Comparison of thyroid stimulators and thyroid hormone concentrations in the sera of pregnant women.

To clarify the role of various thyroid stimulators in normal human pregnancy, we measured serum TSH, chorionic TSH (hCT), hCG, bioassayable thyroid-stimulating activity, T4, T3, T3 uptake, free T4 and free T3 indexes, free T4, and free T3 by dialysis in 339 serum samples from pregnant women at various intervals of pregnancy and in 40 normal female controls. Serum T4 and T3 and free T4 and free T3 indexes were significantly elevated throughout pregnancy in comparison with controls. Free T4 concentration was elevated after 10 weeks of pregnancy and free T3 concentration was elevated at 13--20 weeks. Bioassayable thyroid-stimulating activity was elevated from 9--16 weeks when serum hCG concentrations were highest. Serum TSH levels were significantly lower at 9--12 weeks compared with the rest of pregnancy. hCT was detected in only 35% of sera tested; the mean detectable value was 0.60 +/- 0.04 (SE) microU/ml; only 15% of the detectable values exceeded 1 microU/ml. The level of hCG correlated with bioassayable thyroid-stimulating activity (P less than 0.01). The data indicate that hCT is not a significant thyroid stimulator. We propose that hCG, as a weak thyroid stimulator, causes a modest rise in free thyroid hormone levels early in pregnancy which in turn causes a modest reduction in pituitary TSH secretion.

Difficulties in delivery, including shoulder dystocia and malpresentations of the fetus.

Shoulder dystocia is a true obsteric emergency. It may be suspected in large multiparous women, women who have previously delivered large babies, prolonged pregnancy, women who make poor progress in labor, and when the fetus seems very large to palpation. Women with abnormal pelves should be suspect. More liberal use of cesarean section in these situations will reduce the incidence of shoulder dystocia. It is important to have a carefully considered plan of action if shoulder dystocia does occur. The most helpful and definitive maneuver is extration of the posterior arm. Malpresentations cause acute emergencies mainly because of the associated increased incidence of prolapse of the cord. This possibility should be evaluated immediately when rupture of the membranes occurs. Prompt delivery by cesarean section is the treatment of choice with this complications.

The ultrastructure of a feminizing granulosa-theca tumor.

A 13-year-old girl with evidence of hyperestrinism had a right ovarian tumor removed. This neoplasm was composed predominantly of granulosa cells and exhibited some changes of luteinization. The neoplastic cells displayed an investment of basement membrane material which was closely related to fibrillar collagen within the tumor. Scattered throughout the neoplasms were small numbers of cells with charcteristics of the theca and a few cells had cytoplasmic features suggestive of smooth muscle. The ultrastructural findings of eight similar tumors have been described. In none is the basement membrane material fully appreciated; nevertheless, the production of this extracellular material is a major and distinctive feature of granulosa-theca tumors.

Daily serum follicle-stimulating hormone, luteinizing hormone, and plasma testosterone and androstenedione in hirsute women with polycystic sclerotic ovaries: effects of diethylstilbestrol and norethindrone acetats.

PIP: Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), plasma plasma testosterone and androstenedione, were determined daily in 5 women with mild to hirsutism and polycystic sclerotic ovaries, and in 2 normal controls. Blood was sampled daily for 10 days before and 10 days during administration of diethylstilbestrol 3 mg daily or norethindrone acetate 5 mg daily, during Cycle Days 2-12 in controls. FSH was significantly (p = .05 or less) decreased in 4 patients by diethylstilbestrol, and in the vehicle for serum triglyceride, pre-beta lipoprotein, was not significantly elevated in any subjects. Though the mechanism of these pills' effect on serum lipids is not known, although it appeared to increase in 4 patients and 1 control during stimulation. must produce caution in evaluating long-term oral contraceptive administration.^ieng