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Ulla Feldt-Rasmussen, Karine Bech and John Date

ABSTRACT

To study serum thyroglobulin (Tg) levels in patients with thyroid disorders compared to sex- and age-matched control subjects and to correlate the Tg levels to the thyroid function, 71 patients were investigated before treatment was started.

Serum Tg, measured by a double antibody radioimmunoassay, was elevated in all groups with thyroid disorders, as compared to their controls, but the values showed large overlaps between groups. The highest median values were seen in the two groups of patients with toxic goitres (toxic adenoma and Graves' disease). The Tg values in patients with non-toxic goitres (diffuse and nodular) and in controls showed a log normal distribution, whereas the distribution of values from patients with toxic goitres was different. No correlation was found between serum Tg and serum thyroxine, serum triiodothyronine and serum TSH, respectively.

It is concluded that determination of serum Tg is of little diagnostic value in thyroid diseases.

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Ulla Feldt-Rasmussen, Per Hyltoft Petersen and John Date

ABSTRACT

The aim of the present investigation was to describe variations in serum thyroglobulin in relation to sex and age in a group of normal persons. The method used was a modified double antibody radioimmunoassay characterized by pre-incubation at 37°C of standard or sample with antiserum, resulting in a reduced total incubation time. Both sensitivity and precision were comparable to other published methods.

Of the 152 blood-donors initially investigated, 7 were excluded due to the presence of antithyroglobulin antibodies as evidenced by a radioassay. Both sexes were equally represented with an even distribution of ages from 20-65 years.

Increased serum thyroglobulin with increasing age was demonstrated, the correlation being significant in women (Kendall's τ, P < 0.001). Detectable concentrations of serum thyroglobulin (above 1.7 μg/l) were found in 94 %. Based on the logarithmic transformation, the upper reference limits were determined for men ≦ 40 years: 36 μg/l, > 40 years: 44 μg/l (difference between groups not significant, P > 0.05), and for women ≦ 40 years: 30 μg/l, > 40 years: 60 μg/l (significant difference, P < 0.005).

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Ulla Feldt-Rasmussen, Axel P. Lange, John Date and Mogens Kern Hansen

ABSTRACT

To study the effect on thyroid function 100 mg of clomifene citrate was given once a day to two groups of healthy male volunteers for 5 and 12 consecutive days, respectively.

In both groups serum concentrations of TSH, thyroxine, triiodothyronine, T3 resin uptake test and thyroid hormone binding proteins were measured before, during and after oral administration of clomifene. The effect of clomifene treatment was evaluated in Group 1 by means of serum FSH and LH measurements. Further in Group 2 the serum TSH response to iv TRH (200 μg) was also investigated.

The mean per cent elevations in serum concentrations of FSH and LH were 145 and 200, respectively. In Group 1 a small but statistically significant decrease within reference limits in triiodothyronine (P < 0.01) and free thyroxine index (P < 0.02) was found on day 4 of clomifene. On day 5 a slight increase in TSH was observed (P < 0.05). In Group 2 the response of TSH to TRH showed a non-significant increase after 5 days and a significant increase (P < 0.01) after 12 days of clomifene. Eight days after discontinuation of the drug the response was restored to normal. No changes in the thyroid hormone binding proteins in serum could be demonstrated. Though the observed changes were slight, they indicate that clomifene exerts an influence directly on the thyroid function.

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Vagn Haas, Margaret Marley, Anders Green, John Date, Mogens Blichert-Toft and Erik F. Mogensen

Abstract. The excretion of urinary iodine was studied in a representative population sample from the county of Funen, Denmark, comprising 505 persons between 25–44 years of age, stratified according to geography, age, and sex. Urine samples were collected for 5 h during late afternoon and early evening. The 24-h iodine excretion was estimated on the basis of iodine and creatinine determinations using correlation equations determined in a pilot study of 50 men and women. The iodine excretion was significantly higher in men: 89 μg/24 h (median) than in women: 76 μg/24 h; the whole population: 85 μg/24 h. No significant differences were observed among the age groups studied. The iodine excretion was significantly higher in people living on small islands: 98 μg/24 h (median) compared with 84 μg/24 h in urban regions and 78 μg/24 h in rural districts. Median iodine excretion per gram of creatinine was 58.8 μg for the whole sample. The iodine excretion for men was 77% higher than reported in an earlier investigation performed in Funen, 1969, but still lower than internationally recommended (WHO).

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Ulla Feldt Rasmussen, Axel Kemp, Karine Bech, Stig Nistrup Madsen and John Date

Abstract.

Serum concentrations of thyroglobulin, its antibody, and thyroid stimulating antibodies were studied in 32 patients referred to a department of eye-diseases for exophthalmos. Twenty-three of the patients were or had been medically treated for Graves' disease, one had toxic nodular goitre, one subclinical myxoedema, three euthyroid exophthalmos and four were shown to have non-endocrine eye-disease.

In patients with medically treated Graves' disease serum thyroglobulin was significantly elevated (P < 0.02), the still toxic patients accounting for the highest values. Both thyroid stimulating and thyroglobulin antibodies were detectable in 4 of 18 patients. The rest of the patients had normal concentrations of thyroglobulin and undetectable thyroid stimulating antibodies, but 3 patients had measurable thyroglobulin antibodies. In Graves' patients there was no correlation between serum concentrations of thyroid stimulating antibodies and thyroglobulin, and no clear difference between the frequency of thyroid stimulating or thyroglobulin antibodies in the patients with persistent elevation of circulating thyroid hormones and those remaining euthyroid.

A relation between the thyroid autoantibodies, thyroglobulin and the thyroid hormonal level or severity of the exophthalmic state could not be demonstrated.

It is suggested that hyperthyroidism and exophthalmos are separate disorders, and immunological phenomena probably involved in the pathogenesis of exophthalmos associated with Graves' disease appear to be reflected only locally.

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Ulla Feldt-Rasmussen, Karine Bech, John Date, Per Hyltoft Petersen and Klaus Johansen

Abstract.

Measurement of serum thyroglobulin (Tg) and its autoantibody (TgAb) by radioimmunological methods was performed in 48 patients with Graves' disease during treatment with radioiodine (n = 16) or propylthiouracil (PTU) (n = 32).

Twenty-five of the 48 patients were TgAb positive, their sera being inaccessible to measurement of serum Tg. TgAb showed only minor changes during PTU treatment, whereas TgAb fell rapidly after radioiodine, in 5 of 16 patients to unmeasurable levels, followed by a secondary rise to 4.5 times pre-treatment level after 20 weeks.

Serum Tg showed a steady increase during the first weeks after radioiodine treatment, but fell to lower levels after one year. PTU caused only minor changes in the serum Tg concentration. There was no shift in molecular sizes of either Tg or TgAb during the course of the treatments.

Five of 16 131I-treated patients developed myxoedema, 4 of whom were TgAb positive. Another 3 patients had high increases in TgAb without myxoedema.

Six of 18 patients had relapse of thyrotoxicosis after withdrawal of PTU-treatment. There was no significant difference in serum concentrations of TgAb or Tg between those developing relapse and those remaining in remission, and it is concluded that serum Tg is a poor predictor of relapse in medically treated thyrotoxicosis.