[Effect of gastric bypass on the cardiovascular risk and quality of life in morbid obese patients]. / Efecto del bypass gástrico sobre el riesgo cardiovascular y la calidad de vida en pacientes con obesidad mórbida.

OBJECTIVES: To determine the prevalence of major comorbidities of morbidity obese patients and to evaluate the gastric bypass effect on the weight status, cardiovascular risk and quality of life in these patients. METHODS: The evolution of weight, comorbidity, 10- year follow-up of cardiovascular risk (estimated by the Framingham risk score) and quality of life using the test BAROS (Bariatric Analysis and Reporting Outcome System) was analyzed in 162 patients with morbid obesity before and 2 years after gastric bypass. RESULTS: Body mass index (BMI) was reduced from 51.12 ± 7.22 to 29.94 ± 4.86 kg/m2 (72.85% loss of excess weight). Hypertension (HT), dyslipidemia and type 2 diabetes mellitus (T2DM) were resolved in 71.93%, 91.38% and 82.93% respectively (p < 0.001). Cardiovascular risk greater than 10% was reduced from 25.91% to 4.32% (p < 0.001). According to BAROS scale, surgery was positive in 95% of cases. CONCLUSIONS: Gastric bypass is very effective in weight loss; benefits in comorbidities, cardiovascular risk and quality of life.

Objetivos: Determinar la prevalencia de las principales comorbilidades asociadas a la obesidad mórbida y evaluar el efecto del bypass gástrico sobre el estado ponderal, riesgo cardiovascular y calidad de vida en estos pacientes. Métodos: Estudio descriptivo con medidas del cambio intrasujeto (antes-después) en una muestra de 162 pacientes de los resultados del bypass gástrico sobre la evolución ponderal, comorbilidades asociadas, riesgo cardiovascular a 10 años (estimado mediante las tablas de Framingham) y calidad de vida mediante el test BAROS (Bariatric Analysis and Reporting Outcome System). Resultados: El índice de masa corporal (IMC) se reduce de 51,12 ± 7,22 kg/m2 a 29,94 ± 4,86 kg/m2 (72,85% de sobrepeso perdido) y se resuelven la hipertensión arterial (HTA), la dislipemia y la diabetes mellitus tipo 2 (DMT2) en el 71,93%, 91,38% y 82,93% respectivamente (p < 0,001). El riesgo cardiovascular mayor del 10% se reduce del 25,91% al 4,32% (p < 0,001). Según la escala BAROS, el resultado de la cirugía fue favorable en el 95% de los casos. Conclusiones: La cirugía bariátrica mediante bypass gástrico demuestra ser muy efectiva para la reducción ponderal y comorbilidades asociadas, mejorando notablemente la calidad de vida.

Efecto del bypass gástrico sobre el riesgo cardiovascular y la calidad de vida en pacientes con obesidad mórbida / Effect of gastric bypass on the cardiovascular risk and quality of life in morbid obese patients

Objetivos: Determinar la prevalencia de las principales comorbilidades asociadas a la obesidad mórbida y evaluar el efecto del bypass gástrico sobre el estado ponderal, riesgo cardiovascular y calidad de vida en estospacientes. Métodos: Estudio descriptivo con medidas del cambio intrasujeto (antes-después) en una muestra de 162 pacientes de los resultados del bypass gástrico sobre la evolución ponderal, comorbilidades asociadas, riesgo cardiovascular a 10 años (estimado mediante las tablas de Framingham) y calidad de vida mediante el test BAROS (Bariatric Analysis and Reporting Outcome System).Resultados: El índice de masa corporal (IMC) se reduce de 51,12 ± 7,22 kg/m2 a 29,94 ± 4,86 kg/m2 (72,85% de sobrepeso perdido) y se resuelven la hipertensión arterial(HTA), la dislipemia y la diabetes mellitus tipo 2 (DMT2)en el 71,93%, 91,38% y 82,93% respectivamente (p <0,001). El riesgo cardiovascular mayor del 10% se reduce del 25,91% al 4,32% (p < 0,001). Según la escala BAROS, el resultado de la cirugía fue favorable en el 95% de los casos. Conclusiones: La cirugía bariátrica mediante bypass gástrico demuestra ser muy efectiva para la reducción ponderal y comorbilidades asociadas, mejorando notablemente la calidad de vida (AU)

Objectives: To determine the prevalence of majorcomorbidities of morbidity obese patients and to evaluate the gastric bypass effect on the weight status, cardiovascular risk and quality of life in these patients. Methods: The evolution of weight, comorbidity, 10-year follow-up of cardiovascular risk (estimated by the Framingham risk score) and quality of life using the test B AROS (Bariatric Analysis and Reporting Outcome System) was analyzed in 162 patients with morbid obesity before and 2 years after gastric bypass. Results: Body mass index (BMI) was reduced from 51.12± 7.22 to 29.94 ± 4.86 kg/m2 (72.85% loss of excess weight).Hypertension (HT), dyslipidemia and type 2 diabetes mellitus (T2DM) were resolved in 71.93%, 91.38% and82.93% respectively (p < 0.001). Cardiovascular risk greater than 10% was reduced from 25.91% to 4.32% (p< 0.001). According to BAROS scale, surgery was positive in 95% of cases. Conclusions: Gastric bypass is very effective in weightless; benefits in comorbidities, cardiovascular risk and quality of life (AU)

Life-style factors associated with overweight and obesity among Spanish adults.

OBJECTIVES: To assess the relationship between life styles and eating habits with the overweight and obesity prevalence in a Spanish adult population. METHODS: A population-based, cross-sectional study conducted on 2640 subjects older than 15 years, in Cádiz (Spain). Surveys were conducted in subjects' homes to obtain life styles, eating habits, and anthropometric data. Logistic regression has been used to study the association between the life style variables and overweight and obesity. RESULTS: Prevalence of overweight and obesity in Cadiz is 37% and 17%, respectively; higher in males and increases with age. BMI has an inverse relationship with educational level (PR = 2.3, 1.57-2.38). The highest levels of obesity are associated with daily alcohol consumption (PR = 1.39, 1.29-1.50), greater consumption of television,and sedentary pursuit (PR 1.5, 1.07-1.24). A lower prevalence of obesity is observed among those with active physical activity (10.9% vs 21.6%), with differences between sex. Following a slimming diet is more frequent in the obese and in women but dedicate more hours than men to passive activities. In men is greater the consumption of alcohol, high energy foods and snacks. Overweight and obesity is associated with the male sex (OR = 3.35 2.75-4.07), high consumption of alcohol (OR = 1.38 1.03-1.86) and watching television (OR = 1.52 1.11-2.07), and foods likes bread and cereals (OR = 1.47 1.13-1.91). Exercise activities is a protective factor (OR = 0.76 0.63-0.98). CONCLUSIONS: Life styles factors associated with overweight and obesity present different patterns in men and women and is necessary to understand them to identify areas for behavioural intervention in overweight and obesity patients.

Life-style factors associated with overweight and obesity among Spanish adults / Estilos de vida asociados con sobrepeso y obesidad en adultos españoles

Objectives: To assess the relationship between life styles and eating habits with the overweight and obesity prevalence in a Spanish adult population. Methods: A population-based, cross-sectional study conducted on 2640 subjects older than 15 years, in Cádiz (Spain). Surveys were conducted in subjects' homes to obtain life styles, eating habits, and anthropometric data. Logistic regression has been used to study the association between the life style variables and overweight and obesity. Results: Prevalence of overweight and obesity in Cadiz is 37% and 17%, respectively; higher in males and increases with age. BMI has an inverse relationship with educational level (PR = 2.3, 1.57-2.38). The highest levels of obesity are associated with daily alcohol consumption (PR = 1.39, 1.29-1.50), greater consumption of television, and sedentary pursuit (PR 1.5, 1.07-1.24). A lower prevalence of obesity is observed among those with active physical activity (10.9% vs 21.6%), with differences between sex. Following a slimming diet is more frequent in the obese and in women but dedicate more hours than men to passive activities. In men is greater the consumption of alcohol, high energy foods and snacks. Overweight and obesity is associated with the male sex (OR = 3.35 2.75-4.07), high consumption of alcohol (OR = 1.38 1.03-1.86) and watching television (OR = 1.52 1.11-2.07), and foods likes bread and cereals (OR = 1.47 1.13-1.91). Exercise activities is a protective factor (OR = 0.76 0.63-0.98). Conclusions: Life styles factors associated with overweight and obesity present different patterns in men and women and is necessary to understand them to identify areas for behavioural intervention in overweight and obesity patients (AU)

Objetivo: Valorar la relación existente entre estilos de vida y hábitos alimentarios con la prevalencia de sobrepeso y obesidad en una población adulta española. Método: Estudio transversal de base poblacional realizado en 2.640 adultos mayores de 15 años en Cádiz (España). El estudio se llevó a cabo en el domicilio de los sujetos, recogiéndose mediante una encuesta los hábitos alimentarios y características de los estilos de vida. Resultados: La prevalencia de sobrepeso y obesidad en Cádiz es de 37% y 17% respectivamente, mayor en varones e incrementándose con la edad. El IMC muestra una relación inversa con el nivel educativo (RP = 2,3, 1,57-2,38). Los mayores niveles de obesidad se asocian al consumo diario de alcohol (RP = 1,39, 1,29-1,50), mayor consumo de televisión y hábitos sedentarios (RP = 1,5, 1,07-1,24). Las menores cifras de prevalencia de obesidad se observan en los sujetos con una mayor actividad física (10,9% frente a 21,6%), aunque con diferencias entre sexos. Las mujeres dedican más horas que los hombres a actividades pasivas. Seguir dietas de adelgazamientos es más frecuente en sujetos obesos y en mujeres. En hombres es mayor el consumo de alcohol, alimentos con elevado contenido calórico y comer entre horas. La presencia de sobrepeso y la obesidad se asocia con el sexo masculino (OR = 3,35 2,75-4,07), elevado consumo de alcohol (OR = 1,38 1,03-1,86) y televisión (OR = 1,52 1,11- 2,07), y con mayores consumos de alimentos del grupo de cereales y pan (OR = 1,47 1,13-1,91). La actividad física se comporta como factor protector (OR = 0,76 0,63-0,98). Conclusiones: Los estilos de vida asociados con el sobrepeso y la obesidad presentan diferentes patrones en hombres y mujeres. Es necesario estudiarlos para identificar áreas de intervención en pacientes con sobrepeso y obesidad (AU)

[Analysis of gastric emptying dynamics in relationship to qualitative composition of intake. Comparison between normal-weight and obese subjects]. / Análisis de la dinámica de vaciamiento gástrico en relación con la composición cualitativa de la ingesta. Comparación entre sujetos con normopeso y obesos.

AIMS: To analyze whether the gastric emptying profile could define obesity and to study the impact of macronutrients diet composition on gastric emptying in obese and non obese people. MATERIAL AND METHODS: 47 subjects were selected (12 non obese and 35 obese). The study was organized in 4 visits. In each visit the subject was given isocaloric breakfast differing in macronutrient composition, (either equilibrated, or lipid, protein or carbohydrate rich) quantitative gastric emptying assay was done realized, every 15 minutes for two hours using a radionuclide technique. The week prior to the visit, the subject followed a standard 1,800 cal/day diet. RESULT: A significant interaction between time and diet composition is shown regardless of the group (obese or non-obese) the subject belongs to. The different macronutrient composition differentially affected gastric emptying only in the obese group. Post hoc analysis of the results showed significant differences after 45 min post breakfast between protein and carbohydrate rich breakfast. CONCLUSIONS: Gastric emptying in obese but not in non obese subjects, was significantly modified depending on the intake qualitative composition. These differences are clear when protein rich (significantly slower emptying) is compared versus hydrocarbon enriched diet (significantly faster emptying). A significant difference in gastric emptying between obese and non-obese subjects cannot be established.

Análisis de la dinámica de vaciamiento gástrico en relación con la composición cualitativa de la ingesta. Comparación entre sujetos con normopeso y obesos / Analysis of gastric emptying dynamics in relationship to qualitative composition of intake. Comparison between normal weight and obese subjects

Objetivos. Analizar si el perfil de vaciamiento gástrico podría ser característico en obesidad y estudiar el impacto que la relación de macronutrientes en la dieta tiene sobre el vaciamiento gástrico y las diferencias entre obesos y normopesos. Material y método. Se seleccionan 47 sujetos (12 normopeso y 35 obesos), que realizan 4 visitas durante el estudio. En cada una se administraba un desayuno isocalórico con distinta composición de macronutrientes (equilibrados, lipídico, proteico o hidrocarbonato). Se realizaron estudios cuantitativos de vaciamiento gástrico cada 15 minutos durante dos horas usando la técnica de gammagrafía. La semana previa a cada visita todos los sujetos realizaron una dieta estándar de 1.800 cal/día. Resultados. Se observa una interacción significativa entre los factores tiempo y dieta. Sin embargo, el mismo análisis no demostró esta tendencia al estudiar la evolución del vaciamiento en relación con el grupo al que pertenecía el sujeto (normopeso u obeso). La composición cualitativa de la dieta sólo influyó sobre el vaciamiento gástrico en obesos. El estudio post hoc demostró diferencias significativas fundamentalmente a partir de los 45 minutos postingesta, y entre ingestas ricas en hidratos de carbono y proteínas. Conclusiones. La composición cualitativa de la ingesta ha influido de forma significativa sobre la velocidad de vaciamiento gástrico en sujetos obesos, pero no en normopesos. Esta influencia se hace más evidente en la dieta hidrocarbonada (vaciamiento significativamente más rápido) y proteica (vaciamiento significativamente más lento). No puede establecerse una diferencia significativa de la velocidad de vaciamiento gástrico entre sujetos obesos o normopeso

Aims. To analyze whether the gastric emptying profile could define obesity and to study the impact of macronutrients diet composition on gastric emptying in obese and non obese people. Material and methods. 47 subjects were selected (12 non obese and 35 obese). The study was organized in 4 visits. In each visit the subject was given isocaloric breakfast differing in macronutrient composition, (either equilibrated, or lipid, protein or carbohydrate rich) quantitative gastric emptying assay was done realized, every 15 minutes for two hours using a radionuclide technique. The week prior to the visit, the subject followed a standard 1,800 cal/day diet. Result. A significant interaction between time and diet composition is shown regardless of the group (obese or non obese) the subject belongs to. The different macronutrient composition differentialy affected gastric emptying only in the obese group. Post hoc analysis of the results showed significant differences after 45 min post breakfast between protein and carbohydrate rich breakfast. Conclusions. Gastric emptying in obese but not in non obese subjects, was significantly modified depending on the intake qualitative composition. These differences are clear when protein rich (significantly slower emtying) is compared versus hydrocarbon enriched diet (significantly faster emptying). A significant difference in gastric emptying between obese and non obese subjects cannot be stablished

Evaluación de la calidad asistencial en pacientes con diabetes tipo 2 del Área Sanitaria Cádiz-San Fernando / Evaluation of the quality of care of type 2 diabetic patients from the Health Area 2 Cádiz-San Fernando

Objetivo: Evaluar la calidad de la prestación de atención sanitaria al paciente con diabetes tipo 2 en un área básica de salud. Pacientes y métodos: Estudio observacional descriptivo de una muestra de 517 pacientes con diabetes tipo 2 conocida (intervalo de confianza 95%, nivel de riesgo alfa 0,05) atendidos en Atención Primaria y Endocrinología del área básica de salud Cádiz-San Fernando (228.000 habitantes). Se evalúa la calidad de la atención sanitaria aplicando los criterios de calidad propuestos por el Grupo Europeo de la Federación Internacional de Diabetes. Resultados: Se estudian 517 pacientes con diabetes tipo 2de 63,4 ± 12 años de edad media (59,4% mujeres) y 9,7 ± 8 años de evolución conocida de la diabetes. A pesar de la elevada prevalencia de factores de riesgo cardiovascular (HTA: 58%, dislipemia53%, obesidad: 40%, tabaquismo activo: 19%) y complicaciones crónicas de la diabetes (retinopatía 29%, nefropatía: 20%). El grado de cumplimiento en la realización de autoanálisis de glucemia capilar (35%), exploración anual de los pies (44%), determinación anual de albuminuria (47%) y de un perfil lipídico completo(51%) y participación en actividades educacionales (53%) fue insuficiente. Sin embargo, el porcentaje de determinación anual dehemoglobina glicosilada fue aceptable (81%).Conclusiones: Los pacientes con diabetes tipo 2 del área Cádiz-San Fernando presentan una elevada prevalencia de comorbilidades y complicaciones crónicas, evidenciándose la necesidad de mejora en el cumplimiento de las recomendaciones básicas para el cuidado y control de la enfermedad

Objective: The objective of our study was to evaluate the quality of health care in patients with type 2 in a health care area. Patients and methods: Observational descriptive study of a sample of 517 type 2 diabetes patients (confidence interval at 95% and sensibility at 5%) attended by Primary Care and Endocrinology of a Cádiz-San Fernando health care area (228,000 inhabitants). The quality of health care was evaluated applying the Guidelines of Diabetes Care of European Diabetes Policy Group of International Diabetes Federation. Results: A total of 517 patients with type 2 diabetes, with a mean age of 63.4 ± 12 years (59.4% women) and a mean period of disease evolution of 9.7 ± 8 years were assessed. Despite of great prevalence of cardiovascular risk factors (58% hypertension, 53% dislipemia, 40% obesity, 19% smoker) and chronic diabetes complications (29% retinopathy, 20% nephropathy), it was observed inadequate percentages in self-monitoring of blood glucose (35%), foot examination (44%) and yearly measure of urinary albumin excretion (47%) and blood lipid profile (51%) and patient education programme participation (53%). However, it was observed an adequate percentage of patients with at least one glycated haemoglobin determination at year (81%). Conclusion: Type 2 diabetes patients of Cádiz-San Fernando health care area present a great prevalence of comorbidities and chronic diabetes complications. It is necessary to improve the implementation of diabetes basic care recommendations and control of illness

Characteristics of eating disorders in a university hospital-based Spanish population.

OBJECTIVE: To describe the personal and family antecedents and clinical characteristics of patients with eating disorders (EDs) in a population of the south of Spain; to analyse the influence of lifestyles, family functioning, socioeconomic status (SES), and psychological characteristics in these processes. DESIGN: A university-based case-control study. SETTING: University Hospital (Andalusia, Spain). SUBJECTS: A total of 120 patients with EDs and 240 controls. INTERVENTIONS: SCOFF, EDI, APGAR family, and SES questionnaires. RESULTS: In all, 67.5% of patients presented anorexia (AN), 15% bulimia (BN), and 17.5% mixed forms. EDs emerged at around 18-20 y (95% CI 17.9-19.8). Factors associated with EDs are psychiatric conditions (depression OR: 4.16, anxiety OR: 4.59), more frequent use of medication (OR: 2.26), dietary fibre (OR: 2.59), and laxatives (OR: 3.47). Toxics consumption, sport activity, SES, and family antecedents of pathology are not associated with EDs. An inverse relationship was found between family functioning and the scores in various subscales of the EDI. CONCLUSIONS: Eating disorders in Andalusia (Spain) are influenced significantly more by psychological, family, and cultural factors than by social factors.

Epidemiological study of the influence of family and socioeconomic status in disorders of eating behaviour.

OBJECTIVE: To analyse the differences in family functioning and socioeconomic status between subjects with disorders of eating behaviour and the healthy population, considering the possible relationship of these factors with the psychic characteristics of patients, with consumption of various substances, and with sexual practices. DESIGN: Case-control study. SETTING: 'Puerta del Mar' University Hospital (Andalusia, Spain). SUBJECTS: Conducted on a sample of 120 patients with AN and BN, and 240 controls with an identical distribution by age and sex. INTERVENTIONS: SCOFF, eating disorder inventory (EDI), Apgar family and socioeconomic questionnaires are utilised. RESULTS: Patients with disorders of eating behaviour present greater family dysfunctioning than controls; among cases, this difference is greater in the acute forms, but there are no differences between recent situations or crises due to previous episodes. Family dysfunction is associated with higher scores of multiple subscales of the EDI, which is corroborated on analysing each of the Apgar parameters independently. Family functioning is not associated with other variables such as breast-feeding or consumption of toxic substances. Socioeconomic status does not differentiate cases from controls, or acute situations from evolving ones, or new episodes from other crisis episodes, although differences may be found in the psychic manifestations according to social class. CONCLUSIONS: It is confirmed that family functioning has an influence in these types of disorder, in their evolution and in the psychic characteristics of the patients, without any evidence being found of a relationship between these disorders and socioeconomic status.

Thyroid nodules. Role of fine needle aspiration and intraoperative frozen section examination.

OBJECTIVE: To determine the accuracy of fine needle aspiration (FNA) and intraoperative frozen section examination (IFSE) on thyroid nodules. STUDY DESIGN: The study group consisted of 470 patients who underwent thyroidectomy. FNA was performed on 289 patients and IFSE on 326. The FNA and IFSE results were compared with the final histologic diagnosis obtained after examination of permanent sections. RESULTS: The overall FNA sensitivity was 65%, specificity 88% and positive predictive value 61%. The IFSE sensitivity was 50%, and the specificity and positive predictive value were 100%. When both procedures were used together, FNA identified 16 of 45 (36%) carcinomas as malignant and an additional 13 (29%) as follicular proliferative lesions; IFSE correctly identified only 23 of 45 (51%) carcinomas. CONCLUSION: FNA provides enough information for determining the extent of thyroid surgery when a diagnosis of cancer is made. However, IFSE should be considered a supplementary procedure when FNA is not positive for cancer.

Male pseudohermaphroditism with 5-alpha-reductase deficiency: report of two new familial cases. The importance of early diagnosis.

We report two new familial cases of male pseudohermaphroditism due to 5-alpha-reductase deficiency, from the south of Spain. They were born with ambiguous genitalia and were reared as females. At the time of puberty, both brothers virilized partially and underwent a change of gender role from female to male with a stormy psychic readjustment period. We stress the value of the prolonged chorionic gonadotropin test for an early diagnosis.

[Anatomoclinical and diagnostic characteristics of thyroid carcinoma. Study of 126 cases]. / Características anatomoclínicas y diagnósticas del carcinoma tiroideo. Estudio de 126 casos.

A retrospective review was conducted among 126 patients treated for thyroidal carcinoma--86 papillary, 31 follicular, 4 anaplastic, 1 lymphoma, and 4 non-familiar medullary--in our area between 1979 and 1992. Diagnostic and clinical findings obtained were evaluated along with those from physical examinations, imaging techniques (i.e., echography and gamma spectrometry), and histological study (i.e., fine needle puncture-aspiration and intra-operatory biopsy). The majority (88 cases) presented a hard node or one of elastic consistency, while in 34 cases, there was a diffuse or nodular increase. Only four patients manifested a normal thyroid in the physical examination. A 2.4% had a normal gammagraphy, 70% presented a cold node, 1.6% an alient node, and there was evidence of heterogeneous uptake in 23.7%. In the echography study, 63.3% were noted as being solid nodes, 11.4% as cysts, and 24% as mixed. The sensitivity of the fine needle puncture-aspiration was 76.4% and 66.6% for intraoperative biopsy.

[Treatment of hyperthyroidism from Graves-Basedow's disease]. / Tratamiento del hipertiroidismo por enfermedad de Graves-Basedow.

The Graves's Disease is the most frequent cause of hyperthyroidism. Currently, there is a lack of consensus with respect to the therapeutical role played by synthetic antithyroids, radioactive iodine and surgery. In order to study in depth this issue, we have analyzed the results of the therapy administered to 217 patients with Graves's Disease: 96 were treated with synthetical anti-thyroids, 46 with surgery and 75 with radioactive iodine. After twelve months of therapy with synthetic antithyroids, remission of the disease was observed in 64 patients (67%); the only factor predicting such remission was the absence of ophthalmopathy (p < 0.05); all 64 patients were followed-up during 12 months, detecting the recurrence of hyperthyroidism in 33 of them. Such recurrence is predicted by the serum levels of thyroid hormones before the administration of the therapy (p < 0.001). On the contrary, in patients treated with surgery or radioactive iodine, hyperthyroidism was controlled in 91% and 100% of them, respectively. Given the evolution of patients with Graves's Disease treated with synthetic antithyroids, we suggest the use of a more aggressive approach for the management of these patients.

Hyperthyroidism due to familial pituitary resistance to thyroid hormone: successful control with 3, 5, 3' triiodothyroacetic associated to propranolol.

We herein describe a family with thyroid hormone resistance. Thyroid hormones and basal TSH were elevated. Pituitary tumor or abnormality in thyroid hormone binding proteins were ruled out by appropriate tests. Mother and sister of the propositus presented similar abnormal hormonal features but no hyperthyroidism. Initially the patient was treated with carbimazole (30 mg/day): three months later a dramatic increase in the size of the thyroid gland and in TSH levels (12.5 to 28 mU/l) were noted. Thereafter, dextrothyroxine (D-T4) and 3, 5, 3'-triiodothyroacetic acid (TRIAC) were given consecutively and treatment was accompanied by a decrease of TSH levels (2 mU/l) but thyroid hormone remained elevated. The symptoms and signs of hyperthyroidism improved with the addition of propranolol (30-60 mg/day). In conclusion, the present report describes a new family with the syndrome of THR and variable degrees of involvement among relatives. We suggest the usefulness of TRIAC therapy to decrease TSH levels and propranolol to improve thyrotoxicosis due to pituitary resistance to thyroid hormone.