documented familial papillary carcinoma, one had five members, another had four members, and yet another had three members affected.

Potency of levothyroxine products.

Recently, the company that manufactures the levothyroxine product that we use most often in our practice switched to high-pressure liquid chromotography (HPLC) to monitor their product. As a result, the brand name product now contains 100% of expected potency as determined in our laboratory by radioimmunoassay. Previous studies in our laboratory demonstrated that this product had only 78% of expected potency.

Screening for minimal hypothyroidism. How sensitive is the free thyroxine assay?

The free thyroxine index (FTI) and a free thyroxine (FT4) assay were compared with the thyrotropin-releasing hormone stimulation test in 98 consecutive patients to determine whether the FT4 assay is more sensitive than the FTI in screening patients for minimal hypothyroidism. FTI and FT4 values did not agree with the clinical evaluation in 20% (3/15) of the patients with a transitional thyroid-stimulating hormone (TSH) response (21 to 35 microU/ml) and in 64.3% (9/14) of the patients with an augmented TSH response (greater than 35 microU/ml).

Faster assessment of patients receiving unnecessary thyroid treatment: concise communication.

Forty-five consecutive patients on thyroid hormone treatment without obvious indication were evaluated. Twenty-five of these cases were found to have no evidence of thyroid disease. Biochemical testing was not helpful in making the diagnosis of hypothyroidism in the majority of thyroid-treated hypothyroid patients.

Hyperparathyroidism and thyroid disease. A study of their association.

The incidence of hyperparathyroidism was prospectively evaluated in a group of patients with thyroid disease, and the incidence of thyroid disease was retrospectively evaluated in a group of patients specifically referred for evaluation of hyperparathyroidism. Hyperparathyroidism was ten times more frequent in thyroid patients than expected in a general medical population and was especially prevalent in patients with nodular goiter. The incidence of thyroid disease in patients with hyperparathyroidism was 38.

Potency of brand name and generic levothyroxine.

The tablet thyroxine content of a brand name and two generic products were studied. The mean thyroxine content was significantly different in the generic tablets when compared with that in the brand name product. The coefficient of variation of tablet thyroxine was lowest in the brand name, although this product had only 78% of expected potency.