Examination of serum thyrotropic hormone level by 'supersensitive' immunoradiometric assay in functioning thyroid adenoma.

TSH determination by immunoradiometric assay (IRMA) has enabled the detection of subnormal levels of TSH and has thus opened up new vistas in the differentiation between euthyroidism and hyperthyroidism. The present investigations have proved that in patients with autonomous functioning thyroid adenoma with progressive clinical trend, when 'non-toxic' nodular goitre transforms into toxic adenoma, the basal serum TSH level is gradually decreasing. In case of a functioning thyroid adenoma detected by scintigraphy, the basal TSH concentration of the serum over 0.3 mU/l indicates euthyroidism. In preclinical hyperthyroidism, similarly to toxic adenoma, the serum thyroid hormone determination contributes to differentiating between the two clinical states. The IRMA for TSH determination makes it unnecessary, in the majority of cases, to perform the TRH (thyreotrop-releasing hormone) loading-test, which is needed only if the basal serum TSH level is in the borderline range, i.e. between 0.1 and 0.3 mU/l.

[Gonadotropin-secreting liver cancer in ulcerative colitis]. / Gonadotropin-sezernierendes Leberkarzinom bei Colitis ulcerosa.

The authors present the clinical and pathological data of a 28 year-old female patient, who died after several months of observation. The patient had a 15-year history of mild ulcerative colitis. On admission the diagnosis of primary sclerosing cholangitis was made, but subsequently paraneoplastic gonadotropin secretion became apparent. At autopsy a cholangio- and hepatocellular carcinoma was found and the extrahepatic bile ducts were infiltrated by the cholangiocarcinoma. Using the immunoperoxidase method, the hepatocellular part of the tumour was found to contain human choriogonadotropin.

Functional relationships of the hypothalamic-pituitary-testicular system in Graves' disease.

An increased secretion of gonadotropic hormone was found in hyperthyroid males despite the high basal serum total testosterone and oestradiol levels. This suggests that hyperthyroidism affects the responsiveness of the hypothalamic-pituitary axis to sexual steroid hormones. While in the hyperthyroid patients the elevation of the serum testosterone level in response to chorionic gonadotropin was lower than normally, the LH and FSH responses to LRH were increased. The results indicate that male hyperthyroidism is associated with a loss of responsiveness of the Leydig-cells to adequate stimuli, to which the pituitary reacts by a compensatory increase in its LH-secretion and by an increased reactivity to LRH. It is suggested that in addition to the direct effect of the increased thyroid hormone levels, a secondary elevation of the oestradiol concentration plays a major part in the alterations in question.