Effects of hypothyroidism and hyperthyroidism on insulin-like growth factors and IGF-binding proteins

Normal thyroid status is a prerequisite for the normal growth and development of many tissues. The interrelationships between the thyroid and pituitary-GH-insulin-like growth factor [IGF] axes are complex and not yet fully understood. Subjects and Method: We have studied the effects of hyperthyroidism [n = 22, aged 33.14 +/- 5.41 years] and hypothyroidism [n = 22, clinical = 10 and subclinical = 12, aged 34.5 +/- 5.26 years] on levels of serum immunoreactive [IR] IGF-I and IGF-binding protein 3 [IGFBP-3] measured by IRMA kit. Twenty persons were also included as a normal control group. Eight hyperthyroid and 8 hypothyroid patients were followed up 3 months after specific treatment. The mean IGF-I and IGFBP-3 Z-values were not significantly higher in hyperthyroid patients [-0.40 +/- 0.90 and 2 -0.53 +/- 0.72 respectively] than in the control group [-1.07 +/- 1.05 and -0.99 +/- 0.63 respectively] but they were significantly higher than clinical hypothyroid cases [-1.92 +/- 0.62 and -1.50 +/- 0.76respectively, p < 0.05]. After 3 months of Antithyroid therapy, TSH level increased to 0.01 +/- 0.02 micro IU/ml but is still significantly suppressed. There was significant lowering in their thyroid hormones levels [11.19 + 6.69 pg/ml to 3.l6 + 0.87 pg/ml for T3 and 3.90 +/- 1.62 ng/dl to 1.39 +/- 0.27 ng/dl for T4, p < 0.01]. This mean IGF-I Z-value was significantly lowered [-0.40 +/- 0.90 changed to -0.98 +/- 0.55, p < 0.05] under treatment but the lowered IGFBP-3 Z-value was not significant [-0.53 +/- 0.72 lowered to 0.73 +/- 0.88, p = 0.4]. In clinical cases of hypothyroidism, the mean serum IGF-1 Z value was significantly lower [-1.92 +/- 0.62] than the control group [-1.07 +/- 1.0, p = 0.03]. This difference is not significant in subclinical cases [-1.55 +/- 0.58]. After 3 months therapy in the clinical hypothyroid group, the serum TSH level dropped significantly from 25.94 +/- 22.82 to 16.40 +/- 12. l9micro IU/ml, p < 0.05. The rise of both IGFIZ-values and IGFBP-3 Z values under therapy with thyroxin were not significant [-1.92 +/- 0.62 rose to -1.10 +/- 0.97 for IGFI and -1.50 +/- 0.76 rose to -1.25 +/- 1.51 for IGFBP-3]. In all studied cases as well as in control subjects, serum fT4 and fT3 values were positively correlated [r = 0.627, p < 0.01] and serum TSH levels were inversely correlated [r = 0.312, p < 0.01] with circulating IGF-l concentrations. our data suggest that even subclinical alteration in thyroid functions correlated with IGF-1 concentrations. We have confirmed that IR IGF-I and IGFBP-3 level are low in hypothyroidism and high in hyperthyroidism reflecting a direct relationship between circulating levels of thyroid hormones and IGF-1. Their response to specific therapy suggests their possible use in monitoring the response to treatment in cases of thyroid dysfunction

Evaluation of endoscopic retrograde cholangiopancreatography [ERCP] and ultrasonography in obstructive jaundice

Fifty patients were included in this study. They were 28 males and 22 females. Their ages were ranging from 25 to 79 years with a mean value of 52.5 years. All patients were suspected to have obstructive Jaundice. All patients were subjected to detaliled history and clinical examination, liver function tests, real time abdominal ultrasonography [U.S.] and finally endoscopic retrograde cholangio-pancreatography [ERCP]. The success rate of clinical and laboratory evaluation in differentiating obstructive from non-obstructive jaundice was 76%. The percentage of success of ultrasonography in our study in differentiation between surgical from nonsurgical jaundice was 84.5%, while diagnosing the cause of obstruction in 40% only. On the other hand ERCP defind the site and cause of obstruction in nearly 100%