Abstract. The effect of intravenous versus intranasal TRH stimulation was compared in geriatric patients. In patients receiving both iv and nasal tests (N = 35) there was a good correlation between the TSH responses, but in 3 cases the suspicion of inadequate nasal TRH effect arose. The coefficient of correlation of basal to ΔTSH was better in iv tested patients (116 patients in each group, one half having a positive the other half a negative TRH test). In the majority of patients with suspicious incongruity of basal and Δ TSH the nasal test was done. The specificity and sensitivity of various basal TSH 'cut-off' points to predict a positive TRH test were better in patients with iv TRH tests (in each group 96 consecutively admitted patients). Insufficiency of the nasal test in geriatric patients is mainly explained by the inability of the old people to aspirate the nasal spray effectively. Besides the advantages of iv TRH application in geriatric patients, the frequency of adverse reactions (14% versus 0%) must be considered. Thus, in a hospitalized geriatric patient, the TRH test should be performed iv in the recumbent position; however, for examination of geriatric outpatients the nasal test is recommended.
István Szabolcs, Christoph Ploenes, Wolfdieter Bernard and Jorg Herrmann
Franz Adlkofer, Hannelore Hain, Harald Meinhold, Dieter Kraft, David Ramsden, Jörg Herrmann and Wolf-Dieter Heller
The thyroid function of 13 patients with proteinuria and normal serum creatinine level (Group 1) and 15 patients with proteinuria and increased creatinine level (Group 2) was investigated. The daily urinary T4 1-and T3 excretion was much higher in Group 1 patients than in Group 2 patients (37.1 ± 25.9 nmol T4 vs 17.5 ± 8.7 nmol T4, 3.3 ± 1.6 nmol T3 vs 1.1 ± 0.8 nmol T3, respectively) and correlated in both groups with the protein loss. None of the patients suffered from hypothyroidism as a consequence of this hormone loss. Although the mean serum T4-, T3-, FT4-, FT3-, TBG-and TBPA concentrations in both groups of patients were within the normal range, the urinary hormone loss appeared to influence these values considerably. It was striking that the rT3 concentration in the patients with the highest hormone loss was frequently less than 0.08 nmol/l, the lower limit of detectability. The basal TSH levels in serum of the nephrotic patients were similar to those of normal individuals. The thyroid function of patients with proteinuria accompanied by retention of creatinine due to renal failure was more difficult to assess because different pathological mechanisms may exert their influence on the thyroidal hormone secretion as well as on the peripheral hormone metabolism.