By David G. Ferriman
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1. — a. —Often raised in hypothyroidism. Changes in hyperthyroidism not diagnostic. b. —Unreliable in nervous subjects. Performance of the test under sedation will increase its reliability b u t presents technical difficulties. BMR is also raised in cardiac failure, fever, blood dyscrasias, and other conditions. The test is being replaced by other methods. c. —Tendon reflexes are brisk in hyperthyroidism, and show a characteristic slow relaxation in hypothyroidism. This can be tested by measuring the duration of relaxation of the ankle-jerk, in milliseconds.
Partial thyroidectomy only needed if unsightly, if pressure effects occur, or on suspicion of carcinoma. Thyroxine may lead to regression in a proportion of cases. Salt should be iodized in endemic-goitre areas. —A number of patients are seen with solitary thyroid nodules. A scan of the thyroid may reveal absence of 131 I uptake by the nodule. Some of these are due to inactive adenoma or cysts. A proportion turn out to be carcinoma. I t is usual to remove all such 'cold' nodules. MALIGNANT DISEASE OF THYROID Malignant disease of the thyroid is rare.
4. Auto-immune thyroiditis. 5. Genetic enzyme defects. Studies in iodine-deficiency areas have shown two types of case. One with high 132 I uptake, thyroidal turnover rate, and 48-hour P B I 1 3 1 level; glands contain more iodothyronines than iodotyrosines. The other with low 132 I uptake, thyroidal turnover rate, and 48-hour P B I 1 3 1 level; glands contain more iodotyrosines than iodothyronines. Findings in the latter group are thought to indicate a failure of thyroid function. The findings in the latter group are also observed in sporadic goitre of unknown aetiology.
A Synopsis of Endocrinology and Metabolism by David G. Ferriman