Relationship between the self-assessment and clinical assessment of health status and work ability.

Clinical assessments of health status and work ability were compared with subjective assessments reported on a questionnaire. The clinical examinations included cardiorespiratory, musculoskeletal, and psychological measurements. The subjective work ability comprised an index based on estimations of work ability in relation to diseases, job demands, and psychological resources. For the clinical examinations 89 male and 85 female workers aged 44-58 years were selected according to health and subjective work ability as reported on the questionnaire. Half of the group was healthy and half suffered from either coronary artery disease (men) or low-back pain (women), and the subjective estimations of work ability varied from good to poor. The results indicated that the questionnaire responses on health and work ability related well with the clinically assessed factors at the group level. Some divergence was detected at the individual level, but it could usually be explained on the basis of the available data.

Thyroid function as assessed by routine laboratory tests of workers with long-term lead exposure.

Thyroid function was studied in 176 male workers occupationally exposed to lead. The mean blood lead concentration of the workers was 2.70 (SD 1.15, range 0.70-6.45) mumol/l. The mean duration of lead exposure was 7.6 (range 0.1-20) years. The total thyroxine (T4), free thyroxine (FT4), total triiodothyronine (T3), and thyrotropin concentrations in serum were similar in the workers in the low and high blood lead categories. In regression equations the duration of lead exposure had a weak but significant negative association with T4 and FT4, and this association was particularly pronounced when the analyses were restricted to workers with the most intense lead exposure over time. Thus, the results suggest that thyroid function might be depressed as a result of intense long-term lead exposure.

Thyroglobulin complementary DNA as a means to investigate congenital goiters with impaired thyroglobulin synthesis.

A congenital goiter with impaired thyroglobulin synthesis has been investigated for the presence of messenger RNA coding for thyroglobulin. Using complementary DNA to beef 33 S thyroglobulin mRNA as a probe, we have found that thyroglobulin related sequences are present in the goiter but at a concentration lower than in normal human thyroids. We conclude that the disease is not due to a complete deletion of thyroglobulin gene.

Action of cyclic adenosine 3',5' monophosphate on L-14C-leucine incorporation in a system of rough microsomes from bovine thyroid gland.

The effect of cAMP and varying concentrations of potassium (18-72 mM) on the incorporation of L-14C-leucine into TCA-precipitable protein was studied in a cell-free system comprising rough thyroid microsomes. cAMP (2mM) alone or in combination with theopylline increased the incorporation of leucine into ribosome-bound (after DOC treatment) and extra-vesicular material, but had no significant effect on the DOC-released intravesicular material. Increase of the K+ concentration from 18 mM to 72 mM affected the incorporation of leucine into the microsomal compartments in much the same way as cAMP did. The effect of cAMP and potassium seems to be due in partly to enhanced activation of amino acids, since in a system of pH5 fraction and cell sap, both cAMP and K+ increased the incorporation of 14C-leucine into cold TCA-precipitable material. Experiments with 14C-leucyl-tRNA as a marker suggest that the effect of cAMP and K+ is a consequence not only of increased activation of amino acids, but also of increased binding of activated amino acyl-tRNA to ribosomes.

Thyrotrophin-binding inhibiting immunoglobulins (TBII) in subacute thyroiditis.

The occurrence of thyrotrophin-binding inhibiting immunoglobulins (TBII) was determined by the radioligand receptor method in 8 patients with subacute thyroiditis (ST). In the acute phase 2 out of the 6 cases investigated at this stage were TBII positive and one had a borderline TBII value. All three cases were TBII negative when re-investigated more than 3 months later. In the acute phase the serum thyroglobulin (TG) level was 63.8 +/- 61.9 micrograms/l (mean +/- SD, ref. limit less than 26 micrograms/l) and in the later phase 18.2 +/- 9.3 micrograms/l, the TG level being somewhat higher in the TBII positive cases than in the TBII negative cases. Addition of TG to the TBII assay did not affect the displacement of the labelled TSH from the receptor membranes. The occurrence of TBII may be a secondary phenomenon to the follicular destruction seen in the acute phase of ST and indicated by a rise of serum TG. Nevertheless, TBII in ST has the characteristics of a TSH-receptor antibody and it may interfere with the TSH receptor.

Endocrinologic studies in men exposed occupationally to carbon disulfide.

The effect of long-term occupational exposure to CS2 on various endocrinologic parameters was studied in 15 exposed men and 16 age-matched controls. Duration of exposure varied between 10 and 36 yr. The CS2 concentrations in the viscose rayon plant have been below the Finnish threshold limit value of 30 mg/m3 (10 ppm) under normal operating conditions for the past 10 yr. Before this the exposure was considerably greater. Of the various endocrinologic parameters, serum follicle stimulating hormone (FSH) and luteinizing hormone (LH) were significantly increased in the exposed group, seven workers having values above the reference limit. This was taken as a sign of primary gonadal insufficiency, which was considered only latent as serum testosterone values were unaffected. No changes were seen in serum prolactin values before or after stimulation with thyrotropin releasing hormone (TRH). No disturbance was seen in thyroid function as evaluated by serum thyroxine (T4), free thyroxine index (FT1), triiodothyronine (T3), and the thyrotropin response to TRH. Serum cortisol was also unchanged. These results may reflect high exposure during past decades rather than exposure to the present low CS2 concentrations.

Spontaneous hypothyroidism after antithyroid treatment of hyperthyroid Graves' disease.

Out of 54 patients with hyperthyroid Graves' disease 35 remained euthyroid after treatment with antithyroid agents and have been continuously followed from 1 to 9 yr (4.85 +/- 2.55 yr, mean +/- SD). In 4 patients an exaggerated TSH response to TRH developed from 30 to 111 months after interrupting the treatment and one of them became hypothyroid 50 months (5.0 yr) thereafter. The annual incidence of subclinical hypothyroidism (exaggerated response to TRH) as calculated from the total number of observation yr was 2.5% and that of overt hypothyroidism was 0.6%. These figures are similar to those reported recently in 2 retrospective studies.

Serum gonadotropins and testosterone in men occupationally exposed to carbon disulfide.

Serum levels of gonadotropins and testosterone were determined for 69 men exposed to CS2 in viscose rayon production and for 22 nonexposed male controls. Mean ages of the two groups were 40 and 39 yr, respectively. The duration of exposure to CS2 ranged from 1 to 36 yr (mean, 12.5). Follicle stimulating hormone (FSH) levels were significantly higher among the exposed men than among the controls (13.6 versus 10.0 IU/l). The level of sex hormone binding globulin (SHBG) was significantly lower among the exposed men than among the controls (44 versus 53 nmol/l). Luteinizing hormone (LH) values were significantly higher among the 24-31 yr old exposed men than the controls of the same age. Levels of SHBG, of the free testosterone index, and of FSH and LH in men under 39 yr who had been exposed to CS2 for 1-9 yr differed significantly from those of their controls, whereas only FSH differed significantly among those exposed for 10 or more years in the same age group. In men aged 40 yr or more, after at least 10 yr of exposure, only FSH and LH were significantly higher than in the controls. Although the observed alterations do not seem to have any overt clinical implications for the study groups, they indicate that overall levels of CS2 that are well below the current Finnish threshold limit value (30 mg/m3) may affect the hormonal balance in the pituitary-gonadal axis, favoring the view that there may be an increased risk of latent primary gonadal insufficiency.

Angiotensin-converting enzyme. II. Serum activity in early and newly diagnosed sarcoidosis.

Serum angiotensin-converting enzyme (ACE) was studied in 51 patients with early or newly diagnosed sarcoidosis. Only 45% of these patients had increased ACE activity when their diagnosis was established, which diminishes the diagnostic value of this enzyme measurement. On the other hand, ACE accurately reflected disease activity, and it proved a useful tool for assessing of need for corticosteroid treatment. Patients with acute sarcoidosis associated with erythema nodosum (EN) had low ACE activity compared with the other patients with active, but less acute disease. Serum ACE was not significantly correlated with blood lymphocytes or the immunoglobulins, but there was a positive correlation between the enzyme and serum lysozyme, which strengthens the hypothesis of both enzymes being produced by the epithelioid cells of sarcoid granulomas.

Free thyroxine, free triiodothyronine, and thyrotropin concentrations in hypothyroid and thyroid carcinoma patients receiving thyroxine therapy.

Free thyroxine (FT4) and free triiodothyronine (FT3) concentrations in serum were measured by direct equilibrium dialysis methods in patients receiving thyroxine replacement or suppression therapy. Four of 50 hypothyroid patients euthyroid on replacement therapy (mean thyroxine dose 120 micrograms/day) had supranormal FT4 concentrations, whereas the FT3 concentrations were normal in all. Forty-one of 56 operated thyroid carcinoma patients on suppressive therapy (mean thyroxine dose 214 micrograms/day) had raised FT4 concentrations, whereas the FT3 concentrations was elevated in only one patient. There was a large difference in mean FT4 values for hypothyroid and thyroid carcinoma patients (17.2 vs 29.5 pmol/l), whereas the difference in mean FT3 values was small (5.0 vs 6.1 pmol/l), suggesting a decreased peripheral conversion of T4 to T3 with increasing concentrations of FT4. Serum TSH concentrations, as determined by an immunoradiometric assay, varied from less than 0.02 to 11.9 mU/l in treated hypothyroid patients; 21 patients (42%) had values outside the reference limits. As a single test, serum TSH is therefore not very useful for the assessment of adequate thyroxine dosage in patients with primary hypothyroidism. In thyroid carcinoma patients, the TSH concentrations were less than 0.18 mU/l; 45 patients had values less than 0.02 mU/l indicating sufficient suppression of TSH secretion in the majority of cases. On the basis of these results we recommend the combination of FT3 and TSH tests for monitoring thyroxine replacement and suppression therapy. FT4 appears less useful than FT3 for this purpose even if special reference values values were adopted for each patient group.

Municipal employees' cardiovascular diseases and occupational stress factors in Finland.

The occupational stress factors related to specific cardiovascular diseases were studied by a questionnaire mailed to 6213 municipal employees aged 45 to 58 years, (response rate 85%) and by a specific job analysis of certain municipal occupations. The highest prevalences of self-reported chronic hypertension were found among male transport workers (19%), technical supervisors (19%) and auxiliary workers (15%), as well as among female domestic helpers (18%) and auxiliary workers (18%). Among men the prevalence of coronary heart disease varied from 9% for dump workers to 0% for dentists (mean 5%) and among women from 4% for kitchen supervisors to 0% for physicians (mean 3%). In the work profile groups with the highest rates of reported, specific cardiovascular diseases, the stress factors of women's work (domestic help and auxiliary work) were high energy demands, heavy dynamic and static work with high application of strength, poor postures, and uncomfortable climatic conditions. These stress factors were also typical among men doing auxiliary work. Other common stress factors among men included sensory-motor work done alone in static, monotonous sitting postures, exposured to vibration, drafts, and continuous alertness of the senses (transport work) and to processing and organization of information together with time pressure linked to decision-making and the need for accurate sensory perception (technical supervision work).

Familial and sporadic thyroglobulin deficiency with goitre and hypothyroidism.

The thyroid proteins and iodocompounds were analysed in the thyroid tissue of 4 patients with nontoxic goitre. Subtotal thyroidectomy was performed for tracheal compression. The thyroid components were labelled with a trace amount of 125I before operation. One patient had congenital goitre and hypothyroidism with cretinoid features. Three other patients belonged to the same family. Two had congenital goitre, one of them with subclinical and biochemical hypothyroidism. There was a range of thyroglobulin (TG) deficiency ranging from virtual absence of TG in the most affected patient to 17% of normal in the least affected one. There seemed to be an inverse relationship between TG content and clinical signs. Also with decreasing TG more iodocompounds were found in the 3-8 S region on gradient centrifugation. In the most affected patient all the radioactivity was in the 3-8 S region, in the least affected one it was all found in the 19 S and 27 S regions. The other patients had an intermediate pattern. The 3-8 S fraction contained albumin, IgG and some material which reacted like TG on immunoelectrophoresis except for the least affected patient. The iodine content was normal whereas the iodination of TG was low-normal or low. Iodotyrosines and iodothyronines were found in all glands analysed on column chromatography but only in the most heavily affected patient did the ratio iodotyrosines/iodothyronines seem to be elevated. Evidently TG was not necessary for hormone formation in this gland but the efficiency of the matrix seemed not to suffice for normal hormone production.

Thyrotropin binding inhibiting immunoglobulins (TBII) in Graves' disease, toxic nodular goitre and autoimmune thyroiditis.

The occurrence of thyrotropin binding inhibiting immunoglobulins (TBII) was studied in 144 patients with different types and stages of Graves' disease (GD) including 2 patients with primary hypothyroidism which changed into hyperthyroid GD. TBII were also studied in 17 patients with toxic nodular goitre (TNG) and 29 patients with autoimmune thyroiditis. TBII was determined with a radioligand receptor assay and expressed as a TBII index which was defined as percentage binding of 125-I-labelled bovine TSH to a thyroid membrane fraction in the presence of test immunoglobulins in comparison with the maximal binding. TBII were positive in 69% of patients with untreated hyperthyroid GD, in 65% after 3-6 months of antithyroid treatment, and in 30-40% 3-114 months after discontinuation of therapy. During treatment the TBII index increased slowly towards normal levels differing significantly from the value before therapy not earlier than after at least 12 months' treatment. Both patients with primary hypothyroidism who developed hyperthyroid GD were strongly TBII positive. In patients with TNG TBII were positive in 24%. In about 30% of the patients with Hashimoto's thyroiditis and with spontaneous hypothyroidism positive TBII were registered. Also in 2 out of 9 patients (22%) with symptomless autoimmune thyroiditis TBII were positive. TBII are not specific for hyperthyroid GD but nevertheless useful humoral markers in several types of thyroid disorder.

Marathon run: effects on blood cortisol -- ACTH, iodothyronines -- TSH and vasopressin.

Blood cortisol, ACTH, thyroxine, triiodothyronine, reverse triiodothyronine, thyroid stimulating hormone (TSH) and vasopressin concentrations were determined in 9 runners (29-56 years old) and one 80 year old man taking part in a non-competitive Marathon in Athens, Greece on October 1976. After the run the mean concentrations of cortisol, ACTH and vasopressin showed a significant rise. The thyroid function variables and TSH did not differ from the control values. There was a significant correlation between the cortisol and ACTH levels after the race and also between their increments from the corresponding base values. A significant correlation was found between the physical fitness (as measured by indirect determination of VO2max) and the post-race cortisol levels. One of the well trained runners with a fairly good running time had the highest post-race values for 6 of 7 hormones studied.

Pseudohypoparathyroidism associated with hypercalcitoninaemia.

A case of a 33 year old man with type I of pseudohypoparathyroidism associated with hypercalcitoninaemia and deficiency of prolactin and growth hormone is reported. The diagnosis of pseudohypoparathyroidism was made by recognition of the classic skeletal signs of Albright's osteodystrophy and confirmed by an infusion test with parathyroid hormone, which revealed a lack of both a cyclic AMP and phospaturic response. By investigation of the endocrine status the function of the pituitary/thyroid and pituitary/testis axes as well as the adrenal cortex was observed to be normal. The basal prolactin concentration was however, lower than normal and a lack of response in the growth hormone level in two glucagon tests was observed. Furthermore the basal calcitonin level was higher than normal and by provacation with pentagastrine the calcitonin secretion was very high despite an only slightly decreased serum calcium level. By operation the thyroid gland was normal and by light microscopy of a biopsy no signs of medullary carcinoma was observed. No good explanation for the high calcitonin basal level and secretion was found.

Treatment of maternal hyperthyroidism with antithyroid agents and changes in thyrotrophin and thyroxine in the newborn.

Eleven pregnant women with concomitant hyperthyroidism were treated with antithyroid drugs. At monthly intervals serum thyroxine (T4) and triiodothyronine (T3) were measured with radioimmunoassay, the Sephadex uptake of radioactive triiodothyronine (T3U) determined the free T4 and T3 indices calculated (FT4I, FT3I). TSH-binding inhibiting immunoglobulins (TBII) were determined by the radiomembrane assay. Serum TSH and T4 were measured at delivery from cord blood and/or from the newborn infants some days after birth. Serum TSH was significantly elevated in one infant. There was an inadequate post-partal rise in serum T4 concentration in this child and in another who showed only a marginal elevation of TSH. The mothers of these infants were given carbimazole in doses of 30 and 25 mg/day, respectively, at the time of delivery. No significant changes were seen in other infants, the daily doses being 20 mg of carbimazole or less. There was no clinical indication of hypo- or hyperthyroidism in any of the newborn. The TBII were positive in most patients and there was a trend of normalization during treatment. No relationship between the dose of antithyroid drug and the level of TBII could be seen. During treatment the dose was adjusted according to the FT3I values. This seems to be an adequate laboratory test for this purpose.