RESUMEN
BACKGROUND: Routinary evaluation of FT4 and TSH, in elderly in-patients without thyroid disease shows frequent, isolated and, often unclear, changes from normal values of plasma TSH and FT4 concentrations. A new parameter called "T index" derived from the product of FT4 and TSH values has been used by the authors. In a previous work they studied "T index" variations in 1257 elderly subjects with normal FT4 and TSH levels. They have determined the "T index" theoretic model of distribution and identified a normality range (values from 5.78 to 50.76), a suspect range (values from 2.92 to 5.78 and from 50.76 to 68.6) and a pathologic range (values less than 2.92 and more than 68.6). Aim of this study was to investigate "T index" variations in a group of 357 elderly subjects with altered FT4 and/or TSH levels. METHODS: Patients were divided into eight groups according to different concentrations of FT4 and/or TSH levels. "T index" results were expressed as mean, standard deviation, maximum and minimum values. Patients were therefore divided into three groups (normality range, suspect range, pathologic range) according to "T index" distribution as previously described. RESULTS: In 20% of elderly people hospitalized, we found alterations of thyroid hormones levels represented mostly by: a) FT4 normal; TSH low. b) FT4 normal; TSH high, c) FT4 low; TSH normal. In case of hypothalamus-hypophysis hypothyroidism and in case of hyperthyroidism, "T index" score is, usually, less than 2.92, whereas in case of hypothalamus-hypophysis hypothyroidism and hypothyroidism "T index" score is, nearly always, more than 68.6. When TSH levels are into the range of normality "T index" score has always normality levels. The "T index" helps us to divide patients with subclinical hyperthyroidism into two groups: one with values from 5.78 to 2.92 (suspect range), and the other, with values less than 2.92 pathologic range). In patients with subclinical hypothyroidism, some patients have values from 50.76 to 68.6 (suspect range), other patients have values more than 68.6 (pathologic range). CONCLUSIONS: In case of subclinical hypothyroidism or subclinical hyperthyroidism the use of "T index" seems to be a good way to select the cases in which it is better to start pharmacological treatment (hormonal replacement or thyroid inhibition) from those which is better to follow-up.
Asunto(s)
Tirotropina/sangre , Anciano , Envejecimiento/sangre , Humanos , Hipertiroidismo/sangre , Hipertiroidismo/diagnóstico , Hipotiroidismo/sangre , Hipotiroidismo/diagnóstico , Valores de ReferenciaRESUMEN
BACKGROUND: A variety of severe illnesses can induce changes in thyroid hormone metabolism, leading to findings referred to as "sick euthyroid syndrome" (ESS). These thyroid hormone changes may be mediated in part by cytokines or other inflammatory mediators, acting at the level of the hypothalamus and pituitary gland, the thyroid gland, and the hepatic deiodinase system. The degree of thyroid function disturbance correlates with disease severity and low levels of thyroid hormones predict a poor prognosis in several illnesses. It remains unresolved whether the hormone responses in the ESS represent part of an adaptative response, which lowers tissue energy requirements in the face of systemic illness, or a maladaptive response, which induces damaging tissue hypothyroidism. METHODS: This study examines the incidence of ESS among 220 elderly subjects hospitalized with cancer. In each subjects some individual variables were studied: age, sex, type of cancer, presence of metastasis, rapid shortage of corporeal weight, general clinic condition. The following laboratory parameters were studied: serum glucose, sodium, potassium, calcium, cholesterol, lipids, proteins, leukocytes, serum, lipids haemoglobin, plateletes, VES and the end free triiodothyronine, free tiroxine and thyrotropin. RESULTS: The research points out that ESS is more frequent in the elderly subjects with cancer (incidence 58%). ESS type 1, with FT3 low and FT4 and TSH normal, is the most frequent form. The incidence of ESS is higher in elderly subjects with cancer, with recent and marked lose of corporeal weight (incidence 86%) and in subjects with worst clinical conditions. Finally, a significant direct correlation between FT3/serum cholesterol, FT3/serum proteins, FT3/serum sodium, FT3/FT4 is observed. CONCLUSIONS: The results obtained point out the not yet solved problem of hormone replacement therapy in elderly patients with cancer in bad clinical conditions.
Asunto(s)
Síndromes del Eutiroideo Enfermo/sangre , Síndromes del Eutiroideo Enfermo/etiología , Neoplasias/sangre , Neoplasias/complicaciones , Hormonas Tiroideas/sangre , Anciano , Anciano de 80 o más Años , Síndromes del Eutiroideo Enfermo/epidemiología , Femenino , Humanos , Incidencia , MasculinoRESUMEN
The efficacy of beta methyldigoxin was examined in a group of 40 elderly patients who had been hospitalised due to congested heart decompensation. A good clinical response was obtained in 95.5% of cases with the presence of slight toxic phenomena in 2 cases only (4.5%). The paper underlines the excellent pharmacokinetic pattern of the substance used in the steady state. Steady state digitalemic values were within the acceptable range in 83.76% of cases, whereas underdosage and overdosage phenomena were observed in 6.87% and 9.37% of patients respectively.