ABSTRACT
The pilot study was undertaken to evaluate the role of FNA cytology in the clinical management of patients with thyroid swelling, in a District General Hospital (DGH) setting. One hundred and eleven patients were investigated over a period of 3 years, with a total of 142 fine needle aspirations. Statistical analysis showed a sensitivity of 71%, a specificity of 91% and a false negative rate of 2.7%. These results compare very favourably with other institutions. This study therefore shows that thyroid nodule FNA cytology can be performed in a DGH with a high standard of diagnostic accuracy, the results of which play a key role in patient management.
Subject(s)
Biopsy, Needle , Thyroid Nodule/pathology , Diagnosis, Differential , Evaluation Studies as Topic , Hospitals, District , Hospitals, General , Humans , Pilot Projects , Predictive Value of Tests , Sensitivity and SpecificitySubject(s)
Diabetes Mellitus, Type 1/complications , Fractures, Spontaneous/diagnostic imaging , Tibial Fractures/diagnostic imaging , Adult , Female , Fractures, Spontaneous/complications , Fractures, Spontaneous/therapy , Humans , Radiography , Tibial Fractures/complications , Tibial Fractures/therapySubject(s)
Cocaine/adverse effects , Porphyrias/chemically induced , Acute Disease , Adult , Humans , MaleABSTRACT
Most assays of thyroid stimulating immunoglobulin (TSI) are unsuitable for the quantitation of TSI during the treatment of Graves' hyperthyroidism because assay insensitivity results in some negative responses. Therefore the sensitive cytochemical bioassay was used to investigate the effect of carbimazole on TSI levels as a possible mechanism for the induction of the increased remission rate which is characteristic of thionamide therapy. Twelve patients were studied before therapy for de-novo Graves' hyperthyroidism; seven patients consented to a detailed prospectively study during block-replace therapy with carbimazole 10mg 6 hourly with a later addition of T3 20 micrograms 6 hourly when biochemically euthyroid. In addition thyroid hormone or T3 suppressed technetium (99m Tc) thyroidal uptake was monitored at between weekly and 3 monthly intervals, as well as the clinical findings, total T4 total T3, TSH, antimicrosomal antibody titers and immunoglobulins IgG, IgM and IgA. TSI was detected in all patients before treatment but there was no correlation with any other pretreatment measurements. During therapy TSI fell (in three different patterns) in 6 out of 7 patients studied for between 14-55 weeks (mean 29 weeks). TSI remained unchanged in one patient. Only the 99m Tc uptake correlated with TSI activity in the treated patients as a group (r = 0.71, p less than 0.001). TSI remained detectable in all patients, even in 4 patients in whom T3 suppression of 99m Tc was demonstrated. There is some evidence for a carbimazole effect lowering TSI activity, however relapse rate did not support this. T3 suppressed 99m Tc uptake may be a sensitive in vivo marker of TSI activity.
Subject(s)
Carbimazole/therapeutic use , Graves Disease/immunology , Immunoglobulin G/metabolism , Adult , Autoantibodies/metabolism , Cytological Techniques , Female , Graves Disease/blood , Graves Disease/drug therapy , Humans , Immunoglobulins/metabolism , Immunoglobulins, Thyroid-Stimulating , Male , Middle Aged , Prospective Studies , Sodium Pertechnetate Tc 99m , Thyroid Hormones/blood , Thyrotropin/bloodABSTRACT
Ten patients with Addison's disease, nine with undetectable plasma aldosterone, were found to be sodium and water depleted with high levels of plasma-renin activity despite receiving 0.05-0.1 mg/day of fludrocortisone and optimum doses of glucocorticoid replacement therapy. Fludrocortisone was withdrawn while patients were in hospital on a fixed sodium intake. There was an immediate natriuresis with a further increase in plasma-renin activity. When a daily dose of 0.3 mg of fludrocortisone was given all patients retained sodium and water and gained weight. There was a fall in plasma-renin activity in all patients and an associated fall in blood urea and plasma potassium, and an increase in plasma volume; oedema developed in some patients. At outpatient follow-up, the dose of fludrocortisone was adjusted according to plasma-renin activity. Most patients required 0.2 mg of fludrocortisone to maintain adequate sodium and water balance. These results suggest that patients with Addison's disease on 0.05-0.1 mg of fludrocortisone with undetectable plasma aldosterone levels are currently being undertreated with fludrocortisone. The best way of assessing sodium balance in these patients and their response to fludrocortisone is by measurement of plasma-renin activity in conjunction with 24 h urinary sodium excretion.
Subject(s)
Addison Disease/drug therapy , Fludrocortisone/administration & dosage , Addison Disease/physiopathology , Adult , Aged , Aldosterone/blood , Body Water/metabolism , Female , Follow-Up Studies , Humans , Male , Middle Aged , Plasma Volume , Renin/blood , Sodium/metabolismABSTRACT
The cytochemical section-bioassay of thyroid stimulating activity is described. Plasma of thyrotoxic patients as well as those on block-replace treatment with carbimazole and thyroid hormones was used. Linear parallel responses were obtained over the range 1.5 X 10(-7) to 1.5 X 10(-5) mU/1 MRC LATS-B standard. The index of precision was 0.19 +/- 0.028. The fiducial limits (p=0.95) of a sample tested on ten separate occasions were 52-192%. Specificity was investigated using time course studies, and the effect of anti-TSH or anti-IgG antisera. No effect of methimazole or a variety of other drugs was detected. The assay is accordingly validated for measurement of TSI in patients both untreated and on block-replace therapy.
