Long-term follow-up of a patient with papillary thyroid carcinoma, elevated thyroglobulin levels, and negative imaging studies.

Objective: To describe a patient with papillary thyroid carcinoma who had measurable thyroglobulin (Tg) levels for 20 years without clinical or imaging evidence of a malignant lesion.

Methods: We reviewed the clinical course, pathologic findings, Tg measurements, and results of various imaging studies in our patient and reviewed the literature regarding Tg-positive, diagnostic total-body radioiodine scan-negative patients with thyroid cancer.

Results: Four months after a 3.

The rapid low-dose (1 microgram) cosyntropin test in the immediate postoperative period: results in elderly subjects after major abdominal surgery.

Background: Recently the rapid low-dose (1 microgram) cosyntropin test has been found to be superior to the standard (250 micrograms) rapid cosyntropin test for evaluating the hypothalamic-pituitary-adrenal axis. Because the 1-microgram test has not been studied in postoperative patients, we evaluated the test after major abdominal surgery.

Methods: We performed rapid 1-microgram cosyntropin tests in 20 patients aged 65 years or older immediately and 24 hours after uncomplicated elective abdominal surgery (group A) and in 10 patients who were suspected of having adrenal insufficiency after abdominal surgery (group B).

Serum parathyroid hormone-related protein levels during lactation.

We measured parathyroid hormone-related protein (PTHrP) in the serum of 15 healthy women within three days of beginning breast-feeding and within one hour of completing nursing. A sensitive immunoradiometric assay that measures N-terminal PTHrP containing at least the first 74 amino acids was used. We found normal PTHrP values in all patients.

Postoperative acute adrenal failure caused by transient corticotropin deficiency.

Background: Acute adrenal insufficiency after a surgical procedure or trauma is rarely reported. In recent years, however, we have treated seven patients with acute primary adrenal insufficiency and three patients with secondary adrenal insufficiency who presented with shock after a surgical procedure or trauma. The standard cosyntropin test was misleading for the diagnosis of corticotropin deficiency.

Subclinical hormone secretion by incidentally discovered adrenal masses.

Objective: To determine the frequency of subclinical hormone secretion in incidentally discovered adrenal masses.

Design: We reviewed the radiologic reports of 1779 consecutive computed tomographic scans of the chest, abdomen, and pelvis.

Setting: Regional referral medical center.

Reduced calcitriol requirements for treating hypoparathyroidism during lactation. A case report.

We reduced the dose of calcitriol from 0.75 to 0.25 microgram/d to maintain low normal serum calcium levels in a hypoparathyroid woman during lactation.

Transient corticotropin deficiency in critical illness.

We describe three critically ill patients who displayed indirect evidence of transient corticotropin deficiency. All these patients were elderly, were poorly nourished, and had unexplained hypotension intraoperatively or immediately postoperatively. During the hypotensive episodes, they had inappropriately low plasma cortisol levels (10, 12, and 6 micrograms/dl) and responded dramatically to the administration of glucocorticoids.

Recurrence of 131I-induced thyroid storm after discontinuing glucocorticoid therapy.

A 19-year-old woman with Graves' disease developed thyroid storm 8 days after radioactive iodine therapy. The clinical manifestations of thyroid storm promptly improved after treatment with large doses of propylthiouracil, potassium iodide, propranolol hydrochloride, and dexamethasone. Four days after discontinuing dexamethasone, the syndrome recurred and was corrected by reinstitution of the glucocorticoid.

Spurious elevation of plasma immunoreactive adrenocorticotropic hormone in cyclic Cushing's syndrome.

We studied a 40-year-old woman with cyclic Cushing's syndrome who demonstrated abnormal high-dose dexamethasone suppression and metyrapone stimulation tests. These results, associated with persistent elevations of plasma adrenocorticotropic hormone (ACTH) levels, suggested ectopic secretion of ACTH. Surprisingly, an adrenal adenoma with atrophy of the contralateral adrenal gland was found at exploratory laparotomy.

Thyroid gland size in pregnancy. An ultrasound and clinical study.

We estimated the size of the thyroid gland by palpation and measured thyroid gland volume with ultrasound in the immediate postpartum period and six months after delivery in 16 women. The 13% reduction in the mean thyroid gland volume detected six months after delivery implied that the thyroid gland enlarges slightly during pregnancy. Physical examination, however, did not detect any goiters during the immediate postpartum period and did not identify a change in thyroid gland size six months after delivery.

Rapid loss of lactate dehydrogenase isoenzyme activity in serum by cold-induced formation of immunoglobulin G-lactate dehydrogenase complex.

Lactate dehydrogenase (LD; EC 1.1.1.

Peripheral resistance to thyroid hormone in a family: heterogeneity of clinical presentation.

We describe a family with thyroid hormone resistance. Juvenile Graves disease was diagnosed in the propositus, an 8-month-old boy. He was initially given propylthiouracil, and at 22 months of age underwent subtotal thyroidectomy.

Interference in a chromogenic alpha-amylase assay caused by dye-labeled oligosaccharide-induced precipitation of lipoprotein.

We examined the mechanism by which hypertriglyceridemia interferes with the Roche Diagnostics "Amylochrome" procedure for measurement of amylase in lactescent samples with normal and above-normal amylase activity. The serum blank recommended in the Amylochrome protocol to compensate for lactescence remains inappropriately turbid, compared with the test, and is partly responsible for the underestimation of amylase activity. Other major interference is seen when lipoprotein in hyperlipemic samples with above-normal amylase activity reacts with the soluble oligosaccharide-triazinyl dye product of the Amylochrome assay to form a flocculent blue precipitate.

Elevation of the free thyroxine index in psychiatric patients.

We calculated a free triiodothyronine (FT3) index on 124 patients who exhibited symptoms and signs of hyperthyroidism and elevations of the free thyroxine (FT4) index on initial screening. A thyrotropin-releasing hormone (TRH) test served as the final arbiter of thyroid function if the clinical presentation was not characteristic of hyperthyroidism or if the FT3 index was not elevated. Forty-one of the 124 patients had normal TRH tests and were thus classified as euthyroid.

Serum concentrations of the iodothyronines in elderly subjects: decreased triiodothyronine (T3) and free T3 index.

In four groups of subjects free of thyroid disease, the following determinations were made: serum concentrations of thyroxine (T4), triiodothyronine (T3), reverse T3(rT3) and diiodothyronine (T2), and calculated indices of free thyroxine (FT4) and free triiodothyronine (FT3). Group A comprised healthy subjects aged 16-64; Group B, 24 healthy elderly subjects aged 68-95; Group C, 23 elderly patients with mild well-controlled chronic illnesses, aged 70-85; Group D, 40 nursing home residents aged 66-100. Serum T4 and T2 concentrations and the FT4 index were not affected by age; the rT3 concentration was slightly but significantly elevated only in Group D patients.

Thyroxine toxicosis. A common variant of hyperthyroidism.

To determine the frequency of thyroxine (T4) toxicosis, we calculated a free triiodothyronine index (FT3I) on 124 patients who displayed elevations of the free T4 index (FT4I) on initial screening. If the clinical presentation was not characteristic of hyperthyroidism or if the FT3I was not elevated, a thyrotropin-releasing hormone (TRH) test was performed. Of 83 hyperthryoid patients, 70 displayed elevations of both the FT4 and FT3 indices.