Regression of a large goiter in a patient with resistance to thyroid hormone by every other day treatment with triiodothyronine.

Resistance to thyroid hormone (RTH) is a syndrome of reduced responsiveness to thyroid hormone caused, in the majority of cases, by mutation in the thyroid hormone receptor (TR) beta gene. Partial compensation through increase synthesis and secretion of thyroid hormone is mediated through TSH and results in thyroid gland enlargement. Goiters are of variable size but are recalcitrant to surgical treatment, and tend to recur. We describe a 17-year-old girl with a very large goiter cosmetically unacceptable to the patient. She was the index case of a large Azorean family harbouring the TRbeta mutation R243Q. Complete goiter regression was achieved without significant side effects by administration of L-T3 every other day. The required dose of 250 microg suppressing TSH to values below 0.1 mU/L was derived by titration. Supraphysiological doses of L-T3 can be given safely as long-term treatment of goiter in patients RTH.     

Inhibition by somatostatin of mouse thyroid activity following stimulation by thyrotrophin, isoprenaline and dibutyryl cyclic-AMP.

The recent discovery of somatostatin-containing cells within the thyroid gland infers that somatostatin may influence thyroid activity. This possibility was investigated by measurements of radio-iodine release in mice pre-treated with 125I and T4. The animals were treated with TSH, isoprenaline or dibutyryl-cyclic AMP with and without concomitant injection of somatostatin. It was found that somatostatin reduced the blood 125I increase in response to each of the three thyroid-stimulating agents. The elimination rates of 125I-labelled T4 and T3 were unaffected by somatostatin. The observations suggests that somatostatin may participate in the regulation of thyroid hormone secretion, by an inhibitory effect exerted within the thyroid gland.     

Acute inotropic response of rabbit papillary muscle to triiodothyronine.

The effects of triiodothyronine (T3) on the force frequency responses of isometrically contracting rabbit papillary muscles were studied in the presence of d-glucose, pyruvate or butyrate. The stimulation frequency was varied from 0.1 to 0.5 Hz, and the maximum developed tension and its maximum (Tmx) and minimum (Tmn) time derivative were measured. T3 concentrations ranged from 0.1 to 4.0 ng/ml. The addition of T3 resulted in a substrate-dependent increase in twitch tension; with the largest increases being: d-glucose 118 +/- 7%, pyruvate 143 +/- 6%, butyrate 123 +/- 11%; Tmx:d-glucose 121 +/- 8%, pyruvate 157 +/- 5%, butyrate 138 +/- 12%, and Tmn:d-glucose 150 +/- 10%, pyruvate 159 +/- 6%, butyrate 163 +/- 14%. All three measures of contractility showed a dose-dependent increase reaching a maximum value at a T3 concentration between 1 and 2 ng/ml. These data show that T3 induces an inotropic response in rabbit papillary muscles which is manifested within, approximately 30 min, and that the greatest increase is seen in Tmn.     

Reduction in hepatic triiodothyronine binding capacity induced by fasting.

Triiodothyronine (T3) receptor kinetics were determined in liver nuclei isolated from fasting and fed rats. The results indicate that although affinity equilibrium constants (Ka) did not differ in the two groups, mean (+/- SE) maximal binding capacity (MBC) was reduced significantly to .30 +/- .05 nM/mg DNA in fasting compared to .46 +/- .07 nM/mg DNA (p less than .01) in the fed state. This observed decrease in MBC during fasting apparently could not be accounted for by a differential rates of loss of either DNA or of the receptor during the period of incubation.     

Inhibition of ACTH response to oral and intravenous metyrapone by antiserotoninergic treatment in man.

Plasma ACTH levels after oral and iv metyrapone administration were studied in 7 and 5 healthy women respectively both under basal conditions and after a 4-day treatment with metergoline, a specific antiserotoninergic agent. In 3 additional women, the effects of methysergide, another antiserotoninergic drug, on the plasma ACTH rise induced by oral metyrapone, were evaluated. A significant lowering of the plasma ACTH levels attained after either oral or iv metyrapone was observed following metergoline administration: 149+/-64.3 vs 239+/-49.1 pg/ml (mean peak values), P less than 0.05 in the oral test and 331+/-19.7 vs 221+/-19.5 pg/ml, P less than 0.02 in the iv test. The fall of plasma cortisol caused by metyrapone was comparable before and after the antiserotoninergic treatment. An interference of metergoline in the ACTH radioimmunoassay was also excluded. After metergoline administration, a slight reduction in the baseline plasma ACTH values was noted: 79+/-7.7 vs 67+/-7.7 pg/ml (NS). A decrease, however not statistically significant, of the metyrapone-induced plasma ACTH elevation occured after methysergide administration: 421+/-150.7 vs 344+/-135.1 pg/ml. These results can be interpreted as indicating that antiserotoninergic treatment caused an inhibition of hypophysial ACTH release in response to metyrapone. Caution is recommended, however, before concluding, on the basis of these findings, that serotonin as such plays a physiological stimulating role on ACTH secretion.     

Effects of in vivo triiodothyronine and long acting thyroid stimulator (LATS) administration on the vitro thyroid cAMP response to thyrotrophin and LATS

The present study was undertaken to examine the effects of prolonged in vivo treatment with T3 and long acting thyroid stimulator (LATS) on in vitro responsiveness of mouse thyroid cyclic AMP to thyrotrophin (TSH) and LATS-immunoglobulin G (IgG). In control mice, thyroid cAMP concentrations after incubation with normal-IgG (10 mg/ml) for 2 h, TSH (10 mU/ml) for 10 min and LATS-IgG (10 mg/ml) for 2 h were 1.25 +/- 0.11 (mean +/- SE) (n = 5), 15.87 +/- 3.47 (n = 6) and 2.17 +/- 0.25 pmoles/mg wet weight (n = 6), respectively. In mice given T3 (5 micrograms/ml) in drinking water for 5 days, thyroid cAMP concentrations after an incubation with TSH were reduced by 50%, as compared to those of the control mice. They were also decreased in mice injected ip with 5 mg of LATS-IgG (1000%/5 mg in the McKenzie bioassay) daily for 5 days. Combined treatment with T3 and LATS decreased the cAMP response to TSH only to the same extent as did T3 alone, indicating that the inhibitory effects of T3 and LATS were not additive. Similar findings were observed with the thyroid cAMP response to LATS-IgG in vitro; either T3 or LATS treatment in vivo decreased cAMP response to LATS-IgG in vitro, but combined treatment with T3 and LATS did not cause further inhibition as compared with T3 or LATS treatment alone.(ABSTRACT TRUNCATED AT 250 WORDS)     

Thyroid hormone metabolism in thyroid disease as reflected by the ratio of serum triiodothyronine to thyroxine

In 77 euthyroid subjects the mean ratio between serum triiodothyronine (S-T3) in nmol/l X 10(3) and serum thyroxine (S-T4) in nmol/l was 22.4 with a standard deviation of 4.3. The distribution of the ratio was close to Gaussian. It was not changed in subjects under estrogen effect. The ratio was increased in hypothyroid subjects suggesting a mechanism preserving S-T3 better than S-T4 in thyroid failure. This mechanism seemed independent of TSH as the increasing S-T3/S-T4 ratio in primary hypothyroidism was not correlated to serum TSH (S-TSH), and patients with hypothyroidism of pituitary origin, without any increase in S-TSH, had a significantly elevated S-T3/S-T4 ratio. In subjects taking thyroxine, S-T4 but not S-T3 increased with the dose of thyroxine, leading to decreasing S-T3/S-T4 ratios. This indicates a mechanism that keeps S-T3 within normal limits also when the S-T4 supply is high. This applied also to athyreotic subjects on thyroxine and to subjects on thyroxine plus carbimazole, suggesting that the mechanism is independent of thyroid tissue, uninfluenced by carbimazole, and probably operates via the peripheral metabolism of T4. Changes in the S-T3/S-T4 ratio can be achieved by several mechanisms, and the specificity of ratio changes is low. However, by investigating the ratio S-T3/S-T4 in selected clinical states we can depict the ability of the organism to protect its normal S-T3 level in situations with divergent S-T4 concentrations, even if details about the mechanisms cannot be explained.     

Inhibition by interferon of delayed-type hypersensitivity in the mouse.

The effect of interferon on delayed-type by persensitivity to picryl chloride and sheep erythrocytes was examined in the mouse. When administered to sensitized animals on the day before or the day of challenge, tissue culture interferon inhibited both the ear swelling induced by pieryl chloride and footpad swelling induced by sheep erythrocytes. Newcastle disease virus, when injected into sensitized If-1l or If-1h congenic mice a few hours before challenge, caused an inhibition of delayed-type hypersensitivity which could be related to the amount of serum interferon induced by the virus. These results indicate that interferon production may represent one of the factors responsible for the depression of cell-mediated immune reactions during virus infection.     

Inhibition of thyrotropin- and dibutyryl cyclic AMP-induced secretion of thyroxine and triiodothyronine by catecholamines.

Thyrotropin (TSH), 1 MU/ml and N6, O2'-dibutyryl adenosine 3',5-cyclic monophosphoric acid (dbcAMP) greatly enhanced the release of thyroxine (T4) and triiodothyronine (T3) from mouse thyroids incubated in vitro. L-Epinephrine (E) and L-norepinephrine (NE) strongly inhibited the TSH and dbcAMP-stimulated release of thyroid hormones; L-isoproterenol (IPNE) exerted a relatively weak inhibition. The inhibition by catecholamines was prevented by the alpha-adrenergic blocker, phentolamine; L-propranolol, a beta-adrenergic blocker, had no effect on the inhibition. The TSH-induced release of thyroid hormones was not affected by adrenergic blockers. Epinephrine did not affect the increase in thyroidal cAMP content induced by TSH. These results indicate that catecholamines act by way of an alpha-adrenergic receptor to suppress TSH-stimulated release of thyroid hormones at a point beyond cAMP formation.