Inability of recombinant human thyrotropin to predict the evolution from subclinical hypothyroidism to overt disease. A pilot study.

BACKGROUND: The use of recombinant human TSH (rhTSH) is indicated to evaluate thyroid carcinoma patients. In recent years, some authors have reported that rhTSH could serve as a dynamic test of thyroid reserve. The aim of the present study was to determine whether or not rhTSH can predict the evolution from subclinical hypothyroidism (SH) to overt hypothyroidism. MATERIALS AND METHODS: Twenty-one women who met the diagnostic criteria of SH were enrolled. All patients received a single dose of rhTSH (0.1 mg). Basal blood samples for TSH, free T4 (fT4), thyroglobulin (Tg), and anti-thyoperoxidase and anti-Tg antibodies were obtained before and 1 day after rhTSH administration. All patients were followed for 2 yr, and blood samples were obtained every 6 months. RESULTS: Twenty-four hours after rhTSH administration, the TSH level increased to >20 mU/l in 14 patients; the serum peak TSH levels remained <10 mU/l in only 5 patients. On follow-up, 7 women (33%) required L-T4 replacement therapy for overt hypothyroidism or a persistent TSH level >10 mlU/l. None of the parameters analyzed differed significantly between patients who developed overt hypothyroidism from those who had persistent SH. CONCLUSIONS: The response of thyroid function tests to a single low dose of rhTSH is not useful in identifying those patients with SH who will develop overt hypothyroidism over a 2-yr period.

[The evolution of pulmonary tuberculosis in health area no 4 in Valencia during the period 1988-1993]. / Evolución de la tuberculosis pulmonar en el área de salud 4 de Valencia durante el peródo 1988-1993.

BACKGROUND: Morbidity from Pulmonary tuberculosis, detected by the system EDO in the Autonomous Community of Valencia, shows an increasing trend and differential behaviour in relation with age and constitutes, with no doubt, a Public Health problem involving a joint action of multiple clinical care and preventive units. METHODS: In our study, the cases of notified and confirmed pulmonary tuberculosis over the period 1988-1993 in the Health Area number 4 (Region Camp de Morvedre 167.744 inhabitants) are analyzed by estimating the evolution of incidence, the diagnosis time and place where this diagnosis was made in accordance with the conventional variables of ecological studies and excluding from our registry the cases of those patients with co-infection by virus VIH. RESULTS: The growing evolution of incidence, the mean rate for the period (49.95.10(5) h.), the rate differential per age-groups during the period and the concentration of cases in the young age-groups (15-39 years) constitute, together with the diagnosis time (75.6 days in Primary Health Care; 74.3 in Hospital), the most outstanding results. Nevertheless, the prolongation of the diagnosis time for order age-groups (140-168 days in people older than 54 years) and the absence of a previous known contact, suggest the presence of undetected cases of TBC and dissemination ways other than the interfamily ones. CONCLUSIONS: An improved notification and identification of cases from hospital sources involves the necessity of reducing the mean diagnosis time and the research on the ways of transmission other than the interfamily ones; this explains a limited part of the incidence.