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BACKGROUND AND OBJECTIVE Thyroglobulin (Tg) has been found in varying concentrations in infants and children with congenital hypothyroidism. Our primary goal was to ascertain whether Tg in filter paper blood specimens used for routine newborn screening would be a useful adjunct in the early diagnosis of newborn children with congenital hypothyroidism. Our secondary objective was to correlate the results of the Tg determinations with the results of thyroid scintigraphy in the same cohort of infants with congenital hypothyroidism. DESIGN An RIA kit with high sensitivity for the measurement of Tg in serum was modified for use with filter paper blood specimens. Results of thyroid scintigraphy were obtained from the family physicians on 10 infants with ectopic thyroid glands and 18 who were considered to be athyreotic. MEASUREMENTS Determinations of Tg were carried out retrospectively on newborn screening filter paper blood specimens from 61 full-term normal infants and 42 newborns with confirmed congenital hypothyroidism. RESULTS Thyroglobulin concentrations during the first week of life in the normal controls ranged between 17 and 160 micrograms/l, with a median of 66 micrograms/l. Tg values for infants with ectopic thyroid glands ranged between 38 and 282 micrograms/l, with a median of 160 micrograms/l, with a median of 66 micrograms/liters. Tg values for infants who were considered athyreotic had Tg values ranging between undetectable and 104 micrograms/l with a median of 15 micrograms/l. Fifty per cent of the athyreotic patients and 50% of patients with ectopic thyroid glands had Tg values above or below the normal range and thus fell within the diagnostic category of hypothyroidism on the basis of Tg alone. Fifty per cent of patients who were considered athyreotic by scintigraphy had Tg concentrations ranging from 20 to 104 micrograms/l. CONCLUSION These studies have shown that thyroglobulin can be measured in the same filter paper blood specimens used for routine newborn screening. Estimation of thyroglobulin in screening specimens from hypothyroid and normal infants indicated that some infants with congenital hypothyroidism could be identified solely on the basis of the thyroglobulin concentration. Comparison of the result of scintigraphy with thyroglobulin levels in the same hypothyroid patients suggested that thryoglobulin provided a more reliable marker for the presence or absence of the thyroid gland than did scintigraphy.

Summary. objective The present study was designed to determine the current prevalence of gestational hypothyroidism, since maternal thyroxine deficiency is associated with poor obstetric outcomes and mental retardation in the surviving offspring. design TSH concentrations were measured In the sera of women at 15—18 weeks of gestation. Those sera with TSH concentrations above 6 mU/l and the two sera closest In order with TSH concentrations below 6 mU/l were further analysed for T4, FT4, TBG, and antithyrold antibodies. Study criteria for hypothyroidism were sera with elevated concentrations of TSH plus both a free T4 concentration and a total T4 concentration and /or T4/TBG ratio more than two standard deviations below the mean for the control pregnant women. patients The sera were from 2000 consecutive women In Maine being tested for alpha-fetoprotein concentration at 15–18 weeks of gestation. results TSH concentrations above 6 mU/l ere found in the sera of 49 women, 2.5% of the pregnant women. Six women with elevated TSH concentrations (range 6.9–54 mU/l) had both a FT4 concentration and a T4/TBG ratio and/or a T4 concentration more than two standard deviations below the respective control means, meeting the study criteria for thyroid deficiency, and thus giving a prevalence of 0.3%. The remaining 43 women with elevated TSH concentrations were classified as having compensated thyroid disease although some may have been hypothyroid. Fifty-eight per cent of women with TSH concentrations above 6 mU/l and 90% of the women with elevated TSH concentrations and at least one thyroxine index more than two standard deviations below the control means had positive titres of antithyroid antibodies as opposed to 11% of the controls. conclusions Although it is not known what severity of maternal thyroid deficiency is necessary to cause fetal brain damage, the present data Indicate a sufficiently high prevalence of thyroid dysfunction to demand Investigation of the mental development of the offspring of women with thyroid dysfunction and of the effect of replacement therapy.

We presented data showing a direct correlation of screening T4 values with birthweight in premature infants at this meeting three years ago.We opined that low T4 concentrations were due to decreased protein binding of T4. The next year,we reported data proving the speculation and showing lower binding was more than compensated for in term infants by increased TBG concentration. FT4 concentrations for term and VLBW infants were all within the normal adult range and the neonates had similar TSH concentrations indicating low T4 values were due to NTI. Further findings at 2 weeks in 5 of 32 VLBW infants suggest a Euthyroid Sick Syndrome. We compare clinical and hormonal values of these 5 with the remaining 27 infants in the tables.(cord v 2 wk- * p

Levels of somatomedin-C/insulin-like growth factor-1 (Sm-C/IGF-1) were determined in whole blood collected on filter paper from 41 newborns with congenital hypothyroidism and 183 full-term neonates with normal thyroid function. The mean Sm-C/IGF-1 value of the untreated hypothyroid infants (0.10 U/ml) was virtually identical with that of the normal controls (0.11 U/ml). We are unable to confirm earlier findings of others that Sm-C/IGF-1 concentrations are lower in hypothyroid newborns than in normal infants.

THE administration of small doses of purified preparations of human growth hormone to patients with diabetes mellitus may produce profound changes in the metabolism of carbohydrate, resulting in elevations in blood sugar and the appearance of ketoacidosis.1 2 3 It is of interest that despite the "anti-insulin" effects of human growth hormone, especially in hypophysectomized diabetic patients,4 , 5 small doses of this hormone have had little or no effect upon carbohydrate metabolism in normal subjects6 7 8 or in panhypopituitary dwarfs,9 but few studies have been carried out with human growth hormone in conditions of altered carbohydrate metabolism caused by conditions other than diabetes mellitus. . . .

The anabolic steroids Nilevar and Dianabol were administered to a total of 21 persons for a period of 3 weeks in a dosage of 30 and 10 mg daily, respectively. This regimen resulted in a prompt and appreciable decrease in both the concentration of serum protein-bound iodine and the serum thyroxine-binding capacity. These responses were observed not only in euthyroid subjects but also in athyrotic cases. It is likely that the decrease in PBI is a consequence of the reduced thyroxine-binding capacity of the serum.

IGF-I concentrations were determined by RIA in eluates of dried blood collected on filter paper from infants who ranged in age from 3 to 21 d. The infants were separated into normal (greater than 2.5 kg) and low (less than 2.5 kg) birth wt groups and further subdivided on the basis of normal (greater than 83.7 nmol/liter) or low (less than 64.4 nmol/liter) levels of thyroxine. Both the normal and low birth wt groups whose blood thyroxine was in the normal range had similar mean IGF-I values during the 1st wk of life that were significantly higher (p less than 0.05) than those of either the normal or low birth wt groups whose thyroxine concentrations were below normal. Infants older than 1 wk of age with normal birth wt and normal thyroxine levels had significantly greater (p less than 0.05) mean IGF-I values than those of any of the other groups. Infants in the low birth wt-normal thyroxine group exhibited modest increases in IGF-I levels after the 1st wk of life that were significantly greater (p less than 0.05) than those found in the low birth wt-low thyroxine infants. These studies have demonstrated that IGF-I concentration is correlated positively with total thyroxine and with birth wt and that the latter is confounded by the former.

After injection of glucagon, growth hormone increased to 8.0 ng per milliliter or more in 33 of 34 subjects without apparent pituitary disease. In 21 of 23 patients with pituitary disease the maximum value did not exceed 4.8 ng per milliliter. The glucagon stimulation test is a safe, convenient and reasonably reliable way of testing for growth-hormone deficiency.

SummaryTwelve hours after the intramuscular administration of a single 10 mg dose of human growth hormone (HGH), fasting blood samples were obtained and analyzed for levels of triglycerides and cholesterol. Growth hormone was found to raise fasting plasma triglycerides significantly in a group of 6 middle-aged and elderly diabetic subjects but not in 10 nondiabetic midde-aged and elderly controls. Smaller and less consistent increases were also observed in a group of 6 normal young men and in 6 young women who were taking contraceptive pills at the time. In no group was there any significant change in plasma cholesterol level 12 hr following growth hormone administration.

Since it became evident several years ago that human and simian growth hormone, in contrast to bovine and porcine, were biologically active in man, the metabolic effects of human growth hormone in man have been extensively studied. While in general the results have been similar to those previously seen in animals, the metabolic responsiveness of man to small doses of human growth hormone has been impressive, and the consistency of the human response has been particularly gratifying in view of the many earlier abortive efforts to obtain such results.

The effects of large doses of 6-medroxyprogesterone acetate (Provera) on iodine-131-tri-iodothyronine sponge uptake was investigated in 9 women and 4 men with carcinoma. In 12 out of 13 patients iodine-131-tri-iodothyronine uptake was higher (p less than .003) during treatment; these high values returned to pretreatment levels in 2 out of 3 cases after discontinuation of Provera. There was a significant drop (p less than .05) in protein-bound iodine in 6 patients.