home *** CD-ROM | disk | FTP | other *** search
/ Year Books 1991 / Year Books 1991.iso / dp / 06 / 069.pkg < prev   
Unknown  |  1992-06-06  |  381.4 KB

open in: MacOS 8.1     |     Win98     |     DOS

view JSON data     |     view as text

This file was not able to be converted.
This format is not currently supported by dexvert.

ConfidenceProgramDetectionMatch TypeSupport
66% dexvert OS/2 Installation Package (archive/os2InstallPackage) ext Supported
1% dexvert BeOS Installation Package (archive/beOSInstallPackage) ext Unsupported
1% dexvert Newton Package (archive/newtonPackage) ext Unsupported
1% dexvert Independence War 2 mod Package (other/independenceWar2ModPackage) ext Unsupported
100% file data default



hex view
+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 64 00 |.DP1.1..|......d.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 9c 05 00 00 |......00|........|
|00000020| 58 12 00 00 30 31 00 00 | 00 01 f4 17 00 00 a1 0b |X...01..|........|
|00000030| 00 00 30 32 00 00 00 01 | 95 23 00 00 4a 0e 00 00 |..02....|.#..J...|
|00000040| 30 33 00 00 00 01 df 31 | 00 00 34 0d 00 00 30 34 |03.....1|..4...04|
|00000050| 00 00 00 01 13 3f 00 00 | 89 0d 00 00 30 35 00 00 |.....?..|....05..|
|00000060| 00 01 9c 4c 00 00 2e 11 | 00 00 30 36 00 00 00 01 |...L....|..06....|
|00000070| ca 5d 00 00 d0 0c 00 00 | 30 37 00 00 00 01 9a 6a |.]......|07.....j|
|00000080| 00 00 31 0b 00 00 30 38 | 00 00 00 01 cb 75 00 00 |..1...08|.....u..|
|00000090| 48 0d 00 00 30 39 00 00 | 00 01 13 83 00 00 ca 0b |H...09..|........|
|000000a0| 00 00 31 30 00 00 00 01 | dd 8e 00 00 b6 0e 00 00 |..10....|........|
|000000b0| 31 31 00 00 00 01 93 9d | 00 00 b1 0d 00 00 31 32 |11......|......12|
|000000c0| 00 00 00 01 44 ab 00 00 | a5 10 00 00 31 33 00 00 |....D...|....13..|
|000000d0| 00 01 e9 bb 00 00 d2 10 | 00 00 31 34 00 00 00 01 |........|..14....|
|000000e0| bb cc 00 00 5c 0c 00 00 | 31 35 00 00 00 01 17 d9 |....\...|15......|
|000000f0| 00 00 1e 0c 00 00 31 36 | 00 00 00 01 35 e5 00 00 |......16|....5...|
|00000100| 27 0c 00 00 31 37 00 00 | 00 01 5c f1 00 00 86 0d |'...17..|..\.....|
|00000110| 00 00 31 38 00 00 00 01 | e2 fe 00 00 7a 0c 00 00 |..18....|....z...|
|00000120| 31 39 00 00 00 01 5c 0b | 01 00 b2 10 00 00 32 30 |19....\.|......20|
|00000130| 00 00 00 01 0e 1c 01 00 | c3 0d 00 00 32 31 00 00 |........|....21..|
|00000140| 00 01 d1 29 01 00 96 0c | 00 00 32 32 00 00 00 01 |...)....|..22....|
|00000150| 67 36 01 00 a7 0b 00 00 | 32 33 00 00 00 01 0e 42 |g6......|23.....B|
|00000160| 01 00 07 0e 00 00 32 34 | 00 00 00 01 15 50 01 00 |......24|.....P..|
|00000170| 04 0c 00 00 32 35 00 00 | 00 01 19 5c 01 00 73 0f |....25..|...\..s.|
|00000180| 00 00 32 36 00 00 00 01 | 8c 6b 01 00 48 0d 00 00 |..26....|.k..H...|
|00000190| 32 37 00 00 00 01 d4 78 | 01 00 f5 0c 00 00 32 38 |27.....x|......28|
|000001a0| 00 00 00 01 c9 85 01 00 | b4 0d 00 00 32 39 00 00 |........|....29..|
|000001b0| 00 01 7d 93 01 00 be 0b | 00 00 33 30 00 00 00 01 |..}.....|..30....|
|000001c0| 3b 9f 01 00 64 13 00 00 | 33 31 00 00 00 01 9f b2 |;...d...|31......|
|000001d0| 01 00 77 0b 00 00 33 32 | 00 00 00 01 16 be 01 00 |..w...32|........|
|000001e0| 5d 0d 00 00 33 33 00 00 | 00 01 73 cb 01 00 ee 0c |]...33..|..s.....|
|000001f0| 00 00 33 34 00 00 00 01 | 61 d8 01 00 41 12 00 00 |..34....|a...A...|
|00000200| 33 35 00 00 00 01 a2 ea | 01 00 6f 0b 00 00 33 36 |35......|..o...36|
|00000210| 00 00 00 01 11 f6 01 00 | c1 0f 00 00 33 37 00 00 |........|....37..|
|00000220| 00 01 d2 05 02 00 f5 0f | 00 00 33 38 00 00 00 01 |........|..38....|
|00000230| c7 15 02 00 04 0e 00 00 | 33 39 00 00 00 01 cb 23 |........|39.....#|
|00000240| 02 00 26 0d 00 00 34 30 | 00 00 00 01 f1 30 02 00 |..&...40|.....0..|
|00000250| 83 0c 00 00 34 31 00 00 | 00 01 74 3d 02 00 47 0b |....41..|..t=..G.|
|00000260| 00 00 34 32 00 00 00 01 | bb 48 02 00 e1 11 00 00 |..42....|.H......|
|00000270| 34 33 00 00 00 01 9c 5a | 02 00 a7 0d 00 00 34 34 |43.....Z|......44|
|00000280| 00 00 00 01 43 68 02 00 | 83 0c 00 00 34 35 00 00 |....Ch..|....45..|
|00000290| 00 01 c6 74 02 00 27 0d | 00 00 34 36 00 00 00 01 |...t..'.|..46....|
|000002a0| ed 81 02 00 a7 10 00 00 | 34 37 00 00 00 01 94 92 |........|47......|
|000002b0| 02 00 f6 12 00 00 34 38 | 00 00 00 01 8a a5 02 00 |......48|........|
|000002c0| 27 12 00 00 34 39 00 00 | 00 01 b1 b7 02 00 0b 10 |'...49..|........|
|000002d0| 00 00 35 30 00 00 00 01 | bc c7 02 00 53 0c 00 00 |..50....|....S...|
|000002e0| 35 31 00 00 00 01 0f d4 | 02 00 95 0e 00 00 35 32 |51......|......52|
|000002f0| 00 00 00 01 a4 e2 02 00 | c4 0d 00 00 35 33 00 00 |........|....53..|
|00000300| 00 01 68 f0 02 00 e1 11 | 00 00 35 34 00 00 00 01 |..h.....|..54....|
|00000310| 49 02 03 00 e3 0e 00 00 | 35 35 00 00 00 01 2c 11 |I.......|55....,.|
|00000320| 03 00 71 0f 00 00 35 36 | 00 00 00 01 9d 20 03 00 |..q...56|..... ..|
|00000330| 0e 10 00 00 35 37 00 00 | 00 01 ab 30 03 00 ec 0c |....57..|...0....|
|00000340| 00 00 35 38 00 00 00 01 | 97 3d 03 00 5d 10 00 00 |..58....|.=..]...|
|00000350| 35 39 00 00 00 01 f4 4d | 03 00 d8 0d 00 00 36 30 |59.....M|......60|
|00000360| 00 00 00 01 cc 5b 03 00 | 08 14 00 00 36 31 00 00 |.....[..|....61..|
|00000370| 00 01 d4 6f 03 00 90 12 | 00 00 36 32 00 00 00 01 |...o....|..62....|
|00000380| 64 82 03 00 41 12 00 00 | 36 33 00 00 00 01 a5 94 |d...A...|63......|
|00000390| 03 00 99 11 00 00 36 34 | 00 00 00 01 3e a6 03 00 |......64|....>...|
|000003a0| c4 0d 00 00 36 35 00 00 | 00 01 02 b4 03 00 8d 0d |....65..|........|
|000003b0| 00 00 36 36 00 00 00 01 | 8f c1 03 00 cc 0e 00 00 |..66....|........|
|000003c0| 36 37 00 00 00 01 5b d0 | 03 00 df 11 00 00 36 38 |67....[.|......68|
|000003d0| 00 00 00 01 3a e2 03 00 | be 0f 00 00 36 39 00 00 |....:...|....69..|
|000003e0| 00 01 f8 f1 03 00 97 0f | 00 00 37 30 00 00 00 01 |........|..70....|
|000003f0| 8f 01 04 00 4a 0f 00 00 | 37 31 00 00 00 01 d9 10 |....J...|71......|
|00000400| 04 00 fb 10 00 00 37 32 | 00 00 00 01 d4 21 04 00 |......72|.....!..|
|00000410| 68 10 00 00 37 33 00 00 | 00 01 3c 32 04 00 6e 12 |h...73..|..<2..n.|
|00000420| 00 00 37 34 00 00 00 01 | aa 44 04 00 ea 12 00 00 |..74....|.D......|
|00000430| 37 35 00 00 00 01 94 57 | 04 00 ff 0f 00 00 37 36 |75.....W|......76|
|00000440| 00 00 00 01 93 67 04 00 | 8a 11 00 00 37 37 00 00 |.....g..|....77..|
|00000450| 00 01 1d 79 04 00 53 0f | 00 00 37 38 00 00 00 01 |...y..S.|..78....|
|00000460| 70 88 04 00 99 11 00 00 | 37 39 00 00 00 01 09 9a |p.......|79......|
|00000470| 04 00 16 11 00 00 38 30 | 00 00 00 01 1f ab 04 00 |......80|........|
|00000480| 34 10 00 00 38 31 00 00 | 00 01 53 bb 04 00 51 11 |4...81..|..S...Q.|
|00000490| 00 00 38 32 00 00 00 01 | a4 cc 04 00 57 0e 00 00 |..82....|....W...|
|000004a0| 38 33 00 00 00 01 fb da | 04 00 49 0f 00 00 38 34 |83......|..I...84|
|000004b0| 00 00 00 01 44 ea 04 00 | 0d 10 00 00 38 35 00 00 |....D...|....85..|
|000004c0| 00 01 51 fa 04 00 12 17 | 00 00 38 36 00 00 00 01 |..Q.....|..86....|
|000004d0| 63 11 05 00 31 11 00 00 | 38 37 00 00 00 01 94 22 |c...1...|87....."|
|000004e0| 05 00 c7 0f 00 00 38 38 | 00 00 00 01 5b 32 05 00 |......88|....[2..|
|000004f0| de 13 00 00 38 39 00 00 | 00 01 39 46 05 00 34 0c |....89..|..9F..4.|
|00000500| 00 00 39 30 00 00 00 01 | 6d 52 05 00 cf 10 00 00 |..90....|mR......|
|00000510| 39 31 00 00 00 01 3c 63 | 05 00 aa 0d 00 00 39 32 |91....<c|......92|
|00000520| 00 00 00 01 e6 70 05 00 | 87 13 00 00 39 33 00 00 |.....p..|....93..|
|00000530| 00 01 6d 84 05 00 c1 14 | 00 00 39 34 00 00 00 01 |..m.....|..94....|
|00000540| 2e 99 05 00 5b 0f 00 00 | 39 35 00 00 00 01 89 a8 |....[...|95......|
|00000550| 05 00 50 12 00 00 39 36 | 00 00 00 01 d9 ba 05 00 |..P...96|........|
|00000560| df 0f 00 00 39 37 00 00 | 00 01 b8 ca 05 00 6a 0e |....97..|......j.|
|00000570| 00 00 39 38 00 00 00 01 | 22 d9 05 00 0e 0f 00 00 |..98....|".......|
|00000580| 39 39 00 00 00 01 30 e8 | 05 00 57 0d 00 00 00 00 |99....0.|..W.....|
|00000590| 00 00 00 00 87 f5 05 00 | 00 00 00 00 24 55 6e 69 |........|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 36 39 30 30 7d |que_ID{Y|RB06900}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 50 72 65 64 69 63 74 |..$Title|{Predict|
|000005c0| 69 6f 6e 20 6f 66 20 52 | 65 6d 69 73 73 69 6f 6e |ion of R|emission|
|000005d0| 20 41 66 74 65 72 20 41 | 6e 74 69 74 68 79 72 6f | After A|ntithyro|
|000005e0| 69 64 20 44 72 75 67 20 | 54 72 65 61 74 6d 65 6e |id Drug |Treatmen|
|000005f0| 74 20 69 6e 20 47 72 61 | 76 65 73 27 20 44 69 73 |t in Gra|ves' Dis|
|00000600| 65 61 73 65 7d 0d 0a 24 | 41 75 74 68 6f 72 7b 59 |ease}..$|Author{Y|
|00000610| 6f 75 6e 67 2c 20 45 54 | 0d 0a 53 74 65 65 6c 2c |oung, ET|..Steel,|
|00000620| 20 4e 52 0d 0a 54 61 79 | 6c 6f 72 2c 20 4a 4a 0d | NR..Tay|lor, JJ.|
|00000630| 0a 53 74 65 70 68 65 6e | 73 6f 6e 2c 20 41 4d 0d |.Stephen|son, AM.|
|00000640| 0a 53 74 72 61 74 74 6f | 6e 2c 20 41 0d 0a 48 6f |.Stratto|n, A..Ho|
|00000650| 6c 63 6f 6d 62 65 2c 20 | 4d 0d 0a 4b 65 6e 64 61 |lcombe, |M..Kenda|
|00000660| 6c 6c 2d 54 61 79 6c 6f | 72 2c 20 50 7d 0d 0a 24 |ll-Taylo|r, P}..$|
|00000670| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 41 73 68 69 |Affiliat|ion{Ashi|
|00000680| 6e 67 74 6f 6e 20 48 6f | 73 70 2c 20 41 73 68 69 |ngton Ho|sp, Ashi|
|00000690| 6e 67 74 6f 6e 2c 20 45 | 6e 67 6c 61 6e 64 3b 20 |ngton, E|ngland; |
|000006a0| 52 6f 79 61 6c 20 56 69 | 63 74 6f 72 69 61 20 49 |Royal Vi|ctoria I|
|000006b0| 6e 66 69 72 6d 61 72 79 | 2c 20 4e 65 77 63 61 73 |nfirmary|, Newcas|
|000006c0| 74 6c 65 20 75 70 6f 6e | 20 54 79 6e 65 3b 20 54 |tle upon| Tyne; T|
|000006d0| 69 73 73 75 65 20 54 79 | 70 69 6e 67 20 4c 61 62 |issue Ty|ping Lab|
|000006e0| 20 61 6e 64 20 42 6c 6f | 6f 64 20 54 72 61 6e 73 | and Blo|od Trans|
|000006f0| 66 75 73 69 6f 6e 20 43 | 74 72 2c 20 4e 65 77 63 |fusion C|tr, Newc|
|00000700| 61 73 74 6c 65 20 75 70 | 6f 6e 20 54 79 6e 65 2c |astle up|on Tyne,|
|00000710| 20 45 6e 67 6c 61 6e 64 | 7d 0d 0a 24 53 75 62 6a | England|}..$Subj|
|00000720| 65 63 74 7b 47 72 61 76 | 65 73 27 20 64 69 73 65 |ect{Grav|es' dise|
|00000730| 61 73 65 20 61 6e 74 69 | 74 68 79 72 6f 69 64 20 |ase anti|thyroid |
|00000740| 64 72 75 67 73 20 69 6e | 2c 20 70 72 65 64 69 63 |drugs in|, predic|
|00000750| 74 69 6f 6e 20 6f 66 20 | 72 65 6d 69 73 73 69 6f |tion of |remissio|
|00000760| 6e 20 61 66 74 65 72 3b | 0d 0a 41 6e 74 69 74 68 |n after;|..Antith|
|00000770| 79 72 6f 69 64 20 64 72 | 75 67 73 20 69 6e 20 47 |yroid dr|ugs in G|
|00000780| 72 61 76 65 73 27 20 64 | 69 73 65 61 73 65 2c 20 |raves' d|isease, |
|00000790| 70 72 65 64 69 63 74 69 | 6f 6e 20 6f 66 20 72 65 |predicti|on of re|
|000007a0| 6d 69 73 73 69 6f 6e 20 | 61 66 74 65 72 7d 0d 0a |mission |after}..|
|000007b0| 24 4a 6f 75 72 6e 61 6c | 7b 51 20 4a 20 4d 65 64 |$Journal|{Q J Med|
|000007c0| 7d 0d 0a 24 56 6f 6c 75 | 6d 65 7b 36 36 7d 0d 0a |}..$Volu|me{66}..|
|000007d0| 24 50 61 67 65 7b 31 37 | 35 2d 31 38 39 7d 0d 0a |$Page{17|5-189}..|
|000007e0| 24 44 61 74 65 7b 46 65 | 62 72 75 61 72 79 20 31 |$Date{Fe|bruary 1|
|000007f0| 39 38 38 7d 0d 0a 24 59 | 42 56 6f 6c 7b 31 39 38 |988}..$Y|BVol{198|
|00000800| 39 20 59 65 61 72 20 42 | 6f 6f 6b 20 6f 66 20 4d |9 Year B|ook of M|
|00000810| 65 64 69 63 69 6e 65 2c | 20 50 61 72 74 20 53 69 |edicine,| Part Si|
|00000820| 78 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 34 35 2d |x}..$Cha|pter{45-|
|00000830| 32 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |2}..$YBE|ditor{Dr|
|00000840| 73 2e 20 52 6f 67 65 72 | 73 2c 20 44 65 73 20 50 |s. Roger|s, Des P|
|00000850| 72 65 7a 2c 20 43 6c 69 | 6e 65 2c 20 42 72 61 75 |rez, Cli|ne, Brau|
|00000860| 6e 77 61 6c 64 2c 20 47 | 72 65 65 6e 62 65 72 67 |nwald, G|reenberg|
|00000870| 65 72 2c 20 57 69 6c 73 | 6f 6e 2c 20 45 70 73 74 |er, Wils|on, Epst|
|00000880| 65 69 6e 2c 20 61 6e 64 | 20 4d 61 6c 61 77 69 73 |ein, and| Malawis|
|00000890| 74 61 7d 0d 0a 24 54 61 | 62 6c 65 7b 7d 0d 0a 24 |ta}..$Ta|ble{}..$|
|000008a0| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 4a 2e 44 2e |Commenta|tor{J.D.|
|000008b0| 20 57 69 6c 73 6f 6e 2c | 20 4d 2e 44 2e 7d 0d 0a | Wilson,| M.D.}..|
|000008c0| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 63 29 20 |..Copyri|ght (c) |
|000008d0| 59 65 61 72 20 42 6f 6f | 6b 20 4d 65 64 69 63 61 |Year Boo|k Medica|
|000008e0| 6c 20 50 75 62 6c 69 73 | 68 65 72 73 2c 20 49 6e |l Publis|hers, In|
|000008f0| 63 2e 2c 20 31 39 38 39 | 0d 0a 0d 0a 31 39 38 39 |c., 1989|....1989|
|00000900| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 4d 65 | Year Bo|ok of Me|
|00000910| 64 69 63 69 6e 65 20 28 | 52 29 0d 0a 0d 0a 50 61 |dicine (|R)....Pa|
|00000920| 72 74 20 53 69 78 3a 20 | 20 45 6e 64 6f 63 72 69 |rt Six: | Endocri|
|00000930| 6e 6f 6c 6f 67 79 20 61 | 6e 64 20 4d 65 74 61 62 |nology a|nd Metab|
|00000940| 6f 6c 69 73 6d 0d 0a 0d | 0a 43 68 61 70 74 65 72 |olism...|.Chapter|
|00000950| 20 34 35 2d 2d 54 68 65 | 20 54 68 79 72 6f 69 64 | 45--The| Thyroid|
|00000960| 0d 0a 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |....----|--------|
|00000970| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000980| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009b0| 2d 2d 2d 2d 0d 0a 50 72 | 65 64 69 63 74 69 6f 6e |----..Pr|ediction|
|000009c0| 20 6f 66 20 52 65 6d 69 | 73 73 69 6f 6e 20 41 66 | of Remi|ssion Af|
|000009d0| 74 65 72 20 41 6e 74 69 | 74 68 79 72 6f 69 64 20 |ter Anti|thyroid |
|000009e0| 44 72 75 67 20 54 72 65 | 61 74 6d 65 6e 74 20 69 |Drug Tre|atment i|
|000009f0| 6e 20 47 72 61 76 65 73 | 27 20 44 69 73 65 61 73 |n Graves|' Diseas|
|00000a00| 65 0d 0a 0d 0a 59 6f 75 | 6e 67 20 45 54 2c 20 53 |e....You|ng ET, S|
|00000a10| 74 65 65 6c 20 4e 52 2c | 20 54 61 79 6c 6f 72 20 |teel NR,| Taylor |
|00000a20| 4a 4a 2c 20 53 74 65 70 | 68 65 6e 73 6f 6e 20 41 |JJ, Step|henson A|
|00000a30| 4d 2c 20 53 74 72 61 74 | 74 6f 6e 20 41 2c 20 48 |M, Strat|ton A, H|
|00000a40| 6f 6c 63 6f 6d 62 65 20 | 4d 2c 0d 0a 4b 65 6e 64 |olcombe |M,..Kend|
|00000a50| 61 6c 6c 2d 54 61 79 6c | 6f 72 20 50 0d 0a 28 41 |all-Tayl|or P..(A|
|00000a60| 73 68 69 6e 67 74 6f 6e | 20 48 6f 73 70 2c 20 41 |shington| Hosp, A|
|00000a70| 73 68 69 6e 67 74 6f 6e | 2c 20 45 6e 67 6c 61 6e |shington|, Englan|
|00000a80| 64 3b 20 52 6f 79 61 6c | 20 56 69 63 74 6f 72 69 |d; Royal| Victori|
|00000a90| 61 20 49 6e 66 69 72 6d | 61 72 79 2c 20 4e 65 77 |a Infirm|ary, New|
|00000aa0| 63 61 73 74 6c 65 20 75 | 70 6f 6e 0d 0a 54 79 6e |castle u|pon..Tyn|
|00000ab0| 65 3b 20 54 69 73 73 75 | 65 20 54 79 70 69 6e 67 |e; Tissu|e Typing|
|00000ac0| 20 4c 61 62 20 61 6e 64 | 20 42 6c 6f 6f 64 20 54 | Lab and| Blood T|
|00000ad0| 72 61 6e 73 66 75 73 69 | 6f 6e 20 43 74 72 2c 20 |ransfusi|on Ctr, |
|00000ae0| 4e 65 77 63 61 73 74 6c | 65 20 75 70 6f 6e 20 54 |Newcastl|e upon T|
|00000af0| 79 6e 65 2c 0d 0a 45 6e | 67 6c 61 6e 64 29 0d 0a |yne,..En|gland)..|
|00000b00| 51 20 4a 20 4d 65 64 20 | 36 36 3a 31 37 35 2d 31 |Q J Med |66:175-1|
|00000b10| 38 39 2c 20 46 65 62 72 | 75 61 72 79 20 31 39 38 |89, Febr|uary 198|
|00000b20| 38 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |8..-----|--------|
|00000b30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000b40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000b50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000b60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000b70| 2d 2d 2d 0d 0a 0d 0a 50 | 72 65 2d 63 6f 6d 6d 65 |---....P|re-comme|
|00000b80| 6e 74 0d 0a 0d 0a 20 20 | 20 20 20 54 68 65 20 61 |nt.... | The a|
|00000b90| 62 69 6c 69 74 79 20 74 | 6f 20 70 72 65 64 69 63 |bility t|o predic|
|00000ba0| 74 20 77 68 65 74 68 65 | 72 20 69 6e 64 69 76 69 |t whethe|r indivi|
|00000bb0| 64 75 61 6c 20 70 61 74 | 69 65 6e 74 73 20 77 69 |dual pat|ients wi|
|00000bc0| 74 68 20 68 79 70 65 72 | 74 68 79 72 6f 69 64 69 |th hyper|thyroidi|
|00000bd0| 73 6d 0d 0a 77 69 6c 6c | 20 75 6e 64 65 72 67 6f |sm..will| undergo|
|00000be0| 20 72 65 6d 69 73 73 69 | 6f 6e 20 61 66 74 65 72 | remissi|on after|
|00000bf0| 20 6c 6f 6e 67 2d 74 65 | 72 6d 20 61 6e 74 69 74 | long-te|rm antit|
|00000c00| 68 79 72 6f 69 64 20 64 | 72 75 67 20 74 68 65 72 |hyroid d|rug ther|
|00000c10| 61 70 79 20 77 6f 75 6c | 64 20 62 65 20 61 0d 0a |apy woul|d be a..|
|00000c20| 73 69 67 6e 69 66 69 63 | 61 6e 74 20 61 64 76 61 |signific|ant adva|
|00000c30| 6e 63 65 2e 20 20 4f 6e | 20 74 68 65 20 61 73 73 |nce. On| the ass|
|00000c40| 75 6d 70 74 69 6f 6e 20 | 74 68 61 74 20 64 69 73 |umption |that dis|
|00000c50| 61 70 70 65 61 72 61 6e | 63 65 20 6f 66 20 61 6e |appearan|ce of an|
|00000c60| 74 69 62 6f 64 69 65 73 | 20 74 6f 20 74 68 65 0d |tibodies| to the.|
|00000c70| 0a 74 68 79 72 6f 74 72 | 6f 70 69 6e 20 72 65 63 |.thyrotr|opin rec|
|00000c80| 65 70 74 6f 72 20 77 6f | 75 6c 64 20 62 65 20 61 |eptor wo|uld be a|
|00000c90| 73 73 6f 63 69 61 74 65 | 64 20 77 69 74 68 20 63 |ssociate|d with c|
|00000ca0| 6c 69 6e 69 63 61 6c 20 | 72 65 6d 69 73 73 69 6f |linical |remissio|
|00000cb0| 6e 2c 20 73 65 76 65 72 | 61 6c 0d 0a 69 6e 76 65 |n, sever|al..inve|
|00000cc0| 73 74 69 67 61 74 6f 72 | 73 20 68 61 76 65 20 69 |stigator|s have i|
|00000cd0| 6e 76 65 73 74 69 67 61 | 74 65 64 20 74 68 65 20 |nvestiga|ted the |
|00000ce0| 75 73 65 66 75 6c 6e 65 | 73 73 20 6f 66 20 74 68 |usefulne|ss of th|
|00000cf0| 65 20 6d 65 61 73 75 72 | 65 6d 65 6e 74 20 6f 66 |e measur|ement of|
|00000d00| 20 61 6e 74 69 62 6f 64 | 79 0d 0a 6c 65 76 65 6c | antibod|y..level|
|00000d10| 73 20 66 6f 72 20 70 72 | 65 64 69 63 74 69 6e 67 |s for pr|edicting|
|00000d20| 20 63 6c 69 6e 69 63 61 | 6c 20 6f 75 74 63 6f 6d | clinica|l outcom|
|00000d30| 65 20 61 66 74 65 72 20 | 63 65 73 73 61 74 69 6f |e after |cessatio|
|00000d40| 6e 20 6f 66 20 61 6e 74 | 69 74 68 79 72 6f 69 64 |n of ant|ithyroid|
|00000d50| 20 64 72 75 67 73 2e 0d | 0a 0d 0a 41 62 73 74 72 | drugs..|...Abstr|
|00000d60| 61 63 74 0d 0a 0d 0a 20 | 20 20 20 20 44 65 73 70 |act.... | Desp|
|00000d70| 69 74 65 20 6c 6f 6e 67 | 20 65 78 70 65 72 69 65 |ite long| experie|
|00000d80| 6e 63 65 20 77 69 74 68 | 20 61 6e 74 69 74 68 79 |nce with| antithy|
|00000d90| 72 6f 69 64 20 64 72 75 | 67 73 20 69 6e 20 47 72 |roid dru|gs in Gr|
|00000da0| 61 76 65 73 27 20 64 69 | 73 65 61 73 65 2c 20 69 |aves' di|sease, i|
|00000db0| 74 0d 0a 72 65 6d 61 69 | 6e 73 20 64 69 66 66 69 |t..remai|ns diffi|
|00000dc0| 63 75 6c 74 20 74 6f 20 | 70 72 65 64 69 63 74 20 |cult to |predict |
|00000dd0| 6c 6f 6e 67 2d 6c 61 73 | 74 69 6e 67 20 72 65 6d |long-las|ting rem|
|00000de0| 69 73 73 69 6f 6e 73 20 | 69 6e 20 69 6e 64 69 76 |issions |in indiv|
|00000df0| 69 64 75 61 6c 20 70 61 | 74 69 65 6e 74 73 2e 20 |idual pa|tients. |
|00000e00| 20 41 0d 0a 70 72 6f 73 | 70 65 63 74 69 76 65 20 | A..pros|pective |
|00000e10| 73 74 75 64 79 20 77 61 | 73 20 63 6f 6e 64 75 63 |study wa|s conduc|
|00000e20| 74 65 64 20 74 6f 20 69 | 64 65 6e 74 69 66 79 20 |ted to i|dentify |
|00000e30| 74 68 65 20 66 61 63 74 | 6f 72 73 20 69 6e 66 6c |the fact|ors infl|
|00000e40| 75 65 6e 63 69 6e 67 0d | 0a 72 65 73 70 6f 6e 73 |uencing.|.respons|
|00000e50| 69 76 65 6e 65 73 73 20 | 74 6f 20 73 75 63 68 20 |iveness |to such |
|00000e60| 74 72 65 61 74 6d 65 6e | 74 2e 20 20 53 65 76 65 |treatmen|t. Seve|
|00000e70| 6e 74 79 2d 74 77 6f 20 | 70 61 74 69 65 6e 74 73 |nty-two |patients|
|00000e80| 20 77 69 74 68 20 47 72 | 61 76 65 73 27 0d 0a 68 | with Gr|aves'..h|
|00000e90| 79 70 65 72 74 68 79 72 | 6f 69 64 69 73 6d 20 77 |yperthyr|oidism w|
|00000ea0| 65 72 65 20 67 69 76 65 | 6e 20 63 61 72 62 69 6d |ere give|n carbim|
|00000eb0| 61 7a 6f 6c 65 20 69 6e | 20 61 20 6d 65 61 6e 20 |azole in| a mean |
|00000ec0| 74 6f 74 61 6c 20 64 6f | 73 65 20 6f 66 20 38 20 |total do|se of 8 |
|00000ed0| 67 6d 20 61 6e 64 20 66 | 6f 6c 6c 6f 77 65 64 0d |gm and f|ollowed.|
|00000ee0| 0a 66 6f 72 20 61 6e 20 | 61 76 65 72 61 67 65 20 |.for an |average |
|00000ef0| 6f 66 20 38 20 6d 6f 6e | 74 68 73 2e 20 20 4c 65 |of 8 mon|ths. Le|
|00000f00| 76 6f 74 68 79 72 6f 78 | 69 6e 65 20 77 61 73 20 |vothyrox|ine was |
|00000f10| 61 64 64 65 64 20 69 6e | 20 61 20 64 6f 73 65 20 |added in| a dose |
|00000f20| 6f 66 20 31 35 30 20 6d | 75 20 67 20 64 61 69 6c |of 150 m|u g dail|
|00000f30| 79 0d 0a 61 66 74 65 72 | 20 36 20 77 65 65 6b 73 |y..after| 6 weeks|
|00000f40| 20 6f 66 20 63 61 72 62 | 69 6d 61 7a 6f 6c 65 20 | of carb|imazole |
|00000f50| 74 68 65 72 61 70 79 2e | 20 20 54 77 6f 20 70 61 |therapy.| Two pa|
|00000f60| 74 69 65 6e 74 73 20 72 | 65 63 65 69 76 65 64 20 |tients r|eceived |
|00000f70| 70 72 6f 70 79 6c 74 68 | 69 6f 75 72 61 63 69 6c |propylth|iouracil|
|00000f80| 0d 0a 69 6e 73 74 65 61 | 64 20 6f 66 20 63 61 72 |..instea|d of car|
|00000f90| 62 69 6d 61 7a 6f 6c 65 | 2e 0d 0a 20 20 20 20 20 |bimazole|... |
|00000fa0| 54 68 69 72 74 79 2d 66 | 69 76 65 20 70 61 74 69 |Thirty-f|ive pati|
|00000fb0| 65 6e 74 73 20 72 65 6c | 61 70 73 65 64 20 61 6e |ents rel|apsed an|
|00000fc0| 64 20 33 37 20 72 65 6d | 61 69 6e 65 64 20 69 6e |d 37 rem|ained in|
|00000fd0| 20 72 65 6d 69 73 73 69 | 6f 6e 20 64 75 72 69 6e | remissi|on durin|
|00000fe0| 67 0d 0a 66 6f 6c 6c 6f | 77 2d 75 70 2e 20 20 4c |g..follo|w-up. L|
|00000ff0| 65 76 65 6c 73 20 6f 66 | 20 74 68 79 72 6f 74 72 |evels of| thyrotr|
|00001000| 6f 70 69 6e 20 62 69 6e | 64 69 6e 67 2d 69 6e 68 |opin bin|ding-inh|
|00001010| 69 62 69 74 69 6e 67 20 | 69 6d 6d 75 6e 6f 67 6c |ibiting |immunogl|
|00001020| 6f 62 75 6c 69 6e 20 77 | 65 72 65 20 68 69 67 68 |obulin w|ere high|
|00001030| 65 72 0d 0a 62 65 66 6f | 72 65 20 61 6e 64 20 61 |er..befo|re and a|
|00001040| 66 74 65 72 20 74 72 65 | 61 74 6d 65 6e 74 20 69 |fter tre|atment i|
|00001050| 6e 20 70 61 74 69 65 6e | 74 73 20 77 68 6f 20 72 |n patien|ts who r|
|00001060| 65 6c 61 70 73 65 64 2e | 20 20 48 6f 77 65 76 65 |elapsed.| Howeve|
|00001070| 72 2c 20 6f 6e 6c 79 20 | 76 65 72 79 20 68 69 67 |r, only |very hig|
|00001080| 68 0d 0a 76 61 6c 75 65 | 73 20 77 65 72 65 20 6f |h..value|s were o|
|00001090| 66 20 70 72 6f 67 6e 6f | 73 74 69 63 20 69 6d 70 |f progno|stic imp|
|000010a0| 6f 72 74 20 69 6e 20 69 | 6e 64 69 76 69 64 75 61 |ort in i|ndividua|
|000010b0| 6c 20 70 61 74 69 65 6e | 74 73 2e 20 20 54 68 79 |l patien|ts. Thy|
|000010c0| 72 6f 69 64 2d 73 74 69 | 6d 75 6c 61 74 69 6e 67 |roid-sti|mulating|
|000010d0| 0d 0a 61 6e 74 69 62 6f | 64 69 65 73 20 64 69 64 |..antibo|dies did|
|000010e0| 20 6e 6f 74 20 70 72 65 | 64 69 63 74 20 74 68 65 | not pre|dict the|
|000010f0| 20 6f 75 74 63 6f 6d 65 | 20 6f 66 20 74 72 65 61 | outcome| of trea|
|00001100| 74 6d 65 6e 74 2e 20 20 | 4e 65 69 74 68 65 72 20 |tment. |Neither |
|00001110| 68 75 6d 61 6e 20 6c 65 | 75 6b 6f 63 79 74 65 0d |human le|ukocyte.|
|00001120| 0a 61 6e 74 69 67 65 6e | 20 28 48 4c 41 29 20 42 |.antigen| (HLA) B|
|00001130| 38 20 6e 6f 72 20 48 4c | 41 20 44 52 33 20 63 6f |8 nor HL|A DR3 co|
|00001140| 6e 66 65 72 72 65 64 20 | 61 6e 20 69 6e 63 72 65 |nferred |an incre|
|00001150| 61 73 65 64 20 72 69 73 | 6b 20 6f 66 20 72 65 6c |ased ris|k of rel|
|00001160| 61 70 73 69 6e 67 2e 20 | 20 52 65 6c 61 70 73 65 |apsing. | Relapse|
|00001170| 0d 0a 77 61 73 20 64 69 | 72 65 63 74 6c 79 20 72 |..was di|rectly r|
|00001180| 65 6c 61 74 65 64 20 74 | 6f 20 74 68 65 20 73 65 |elated t|o the se|
|00001190| 76 65 72 69 74 79 20 6f | 66 20 64 69 73 65 61 73 |verity o|f diseas|
|000011a0| 65 20 61 74 20 64 69 61 | 67 6e 6f 73 69 73 2c 20 |e at dia|gnosis, |
|000011b0| 61 73 20 72 65 66 6c 65 | 63 74 65 64 20 62 79 0d |as refle|cted by.|
|000011c0| 0a 73 65 72 75 6d 20 74 | 72 69 69 64 6f 74 68 79 |.serum t|riidothy|
|000011d0| 72 6f 6e 69 6e 65 20 28 | 54 33 29 2c 20 61 6e 64 |ronine (|T3), and|
|000011e0| 20 74 6f 20 74 68 79 72 | 6f 69 64 20 67 6c 61 6e | to thyr|oid glan|
|000011f0| 64 20 73 69 7a 65 2e 20 | 20 41 67 65 2c 20 6f 70 |d size. | Age, op|
|00001200| 68 74 68 61 6c 6d 6f 70 | 61 74 68 79 2c 20 61 6e |hthalmop|athy, an|
|00001210| 64 0d 0a 61 20 66 61 6d | 69 6c 79 20 68 69 73 74 |d..a fam|ily hist|
|00001220| 6f 72 79 20 6f 66 20 74 | 68 79 72 6f 69 64 20 64 |ory of t|hyroid d|
|00001230| 69 73 65 61 73 65 20 77 | 65 72 65 20 6e 6f 74 20 |isease w|ere not |
|00001240| 70 72 65 64 69 63 74 69 | 76 65 20 66 61 63 74 6f |predicti|ve facto|
|00001250| 72 73 2e 0d 0a 20 20 20 | 20 20 47 6f 69 74 65 72 |rs... | Goiter|
|00001260| 20 73 69 7a 65 20 61 6e | 64 20 74 68 65 20 73 65 | size an|d the se|
|00001270| 72 75 6d 20 54 33 20 6c | 65 76 65 6c 20 61 74 20 |rum T3 l|evel at |
|00001280| 64 69 61 67 6e 6f 73 69 | 73 20 6f 66 20 47 72 61 |diagnosi|s of Gra|
|00001290| 76 65 73 27 20 64 69 73 | 65 61 73 65 20 70 72 6f |ves' dis|ease pro|
|000012a0| 76 69 64 65 0d 0a 74 68 | 65 20 62 65 73 74 20 69 |vide..th|e best i|
|000012b0| 6e 64 69 63 61 74 69 6f | 6e 20 6f 66 20 74 68 65 |ndicatio|n of the|
|000012c0| 20 6f 75 74 63 6f 6d 65 | 20 6f 66 20 61 6e 74 69 | outcome| of anti|
|000012d0| 74 68 79 72 6f 69 64 20 | 64 72 75 67 20 74 72 65 |thyroid |drug tre|
|000012e0| 61 74 6d 65 6e 74 2e 20 | 20 54 68 65 72 61 70 79 |atment. | Therapy|
|000012f0| 20 69 73 0d 0a 6d 6f 73 | 74 20 6c 69 6b 65 6c 79 | is..mos|t likely|
|00001300| 20 74 6f 20 73 75 63 63 | 65 65 64 20 69 6e 20 70 | to succ|eed in p|
|00001310| 61 74 69 65 6e 74 73 20 | 77 69 74 68 20 61 20 73 |atients |with a s|
|00001320| 6d 61 6c 6c 20 6f 72 20 | 69 6d 70 61 6c 70 61 62 |mall or |impalpab|
|00001330| 6c 65 20 74 68 79 72 6f | 69 64 20 6f 72 20 61 20 |le thyro|id or a |
|00001340| 73 65 72 75 6d 0d 0a 54 | 33 20 6c 65 76 65 6c 20 |serum..T|3 level |
|00001350| 6f 66 20 6c 65 73 73 20 | 74 68 61 6e 20 35 20 6e |of less |than 5 n|
|00001360| 6d 6f 6c 2f 4c 2e 0d 0a | 0d 0a 50 6f 73 74 2d 43 |mol/L...|..Post-C|
|00001370| 6f 6d 6d 65 6e 74 0d 0a | 0d 0a 20 20 20 20 20 49 |omment..|.. I|
|00001380| 6e 20 6d 79 20 6f 70 69 | 6e 69 6f 6e 20 74 68 65 |n my opi|nion the|
|00001390| 20 63 72 69 74 69 63 61 | 6c 20 66 65 61 74 75 72 | critica|l featur|
|000013a0| 65 20 6f 66 20 74 68 69 | 73 20 70 61 70 65 72 20 |e of thi|s paper |
|000013b0| 61 6e 64 20 6f 66 20 73 | 69 6d 69 6c 61 72 20 72 |and of s|imilar r|
|000013c0| 65 70 6f 72 74 73 20 62 | 79 0d 0a 6f 74 68 65 72 |eports b|y..other|
|000013d0| 20 69 6e 76 65 73 74 69 | 67 61 74 6f 72 73 20 5b | investi|gators [|
|000013e0| 31 2c 32 5d 20 69 73 20 | 74 68 61 74 20 6c 6f 6e |1,2] is |that lon|
|000013f0| 67 2d 74 65 72 6d 20 72 | 65 6d 69 73 73 69 6f 6e |g-term r|emission|
|00001400| 20 63 61 6e 20 6f 63 63 | 75 72 20 64 65 73 70 69 | can occ|ur despi|
|00001410| 74 65 0d 0a 70 65 72 73 | 69 73 74 65 6e 63 65 20 |te..pers|istence |
|00001420| 6f 66 20 74 68 79 72 6f | 69 64 2d 73 74 69 6d 75 |of thyro|id-stimu|
|00001430| 6c 61 74 69 6e 67 20 61 | 6e 74 69 62 6f 64 69 65 |lating a|ntibodie|
|00001440| 73 20 69 6e 20 70 6c 61 | 73 6d 61 2c 20 73 75 67 |s in pla|sma, sug|
|00001450| 67 65 73 74 69 6e 67 20 | 74 68 61 74 0d 0a 64 65 |gesting |that..de|
|00001460| 76 65 6c 6f 70 6d 65 6e | 74 20 6f 66 20 61 20 72 |velopmen|t of a r|
|00001470| 65 64 75 63 65 64 20 66 | 75 6e 63 74 69 6f 6e 61 |educed f|unctiona|
|00001480| 6c 20 72 65 73 65 72 76 | 65 20 6f 66 20 74 68 65 |l reserv|e of the|
|00001490| 20 74 68 79 72 6f 69 64 | 20 69 6d 70 61 69 72 73 | thyroid| impairs|
|000014a0| 0d 0a 72 65 73 70 6f 6e | 73 69 76 65 6e 65 73 73 |..respon|siveness|
|000014b0| 20 74 6f 20 74 68 65 20 | 61 6e 74 69 62 6f 64 69 | to the |antibodi|
|000014c0| 65 73 20 61 6e 64 20 6d | 61 79 20 62 65 20 72 65 |es and m|ay be re|
|000014d0| 73 70 6f 6e 73 69 62 6c | 65 20 66 6f 72 20 72 65 |sponsibl|e for re|
|000014e0| 6d 69 73 73 69 6f 6e 2e | 20 20 49 74 20 69 73 0d |mission.| It is.|
|000014f0| 0a 6e 6f 74 65 77 6f 72 | 74 68 79 20 74 68 61 74 |.notewor|thy that|
|00001500| 20 74 68 79 72 6f 69 64 | 20 73 69 7a 65 20 69 73 | thyroid| size is|
|00001510| 20 73 74 69 6c 6c 20 70 | 72 6f 62 61 62 6c 79 20 | still p|robably |
|00001520| 74 68 65 20 62 65 73 74 | 20 70 72 65 64 69 63 74 |the best| predict|
|00001530| 6f 72 20 6f 66 20 6c 6f | 6e 67 2d 74 65 72 6d 0d |or of lo|ng-term.|
|00001540| 0a 72 65 73 70 6f 6e 73 | 65 3a 20 20 74 68 65 20 |.respons|e: the |
|00001550| 73 6d 61 6c 6c 65 72 20 | 74 68 65 20 67 6c 61 6e |smaller |the glan|
|00001560| 64 20 61 74 20 69 6e 69 | 74 69 61 74 69 6f 6e 20 |d at ini|tiation |
|00001570| 6f 66 20 74 68 65 72 61 | 70 79 2c 20 74 68 65 20 |of thera|py, the |
|00001580| 6d 6f 72 65 20 6c 69 6b | 65 6c 79 20 61 0d 0a 6c |more lik|ely a..l|
|00001590| 6f 6e 67 2d 74 65 72 6d | 20 72 65 6d 69 73 73 69 |ong-term| remissi|
|000015a0| 6f 6e 2e 0d 0a 20 20 20 | 20 20 4f 72 61 6c 20 63 |on... | Oral c|
|000015b0| 68 6f 6c 65 63 79 73 74 | 6f 67 72 61 70 68 69 63 |holecyst|ographic|
|000015c0| 20 78 2d 72 61 79 20 63 | 6f 6e 74 72 61 73 74 20 | x-ray c|ontrast |
|000015d0| 61 67 65 6e 74 73 20 68 | 61 76 65 20 62 65 65 6e |agents h|ave been|
|000015e0| 20 74 72 69 65 64 20 69 | 6e 20 74 68 65 0d 0a 6c | tried i|n the..l|
|000015f0| 6f 6e 67 2d 74 65 72 6d | 20 6d 61 6e 61 67 65 6d |ong-term| managem|
|00001600| 65 6e 74 20 6f 66 20 74 | 68 79 72 6f 74 6f 78 69 |ent of t|hyrotoxi|
|00001610| 63 6f 73 69 73 20 69 6e | 20 72 65 63 65 6e 74 20 |cosis in| recent |
|00001620| 79 65 61 72 73 2e 20 20 | 54 68 65 73 65 20 61 67 |years. |These ag|
|00001630| 65 6e 74 73 20 61 72 65 | 0d 0a 62 65 6c 69 65 76 |ents are|..believ|
|00001640| 65 64 20 74 6f 20 77 6f | 72 6b 20 62 6f 74 68 20 |ed to wo|rk both |
|00001650| 62 79 20 69 6e 68 69 62 | 69 74 69 6e 67 20 6f 75 |by inhib|iting ou|
|00001660| 74 65 72 20 72 69 6e 67 | 20 35 27 20 64 65 69 6f |ter ring| 5' deio|
|00001670| 64 69 6e 61 74 69 6f 6e | 20 6f 66 20 74 68 79 72 |dination| of thyr|
|00001680| 6f 78 69 6e 65 20 61 6e | 64 0d 0a 62 79 20 67 65 |oxine an|d..by ge|
|00001690| 6e 65 72 61 74 69 6e 67 | 20 69 6f 64 69 6e 65 20 |nerating| iodine |
|000016a0| 77 69 74 68 69 6e 20 74 | 68 65 20 74 68 79 72 6f |within t|he thyro|
|000016b0| 69 64 2e 20 20 41 73 20 | 6d 6f 6e 6f 74 68 65 72 |id. As |monother|
|000016c0| 61 70 79 20 74 68 65 20 | 61 67 65 6e 74 73 20 61 |apy the |agents a|
|000016d0| 72 65 20 6e 6f 74 0d 0a | 65 66 66 65 63 74 69 76 |re not..|effectiv|
|000016e0| 65 20 69 6e 20 6d 61 6e | 79 20 68 79 70 65 72 74 |e in man|y hypert|
|000016f0| 68 79 72 6f 69 64 20 70 | 61 74 69 65 6e 74 73 2c |hyroid p|atients,|
|00001700| 20 5b 33 5d 20 62 75 74 | 20 69 6e 20 63 6f 6d 62 | [3] but| in comb|
|00001710| 69 6e 61 74 69 6f 6e 20 | 77 69 74 68 20 6d 65 74 |ination |with met|
|00001720| 68 69 6d 61 7a 6f 6c 65 | 0d 0a 73 6f 64 69 75 6d |himazole|..sodium|
|00001730| 20 69 70 6f 64 61 74 65 | 20 63 61 75 73 65 73 20 | ipodate| causes |
|00001740| 61 20 72 61 70 69 64 20 | 64 65 63 72 65 61 73 65 |a rapid |decrease|
|00001750| 20 69 6e 20 73 65 72 75 | 6d 20 54 33 20 6c 65 76 | in seru|m T3 lev|
|00001760| 65 6c 73 2e 20 5b 34 5d | 20 20 54 68 65 20 61 67 |els. [4]| The ag|
|00001770| 65 6e 74 73 20 74 68 75 | 73 0d 0a 6d 61 79 20 68 |ents thu|s..may h|
|00001780| 61 76 65 20 61 20 72 6f | 6c 65 20 74 6f 20 70 6c |ave a ro|le to pl|
|00001790| 61 79 20 69 6e 20 74 68 | 65 20 61 63 75 74 65 20 |ay in th|e acute |
|000017a0| 6d 61 6e 61 67 65 6d 65 | 6e 74 20 6f 66 20 73 65 |manageme|nt of se|
|000017b0| 76 65 72 65 20 74 68 79 | 72 6f 74 6f 78 69 63 6f |vere thy|rotoxico|
|000017c0| 73 69 73 2c 20 73 75 63 | 68 0d 0a 61 73 20 69 6e |sis, suc|h..as in|
|000017d0| 20 74 68 79 72 6f 69 64 | 20 73 74 6f 72 6d 2e 2d | thyroid| storm.-|
|000017e0| 2d 4a 2e 44 2e 20 57 69 | 6c 73 6f 6e 2c 20 4d 2e |-J.D. Wi|lson, M.|
|000017f0| 44 2e 0d 0a 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |D...$Uni|que_ID{Y|
|00001800| 52 42 30 36 39 30 31 7d | 0d 0a 24 54 69 74 6c 65 |RB06901}|..$Title|
|00001810| 7b 54 68 79 72 6f 69 64 | 20 44 79 73 66 75 6e 63 |{Thyroid| Dysfunc|
|00001820| 74 69 6f 6e 20 41 66 74 | 65 72 20 44 65 6c 69 76 |tion Aft|er Deliv|
|00001830| 65 72 79 3a 20 20 49 6e | 63 69 64 65 6e 63 65 20 |ery: In|cidence |
|00001840| 61 6e 64 20 43 6c 69 6e | 69 63 61 6c 20 43 6f 75 |and Clin|ical Cou|
|00001850| 72 73 65 7d 0d 0a 24 41 | 75 74 68 6f 72 7b 4c 65 |rse}..$A|uthor{Le|
|00001860| 72 76 61 6e 67 2c 20 48 | 2d 48 0d 0a 50 72 79 64 |rvang, H|-H..Pryd|
|00001870| 73 2c 20 4f 0d 0a 4f 73 | 74 65 72 67 61 61 72 64 |s, O..Os|tergaard|
|00001880| 20 4b 72 69 73 74 65 6e | 73 65 6e 20 48 50 7d 0d | Kristen|sen HP}.|
|00001890| 0a 24 41 66 66 69 6c 69 | 61 74 69 6f 6e 7b 43 65 |.$Affili|ation{Ce|
|000018a0| 6e 74 72 61 6c 20 48 6f | 73 70 20 6f 66 20 53 6c |ntral Ho|sp of Sl|
|000018b0| 61 67 65 6c 73 65 2c 20 | 44 65 6e 6d 61 72 6b 3b |agelse, |Denmark;|
|000018c0| 20 43 65 6e 74 72 61 6c | 20 48 6f 73 70 20 6f 66 | Central| Hosp of|
|000018d0| 20 4e 61 65 73 74 76 65 | 64 2c 20 4e 61 65 73 74 | Naestve|d, Naest|
|000018e0| 76 65 64 2c 20 44 65 6e | 6d 61 72 6b 7d 0d 0a 24 |ved, Den|mark}..$|
|000018f0| 53 75 62 6a 65 63 74 7b | 54 68 79 72 6f 69 64 20 |Subject{|Thyroid |
|00001900| 64 79 73 66 75 6e 63 74 | 69 6f 6e 20 61 66 74 65 |dysfunct|ion afte|
|00001910| 72 20 64 65 6c 69 76 65 | 72 79 3b 20 44 65 6c 69 |r delive|ry; Deli|
|00001920| 76 65 72 79 20 74 68 79 | 72 6f 69 64 20 64 79 73 |very thy|roid dys|
|00001930| 66 75 6e 63 74 69 6f 6e | 20 61 66 74 65 72 7d 0d |function| after}.|
|00001940| 0a 24 4a 6f 75 72 6e 61 | 6c 7b 41 63 74 61 20 4d |.$Journa|l{Acta M|
|00001950| 65 64 20 53 63 61 6e 64 | 7d 0d 0a 24 56 6f 6c 75 |ed Scand|}..$Volu|
|00001960| 6d 65 7b 32 32 32 7d 0d | 0a 24 50 61 67 65 7b 33 |me{222}.|.$Page{3|
|00001970| 36 39 2d 33 37 34 7d 0d | 0a 24 44 61 74 65 7b 31 |69-374}.|.$Date{1|
|00001980| 39 38 37 7d 0d 0a 24 59 | 42 56 6f 6c 7b 31 39 38 |987}..$Y|BVol{198|
|00001990| 39 20 59 65 61 72 20 42 | 6f 6f 6b 20 6f 66 20 4d |9 Year B|ook of M|
|000019a0| 65 64 69 63 69 6e 65 2c | 20 50 61 72 74 20 53 69 |edicine,| Part Si|
|000019b0| 78 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 34 35 2d |x}..$Cha|pter{45-|
|000019c0| 33 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |3}..$YBE|ditor{Dr|
|000019d0| 73 2e 20 52 6f 67 65 72 | 73 2c 20 44 65 73 20 50 |s. Roger|s, Des P|
|000019e0| 72 65 7a 2c 20 43 6c 69 | 6e 65 2c 20 42 72 61 75 |rez, Cli|ne, Brau|
|000019f0| 6e 77 61 6c 64 2c 20 47 | 72 65 65 6e 62 65 72 67 |nwald, G|reenberg|
|00001a00| 65 72 2c 20 57 69 6c 73 | 6f 6e 2c 20 45 70 73 74 |er, Wils|on, Epst|
|00001a10| 65 69 6e 2c 20 61 6e 64 | 20 4d 61 6c 61 77 69 73 |ein, and| Malawis|
|00001a20| 74 61 7d 0d 0a 24 54 61 | 62 6c 65 7b 7d 0d 0a 24 |ta}..$Ta|ble{}..$|
|00001a30| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 4a 2e 44 2e |Commenta|tor{J.D.|
|00001a40| 20 57 69 6c 73 6f 6e 2c | 20 4d 2e 44 2e 7d 0d 0a | Wilson,| M.D.}..|
|00001a50| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 63 29 20 |..Copyri|ght (c) |
|00001a60| 59 65 61 72 20 42 6f 6f | 6b 20 4d 65 64 69 63 61 |Year Boo|k Medica|
|00001a70| 6c 20 50 75 62 6c 69 73 | 68 65 72 73 2c 20 49 6e |l Publis|hers, In|
|00001a80| 63 2e 2c 20 31 39 38 39 | 0d 0a 0d 0a 31 39 38 39 |c., 1989|....1989|
|00001a90| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 4d 65 | Year Bo|ok of Me|
|00001aa0| 64 69 63 69 6e 65 20 28 | 52 29 0d 0a 0d 0a 50 61 |dicine (|R)....Pa|
|00001ab0| 72 74 20 53 69 78 3a 20 | 20 45 6e 64 6f 63 72 69 |rt Six: | Endocri|
|00001ac0| 6e 6f 6c 6f 67 79 20 61 | 6e 64 20 4d 65 74 61 62 |nology a|nd Metab|
|00001ad0| 6f 6c 69 73 6d 0d 0a 0d | 0a 43 68 61 70 74 65 72 |olism...|.Chapter|
|00001ae0| 20 34 35 2d 2d 54 68 65 | 20 54 68 79 72 6f 69 64 | 45--The| Thyroid|
|00001af0| 0d 0a 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |....----|--------|
|00001b00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b40| 2d 2d 2d 2d 0d 0a 54 68 | 79 72 6f 69 64 20 44 79 |----..Th|yroid Dy|
|00001b50| 73 66 75 6e 63 74 69 6f | 6e 20 41 66 74 65 72 20 |sfunctio|n After |
|00001b60| 44 65 6c 69 76 65 72 79 | 3a 20 20 49 6e 63 69 64 |Delivery|: Incid|
|00001b70| 65 6e 63 65 20 61 6e 64 | 20 43 6c 69 6e 69 63 61 |ence and| Clinica|
|00001b80| 6c 20 43 6f 75 72 73 65 | 0d 0a 0d 0a 4c 65 72 76 |l Course|....Lerv|
|00001b90| 61 6e 67 20 48 2d 48 2c | 20 50 72 79 64 73 20 4f |ang H-H,| Pryds O|
|00001ba0| 2c 20 4f 73 74 65 72 67 | 61 61 72 64 20 4b 72 69 |, Osterg|aard Kri|
|00001bb0| 73 74 65 6e 73 65 6e 20 | 48 50 0d 0a 28 43 65 6e |stensen |HP..(Cen|
|00001bc0| 74 72 61 6c 20 48 6f 73 | 70 20 6f 66 20 53 6c 61 |tral Hos|p of Sla|
|00001bd0| 67 65 6c 73 65 2c 20 44 | 65 6e 6d 61 72 6b 3b 20 |gelse, D|enmark; |
|00001be0| 43 65 6e 74 72 61 6c 20 | 48 6f 73 70 20 6f 66 20 |Central |Hosp of |
|00001bf0| 4e 61 65 73 74 76 65 64 | 2c 20 4e 61 65 73 74 76 |Naestved|, Naestv|
|00001c00| 65 64 2c 0d 0a 44 65 6e | 6d 61 72 6b 29 0d 0a 41 |ed,..Den|mark)..A|
|00001c10| 63 74 61 20 4d 65 64 20 | 53 63 61 6e 64 20 32 32 |cta Med |Scand 22|
|00001c20| 32 3a 33 36 39 2d 33 37 | 34 2c 20 31 39 38 37 0d |2:369-37|4, 1987.|
|00001c30| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00001c40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001c50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001c60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001c70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001c80| 2d 0d 0a 0d 0a 50 72 65 | 2d 43 6f 6d 6d 65 6e 74 |-....Pre|-Comment|
|00001c90| 0d 0a 0d 0a 20 20 20 20 | 20 50 6f 73 74 70 61 72 |.... | Postpar|
|00001ca0| 74 75 6d 20 70 61 69 6e | 6c 65 73 73 20 74 68 79 |tum pain|less thy|
|00001cb0| 72 6f 69 64 69 74 69 73 | 20 77 69 74 68 20 74 72 |roiditis| with tr|
|00001cc0| 61 6e 73 69 65 6e 74 20 | 68 79 70 65 72 74 68 79 |ansient |hyperthy|
|00001cd0| 72 6f 69 64 69 73 6d 20 | 72 65 73 65 6d 62 6c 65 |roidism |resemble|
|00001ce0| 73 0d 0a 61 6e 64 20 6d | 61 79 20 73 68 61 72 65 |s..and m|ay share|
|00001cf0| 20 61 20 63 6f 6d 6d 6f | 6e 20 65 74 69 6f 6c 6f | a commo|n etiolo|
|00001d00| 67 79 20 77 69 74 68 20 | 6f 74 68 65 72 20 74 79 |gy with |other ty|
|00001d10| 70 65 73 20 6f 66 20 70 | 61 69 6e 6c 65 73 73 20 |pes of p|ainless |
|00001d20| 74 68 79 72 6f 69 64 69 | 74 69 73 20 28 73 65 65 |thyroidi|tis (see|
|00001d30| 0d 0a 74 68 65 20 31 39 | 38 36 20 59 45 41 52 20 |..the 19|86 YEAR |
|00001d40| 42 4f 4f 4b 20 4f 46 20 | 4d 45 44 49 43 49 4e 45 |BOOK OF |MEDICINE|
|00001d50| 29 2e 20 20 49 74 20 69 | 73 20 6e 6f 77 20 63 6c |). It i|s now cl|
|00001d60| 65 61 72 20 74 68 61 74 | 20 70 6f 73 74 70 61 72 |ear that| postpar|
|00001d70| 74 75 6d 20 74 68 79 72 | 6f 69 64 0d 0a 64 79 73 |tum thyr|oid..dys|
|00001d80| 66 75 6e 63 74 69 6f 6e | 20 63 61 6e 20 73 70 61 |function| can spa|
|00001d90| 6e 20 61 20 62 72 6f 61 | 64 20 73 70 65 63 74 72 |n a broa|d spectr|
|00001da0| 75 6d 20 6f 66 20 66 75 | 6e 63 74 69 6f 6e 61 6c |um of fu|nctional|
|00001db0| 20 61 6e 64 20 61 6e 61 | 74 6f 6d 69 63 61 6c 0d | and ana|tomical.|
|00001dc0| 0a 61 62 6e 6f 72 6d 61 | 6c 69 74 69 65 73 2e 0d |.abnorma|lities..|
|00001dd0| 0a 0d 0a 41 62 73 74 72 | 61 63 74 0d 0a 0d 0a 20 |...Abstr|act.... |
|00001de0| 20 20 20 20 54 68 65 20 | 69 6e 63 69 64 65 6e 63 | The |incidenc|
|00001df0| 65 20 6f 66 20 70 6f 73 | 74 70 61 72 74 75 6d 20 |e of pos|tpartum |
|00001e00| 74 68 79 72 6f 69 64 20 | 64 79 73 66 75 6e 63 74 |thyroid |dysfunct|
|00001e10| 69 6f 6e 20 77 61 73 20 | 65 73 74 69 6d 61 74 65 |ion was |estimate|
|00001e20| 64 20 69 6e 20 61 0d 0a | 70 72 6f 73 70 65 63 74 |d in a..|prospect|
|00001e30| 69 76 65 20 73 65 72 69 | 65 73 20 6f 66 20 35 39 |ive seri|es of 59|
|00001e40| 31 20 44 61 6e 69 73 68 | 20 77 6f 6d 65 6e 20 77 |1 Danish| women w|
|00001e50| 68 6f 20 64 65 6c 69 76 | 65 72 65 64 20 69 6e 66 |ho deliv|ered inf|
|00001e60| 61 6e 74 73 20 69 6e 20 | 61 20 36 2d 6d 6f 6e 74 |ants in |a 6-mont|
|00001e70| 68 0d 0a 70 65 72 69 6f | 64 2e 20 20 53 65 76 65 |h..perio|d. Seve|
|00001e80| 6e 20 77 6f 6d 65 6e 20 | 77 65 72 65 20 68 79 70 |n women |were hyp|
|00001e90| 6f 74 68 79 72 6f 69 64 | 20 61 6e 64 20 31 36 20 |othyroid| and 16 |
|00001ea0| 77 65 72 65 20 74 68 79 | 72 6f 74 6f 78 69 63 20 |were thy|rotoxic |
|00001eb0| 61 66 74 65 72 20 64 65 | 6c 69 76 65 72 79 2e 0d |after de|livery..|
|00001ec0| 0a 54 68 65 20 6f 76 65 | 72 61 6c 6c 20 69 6e 63 |.The ove|rall inc|
|00001ed0| 69 64 65 6e 63 65 20 6f | 66 20 70 6f 73 74 70 61 |idence o|f postpa|
|00001ee0| 72 74 75 6d 20 64 79 73 | 66 75 6e 63 74 69 6f 6e |rtum dys|function|
|00001ef0| 20 77 61 73 20 33 2e 39 | 25 2e 20 20 44 79 73 66 | was 3.9|%. Dysf|
|00001f00| 75 6e 63 74 69 6f 6e 20 | 75 73 75 61 6c 6c 79 0d |unction |usually.|
|00001f10| 0a 77 61 73 20 74 72 61 | 6e 73 69 65 6e 74 20 62 |.was tra|nsient b|
|00001f20| 75 74 20 70 65 72 73 69 | 73 74 65 64 20 69 6e 20 |ut persi|sted in |
|00001f30| 33 20 77 6f 6d 65 6e 2e | 20 20 50 6f 73 69 74 69 |3 women.| Positi|
|00001f40| 76 65 20 74 69 74 65 72 | 73 20 6f 66 20 74 68 79 |ve titer|s of thy|
|00001f50| 72 6f 69 64 20 6d 69 63 | 72 6f 73 6f 6d 61 6c 0d |roid mic|rosomal.|
|00001f60| 0a 61 6e 74 69 62 6f 64 | 79 20 77 65 72 65 20 66 |.antibod|y were f|
|00001f70| 6f 75 6e 64 20 69 6e 20 | 36 2e 34 25 20 6f 66 20 |ound in |6.4% of |
|00001f80| 74 68 65 20 67 72 6f 75 | 70 20 33 20 6d 6f 6e 74 |the grou|p 3 mont|
|00001f90| 68 73 20 61 66 74 65 72 | 20 64 65 6c 69 76 65 72 |hs after| deliver|
|00001fa0| 79 2e 20 20 54 68 65 79 | 20 77 65 72 65 0d 0a 6d |y. They| were..m|
|00001fb0| 6f 72 65 20 66 72 65 71 | 75 65 6e 74 20 69 6e 20 |ore freq|uent in |
|00001fc0| 77 6f 6d 65 6e 20 77 69 | 74 68 20 74 68 79 72 6f |women wi|th thyro|
|00001fd0| 69 64 20 64 79 73 66 75 | 6e 63 74 69 6f 6e 2e 20 |id dysfu|nction. |
|00001fe0| 20 50 65 61 6b 20 74 69 | 74 65 72 73 2c 20 70 72 | Peak ti|ters, pr|
|00001ff0| 65 73 65 6e 74 20 35 2d | 36 0d 0a 6d 6f 6e 74 68 |esent 5-|6..month|
|00002000| 73 20 61 66 74 65 72 20 | 64 65 6c 69 76 65 72 79 |s after |delivery|
|00002010| 2c 20 77 65 72 65 20 61 | 73 73 6f 63 69 61 74 65 |, were a|ssociate|
|00002020| 64 20 77 69 74 68 20 68 | 79 70 6f 74 68 79 72 6f |d with h|ypothyro|
|00002030| 69 64 69 73 6d 2e 20 20 | 41 20 68 69 73 74 6f 72 |idism. |A histor|
|00002040| 79 20 6f 66 20 6b 6e 6f | 77 6e 0d 0a 6f 72 20 73 |y of kno|wn..or s|
|00002050| 75 73 70 65 63 74 65 64 | 20 61 75 74 6f 69 6d 6d |uspected| autoimm|
|00002060| 75 6e 65 20 74 68 79 72 | 6f 69 64 20 64 69 73 65 |une thyr|oid dise|
|00002070| 61 73 65 20 77 61 73 20 | 65 6c 69 63 69 74 65 64 |ase was |elicited|
|00002080| 20 66 72 6f 6d 20 33 30 | 25 20 6f 66 20 74 68 65 | from 30|% of the|
|00002090| 20 77 6f 6d 65 6e 20 77 | 69 74 68 0d 0a 70 6f 73 | women w|ith..pos|
|000020a0| 74 70 61 72 74 75 6d 20 | 74 68 79 72 6f 69 64 20 |tpartum |thyroid |
|000020b0| 64 79 73 66 75 6e 63 74 | 69 6f 6e 20 61 6e 64 20 |dysfunct|ion and |
|000020c0| 35 25 20 6f 66 20 74 68 | 65 20 6f 74 68 65 72 20 |5% of th|e other |
|000020d0| 77 6f 6d 65 6e 2e 0d 0a | 20 20 20 20 20 46 6f 75 |women...| Fou|
|000020e0| 72 20 70 65 72 63 65 6e | 74 20 6f 66 20 74 68 65 |r percen|t of the|
|000020f0| 20 77 6f 6d 65 6e 20 69 | 6e 20 74 68 69 73 20 70 | women i|n this p|
|00002100| 72 6f 73 70 65 63 74 69 | 76 65 20 73 65 72 69 65 |rospecti|ve serie|
|00002110| 73 20 68 61 64 20 70 6f | 73 74 70 61 72 74 75 6d |s had po|stpartum|
|00002120| 20 74 68 79 72 6f 69 64 | 0d 0a 64 79 73 66 75 6e | thyroid|..dysfun|
|00002130| 63 74 69 6f 6e 2c 20 77 | 68 69 63 68 20 75 73 75 |ction, w|hich usu|
|00002140| 61 6c 6c 79 20 72 65 73 | 6f 6c 76 65 64 20 77 69 |ally res|olved wi|
|00002150| 74 68 69 6e 20 31 20 79 | 65 61 72 2e 20 20 44 79 |thin 1 y|ear. Dy|
|00002160| 73 66 75 6e 63 74 69 6f | 6e 20 77 61 73 20 61 73 |sfunctio|n was as|
|00002170| 73 6f 63 69 61 74 65 64 | 0d 0a 77 69 74 68 20 70 |sociated|..with p|
|00002180| 6f 73 69 74 69 76 65 20 | 74 68 79 72 6f 69 64 20 |ositive |thyroid |
|00002190| 6d 69 63 72 6f 73 6f 6d | 61 6c 20 61 6e 74 69 62 |microsom|al antib|
|000021a0| 6f 64 79 20 74 69 74 65 | 72 73 2e 20 20 44 69 73 |ody tite|rs. Dis|
|000021b0| 6f 72 64 65 72 65 64 20 | 61 75 74 6f 69 6d 6d 75 |ordered |autoimmu|
|000021c0| 6e 69 74 79 20 6d 61 79 | 0d 0a 75 6e 64 65 72 6c |nity may|..underl|
|000021d0| 69 65 20 70 6f 73 74 70 | 61 72 74 75 6d 20 74 68 |ie postp|artum th|
|000021e0| 79 72 6f 69 64 20 64 79 | 73 66 75 6e 63 74 69 6f |yroid dy|sfunctio|
|000021f0| 6e 2e 0d 0a 0d 0a 50 6f | 73 74 2d 43 6f 6d 6d 65 |n.....Po|st-Comme|
|00002200| 6e 74 0d 0a 0d 0a 20 20 | 20 20 20 41 6e 20 65 76 |nt.... | An ev|
|00002210| 65 6e 20 68 69 67 68 65 | 72 20 69 6e 63 69 64 65 |en highe|r incide|
|00002220| 6e 63 65 20 6f 66 20 70 | 6f 73 74 70 61 72 74 75 |nce of p|ostpartu|
|00002230| 6d 20 74 68 79 72 6f 69 | 64 20 64 79 73 66 75 6e |m thyroi|d dysfun|
|00002240| 63 74 69 6f 6e 20 68 61 | 73 20 62 65 65 6e 0d 0a |ction ha|s been..|
|00002250| 72 65 70 6f 72 74 65 64 | 20 69 6e 20 57 61 6c 65 |reported| in Wale|
|00002260| 73 2e 20 5b 31 5d 20 20 | 49 6e 20 62 6f 74 68 20 |s. [1] |In both |
|00002270| 73 65 72 69 65 73 20 74 | 72 61 6e 73 69 65 6e 74 |series t|ransient|
|00002280| 20 68 79 70 65 72 74 68 | 79 72 6f 69 64 69 73 6d | hyperth|yroidism|
|00002290| 20 77 61 73 20 6d 6f 72 | 65 0d 0a 66 72 65 71 75 | was mor|e..frequ|
|000022a0| 65 6e 74 20 74 68 61 6e | 20 74 72 61 6e 73 69 65 |ent than| transie|
|000022b0| 6e 74 20 68 79 70 6f 74 | 68 79 72 6f 69 64 69 73 |nt hypot|hyroidis|
|000022c0| 6d 2c 20 61 6e 64 20 70 | 65 72 6d 61 6e 65 6e 74 |m, and p|ermanent|
|000022d0| 20 74 68 79 72 6f 69 64 | 20 64 79 73 66 75 6e 63 | thyroid| dysfunc|
|000022e0| 74 69 6f 6e 20 77 61 73 | 0d 0a 74 68 65 20 65 78 |tion was|..the ex|
|000022f0| 63 65 70 74 69 6f 6e 2e | 20 20 41 77 61 72 65 6e |ception.| Awaren|
|00002300| 65 73 73 20 6f 66 20 74 | 68 65 20 63 6f 75 72 73 |ess of t|he cours|
|00002310| 65 20 6f 66 20 74 68 69 | 73 20 64 79 73 66 75 6e |e of thi|s dysfun|
|00002320| 63 74 69 6f 6e 20 69 73 | 20 6f 66 20 69 6d 70 6f |ction is| of impo|
|00002330| 72 74 61 6e 63 65 20 74 | 6f 0d 0a 70 72 65 63 6c |rtance t|o..precl|
|00002340| 75 64 65 20 69 6e 61 70 | 70 72 6f 70 72 69 61 74 |ude inap|propriat|
|00002350| 65 20 70 65 72 6d 61 6e | 65 6e 74 20 74 68 65 72 |e perman|ent ther|
|00002360| 61 70 79 20 66 6f 72 20 | 73 65 6c 66 2d 6c 69 6d |apy for |self-lim|
|00002370| 69 74 65 64 20 64 69 73 | 6f 72 64 65 72 73 2e 2d |ited dis|orders.-|
|00002380| 2d 4a 2e 44 2e 0d 0a 57 | 69 6c 73 6f 6e 2c 20 4d |-J.D...W|ilson, M|
|00002390| 2e 44 2e 0d 0a 24 55 6e | 69 71 75 65 5f 49 44 7b |.D...$Un|ique_ID{|
|000023a0| 59 52 42 30 36 39 30 32 | 7d 0d 0a 24 54 69 74 6c |YRB06902|}..$Titl|
|000023b0| 65 7b 41 20 44 6f 75 62 | 6c 65 2d 42 6c 69 6e 64 |e{A Doub|le-Blind|
|000023c0| 20 43 72 6f 73 73 6f 76 | 65 72 20 31 32 2d 4d 6f | Crossov|er 12-Mo|
|000023d0| 6e 74 68 20 53 74 75 64 | 79 20 6f 66 20 4c 2d 54 |nth Stud|y of L-T|
|000023e0| 68 79 72 6f 78 69 6e 65 | 20 54 72 65 61 74 6d 65 |hyroxine| Treatme|
|000023f0| 6e 74 20 6f 66 20 57 6f | 6d 65 6e 20 77 69 74 68 |nt of Wo|men with|
|00002400| 20 53 75 62 63 6c 69 6e | 69 63 61 6c 27 20 48 79 | Subclin|ical' Hy|
|00002410| 70 6f 74 68 79 72 6f 69 | 64 69 73 6d 7d 0d 0a 24 |pothyroi|dism}..$|
|00002420| 41 75 74 68 6f 72 7b 4e | 79 73 74 72 6f 6d 2c 20 |Author{N|ystrom, |
|00002430| 45 0d 0a 43 61 69 64 61 | 68 6c 2c 20 4b 0d 0a 46 |E..Caida|hl, K..F|
|00002440| 61 67 65 72 2c 20 47 0d | 0a 57 69 6b 6b 65 6c 73 |ager, G.|.Wikkels|
|00002450| 6f 2c 20 43 0d 0a 4c 75 | 6e 64 62 65 72 67 2c 20 |o, C..Lu|ndberg, |
|00002460| 50 2d 41 0d 0a 4c 69 6e | 64 73 74 65 64 74 2c 20 |P-A..Lin|dstedt, |
|00002470| 47 7d 0d 0a 24 41 66 66 | 69 6c 69 61 74 69 6f 6e |G}..$Aff|iliation|
|00002480| 7b 47 6f 74 68 65 6e 62 | 75 72 67 20 55 6e 69 76 |{Gothenb|urg Univ|
|00002490| 2c 20 47 6f 74 65 62 6f | 72 67 2c 20 53 77 65 64 |, Gotebo|rg, Swed|
|000024a0| 65 6e 7d 0d 0a 24 53 75 | 62 6a 65 63 74 7b 4c 2d |en}..$Su|bject{L-|
|000024b0| 54 68 79 72 6f 78 69 6e | 65 20 69 6e 20 68 79 70 |Thyroxin|e in hyp|
|000024c0| 6f 74 68 79 72 6f 69 64 | 69 73 6d 2c 20 22 73 75 |othyroid|ism, "su|
|000024d0| 62 63 6c 69 6e 69 63 61 | 6c 2c 22 20 69 6e 20 77 |bclinica|l," in w|
|000024e0| 6f 6d 65 6e 3b 20 48 79 | 70 6f 74 68 79 72 6f 69 |omen; Hy|pothyroi|
|000024f0| 64 69 73 6d 0d 0a 22 73 | 75 62 63 6c 69 6e 69 63 |dism.."s|ubclinic|
|00002500| 61 6c 2c 22 20 69 6e 20 | 77 6f 6d 65 6e 2c 20 4c |al," in |women, L|
|00002510| 2d 74 68 79 72 6f 78 69 | 6e 65 20 69 6e 7d 0d 0a |-thyroxi|ne in}..|
|00002520| 24 4a 6f 75 72 6e 61 6c | 7b 43 6c 69 6e 20 45 6e |$Journal|{Clin En|
|00002530| 64 6f 63 72 69 6e 6f 6c | 20 28 4f 78 66 29 7d 0d |docrinol| (Oxf)}.|
|00002540| 0a 24 56 6f 6c 75 6d 65 | 7b 32 39 7d 0d 0a 24 50 |.$Volume|{29}..$P|
|00002550| 61 67 65 7b 36 33 2d 37 | 35 7d 0d 0a 24 44 61 74 |age{63-7|5}..$Dat|
|00002560| 65 7b 31 39 38 38 7d 0d | 0a 24 59 42 56 6f 6c 7b |e{1988}.|.$YBVol{|
|00002570| 31 39 38 39 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1989 Yea|r Book o|
|00002580| 66 20 4d 65 64 69 63 69 | 6e 65 2c 20 50 61 72 74 |f Medici|ne, Part|
|00002590| 20 53 69 78 7d 0d 0a 24 | 43 68 61 70 74 65 72 7b | Six}..$|Chapter{|
|000025a0| 34 35 2d 34 7d 0d 0a 24 | 59 42 45 64 69 74 6f 72 |45-4}..$|YBEditor|
|000025b0| 7b 44 72 73 2e 20 52 6f | 67 65 72 73 2c 20 44 65 |{Drs. Ro|gers, De|
|000025c0| 73 20 50 72 65 7a 2c 20 | 43 6c 69 6e 65 2c 20 42 |s Prez, |Cline, B|
|000025d0| 72 61 75 6e 77 61 6c 64 | 2c 20 47 72 65 65 6e 62 |raunwald|, Greenb|
|000025e0| 65 72 67 65 72 2c 20 57 | 69 6c 73 6f 6e 2c 20 45 |erger, W|ilson, E|
|000025f0| 70 73 74 65 69 6e 2c 20 | 61 6e 64 20 4d 61 6c 61 |pstein, |and Mala|
|00002600| 77 69 73 74 61 7d 0d 0a | 24 54 61 62 6c 65 7b 7d |wista}..|$Table{}|
|00002610| 0d 0a 24 43 6f 6d 6d 65 | 6e 74 61 74 6f 72 7b 4a |..$Comme|ntator{J|
|00002620| 2e 44 2e 20 57 69 6c 73 | 6f 6e 2c 20 4d 2e 44 2e |.D. Wils|on, M.D.|
|00002630| 7d 0d 0a 0d 0a 43 6f 70 | 79 72 69 67 68 74 20 28 |}....Cop|yright (|
|00002640| 63 29 20 59 65 61 72 20 | 42 6f 6f 6b 20 4d 65 64 |c) Year |Book Med|
|00002650| 69 63 61 6c 20 50 75 62 | 6c 69 73 68 65 72 73 2c |ical Pub|lishers,|
|00002660| 20 49 6e 63 2e 2c 20 31 | 39 38 39 0d 0a 0d 0a 31 | Inc., 1|989....1|
|00002670| 39 38 39 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |989 Year| Book of|
|00002680| 20 4d 65 64 69 63 69 6e | 65 20 28 52 29 0d 0a 0d | Medicin|e (R)...|
|00002690| 0a 50 61 72 74 20 53 69 | 78 3a 20 20 45 6e 64 6f |.Part Si|x: Endo|
|000026a0| 63 72 69 6e 6f 6c 6f 67 | 79 20 61 6e 64 20 4d 65 |crinolog|y and Me|
|000026b0| 74 61 62 6f 6c 69 73 6d | 0d 0a 0d 0a 43 68 61 70 |tabolism|....Chap|
|000026c0| 74 65 72 20 34 35 2d 2d | 54 68 65 20 54 68 79 72 |ter 45--|The Thyr|
|000026d0| 6f 69 64 0d 0a 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d |oid....-|--------|
|000026e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000026f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002700| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002710| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002720| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 41 20 44 6f 75 62 6c |-------.|.A Doubl|
|00002730| 65 2d 42 6c 69 6e 64 20 | 43 72 6f 73 73 6f 76 65 |e-Blind |Crossove|
|00002740| 72 20 31 32 2d 4d 6f 6e | 74 68 20 53 74 75 64 79 |r 12-Mon|th Study|
|00002750| 20 6f 66 20 4c 2d 54 68 | 79 72 6f 78 69 6e 65 20 | of L-Th|yroxine |
|00002760| 54 72 65 61 74 6d 65 6e | 74 20 6f 66 20 57 6f 6d |Treatmen|t of Wom|
|00002770| 65 6e 20 77 69 74 68 0d | 0a 27 53 75 62 63 6c 69 |en with.|.'Subcli|
|00002780| 6e 69 63 61 6c 27 20 48 | 79 70 6f 74 68 79 72 6f |nical' H|ypothyro|
|00002790| 69 64 69 73 6d 0d 0a 0d | 0a 4e 79 73 74 72 6f 6d |idism...|.Nystrom|
|000027a0| 20 45 2c 20 43 61 69 64 | 61 68 6c 20 4b 2c 20 46 | E, Caid|ahl K, F|
|000027b0| 61 67 65 72 20 47 2c 20 | 57 69 6b 6b 65 6c 73 6f |ager G, |Wikkelso|
|000027c0| 20 43 2c 20 4c 75 6e 64 | 62 65 72 67 20 50 2d 41 | C, Lund|berg P-A|
|000027d0| 2c 20 4c 69 6e 64 73 74 | 65 64 74 20 47 0d 0a 28 |, Lindst|edt G..(|
|000027e0| 47 6f 74 68 65 6e 62 75 | 72 67 20 55 6e 69 76 2c |Gothenbu|rg Univ,|
|000027f0| 20 47 6f 74 65 62 6f 72 | 67 2c 20 53 77 65 64 65 | Gotebor|g, Swede|
|00002800| 6e 29 0d 0a 43 6c 69 6e | 20 45 6e 64 6f 63 72 69 |n)..Clin| Endocri|
|00002810| 6e 6f 6c 20 28 4f 78 66 | 29 20 32 39 3a 36 33 2d |nol (Oxf|) 29:63-|
|00002820| 37 35 2c 20 31 39 38 38 | 0d 0a 2d 2d 2d 2d 2d 2d |75, 1988|..------|
|00002830| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 0d 0a 50 72 |--------|--....Pr|
|00002880| 65 2d 43 6f 6d 6d 65 6e | 74 0d 0a 0d 0a 20 20 20 |e-Commen|t.... |
|00002890| 20 20 53 75 62 63 6c 69 | 6e 69 63 61 6c 20 68 79 | Subcli|nical hy|
|000028a0| 70 6f 74 68 79 72 6f 69 | 64 69 73 6d 20 69 73 20 |pothyroi|dism is |
|000028b0| 61 6e 20 65 6e 74 69 74 | 79 20 69 6e 20 77 68 69 |an entit|y in whi|
|000028c0| 63 68 20 70 65 72 73 6f | 6e 73 20 77 69 74 68 20 |ch perso|ns with |
|000028d0| 6e 6f 72 6d 61 6c 0d 0a | 63 6f 6e 63 65 6e 74 72 |normal..|concentr|
|000028e0| 61 74 69 6f 6e 73 20 6f | 66 20 74 68 79 72 6f 69 |ations o|f thyroi|
|000028f0| 64 20 68 6f 72 6d 6f 6e | 65 20 68 61 76 65 20 65 |d hormon|e have e|
|00002900| 6c 65 76 61 74 65 64 20 | 74 68 79 72 6f 74 72 6f |levated |thyrotro|
|00002910| 70 69 6e 20 6c 65 76 65 | 6c 73 2e 20 20 49 6e 20 |pin leve|ls. In |
|00002920| 6f 74 68 65 72 0d 0a 77 | 6f 72 64 73 2c 20 6e 6f |other..w|ords, no|
|00002930| 72 6d 61 6c 20 74 68 79 | 72 6f 69 64 20 68 6f 72 |rmal thy|roid hor|
|00002940| 6d 6f 6e 65 20 6c 65 76 | 65 6c 73 20 61 72 65 20 |mone lev|els are |
|00002950| 61 63 68 69 65 76 65 64 | 20 61 74 20 74 68 65 20 |achieved| at the |
|00002960| 65 78 70 65 6e 73 65 20 | 6f 66 20 65 6c 65 76 61 |expense |of eleva|
|00002970| 74 65 64 0d 0a 74 68 79 | 72 6f 74 72 6f 70 69 6e |ted..thy|rotropin|
|00002980| 20 73 65 63 72 65 74 69 | 6f 6e 2e 20 20 54 68 65 | secreti|on. The|
|00002990| 20 71 75 65 73 74 69 6f | 6e 20 6f 66 20 77 68 65 | questio|n of whe|
|000029a0| 74 68 65 72 20 74 6f 20 | 74 72 65 61 74 20 74 68 |ther to |treat th|
|000029b0| 69 73 20 65 6e 74 69 74 | 79 20 69 73 20 61 0d 0a |is entit|y is a..|
|000029c0| 63 68 61 6c 6c 65 6e 67 | 69 6e 67 20 6f 6e 65 2e |challeng|ing one.|
|000029d0| 0d 0a 0d 0a 41 62 73 74 | 72 61 63 74 0d 0a 0d 0a |....Abst|ract....|
|000029e0| 20 20 20 20 20 41 75 74 | 6f 69 6d 6d 75 6e 65 20 | Aut|oimmune |
|000029f0| 74 68 79 72 6f 69 64 20 | 64 69 73 65 61 73 65 20 |thyroid |disease |
|00002a00| 69 73 20 66 72 65 71 75 | 65 6e 74 20 69 6e 20 77 |is frequ|ent in w|
|00002a10| 6f 6d 65 6e 2c 20 65 73 | 70 65 63 69 61 6c 6c 79 |omen, es|pecially|
|00002a20| 20 61 66 74 65 72 20 74 | 68 65 0d 0a 6d 65 6e 6f | after t|he..meno|
|00002a30| 70 61 75 73 65 2e 20 20 | 41 20 64 6f 75 62 6c 65 |pause. |A double|
|00002a40| 2d 62 6c 69 6e 64 20 73 | 74 75 64 79 20 6f 66 20 |-blind s|tudy of |
|00002a50| 6c 65 76 6f 74 68 79 72 | 6f 78 69 6e 65 20 77 61 |levothyr|oxine wa|
|00002a60| 73 20 70 65 72 66 6f 72 | 6d 65 64 20 74 6f 20 64 |s perfor|med to d|
|00002a70| 65 74 65 72 6d 69 6e 65 | 0d 0a 77 68 65 74 68 65 |etermine|..whethe|
|00002a80| 72 20 65 61 72 6c 79 20 | 74 72 65 61 74 6d 65 6e |r early |treatmen|
|00002a90| 74 20 69 73 20 68 65 6c | 70 66 75 6c 20 74 6f 20 |t is hel|pful to |
|00002aa0| 77 6f 6d 65 6e 20 68 61 | 76 69 6e 67 20 73 6c 69 |women ha|ving sli|
|00002ab0| 67 68 74 6c 79 20 65 6c | 65 76 61 74 65 64 20 74 |ghtly el|evated t|
|00002ac0| 68 79 72 6f 74 72 6f 70 | 69 6e 0d 0a 6c 65 76 65 |hyrotrop|in..leve|
|00002ad0| 6c 73 2e 20 20 54 77 65 | 6e 74 79 20 77 6f 6d 65 |ls. Twe|nty wome|
|00002ae0| 6e 20 77 69 74 68 6f 75 | 74 20 63 6c 69 6e 69 63 |n withou|t clinic|
|00002af0| 61 6c 20 74 68 79 72 6f | 69 64 20 64 69 73 65 61 |al thyro|id disea|
|00002b00| 73 65 20 70 61 72 74 69 | 63 69 70 61 74 65 64 20 |se parti|cipated |
|00002b10| 69 6e 20 74 68 65 0d 0a | 73 74 75 64 79 2e 20 20 |in the..|study. |
|00002b20| 54 68 65 79 20 68 61 64 | 20 74 68 79 72 6f 69 64 |They had| thyroid|
|00002b30| 20 68 6f 72 6d 6f 6e 65 | 20 6c 65 76 65 6c 73 20 | hormone| levels |
|00002b40| 77 69 74 68 69 6e 20 6e | 6f 72 6d 61 6c 20 6c 69 |within n|ormal li|
|00002b50| 6d 69 74 73 20 62 75 74 | 20 61 6e 20 65 78 61 67 |mits but| an exag|
|00002b60| 67 65 72 61 74 65 64 0d | 0a 74 68 79 72 6f 74 72 |gerated.|.thyrotr|
|00002b70| 6f 70 69 6e 20 72 65 73 | 70 6f 6e 73 65 20 74 6f |opin res|ponse to|
|00002b80| 20 74 68 79 72 6f 6c 69 | 62 65 72 69 6e 2e 20 20 | thyroli|berin. |
|00002b90| 54 68 65 20 77 6f 6d 65 | 6e 20 72 65 63 65 69 76 |The wome|n receiv|
|00002ba0| 65 64 20 30 2e 31 20 6d | 67 20 6f 66 0d 0a 6c 65 |ed 0.1 m|g of..le|
|00002bb0| 76 6f 74 68 79 72 6f 78 | 69 6e 65 20 61 6e 64 20 |vothyrox|ine and |
|00002bc0| 70 6c 61 63 65 62 6f 20 | 66 6f 72 20 36 2d 6d 6f |placebo |for 6-mo|
|00002bd0| 6e 74 68 20 70 65 72 69 | 6f 64 73 20 69 6e 20 61 |nth peri|ods in a|
|00002be0| 20 63 72 6f 73 73 6f 76 | 65 72 20 64 65 73 69 67 | crossov|er desig|
|00002bf0| 6e 2e 0d 0a 20 20 20 20 | 20 53 65 72 75 6d 20 70 |n... | Serum p|
|00002c00| 72 6f 63 6f 6c 6c 61 67 | 65 6e 2d 49 49 49 2d 70 |rocollag|en-III-p|
|00002c10| 65 70 74 69 64 65 20 6c | 65 76 65 6c 73 20 69 6e |eptide l|evels in|
|00002c20| 63 72 65 61 73 65 64 20 | 69 6e 20 31 33 20 6f 66 |creased |in 13 of|
|00002c30| 20 31 37 20 77 6f 6d 65 | 6e 20 77 68 6f 0d 0a 63 | 17 wome|n who..c|
|00002c40| 6f 6d 70 6c 65 74 65 64 | 20 74 68 65 20 73 74 75 |ompleted| the stu|
|00002c50| 64 79 20 69 6e 20 61 73 | 73 6f 63 69 61 74 69 6f |dy in as|sociatio|
|00002c60| 6e 20 77 69 74 68 20 74 | 68 79 72 6f 78 69 6e 65 |n with t|hyroxine|
|00002c70| 20 74 72 65 61 74 6d 65 | 6e 74 2e 20 20 54 68 65 | treatme|nt. The|
|00002c80| 72 65 20 77 61 73 20 6c | 69 74 74 6c 65 0d 0a 6f |re was l|ittle..o|
|00002c90| 72 20 6e 6f 20 65 66 66 | 65 63 74 20 6f 6e 20 6c |r no eff|ect on l|
|00002ca0| 65 76 65 6c 73 20 6f 66 | 20 73 65 72 75 6d 20 63 |evels of| serum c|
|00002cb0| 72 65 61 74 69 6e 65 20 | 6b 69 6e 61 73 65 2c 20 |reatine |kinase, |
|00002cc0| 74 72 61 6e 73 63 6f 72 | 74 69 6e 2c 20 6f 72 20 |transcor|tin, or |
|00002cd0| 73 65 78 0d 0a 68 6f 72 | 6d 6f 6e 65 2d 62 69 6e |sex..hor|mone-bin|
|00002ce0| 64 69 6e 67 20 67 6c 6f | 62 75 6c 69 6e 2e 20 20 |ding glo|bulin. |
|00002cf0| 53 79 6d 70 74 6f 6d 20 | 73 63 6f 72 65 73 20 64 |Symptom |scores d|
|00002d00| 65 63 72 65 61 73 65 64 | 20 64 75 72 69 6e 67 20 |ecreased| during |
|00002d10| 74 72 65 61 74 6d 65 6e | 74 2e 20 20 46 6f 75 72 |treatmen|t. Four|
|00002d20| 0d 0a 77 6f 6d 65 6e 20 | 73 74 61 72 74 69 6e 67 |..women |starting|
|00002d30| 20 6c 65 76 6f 74 68 79 | 72 6f 78 69 6e 65 20 74 | levothy|roxine t|
|00002d40| 68 65 72 61 70 79 20 68 | 61 64 20 61 20 6d 61 72 |herapy h|ad a mar|
|00002d50| 6b 65 64 2c 20 70 72 6f | 6c 6f 6e 67 65 64 20 72 |ked, pro|longed r|
|00002d60| 69 73 65 20 69 6e 20 74 | 68 79 72 6f 74 72 6f 70 |ise in t|hyrotrop|
|00002d70| 69 6e 0d 0a 62 75 74 20 | 72 65 6d 61 69 6e 65 64 |in..but |remained|
|00002d80| 20 63 6c 69 6e 69 63 61 | 6c 6c 79 20 65 75 74 68 | clinica|lly euth|
|00002d90| 79 72 6f 69 64 2e 20 20 | 46 6f 75 72 20 77 6f 6d |yroid. |Four wom|
|00002da0| 65 6e 20 69 6d 70 72 6f | 76 65 64 20 70 73 79 63 |en impro|ved psyc|
|00002db0| 68 6f 6d 65 74 72 69 63 | 61 6c 6c 79 20 64 75 72 |hometric|ally dur|
|00002dc0| 69 6e 67 0d 0a 74 72 65 | 61 74 6d 65 6e 74 2e 0d |ing..tre|atment..|
|00002dd0| 0a 20 20 20 20 20 53 6f | 6d 65 20 77 6f 6d 65 6e |. So|me women|
|00002de0| 20 77 69 74 68 20 22 73 | 75 62 63 6c 69 6e 69 63 | with "s|ubclinic|
|00002df0| 61 6c 22 20 68 79 70 6f | 74 68 79 72 6f 69 64 69 |al" hypo|thyroidi|
|00002e00| 73 6d 2c 20 77 68 6f 20 | 68 61 76 65 20 61 20 6c |sm, who |have a l|
|00002e10| 6f 77 20 73 65 72 75 6d | 0d 0a 74 72 69 69 6f 64 |ow serum|..triiod|
|00002e20| 6f 74 68 79 72 6f 6e 69 | 6e 65 20 6c 65 76 65 6c |othyroni|ne level|
|00002e30| 2c 20 6d 61 79 20 62 65 | 6e 65 66 69 74 20 66 72 |, may be|nefit fr|
|00002e40| 6f 6d 20 6c 65 76 6f 74 | 68 79 72 6f 78 69 6e 65 |om levot|hyroxine|
|00002e50| 20 74 68 65 72 61 70 79 | 2e 20 20 41 20 36 2d 6d | therapy|. A 6-m|
|00002e60| 6f 6e 74 68 20 74 72 69 | 61 6c 0d 0a 6d 61 79 20 |onth tri|al..may |
|00002e70| 62 65 20 61 70 70 72 6f | 70 72 69 61 74 65 20 69 |be appro|priate i|
|00002e80| 66 20 73 6f 6d 65 20 73 | 79 6d 70 74 6f 6d 73 20 |f some s|ymptoms |
|00002e90| 73 75 67 67 65 73 74 69 | 76 65 20 6f 66 20 68 79 |suggesti|ve of hy|
|00002ea0| 70 6f 74 68 79 72 6f 69 | 64 69 73 6d 20 61 72 65 |pothyroi|dism are|
|00002eb0| 20 70 72 65 73 65 6e 74 | 2e 0d 0a 0d 0a 50 6f 73 | present|.....Pos|
|00002ec0| 74 2d 43 6f 6d 6d 65 6e | 74 0d 0a 0d 0a 20 20 20 |t-Commen|t.... |
|00002ed0| 20 20 41 20 73 69 6d 69 | 6c 61 72 20 63 6f 6e 63 | A simi|lar conc|
|00002ee0| 6c 75 73 69 6f 6e 20 68 | 61 73 20 62 65 65 6e 20 |lusion h|as been |
|00002ef0| 72 65 61 63 68 65 64 20 | 62 79 20 44 72 69 6e 6b |reached |by Drink|
|00002f00| 20 61 6e 64 20 4e 6f 6c | 74 65 6e 2c 20 5b 31 5d | and Nol|ten, [1]|
|00002f10| 20 6e 61 6d 65 6c 79 2c | 20 74 68 61 74 0d 0a 6c | namely,| that..l|
|00002f20| 6f 6e 67 2d 74 65 72 6d | 20 61 64 6d 69 6e 69 73 |ong-term| adminis|
|00002f30| 74 72 61 74 69 6f 6e 20 | 6f 66 20 6c 65 76 6f 74 |tration |of levot|
|00002f40| 68 79 72 6f 78 69 6e 65 | 20 74 6f 20 73 75 63 68 |hyroxine| to such|
|00002f50| 20 77 6f 6d 65 6e 20 6d | 61 79 20 62 65 20 70 72 | women m|ay be pr|
|00002f60| 6f 70 68 79 6c 61 63 74 | 69 63 20 69 6e 0d 0a 70 |ophylact|ic in..p|
|00002f70| 72 65 76 65 6e 74 69 6e | 67 20 74 68 65 20 64 65 |reventin|g the de|
|00002f80| 76 65 6c 6f 70 6d 65 6e | 74 20 6f 66 20 68 79 70 |velopmen|t of hyp|
|00002f90| 6f 74 68 79 72 6f 69 64 | 69 73 6d 2c 20 65 76 65 |othyroid|ism, eve|
|00002fa0| 6e 20 77 68 65 6e 20 69 | 6d 70 72 6f 76 65 6d 65 |n when i|mproveme|
|00002fb0| 6e 74 73 20 69 6e 0d 0a | 73 79 6d 70 74 6f 6d 61 |nts in..|symptoma|
|00002fc0| 74 6f 6c 6f 67 79 20 64 | 6f 20 6e 6f 74 20 6f 63 |tology d|o not oc|
|00002fd0| 63 75 72 2e 20 20 54 68 | 69 73 20 70 72 61 63 74 |cur. Th|is pract|
|00002fe0| 69 63 65 20 6d 61 6b 65 | 73 20 6d 65 20 6e 65 72 |ice make|s me ner|
|00002ff0| 76 6f 75 73 2e 20 20 49 | 20 63 6f 6e 63 65 64 65 |vous. I| concede|
|00003000| 20 74 68 61 74 20 69 74 | 0d 0a 6d 69 67 68 74 20 | that it|..might |
|00003010| 62 65 20 77 61 72 72 61 | 6e 74 65 64 20 69 6e 20 |be warra|nted in |
|00003020| 61 20 73 75 62 73 65 74 | 20 6f 66 20 77 6f 6d 65 |a subset| of wome|
|00003030| 6e 20 69 6e 20 77 68 6f | 6d 20 70 65 72 69 6f 64 |n in who|m period|
|00003040| 69 63 20 6d 6f 6e 69 74 | 6f 72 69 6e 67 20 69 73 |ic monit|oring is|
|00003050| 20 6e 6f 74 0d 0a 70 72 | 61 63 74 69 63 61 6c 2e | not..pr|actical.|
|00003060| 20 20 48 6f 77 65 76 65 | 72 2c 20 6c 6f 6e 67 2d | Howeve|r, long-|
|00003070| 74 65 72 6d 20 6c 65 76 | 6f 74 68 79 72 6f 78 69 |term lev|othyroxi|
|00003080| 6e 65 20 74 68 65 72 61 | 70 79 20 69 73 20 61 73 |ne thera|py is as|
|00003090| 73 6f 63 69 61 74 65 64 | 20 77 69 74 68 0d 0a 64 |sociated| with..d|
|000030a0| 65 63 72 65 61 73 65 64 | 20 68 69 70 20 62 6f 6e |ecreased| hip bon|
|000030b0| 65 20 64 65 6e 73 69 74 | 79 2c 20 5b 32 5d 20 61 |e densit|y, [2] a|
|000030c0| 6e 64 20 6d 61 6e 79 20 | 69 6e 64 69 76 69 64 75 |nd many |individu|
|000030d0| 61 6c 73 20 77 69 74 68 | 20 73 75 62 63 6c 69 6e |als with| subclin|
|000030e0| 69 63 61 6c 0d 0a 68 79 | 70 6f 74 68 79 72 6f 69 |ical..hy|pothyroi|
|000030f0| 64 69 73 6d 20 61 72 65 | 20 70 6f 73 74 6d 65 6e |dism are| postmen|
|00003100| 6f 70 61 75 73 61 6c 20 | 77 6f 6d 65 6e 20 61 74 |opausal |women at|
|00003110| 20 72 69 73 6b 20 66 6f | 72 20 6f 73 74 65 6f 70 | risk fo|r osteop|
|00003120| 6f 72 6f 73 69 73 2e 20 | 20 41 74 20 74 68 65 20 |orosis. | At the |
|00003130| 76 65 72 79 0d 0a 6c 65 | 61 73 74 2c 20 65 61 63 |very..le|ast, eac|
|00003140| 68 20 70 61 74 69 65 6e | 74 20 74 72 65 61 74 65 |h patien|t treate|
|00003150| 64 20 66 6f 72 20 73 75 | 62 63 6c 69 6e 69 63 61 |d for su|bclinica|
|00003160| 6c 20 68 79 70 6f 74 68 | 79 72 6f 69 64 69 73 6d |l hypoth|yroidism|
|00003170| 20 73 68 6f 75 6c 64 20 | 62 65 20 67 69 76 65 6e | should |be given|
|00003180| 20 74 68 65 0d 0a 61 62 | 73 6f 6c 75 74 65 20 6d | the..ab|solute m|
|00003190| 69 6e 69 6d 61 6c 20 64 | 6f 73 65 20 74 6f 20 72 |inimal d|ose to r|
|000031a0| 65 74 75 72 6e 20 73 65 | 72 75 6d 20 74 68 79 72 |eturn se|rum thyr|
|000031b0| 6f 74 72 6f 70 69 6e 20 | 6c 65 76 65 6c 73 20 74 |otropin |levels t|
|000031c0| 6f 20 6e 6f 72 6d 61 6c | 2e 2d 2d 4a 2e 44 2e 0d |o normal|.--J.D..|
|000031d0| 0a 57 69 6c 73 6f 6e 2c | 20 4d 2e 44 2e 0d 0a 24 |.Wilson,| M.D...$|
|000031e0| 55 6e 69 71 75 65 5f 49 | 44 7b 59 52 42 30 36 39 |Unique_I|D{YRB069|
|000031f0| 30 33 7d 0d 0a 24 54 69 | 74 6c 65 7b 4c 6f 6e 67 |03}..$Ti|tle{Long|
|00003200| 2d 54 65 72 6d 20 47 72 | 6f 77 74 68 20 69 6e 20 |-Term Gr|owth in |
|00003210| 4a 75 76 65 6e 69 6c 65 | 20 41 63 71 75 69 72 65 |Juvenile| Acquire|
|00003220| 64 20 48 79 70 6f 74 68 | 79 72 6f 69 64 69 73 6d |d Hypoth|yroidism|
|00003230| 3a 20 20 54 68 65 20 46 | 61 69 6c 75 72 65 20 74 |: The F|ailure t|
|00003240| 6f 20 41 63 68 69 65 76 | 65 20 4e 6f 72 6d 61 6c |o Achiev|e Normal|
|00003250| 20 41 64 75 6c 74 20 53 | 74 61 74 75 72 65 7d 0d | Adult S|tature}.|
|00003260| 0a 24 41 75 74 68 6f 72 | 7b 52 69 76 6b 65 65 73 |.$Author|{Rivkees|
|00003270| 2c 20 53 41 0d 0a 42 6f | 64 65 2c 20 48 48 0d 0a |, SA..Bo|de, HH..|
|00003280| 43 72 61 77 66 6f 72 64 | 2c 20 4a 44 7d 0d 0a 24 |Crawford|, JD}..$|
|00003290| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 4d 61 73 73 |Affiliat|ion{Mass|
|000032a0| 61 63 68 75 73 65 74 74 | 73 20 47 65 6e 20 48 6f |achusett|s Gen Ho|
|000032b0| 73 70 2c 20 42 6f 73 74 | 6f 6e 3b 20 48 61 72 76 |sp, Bost|on; Harv|
|000032c0| 61 72 64 20 4d 65 64 20 | 53 63 68 6f 6f 6c 7d 0d |ard Med |School}.|
|000032d0| 0a 24 53 75 62 6a 65 63 | 74 7b 53 74 61 74 75 72 |.$Subjec|t{Statur|
|000032e0| 65 20 6e 6f 72 6d 61 6c | 20 61 64 75 6c 74 2c 20 |e normal| adult, |
|000032f0| 66 61 69 6c 75 72 65 20 | 74 6f 20 61 63 68 69 65 |failure |to achie|
|00003300| 76 65 20 69 6e 20 6a 75 | 76 65 6e 69 6c 65 20 61 |ve in ju|venile a|
|00003310| 63 71 75 69 72 65 64 0d | 0a 68 79 70 6f 74 68 79 |cquired.|.hypothy|
|00003320| 72 6f 69 64 69 73 6d 3b | 20 48 79 70 6f 74 68 79 |roidism;| Hypothy|
|00003330| 72 6f 69 64 69 73 6d 20 | 6a 75 76 65 6e 69 6c 65 |roidism |juvenile|
|00003340| 20 61 63 71 75 69 72 65 | 64 2c 20 6c 6f 6e 67 2d | acquire|d, long-|
|00003350| 74 65 72 6d 20 67 72 6f | 77 74 68 20 69 6e 3b 20 |term gro|wth in; |
|00003360| 47 72 6f 77 74 68 0d 0a | 6c 6f 6e 67 2d 74 65 72 |Growth..|long-ter|
|00003370| 6d 2c 20 69 6e 20 6a 75 | 76 65 6e 69 6c 65 20 61 |m, in ju|venile a|
|00003380| 63 71 75 69 72 65 64 20 | 68 79 70 6f 74 68 79 72 |cquired |hypothyr|
|00003390| 6f 69 64 69 73 6d 3b 20 | 43 68 69 6c 64 72 65 6e |oidism; |Children|
|000033a0| 20 68 79 70 6f 74 68 79 | 72 6f 69 64 69 73 6d 20 | hypothy|roidism |
|000033b0| 69 6e 2c 0d 0a 61 63 71 | 75 69 72 65 64 2c 20 6c |in,..acq|uired, l|
|000033c0| 6f 6e 67 2d 74 65 72 6d | 20 67 72 6f 77 74 68 20 |ong-term| growth |
|000033d0| 69 6e 7d 0d 0a 24 4a 6f | 75 72 6e 61 6c 7b 4e 20 |in}..$Jo|urnal{N |
|000033e0| 45 6e 67 6c 20 4a 20 4d | 65 64 7d 0d 0a 24 56 6f |Engl J M|ed}..$Vo|
|000033f0| 6c 75 6d 65 7b 33 31 38 | 7d 0d 0a 24 50 61 67 65 |lume{318|}..$Page|
|00003400| 7b 35 39 39 2d 36 30 32 | 7d 0d 0a 24 44 61 74 65 |{599-602|}..$Date|
|00003410| 7b 4d 61 72 63 68 20 31 | 30 2c 20 31 39 38 38 7d |{March 1|0, 1988}|
|00003420| 0d 0a 24 59 42 56 6f 6c | 7b 31 39 38 39 20 59 65 |..$YBVol|{1989 Ye|
|00003430| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 4d 65 64 69 63 |ar Book |of Medic|
|00003440| 69 6e 65 2c 20 50 61 72 | 74 20 53 69 78 7d 0d 0a |ine, Par|t Six}..|
|00003450| 24 43 68 61 70 74 65 72 | 7b 34 35 2d 35 7d 0d 0a |$Chapter|{45-5}..|
|00003460| 24 59 42 45 64 69 74 6f | 72 7b 44 72 73 2e 20 52 |$YBEdito|r{Drs. R|
|00003470| 6f 67 65 72 73 2c 20 44 | 65 73 20 50 72 65 7a 2c |ogers, D|es Prez,|
|00003480| 20 43 6c 69 6e 65 2c 20 | 42 72 61 75 6e 77 61 6c | Cline, |Braunwal|
|00003490| 64 2c 20 47 72 65 65 6e | 62 65 72 67 65 72 2c 20 |d, Green|berger, |
|000034a0| 57 69 6c 73 6f 6e 2c 20 | 45 70 73 74 65 69 6e 2c |Wilson, |Epstein,|
|000034b0| 20 61 6e 64 20 4d 61 6c | 61 77 69 73 74 61 7d 0d | and Mal|awista}.|
|000034c0| 0a 24 54 61 62 6c 65 7b | 54 61 62 6c 65 20 4f 6d |.$Table{|Table Om|
|000034d0| 69 74 74 65 64 7d 0d 0a | 24 43 6f 6d 6d 65 6e 74 |itted}..|$Comment|
|000034e0| 61 74 6f 72 7b 4a 2e 44 | 2e 20 57 69 6c 73 6f 6e |ator{J.D|. Wilson|
|000034f0| 2c 20 4d 2e 44 2e 7d 0d | 0a 0d 0a 43 6f 70 79 72 |, M.D.}.|...Copyr|
|00003500| 69 67 68 74 20 28 63 29 | 20 59 65 61 72 20 42 6f |ight (c)| Year Bo|
|00003510| 6f 6b 20 4d 65 64 69 63 | 61 6c 20 50 75 62 6c 69 |ok Medic|al Publi|
|00003520| 73 68 65 72 73 2c 20 49 | 6e 63 2e 2c 20 31 39 38 |shers, I|nc., 198|
|00003530| 39 0d 0a 0d 0a 31 39 38 | 39 20 59 65 61 72 20 42 |9....198|9 Year B|
|00003540| 6f 6f 6b 20 6f 66 20 4d | 65 64 69 63 69 6e 65 20 |ook of M|edicine |
|00003550| 28 52 29 0d 0a 0d 0a 50 | 61 72 74 20 53 69 78 3a |(R)....P|art Six:|
|00003560| 20 20 45 6e 64 6f 63 72 | 69 6e 6f 6c 6f 67 79 20 | Endocr|inology |
|00003570| 61 6e 64 20 4d 65 74 61 | 62 6f 6c 69 73 6d 0d 0a |and Meta|bolism..|
|00003580| 0d 0a 43 68 61 70 74 65 | 72 20 34 35 2d 2d 54 68 |..Chapte|r 45--Th|
|00003590| 65 20 54 68 79 72 6f 69 | 64 0d 0a 0d 0a 2d 2d 2d |e Thyroi|d....---|
|000035a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000035b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000035c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000035d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000035e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 4c |--------|-----..L|
|000035f0| 6f 6e 67 2d 54 65 72 6d | 20 47 72 6f 77 74 68 20 |ong-Term| Growth |
|00003600| 69 6e 20 4a 75 76 65 6e | 69 6c 65 20 41 63 71 75 |in Juven|ile Acqu|
|00003610| 69 72 65 64 20 48 79 70 | 6f 74 68 79 72 6f 69 64 |ired Hyp|othyroid|
|00003620| 69 73 6d 3a 20 20 54 68 | 65 20 46 61 69 6c 75 72 |ism: Th|e Failur|
|00003630| 65 20 74 6f 20 41 63 68 | 69 65 76 65 0d 0a 4e 6f |e to Ach|ieve..No|
|00003640| 72 6d 61 6c 20 41 64 75 | 6c 74 20 53 74 61 74 75 |rmal Adu|lt Statu|
|00003650| 72 65 0d 0a 0d 0a 52 69 | 76 6b 65 65 73 20 53 41 |re....Ri|vkees SA|
|00003660| 2c 20 42 6f 64 65 20 48 | 48 2c 20 43 72 61 77 66 |, Bode H|H, Crawf|
|00003670| 6f 72 64 20 4a 44 0d 0a | 28 4d 61 73 73 61 63 68 |ord JD..|(Massach|
|00003680| 75 73 65 74 74 73 20 47 | 65 6e 20 48 6f 73 70 2c |usetts G|en Hosp,|
|00003690| 20 42 6f 73 74 6f 6e 3b | 20 48 61 72 76 61 72 64 | Boston;| Harvard|
|000036a0| 20 4d 65 64 20 53 63 68 | 6f 6f 6c 29 0d 0a 4e 20 | Med Sch|ool)..N |
|000036b0| 45 6e 67 6c 20 4a 20 4d | 65 64 20 33 31 38 3a 35 |Engl J M|ed 318:5|
|000036c0| 39 39 2d 36 30 32 2c 20 | 4d 61 72 63 68 20 31 30 |99-602, |March 10|
|000036d0| 2c 20 31 39 38 38 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |, 1988..|--------|
|000036e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000036f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003700| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003710| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003720| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 0d 0a 50 72 65 2d |--------|....Pre-|
|00003730| 43 6f 6d 6d 65 6e 74 0d | 0a 0d 0a 20 20 20 20 20 |Comment.|... |
|00003740| 54 68 65 20 74 72 65 61 | 74 6d 65 6e 74 20 6f 66 |The trea|tment of|
|00003750| 20 68 79 70 6f 74 68 79 | 72 6f 69 64 69 73 6d 20 | hypothy|roidism |
|00003760| 69 73 20 75 73 75 61 6c | 6c 79 20 74 68 65 20 6d |is usual|ly the m|
|00003770| 6f 73 74 20 73 75 63 63 | 65 73 73 66 75 6c 20 6f |ost succ|essful o|
|00003780| 66 20 68 6f 72 6d 6f 6e | 61 6c 0d 0a 74 68 65 72 |f hormon|al..ther|
|00003790| 61 70 69 65 73 2c 20 62 | 75 74 20 74 68 65 72 65 |apies, b|ut there|
|000037a0| 20 61 72 65 20 63 6c 65 | 61 72 2d 63 75 74 20 64 | are cle|ar-cut d|
|000037b0| 61 6e 67 65 72 73 20 69 | 66 20 74 68 65 72 61 70 |angers i|f therap|
|000037c0| 79 20 69 73 20 64 65 6c | 61 79 65 64 20 69 6e 20 |y is del|ayed in |
|000037d0| 6a 75 76 65 6e 69 6c 65 | 73 0d 0a 77 69 74 68 20 |juvenile|s..with |
|000037e0| 68 79 70 6f 74 68 79 72 | 6f 69 64 69 73 6d 2e 0d |hypothyr|oidism..|
|000037f0| 0a 0d 0a 41 62 73 74 72 | 61 63 74 0d 0a 0d 0a 20 |...Abstr|act.... |
|00003800| 20 20 20 20 49 74 20 68 | 61 73 20 62 65 65 6e 20 | It h|as been |
|00003810| 67 65 6e 65 72 61 6c 6c | 79 20 62 65 6c 69 65 76 |generall|y believ|
|00003820| 65 64 20 74 68 61 74 20 | 77 69 74 68 20 70 72 6f |ed that |with pro|
|00003830| 70 65 72 20 72 65 70 6c | 61 63 65 6d 65 6e 74 20 |per repl|acement |
|00003840| 74 68 65 72 61 70 79 20 | 69 6e 0d 0a 70 61 74 69 |therapy |in..pati|
|00003850| 65 6e 74 73 20 77 69 74 | 68 20 61 63 71 75 69 72 |ents wit|h acquir|
|00003860| 65 64 20 6a 75 76 65 6e | 69 6c 65 20 68 79 70 6f |ed juven|ile hypo|
|00003870| 74 68 79 72 6f 69 64 69 | 73 6d 20 63 61 74 63 68 |thyroidi|sm catch|
|00003880| 2d 75 70 20 67 72 6f 77 | 74 68 20 69 73 20 63 6f |-up grow|th is co|
|00003890| 6d 70 6c 65 74 65 20 61 | 6e 64 0d 0a 6e 6f 72 6d |mplete a|nd..norm|
|000038a0| 61 6c 20 61 64 75 6c 74 | 20 73 74 61 74 75 72 65 |al adult| stature|
|000038b0| 20 69 73 20 61 74 74 61 | 69 6e 65 64 2e 20 20 54 | is atta|ined. T|
|000038c0| 6f 20 74 65 73 74 20 74 | 68 69 73 20 61 73 73 75 |o test t|his assu|
|000038d0| 6d 70 74 69 6f 6e 2c 20 | 61 20 63 6f 6d 70 72 65 |mption, |a compre|
|000038e0| 68 65 6e 73 69 76 65 0d | 0a 65 76 61 6c 75 61 74 |hensive.|.evaluat|
|000038f0| 69 6f 6e 20 77 61 73 20 | 6d 61 64 65 20 6f 66 20 |ion was |made of |
|00003900| 74 68 65 20 6c 6f 6e 67 | 2d 74 65 72 6d 20 67 72 |the long|-term gr|
|00003910| 6f 77 74 68 20 70 61 74 | 74 65 72 6e 73 20 6f 66 |owth pat|terns of|
|00003920| 20 63 68 69 6c 64 72 65 | 6e 20 74 72 65 61 74 65 | childre|n treate|
|00003930| 64 20 66 6f 72 0d 0a 6c | 6f 6e 67 2d 73 74 61 6e |d for..l|ong-stan|
|00003940| 64 69 6e 67 2c 20 70 72 | 65 70 75 62 65 72 74 61 |ding, pr|epuberta|
|00003950| 6c 6c 79 20 61 63 71 75 | 69 72 65 64 20 68 79 70 |lly acqu|ired hyp|
|00003960| 6f 74 68 79 72 6f 69 64 | 69 73 6d 2e 0d 0a 20 20 |othyroid|ism... |
|00003970| 20 20 20 45 69 67 68 74 | 65 65 6e 20 67 69 72 6c | Eight|een girl|
|00003980| 73 20 61 6e 64 20 36 20 | 62 6f 79 73 20 77 65 72 |s and 6 |boys wer|
|00003990| 65 20 73 74 75 64 69 65 | 64 2e 20 20 46 6f 72 20 |e studie|d. For |
|000039a0| 67 69 72 6c 73 2c 20 74 | 68 65 20 6d 65 61 6e 20 |girls, t|he mean |
|000039b0| 61 67 65 20 77 61 73 0d | 0a 31 31 2e 34 20 2b 2f |age was.|.11.4 +/|
|000039c0| 2d 20 32 2e 37 20 79 65 | 61 72 73 20 61 6e 64 20 |- 2.7 ye|ars and |
|000039d0| 74 68 65 20 6d 65 61 6e | 20 62 6f 6e 65 20 61 67 |the mean| bone ag|
|000039e0| 65 20 77 61 73 20 36 2e | 32 20 2b 2f 2d 20 33 2e |e was 6.|2 +/- 3.|
|000039f0| 31 20 79 65 61 72 73 2e | 20 20 46 6f 72 20 62 6f |1 years.| For bo|
|00003a00| 79 73 20 74 68 65 0d 0a | 6d 65 61 6e 20 61 67 65 |ys the..|mean age|
|00003a10| 20 77 61 73 20 31 30 2e | 34 36 20 2b 2f 2d 20 34 | was 10.|46 +/- 4|
|00003a20| 2e 37 20 79 65 61 72 73 | 20 61 6e 64 20 74 68 65 |.7 years| and the|
|00003a30| 20 6d 65 61 6e 20 62 6f | 6e 65 20 61 67 65 20 77 | mean bo|ne age w|
|00003a40| 61 73 20 36 2e 34 20 2b | 2f 2d 20 32 2e 37 20 79 |as 6.4 +|/- 2.7 y|
|00003a50| 65 61 72 73 2e 0d 0a 54 | 68 65 20 63 68 69 6c 64 |ears...T|he child|
|00003a60| 72 65 6e 20 68 61 64 20 | 73 65 76 65 72 65 20 70 |ren had |severe p|
|00003a70| 72 69 6d 61 72 79 20 68 | 79 70 6f 74 68 79 72 6f |rimary h|ypothyro|
|00003a80| 69 64 69 73 6d 2c 20 77 | 69 74 68 20 73 65 72 75 |idism, w|ith seru|
|00003a90| 6d 20 74 68 79 72 6f 78 | 69 6e 65 20 6c 65 76 65 |m thyrox|ine leve|
|00003aa0| 6c 73 20 6f 66 0d 0a 31 | 2e 31 20 2b 2f 2d 20 30 |ls of..1|.1 +/- 0|
|00003ab0| 2e 33 20 6d 75 5f 67 2f | 64 6c 2e 20 20 41 74 20 |.3 mu_g/|dl. At |
|00003ac0| 64 69 61 67 6e 6f 73 69 | 73 2c 20 74 68 65 20 67 |diagnosi|s, the g|
|00003ad0| 69 72 6c 73 27 20 68 65 | 69 67 68 74 73 20 77 65 |irls' he|ights we|
|00003ae0| 72 65 20 34 2e 30 34 20 | 2b 2f 2d 20 30 2e 35 20 |re 4.04 |+/- 0.5 |
|00003af0| 53 44 20 61 6e 64 0d 0a | 74 68 65 20 62 6f 79 73 |SD and..|the boys|
|00003b00| 27 20 68 65 69 67 68 74 | 73 20 77 65 72 65 20 33 |' height|s were 3|
|00003b10| 2e 31 35 20 2b 2f 2d 20 | 30 2e 34 20 53 44 20 62 |.15 +/- |0.4 SD b|
|00003b20| 65 6c 6f 77 20 74 68 65 | 20 6d 65 61 6e 20 66 6f |elow the| mean fo|
|00003b30| 72 20 6e 6f 72 6d 61 6c | 20 63 68 69 6c 64 72 65 |r normal| childre|
|00003b40| 6e 2e 0d 0a 50 61 74 69 | 65 6e 74 73 20 77 65 72 |n...Pati|ents wer|
|00003b50| 65 20 74 72 65 61 74 65 | 64 20 77 69 74 68 20 6c |e treate|d with l|
|00003b60| 65 76 6f 74 68 79 72 6f | 78 69 6e 65 20 74 6f 20 |evothyro|xine to |
|00003b70| 6d 61 69 6e 74 61 69 6e | 20 6e 6f 72 6d 61 6c 20 |maintain| normal |
|00003b80| 74 68 79 72 6f 69 64 20 | 66 75 6e 63 74 69 6f 6e |thyroid |function|
|00003b90| 2e 0d 0a 49 6e 20 74 68 | 65 20 66 69 72 73 74 20 |...In th|e first |
|00003ba0| 31 38 20 6d 6f 6e 74 68 | 73 20 6f 66 20 74 68 65 |18 month|s of the|
|00003bb0| 72 61 70 79 2c 20 73 6b | 65 6c 65 74 61 6c 20 6d |rapy, sk|eletal m|
|00003bc0| 61 74 75 72 61 74 69 6f | 6e 20 65 78 63 65 65 64 |aturatio|n exceed|
|00003bd0| 65 64 20 74 68 65 20 67 | 72 6f 77 74 68 20 69 6e |ed the g|rowth in|
|00003be0| 0d 0a 73 74 61 74 75 72 | 65 20 72 65 67 61 72 64 |..statur|e regard|
|00003bf0| 6c 65 73 73 20 6f 66 20 | 77 68 65 74 68 65 72 20 |less of |whether |
|00003c00| 74 68 65 20 70 61 74 69 | 65 6e 74 73 20 77 65 72 |the pati|ents wer|
|00003c10| 65 20 75 6e 64 65 72 67 | 6f 69 6e 67 20 70 75 62 |e underg|oing pub|
|00003c20| 65 72 74 61 6c 20 64 65 | 76 65 6c 6f 70 6d 65 6e |ertal de|velopmen|
|00003c30| 74 2e 0d 0a 41 74 20 6d | 61 74 75 72 69 74 79 2c |t...At m|aturity,|
|00003c40| 20 74 68 65 20 67 69 72 | 6c 73 20 73 74 6f 6f 64 | the gir|ls stood|
|00003c50| 20 61 74 20 31 34 39 20 | 63 6d 20 2b 2f 2d 20 35 | at 149 |cm +/- 5|
|00003c60| 20 63 6d 2c 20 61 6e 64 | 20 62 6f 79 73 20 61 74 | cm, and| boys at|
|00003c70| 20 31 36 38 20 63 6d 20 | 2b 2f 2d 20 35 2e 31 20 | 168 cm |+/- 5.1 |
|00003c80| 63 6d 2c 0d 0a 61 62 6f | 75 74 20 32 20 53 44 20 |cm,..abo|ut 2 SD |
|00003c90| 62 65 6c 6f 77 20 6e 6f | 72 6d 61 6c 20 61 64 75 |below no|rmal adu|
|00003ca0| 6c 74 20 73 74 61 74 75 | 72 65 2e 20 20 48 65 69 |lt statu|re. Hei|
|00003cb0| 67 68 74 73 20 61 74 20 | 6d 61 74 75 72 69 74 79 |ghts at |maturity|
|00003cc0| 20 77 65 72 65 20 6c 6f | 77 65 72 20 74 68 61 6e | were lo|wer than|
|00003cd0| 0d 0a 6d 69 64 70 61 72 | 65 6e 74 61 6c 20 68 65 |..midpar|ental he|
|00003ce0| 69 67 68 74 73 20 61 6e | 64 20 70 72 65 2d 69 6c |ights an|d pre-il|
|00003cf0| 6c 6e 65 73 73 20 53 44 | 20 73 63 6f 72 65 73 20 |lness SD| scores |
|00003d00| 66 6f 72 20 68 65 69 67 | 68 74 20 28 46 69 67 20 |for heig|ht (Fig |
|00003d10| 34 35 2d 31 29 2e 20 20 | 54 68 65 20 61 64 75 6c |45-1). |The adul|
|00003d20| 74 0d 0a 73 74 61 74 75 | 72 65 20 64 65 66 69 63 |t..statu|re defic|
|00003d30| 69 74 20 77 61 73 20 72 | 65 6c 61 74 65 64 20 74 |it was r|elated t|
|00003d40| 6f 20 74 68 65 20 64 75 | 72 61 74 69 6f 6e 20 6f |o the du|ration o|
|00003d50| 66 20 68 79 70 6f 74 68 | 79 72 6f 69 64 69 73 6d |f hypoth|yroidism|
|00003d60| 20 62 65 66 6f 72 65 20 | 74 72 65 61 74 6d 65 6e | before |treatmen|
|00003d70| 74 2e 0d 0a 20 20 20 20 | 20 44 65 73 70 69 74 65 |t... | Despite|
|00003d80| 20 74 72 65 61 74 6d 65 | 6e 74 2c 20 70 72 6f 6c | treatme|nt, prol|
|00003d90| 6f 6e 67 65 64 20 6a 75 | 76 65 6e 69 6c 65 20 61 |onged ju|venile a|
|00003da0| 63 71 75 69 72 65 64 20 | 68 79 70 6f 74 68 79 72 |cquired |hypothyr|
|00003db0| 6f 69 64 69 73 6d 20 72 | 65 73 75 6c 74 73 20 69 |oidism r|esults i|
|00003dc0| 6e 20 61 0d 0a 70 65 72 | 6d 61 6e 65 6e 74 20 68 |n a..per|manent h|
|00003dd0| 65 69 67 68 74 20 64 65 | 66 69 63 69 74 2e 20 20 |eight de|ficit. |
|00003de0| 54 68 69 73 20 64 65 66 | 69 63 69 74 20 69 73 20 |This def|icit is |
|00003df0| 72 65 6c 61 74 65 64 20 | 74 6f 20 74 68 65 20 64 |related |to the d|
|00003e00| 75 72 61 74 69 6f 6e 20 | 6f 66 20 74 68 79 72 6f |uration |of thyro|
|00003e10| 78 69 6e 65 0d 0a 64 65 | 66 69 63 69 65 6e 63 79 |xine..de|ficiency|
|00003e20| 20 62 65 66 6f 72 65 20 | 74 72 65 61 74 6d 65 6e | before |treatmen|
|00003e30| 74 2e 0d 0a 0d 0a 50 6f | 73 74 2d 43 6f 6d 6d 65 |t.....Po|st-Comme|
|00003e40| 6e 74 0d 0a 0d 0a 20 20 | 20 20 20 4a 75 76 65 6e |nt.... | Juven|
|00003e50| 69 6c 65 20 68 79 70 6f | 74 68 79 6f 69 64 69 73 |ile hypo|thyoidis|
|00003e60| 6d 20 63 61 6e 20 61 6c | 73 6f 20 63 61 75 73 65 |m can al|so cause|
|00003e70| 20 61 62 6e 6f 72 6d 61 | 6c 20 73 65 78 75 61 6c | abnorma|l sexual|
|00003e80| 20 64 65 76 65 6c 6f 70 | 6d 65 6e 74 20 69 6e 63 | develop|ment inc|
|00003e90| 6c 75 64 69 6e 67 0d 0a | 70 72 65 6d 61 74 75 72 |luding..|prematur|
|00003ea0| 65 20 62 72 65 61 73 74 | 20 64 65 76 65 6c 6f 70 |e breast| develop|
|00003eb0| 6d 65 6e 74 20 61 6e 64 | 20 6f 76 61 72 69 61 6e |ment and| ovarian|
|00003ec0| 20 65 6e 6c 61 72 67 65 | 6d 65 6e 74 20 69 6e 20 | enlarge|ment in |
|00003ed0| 67 69 72 6c 73 20 61 6e | 64 20 74 65 73 74 69 63 |girls an|d testic|
|00003ee0| 75 6c 61 72 0d 0a 65 6e | 6c 61 72 67 65 6d 65 6e |ular..en|largemen|
|00003ef0| 74 20 69 6e 20 62 6f 79 | 73 2e 20 5b 31 5d 2d 2d |t in boy|s. [1]--|
|00003f00| 4a 2e 44 2e 20 57 69 6c | 73 6f 6e 2c 20 4d 2e 44 |J.D. Wil|son, M.D|
|00003f10| 2e 0d 0a 24 55 6e 69 71 | 75 65 5f 49 44 7b 59 52 |...$Uniq|ue_ID{YR|
|00003f20| 42 30 36 39 30 34 7d 0d | 0a 24 54 69 74 6c 65 7b |B06904}.|.$Title{|
|00003f30| 45 66 66 65 63 74 20 6f | 66 20 50 72 65 64 6e 69 |Effect o|f Predni|
|00003f40| 73 6f 6c 6f 6e 65 20 61 | 6e 64 20 53 61 6c 69 63 |solone a|nd Salic|
|00003f50| 79 6c 61 74 65 20 6f 6e | 20 53 65 72 75 6d 20 54 |ylate on| Serum T|
|00003f60| 68 79 72 6f 67 6c 6f 62 | 75 6c 69 6e 20 4c 65 76 |hyroglob|ulin Lev|
|00003f70| 65 6c 20 69 6e 20 50 61 | 74 69 65 6e 74 73 20 77 |el in Pa|tients w|
|00003f80| 69 74 68 20 53 75 62 61 | 63 75 74 65 20 54 68 79 |ith Suba|cute Thy|
|00003f90| 72 6f 69 64 69 74 69 73 | 7d 0d 0a 24 41 75 74 68 |roiditis|}..$Auth|
|00003fa0| 6f 72 7b 59 61 6d 61 6d | 6f 74 6f 2c 20 4d 0d 0a |or{Yamam|oto, M..|
|00003fb0| 53 61 69 74 6f 2c 20 53 | 0d 0a 53 61 6b 75 72 61 |Saito, S|..Sakura|
|00003fc0| 64 61 2c 20 54 0d 0a 46 | 75 6b 61 7a 61 77 61 2c |da, T..F|ukazawa,|
|00003fd0| 20 48 0d 0a 59 6f 73 68 | 69 64 61 2c 20 4b 0d 0a | H..Yosh|ida, K..|
|00003fe0| 4b 61 69 73 65 2c 20 4b | 0d 0a 4b 61 69 73 65 2c |Kaise, K|..Kaise,|
|00003ff0| 20 4e 0d 0a 4e 6f 6d 75 | 72 61 2c 20 54 0d 0a 49 | N..Nomu|ra, T..I|
|00004000| 74 61 67 61 6b 69 2c 20 | 59 0d 0a 59 6f 6e 65 6d |tagaki, |Y..Yonem|
|00004010| 69 74 73 75 2c 20 4b 0d | 0a 59 6f 73 68 69 6e 61 |itsu, K.|.Yoshina|
|00004020| 67 61 2c 20 4b 7d 0d 0a | 24 41 66 66 69 6c 69 61 |ga, K}..|$Affilia|
|00004030| 74 69 6f 6e 7b 54 6f 68 | 6f 6b 75 20 55 6e 69 76 |tion{Toh|oku Univ|
|00004040| 2c 20 4a 61 70 61 6e 7d | 0d 0a 24 53 75 62 6a 65 |, Japan}|..$Subje|
|00004050| 63 74 7b 54 68 79 72 6f | 69 64 69 74 69 73 20 73 |ct{Thyro|iditis s|
|00004060| 75 62 61 63 75 74 65 2c | 20 70 72 65 64 6e 69 73 |ubacute,| prednis|
|00004070| 6f 6c 6f 6e 65 20 49 6e | 64 20 73 61 6c 69 63 79 |olone In|d salicy|
|00004080| 6c 61 74 65 20 69 6e 3b | 20 54 68 79 72 6f 67 6c |late in;| Thyrogl|
|00004090| 6f 62 75 6c 69 6e 0d 0a | 6c 65 76 65 6c 20 69 6e |obulin..|level in|
|000040a0| 20 73 75 62 61 63 75 74 | 65 20 74 68 79 72 6f 69 | subacut|e thyroi|
|000040b0| 64 69 74 69 73 20 61 66 | 74 65 72 20 70 72 65 64 |ditis af|ter pred|
|000040c0| 6e 69 73 6f 6c 6f 6e 65 | 20 61 6e 64 20 73 61 6c |nisolone| and sal|
|000040d0| 69 63 79 6c 61 74 65 3b | 20 53 61 6c 69 63 79 6c |icylate;| Salicyl|
|000040e0| 61 74 65 20 69 6e 0d 0a | 74 68 79 72 6f 69 64 69 |ate in..|thyroidi|
|000040f0| 74 69 73 2c 20 73 75 62 | 61 63 75 74 65 3b 20 50 |tis, sub|acute; P|
|00004100| 72 65 64 6e 69 73 6f 6c | 6f 6e 65 20 69 6e 20 74 |rednisol|one in t|
|00004110| 68 79 72 6f 69 64 69 74 | 69 73 2c 20 73 75 62 61 |hyroidit|is, suba|
|00004120| 63 75 74 65 7d 0d 0a 24 | 4a 6f 75 72 6e 61 6c 7b |cute}..$|Journal{|
|00004130| 43 6c 69 6e 20 45 6e 64 | 6f 63 72 69 6e 6f 6c 20 |Clin End|ocrinol |
|00004140| 28 4f 78 66 29 7d 0d 0a | 24 56 6f 6c 75 6d 65 7b |(Oxf)}..|$Volume{|
|00004150| 32 37 7d 0d 0a 24 50 61 | 67 65 7b 33 33 39 2d 33 |27}..$Pa|ge{339-3|
|00004160| 34 34 7d 0d 0a 24 44 61 | 74 65 7b 53 65 70 74 65 |44}..$Da|te{Septe|
|00004170| 6d 62 65 72 20 31 39 38 | 37 7d 0d 0a 24 59 42 56 |mber 198|7}..$YBV|
|00004180| 6f 6c 7b 31 39 38 39 20 | 59 65 61 72 20 42 6f 6f |ol{1989 |Year Boo|
|00004190| 6b 20 6f 66 20 4d 65 64 | 69 63 69 6e 65 2c 20 50 |k of Med|icine, P|
|000041a0| 61 72 74 20 53 69 78 7d | 0d 0a 24 43 68 61 70 74 |art Six}|..$Chapt|
|000041b0| 65 72 7b 34 35 2d 36 7d | 0d 0a 24 59 42 45 64 69 |er{45-6}|..$YBEdi|
|000041c0| 74 6f 72 7b 44 72 73 2e | 20 52 6f 67 65 72 73 2c |tor{Drs.| Rogers,|
|000041d0| 20 44 65 73 20 50 72 65 | 7a 2c 20 43 6c 69 6e 65 | Des Pre|z, Cline|
|000041e0| 2c 20 42 72 61 75 6e 77 | 61 6c 64 2c 20 47 72 65 |, Braunw|ald, Gre|
|000041f0| 65 6e 62 65 72 67 65 72 | 2c 20 57 69 6c 73 6f 6e |enberger|, Wilson|
|00004200| 2c 20 45 70 73 74 65 69 | 6e 2c 20 61 6e 64 20 4d |, Epstei|n, and M|
|00004210| 61 6c 61 77 69 73 74 61 | 7d 0d 0a 24 54 61 62 6c |alawista|}..$Tabl|
|00004220| 65 7b 7d 0d 0a 24 43 6f | 6d 6d 65 6e 74 61 74 6f |e{}..$Co|mmentato|
|00004230| 72 7b 4a 2e 44 2e 20 57 | 69 6c 73 6f 6e 2c 20 4d |r{J.D. W|ilson, M|
|00004240| 2e 44 2e 7d 0d 0a 0d 0a | 43 6f 70 79 72 69 67 68 |.D.}....|Copyrigh|
|00004250| 74 20 28 63 29 20 59 65 | 61 72 20 42 6f 6f 6b 20 |t (c) Ye|ar Book |
|00004260| 4d 65 64 69 63 61 6c 20 | 50 75 62 6c 69 73 68 65 |Medical |Publishe|
|00004270| 72 73 2c 20 49 6e 63 2e | 2c 20 31 39 38 39 0d 0a |rs, Inc.|, 1989..|
|00004280| 0d 0a 31 39 38 39 20 59 | 65 61 72 20 42 6f 6f 6b |..1989 Y|ear Book|
|00004290| 20 6f 66 20 4d 65 64 69 | 63 69 6e 65 20 28 52 29 | of Medi|cine (R)|
|000042a0| 0d 0a 0d 0a 50 61 72 74 | 20 53 69 78 3a 20 20 45 |....Part| Six: E|
|000042b0| 6e 64 6f 63 72 69 6e 6f | 6c 6f 67 79 20 61 6e 64 |ndocrino|logy and|
|000042c0| 20 4d 65 74 61 62 6f 6c | 69 73 6d 0d 0a 0d 0a 43 | Metabol|ism....C|
|000042d0| 68 61 70 74 65 72 20 34 | 35 2d 2d 54 68 65 20 54 |hapter 4|5--The T|
|000042e0| 68 79 72 6f 69 64 0d 0a | 0d 0a 2d 2d 2d 2d 2d 2d |hyroid..|..------|
|000042f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004300| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004310| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004320| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004330| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 45 66 66 65 |--------|--..Effe|
|00004340| 63 74 20 6f 66 20 50 72 | 65 64 6e 69 73 6f 6c 6f |ct of Pr|ednisolo|
|00004350| 6e 65 20 61 6e 64 20 53 | 61 6c 69 63 79 6c 61 74 |ne and S|alicylat|
|00004360| 65 20 6f 6e 20 53 65 72 | 75 6d 20 54 68 79 72 6f |e on Ser|um Thyro|
|00004370| 67 6c 6f 62 75 6c 69 6e | 20 4c 65 76 65 6c 20 69 |globulin| Level i|
|00004380| 6e 20 50 61 74 69 65 6e | 74 73 0d 0a 77 69 74 68 |n Patien|ts..with|
|00004390| 20 53 75 62 61 63 75 74 | 65 20 54 68 79 72 6f 69 | Subacut|e Thyroi|
|000043a0| 64 69 74 69 73 0d 0a 0d | 0a 59 61 6d 61 6d 6f 74 |ditis...|.Yamamot|
|000043b0| 6f 20 4d 2c 20 53 61 69 | 74 6f 20 53 2c 20 53 61 |o M, Sai|to S, Sa|
|000043c0| 6b 75 72 61 64 61 20 54 | 2c 20 46 75 6b 61 7a 61 |kurada T|, Fukaza|
|000043d0| 77 61 20 48 2c 20 59 6f | 73 68 69 64 61 20 4b 2c |wa H, Yo|shida K,|
|000043e0| 20 4b 61 69 73 65 20 4b | 2c 20 4b 61 69 73 65 20 | Kaise K|, Kaise |
|000043f0| 4e 2c 0d 0a 4e 6f 6d 75 | 72 61 20 54 2c 20 49 74 |N,..Nomu|ra T, It|
|00004400| 61 67 61 6b 69 20 59 2c | 20 59 6f 6e 65 6d 69 74 |agaki Y,| Yonemit|
|00004410| 73 75 20 4b 2c 20 59 6f | 73 68 69 6e 61 67 61 20 |su K, Yo|shinaga |
|00004420| 4b 0d 0a 28 54 6f 68 6f | 6b 75 20 55 6e 69 76 2c |K..(Toho|ku Univ,|
|00004430| 20 4a 61 70 61 6e 29 0d | 0a 43 6c 69 6e 20 45 6e | Japan).|.Clin En|
|00004440| 64 6f 63 72 69 6e 6f 6c | 20 28 4f 78 66 29 20 32 |docrinol| (Oxf) 2|
|00004450| 37 3a 33 33 39 2d 33 34 | 34 2c 20 53 65 70 74 65 |7:339-34|4, Septe|
|00004460| 6d 62 65 72 20 31 39 38 | 37 0d 0a 2d 2d 2d 2d 2d |mber 198|7..-----|
|00004470| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004480| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004490| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000044a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000044b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 50 |--------|---....P|
|000044c0| 72 65 2d 43 6f 6d 6d 65 | 6e 74 0d 0a 0d 0a 20 20 |re-Comme|nt.... |
|000044d0| 20 20 20 54 68 65 20 61 | 70 70 72 6f 70 72 69 61 | The a|ppropria|
|000044e0| 74 65 20 6d 61 6e 61 67 | 65 6d 65 6e 74 20 6f 66 |te manag|ement of|
|000044f0| 20 73 75 62 61 63 75 74 | 65 20 74 68 79 72 6f 69 | subacut|e thyroi|
|00004500| 64 69 74 69 73 20 69 73 | 20 6e 6f 74 20 61 6c 77 |ditis is| not alw|
|00004510| 61 79 73 20 63 6c 65 61 | 72 2d 63 75 74 2e 0d 0a |ays clea|r-cut...|
|00004520| 0d 0a 41 62 73 74 72 61 | 63 74 0d 0a 0d 0a 20 20 |..Abstra|ct.... |
|00004530| 20 20 20 54 77 65 6c 76 | 65 20 70 61 74 69 65 6e | Twelv|e patien|
|00004540| 74 73 20 77 69 74 68 20 | 74 79 70 69 63 61 6c 20 |ts with |typical |
|00004550| 73 75 62 61 63 75 74 65 | 20 74 68 79 72 6f 69 64 |subacute| thyroid|
|00004560| 69 74 69 73 20 70 61 72 | 74 69 63 69 70 61 74 65 |itis par|ticipate|
|00004570| 64 20 69 6e 20 61 20 73 | 74 75 64 79 0d 0a 6f 66 |d in a s|tudy..of|
|00004580| 20 70 72 65 64 6e 69 73 | 6f 6c 6f 6e 65 20 61 6e | prednis|olone an|
|00004590| 64 20 73 61 6c 69 63 79 | 6c 61 74 65 20 74 68 65 |d salicy|late the|
|000045a0| 72 61 70 79 2e 20 20 53 | 69 78 20 70 61 74 69 65 |rapy. S|ix patie|
|000045b0| 6e 74 73 20 77 69 74 68 | 20 6d 69 6c 64 20 73 79 |nts with| mild sy|
|000045c0| 6d 70 74 6f 6d 73 0d 0a | 72 65 63 65 69 76 65 64 |mptoms..|received|
|000045d0| 20 32 20 67 6d 20 6f 66 | 20 73 61 6c 69 63 79 6c | 2 gm of| salicyl|
|000045e0| 61 74 65 20 64 61 69 6c | 79 2c 20 77 68 65 72 65 |ate dail|y, where|
|000045f0| 61 73 20 36 20 6f 74 68 | 65 72 20 70 61 74 69 65 |as 6 oth|er patie|
|00004600| 6e 74 73 20 77 69 74 68 | 20 6d 6f 72 65 20 6d 61 |nts with| more ma|
|00004610| 72 6b 65 64 0d 0a 73 79 | 6d 70 74 6f 6d 73 20 72 |rked..sy|mptoms r|
|00004620| 65 63 65 69 76 65 64 20 | 70 72 65 64 6e 69 73 6f |eceived |predniso|
|00004630| 6c 6f 6e 65 20 69 6e 20 | 64 65 63 72 65 61 73 69 |lone in |decreasi|
|00004640| 6e 67 20 64 6f 73 65 73 | 20 66 72 6f 6d 20 33 30 |ng doses| from 30|
|00004650| 20 74 6f 20 35 20 6d 67 | 20 64 61 69 6c 79 2e 0d | to 5 mg| daily..|
|00004660| 0a 54 72 65 61 74 6d 65 | 6e 74 20 6c 61 73 74 65 |.Treatme|nt laste|
|00004670| 64 20 66 6f 72 20 37 2d | 39 20 77 65 65 6b 73 2e |d for 7-|9 weeks.|
|00004680| 0d 0a 20 20 20 20 20 41 | 6c 6c 20 70 61 74 69 65 |.. A|ll patie|
|00004690| 6e 74 73 20 69 6e 69 74 | 69 61 6c 6c 79 20 68 61 |nts init|ially ha|
|000046a0| 64 20 69 6e 63 72 65 61 | 73 65 64 20 74 68 79 72 |d increa|sed thyr|
|000046b0| 6f 69 64 20 68 6f 72 6d | 6f 6e 65 20 61 6e 64 20 |oid horm|one and |
|000046c0| 74 68 79 72 6f 67 6c 6f | 62 75 6c 69 6e 0d 0a 76 |thyroglo|bulin..v|
|000046d0| 61 6c 75 65 73 2e 20 20 | 56 61 6c 75 65 73 20 64 |alues. |Values d|
|000046e0| 65 63 6c 69 6e 65 64 20 | 77 69 74 68 69 6e 20 61 |eclined |within a|
|000046f0| 62 6f 75 74 20 34 20 77 | 65 65 6b 73 20 69 6e 20 |bout 4 w|eeks in |
|00004700| 62 6f 74 68 20 74 72 65 | 61 74 6d 65 6e 74 20 67 |both tre|atment g|
|00004710| 72 6f 75 70 73 2e 0d 0a | 48 6f 77 65 76 65 72 2c |roups...|However,|
|00004720| 20 74 68 65 20 64 65 63 | 72 65 61 73 65 20 69 6e | the dec|rease in|
|00004730| 20 74 68 79 72 6f 67 6c | 6f 62 75 6c 69 6e 20 77 | thyrogl|obulin w|
|00004740| 61 73 20 64 65 6c 61 79 | 65 64 20 69 6e 20 73 61 |as delay|ed in sa|
|00004750| 6c 69 63 79 6c 61 74 65 | 2d 74 72 65 61 74 65 64 |licylate|-treated|
|00004760| 0d 0a 70 61 74 69 65 6e | 74 73 2c 20 64 65 73 70 |..patien|ts, desp|
|00004770| 69 74 65 20 65 61 72 6c | 79 20 72 65 64 75 63 74 |ite earl|y reduct|
|00004780| 69 6f 6e 73 20 69 6e 20 | 74 68 79 72 6f 69 64 20 |ions in |thyroid |
|00004790| 68 6f 72 6d 6f 6e 65 20 | 6c 65 76 65 6c 73 20 61 |hormone |levels a|
|000047a0| 6e 64 20 74 68 65 0d 0a | 73 65 64 69 6d 65 6e 74 |nd the..|sediment|
|000047b0| 61 74 69 6f 6e 20 72 61 | 74 65 2e 20 20 41 66 74 |ation ra|te. Aft|
|000047c0| 65 72 20 74 68 65 20 65 | 61 72 6c 79 20 70 68 61 |er the e|arly pha|
|000047d0| 73 65 20 6f 66 20 74 72 | 65 61 74 6d 65 6e 74 2c |se of tr|eatment,|
|000047e0| 20 73 65 72 75 6d 20 74 | 68 79 72 6f 67 6c 6f 62 | serum t|hyroglob|
|000047f0| 75 6c 69 6e 0d 0a 6c 65 | 76 65 6c 73 20 77 65 72 |ulin..le|vels wer|
|00004800| 65 20 6c 6f 77 65 72 20 | 69 6e 20 70 72 65 64 6e |e lower |in predn|
|00004810| 69 73 6f 6c 6f 6e 65 2d | 74 72 65 61 74 65 64 20 |isolone-|treated |
|00004820| 70 61 74 69 65 6e 74 73 | 2e 20 20 54 68 79 72 6f |patients|. Thyro|
|00004830| 74 72 6f 70 69 6e 20 6c | 65 76 65 6c 73 0d 0a 69 |tropin l|evels..i|
|00004840| 6e 63 72 65 61 73 65 64 | 20 6f 6e 6c 79 20 73 6c |ncreased| only sl|
|00004850| 69 67 68 74 6c 79 20 69 | 6e 20 70 61 74 69 65 6e |ightly i|n patien|
|00004860| 74 73 20 69 6e 20 62 6f | 74 68 20 67 72 6f 75 70 |ts in bo|th group|
|00004870| 73 2e 0d 0a 20 20 20 20 | 20 50 72 65 64 6e 69 73 |s... | Prednis|
|00004880| 6f 6c 6f 6e 65 20 6d 61 | 79 20 72 61 70 69 64 6c |olone ma|y rapidl|
|00004890| 79 20 6c 6f 77 65 72 20 | 74 68 79 72 6f 67 6c 6f |y lower |thyroglo|
|000048a0| 62 75 6c 69 6e 20 6c 65 | 76 65 6c 73 20 69 6e 20 |bulin le|vels in |
|000048b0| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 0d 0a 73 |patients| with..s|
|000048c0| 75 62 61 63 75 74 65 20 | 74 68 79 72 6f 69 64 69 |ubacute |thyroidi|
|000048d0| 74 69 73 20 62 79 20 69 | 6e 68 69 62 69 74 69 6e |tis by i|nhibitin|
|000048e0| 67 20 69 6e 74 72 61 74 | 68 79 72 6f 69 64 61 6c |g intrat|hyroidal|
|000048f0| 20 68 79 64 72 6f 6c 79 | 73 69 73 2e 20 20 41 20 | hydroly|sis. A |
|00004900| 66 61 6c 6c 20 69 6e 0d | 0a 74 68 79 72 6f 67 6c |fall in.|.thyrogl|
|00004910| 6f 62 75 6c 69 6e 20 61 | 6e 64 20 72 65 73 6f 6c |obulin a|nd resol|
|00004920| 75 74 69 6f 6e 20 6f 66 | 20 74 68 79 72 6f 69 64 |ution of| thyroid|
|00004930| 20 68 6f 72 6d 6f 6e 65 | 20 61 62 6e 6f 72 6d 61 | hormone| abnorma|
|00004940| 6c 69 74 69 65 73 20 63 | 61 6e 20 62 65 20 61 63 |lities c|an be ac|
|00004950| 68 69 65 76 65 64 20 69 | 6e 0d 0a 74 68 65 20 65 |hieved i|n..the e|
|00004960| 61 72 6c 79 20 70 68 61 | 73 65 20 6f 66 20 64 69 |arly pha|se of di|
|00004970| 73 65 61 73 65 20 62 79 | 20 61 64 6d 69 6e 69 73 |sease by| adminis|
|00004980| 74 65 72 69 6e 67 20 70 | 72 65 64 6e 69 73 6f 6c |tering p|rednisol|
|00004990| 6f 6e 65 2e 0d 0a 0d 0a | 50 6f 73 74 2d 43 6f 6d |one.....|Post-Com|
|000049a0| 6d 65 6e 74 0d 0a 0d 0a | 20 20 20 20 20 42 65 63 |ment....| Bec|
|000049b0| 61 75 73 65 20 65 6c 65 | 76 61 74 65 64 20 6c 65 |ause ele|vated le|
|000049c0| 76 65 6c 73 20 6f 66 20 | 73 65 72 75 6d 20 74 68 |vels of |serum th|
|000049d0| 79 72 6f 67 6c 6f 62 75 | 6c 69 6e 20 61 72 65 20 |yroglobu|lin are |
|000049e0| 61 6e 20 69 6e 64 69 63 | 61 74 69 6f 6e 20 6f 66 |an indic|ation of|
|000049f0| 0d 0a 63 65 6c 6c 75 6c | 61 72 20 64 61 6d 61 67 |..cellul|ar damag|
|00004a00| 65 20 69 6e 20 73 75 62 | 61 63 75 74 65 20 74 68 |e in sub|acute th|
|00004a10| 79 72 6f 69 64 69 74 69 | 73 2c 20 69 74 20 69 73 |yroiditi|s, it is|
|00004a20| 20 6c 6f 67 69 63 61 6c | 20 74 6f 20 61 73 73 75 | logical| to assu|
|00004a30| 6d 65 20 74 68 61 74 20 | 74 68 65 20 6d 6f 72 65 |me that |the more|
|00004a40| 0d 0a 72 61 70 69 64 20 | 72 65 74 75 72 6e 20 6f |..rapid |return o|
|00004a50| 66 20 74 68 79 72 6f 67 | 6c 6f 62 75 6c 69 6e 20 |f thyrog|lobulin |
|00004a60| 6c 65 76 65 6c 73 20 74 | 6f 20 6e 6f 72 6d 61 6c |levels t|o normal|
|00004a70| 20 61 66 74 65 72 20 67 | 6c 75 63 6f 63 6f 72 74 | after g|lucocort|
|00004a80| 69 63 6f 69 64 20 74 68 | 65 72 61 70 79 0d 0a 69 |icoid th|erapy..i|
|00004a90| 6e 64 69 63 61 74 65 73 | 20 6d 6f 72 65 20 72 61 |ndicates| more ra|
|00004aa0| 70 69 64 20 68 65 61 6c | 69 6e 67 20 6f 66 20 74 |pid heal|ing of t|
|00004ab0| 68 65 20 69 6e 66 6c 61 | 6d 6d 61 74 6f 72 79 20 |he infla|mmatory |
|00004ac0| 70 72 6f 63 65 73 73 2e | 20 20 48 6f 77 65 76 65 |process.| Howeve|
|00004ad0| 72 2c 20 74 68 79 72 6f | 69 64 0d 0a 66 75 6e 63 |r, thyro|id..func|
|00004ae0| 74 69 6f 6e 20 74 65 73 | 74 73 20 69 6d 70 72 6f |tion tes|ts impro|
|00004af0| 76 65 64 20 65 71 75 61 | 6c 6c 79 20 77 69 74 68 |ved equa|lly with|
|00004b00| 20 62 6f 74 68 20 74 68 | 65 72 61 70 69 65 73 2c | both th|erapies,|
|00004b10| 20 61 6e 64 20 69 74 20 | 6d 61 6b 65 73 20 73 65 | and it |makes se|
|00004b20| 6e 73 65 20 74 6f 20 6d | 65 20 74 6f 0d 0a 74 72 |nse to m|e to..tr|
|00004b30| 65 61 74 20 61 6c 6c 20 | 70 61 74 69 65 6e 74 73 |eat all |patients|
|00004b40| 20 69 6e 69 74 69 61 6c | 6c 79 20 77 69 74 68 20 | initial|ly with |
|00004b50| 73 61 6c 69 63 79 6c 61 | 74 65 73 20 61 6e 64 20 |salicyla|tes and |
|00004b60| 74 6f 20 72 65 73 65 72 | 76 65 20 67 6c 75 63 6f |to reser|ve gluco|
|00004b70| 63 6f 72 74 69 63 6f 69 | 64 0d 0a 74 68 65 72 61 |corticoi|d..thera|
|00004b80| 70 79 20 66 6f 72 20 74 | 68 6f 73 65 20 77 68 6f |py for t|hose who|
|00004b90| 20 64 6f 20 6e 6f 74 20 | 72 65 73 70 6f 6e 64 20 | do not |respond |
|00004ba0| 70 72 6f 6d 70 74 6c 79 | 2e 20 20 49 74 20 69 73 |promptly|. It is|
|00004bb0| 20 6d 79 20 69 6d 70 72 | 65 73 73 69 6f 6e 20 74 | my impr|ession t|
|00004bc0| 68 61 74 0d 0a 65 78 61 | 63 65 72 62 61 74 69 6f |hat..exa|cerbatio|
|00004bd0| 6e 20 66 6f 6c 6c 6f 77 | 69 6e 67 20 63 65 73 73 |n follow|ing cess|
|00004be0| 61 74 69 6f 6e 20 6f 66 | 20 74 68 65 72 61 70 79 |ation of| therapy|
|00004bf0| 20 69 73 20 6c 65 73 73 | 20 63 6f 6d 6d 6f 6e 20 | is less| common |
|00004c00| 61 66 74 65 72 20 73 61 | 6c 69 63 79 6c 61 74 65 |after sa|licylate|
|00004c10| 20 74 68 61 6e 0d 0a 61 | 66 74 65 72 20 67 6c 75 | than..a|fter glu|
|00004c20| 63 6f 63 6f 72 74 69 63 | 6f 69 64 20 74 68 65 72 |cocortic|oid ther|
|00004c30| 61 70 79 2c 20 70 6f 73 | 73 69 62 6c 79 20 62 65 |apy, pos|sibly be|
|00004c40| 63 61 75 73 65 20 67 6c | 75 63 6f 63 6f 72 74 69 |cause gl|ucocorti|
|00004c50| 63 6f 69 64 20 74 68 65 | 72 61 70 79 20 69 73 20 |coid the|rapy is |
|00004c60| 75 73 75 61 6c 6c 79 0d | 0a 73 74 6f 70 70 65 64 |usually.|.stopped|
|00004c70| 20 65 61 72 6c 69 65 72 | 20 69 6e 20 74 68 65 20 | earlier| in the |
|00004c80| 63 6f 75 72 73 65 2e 2d | 2d 4a 2e 44 2e 20 57 69 |course.-|-J.D. Wi|
|00004c90| 6c 73 6f 6e 2c 20 4d 2e | 44 2e 0d 0a 24 55 6e 69 |lson, M.|D...$Uni|
|00004ca0| 71 75 65 5f 49 44 7b 59 | 52 42 30 36 39 30 35 7d |que_ID{Y|RB06905}|
|00004cb0| 0d 0a 24 54 69 74 6c 65 | 7b 50 61 70 69 6c 6c 61 |..$Title|{Papilla|
|00004cc0| 72 79 20 61 6e 64 20 46 | 6f 6c 6c 69 63 75 6c 61 |ry and F|ollicula|
|00004cd0| 72 20 54 68 79 72 6f 69 | 64 20 43 61 6e 63 65 72 |r Thyroi|d Cancer|
|00004ce0| 3a 20 20 50 72 6f 67 6e | 6f 73 74 69 63 20 46 61 |: Progn|ostic Fa|
|00004cf0| 63 74 6f 72 73 20 69 6e | 20 31 2c 35 37 38 20 50 |ctors in| 1,578 P|
|00004d00| 61 74 69 65 6e 74 73 7d | 0d 0a 24 41 75 74 68 6f |atients}|..$Autho|
|00004d10| 72 7b 53 69 6d 70 73 6f | 6e 2c 20 57 4a 0d 0a 4d |r{Simpso|n, WJ..M|
|00004d20| 63 4b 69 6e 6e 65 79 2c | 20 53 45 0d 0a 43 61 72 |cKinney,| SE..Car|
|00004d30| 72 75 74 68 65 72 73 2c | 20 4a 53 0d 0a 47 6f 73 |ruthers,| JS..Gos|
|00004d40| 70 6f 64 61 72 6f 77 69 | 63 7a 2c 20 4d 4b 0d 0a |podarowi|cz, MK..|
|00004d50| 53 75 74 63 6c 69 66 66 | 65 2c 20 53 42 0d 0a 50 |Sutcliff|e, SB..P|
|00004d60| 61 6e 7a 61 72 65 6c 6c | 61 2c 20 54 7d 0d 0a 24 |anzarell|a, T}..$|
|00004d70| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 50 72 69 6e |Affiliat|ion{Prin|
|00004d80| 63 65 73 73 20 4d 61 72 | 67 61 72 65 74 20 48 6f |cess Mar|garet Ho|
|00004d90| 73 70 2c 20 54 6f 72 6f | 6e 74 6f 3b 20 55 6e 69 |sp, Toro|nto; Uni|
|00004da0| 76 20 6f 66 20 54 6f 72 | 6f 6e 74 6f 3b 20 4f 6e |v of Tor|onto; On|
|00004db0| 74 61 72 69 6f 20 43 61 | 6e 63 65 72 20 49 6e 73 |tario Ca|ncer Ins|
|00004dc0| 74 2c 20 54 6f 72 6f 6e | 74 6f 7d 0d 0a 24 53 75 |t, Toron|to}..$Su|
|00004dd0| 62 6a 65 63 74 7b 54 68 | 79 72 6f 69 64 20 61 73 |bject{Th|yroid as|
|00004de0| 70 69 72 61 74 69 6f 6e | 20 6f 66 2c 20 66 69 6e |piration| of, fin|
|00004df0| 65 20 6e 65 65 64 6c 65 | 2c 20 35 31 34 20 63 61 |e needle|, 514 ca|
|00004e00| 6e 63 65 72 2c 20 70 61 | 70 69 6c 6c 61 72 79 20 |ncer, pa|pillary |
|00004e10| 61 6e 64 20 66 6f 6c 6c | 69 63 75 6c 61 72 2c 20 |and foll|icular, |
|00004e20| 70 72 6f 67 6e 6f 73 69 | 73 3b 0d 0a 43 61 6e 63 |prognosi|s;..Canc|
|00004e30| 65 72 20 74 68 79 72 6f | 69 64 2c 20 70 61 70 69 |er thyro|id, papi|
|00004e40| 6c 6c 61 72 79 20 61 6e | 64 20 66 6f 6c 6c 69 63 |llary an|d follic|
|00004e50| 75 6c 61 72 2c 20 70 72 | 6f 67 6e 6f 73 69 73 7d |ular, pr|ognosis}|
|00004e60| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 41 6d 20 4a 20 |..$Journ|al{Am J |
|00004e70| 4d 65 64 7d 0d 0a 24 56 | 6f 6c 75 6d 65 7b 38 33 |Med}..$V|olume{83|
|00004e80| 7d 0d 0a 24 50 61 67 65 | 7b 34 37 39 2d 34 38 38 |}..$Page|{479-488|
|00004e90| 7d 0d 0a 24 44 61 74 65 | 7b 53 65 70 74 65 6d 62 |}..$Date|{Septemb|
|00004ea0| 65 72 20 31 39 38 37 7d | 0d 0a 24 59 42 56 6f 6c |er 1987}|..$YBVol|
|00004eb0| 7b 31 39 38 39 20 59 65 | 61 72 20 42 6f 6f 6b 20 |{1989 Ye|ar Book |
|00004ec0| 6f 66 20 4d 65 64 69 63 | 69 6e 65 2c 20 50 61 72 |of Medic|ine, Par|
|00004ed0| 74 20 53 69 78 7d 0d 0a | 24 43 68 61 70 74 65 72 |t Six}..|$Chapter|
|00004ee0| 7b 34 35 2d 37 7d 0d 0a | 24 59 42 45 64 69 74 6f |{45-7}..|$YBEdito|
|00004ef0| 72 7b 44 72 73 2e 20 52 | 6f 67 65 72 73 2c 20 44 |r{Drs. R|ogers, D|
|00004f00| 65 73 20 50 72 65 7a 2c | 20 43 6c 69 6e 65 2c 20 |es Prez,| Cline, |
|00004f10| 42 72 61 75 6e 77 61 6c | 64 2c 20 47 72 65 65 6e |Braunwal|d, Green|
|00004f20| 62 65 72 67 65 72 2c 20 | 57 69 6c 73 6f 6e 2c 20 |berger, |Wilson, |
|00004f30| 45 70 73 74 65 69 6e 2c | 20 61 6e 64 20 4d 61 6c |Epstein,| and Mal|
|00004f40| 61 77 69 73 74 61 7d 0d | 0a 24 54 61 62 6c 65 7b |awista}.|.$Table{|
|00004f50| 7d 0d 0a 24 43 6f 6d 6d | 65 6e 74 61 74 6f 72 7b |}..$Comm|entator{|
|00004f60| 4a 2e 44 2e 20 57 69 6c | 73 6f 6e 2c 20 4d 2e 44 |J.D. Wil|son, M.D|
|00004f70| 2e 7d 0d 0a 0d 0a 43 6f | 70 79 72 69 67 68 74 20 |.}....Co|pyright |
|00004f80| 28 63 29 20 59 65 61 72 | 20 42 6f 6f 6b 20 4d 65 |(c) Year| Book Me|
|00004f90| 64 69 63 61 6c 20 50 75 | 62 6c 69 73 68 65 72 73 |dical Pu|blishers|
|00004fa0| 2c 20 49 6e 63 2e 2c 20 | 31 39 38 39 0d 0a 0d 0a |, Inc., |1989....|
|00004fb0| 31 39 38 39 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1989 Yea|r Book o|
|00004fc0| 66 20 4d 65 64 69 63 69 | 6e 65 20 28 52 29 0d 0a |f Medici|ne (R)..|
|00004fd0| 0d 0a 50 61 72 74 20 53 | 69 78 3a 20 20 45 6e 64 |..Part S|ix: End|
|00004fe0| 6f 63 72 69 6e 6f 6c 6f | 67 79 20 61 6e 64 20 4d |ocrinolo|gy and M|
|00004ff0| 65 74 61 62 6f 6c 69 73 | 6d 0d 0a 0d 0a 43 68 61 |etabolis|m....Cha|
|00005000| 70 74 65 72 20 34 35 2d | 2d 54 68 65 20 54 68 79 |pter 45-|-The Thy|
|00005010| 72 6f 69 64 0d 0a 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |roid....|--------|
|00005020| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005030| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005040| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005050| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005060| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 50 61 70 69 6c 6c |--------|..Papill|
|00005070| 61 72 79 20 61 6e 64 20 | 46 6f 6c 6c 69 63 75 6c |ary and |Follicul|
|00005080| 61 72 20 54 68 79 72 6f | 69 64 20 43 61 6e 63 65 |ar Thyro|id Cance|
|00005090| 72 3a 20 20 50 72 6f 67 | 6e 6f 73 74 69 63 20 46 |r: Prog|nostic F|
|000050a0| 61 63 74 6f 72 73 20 69 | 6e 20 31 2c 35 37 38 20 |actors i|n 1,578 |
|000050b0| 50 61 74 69 65 6e 74 73 | 0d 0a 0d 0a 53 69 6d 70 |Patients|....Simp|
|000050c0| 73 6f 6e 20 57 4a 2c 20 | 4d 63 4b 69 6e 6e 65 79 |son WJ, |McKinney|
|000050d0| 20 53 45 2c 20 43 61 72 | 72 75 74 68 65 72 73 20 | SE, Car|ruthers |
|000050e0| 4a 53 2c 20 47 6f 73 70 | 6f 64 61 72 6f 77 69 63 |JS, Gosp|odarowic|
|000050f0| 7a 20 4d 4b 2c 20 53 75 | 74 63 6c 69 66 66 65 20 |z MK, Su|tcliffe |
|00005100| 53 42 2c 20 61 6e 64 0d | 0a 50 61 6e 7a 61 72 65 |SB, and.|.Panzare|
|00005110| 6c 6c 61 20 54 0d 0a 28 | 50 72 69 6e 63 65 73 73 |lla T..(|Princess|
|00005120| 20 4d 61 72 67 61 72 65 | 74 20 48 6f 73 70 2c 20 | Margare|t Hosp, |
|00005130| 54 6f 72 6f 6e 74 6f 3b | 20 55 6e 69 76 20 6f 66 |Toronto;| Univ of|
|00005140| 20 54 6f 72 6f 6e 74 6f | 3b 20 4f 6e 74 61 72 69 | Toronto|; Ontari|
|00005150| 6f 20 43 61 6e 63 65 72 | 20 49 6e 73 74 2c 0d 0a |o Cancer| Inst,..|
|00005160| 54 6f 72 6f 6e 74 6f 29 | 0d 0a 41 6d 20 4a 20 4d |Toronto)|..Am J M|
|00005170| 65 64 20 38 33 3a 34 37 | 39 2d 34 38 38 2c 20 53 |ed 83:47|9-488, S|
|00005180| 65 70 74 65 6d 62 65 72 | 20 31 39 38 37 0d 0a 2d |eptember| 1987..-|
|00005190| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000051a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000051b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000051c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000051d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|000051e0| 0a 0d 0a 50 72 65 2d 63 | 6f 6d 6d 65 6e 74 0d 0a |...Pre-c|omment..|
|000051f0| 0d 0a 20 20 20 20 20 53 | 6f 2d 63 61 6c 6c 65 64 |.. S|o-called|
|00005200| 20 70 72 6f 67 6e 6f 73 | 74 69 63 20 66 61 63 74 | prognos|tic fact|
|00005210| 6f 72 73 20 61 72 65 20 | 6e 6f 74 20 75 73 75 61 |ors are |not usua|
|00005220| 6c 6c 79 20 68 65 6c 70 | 66 75 6c 20 69 6e 20 74 |lly help|ful in t|
|00005230| 68 65 20 6d 61 6e 61 67 | 65 6d 65 6e 74 20 6f 66 |he manag|ement of|
|00005240| 0d 0a 69 6e 64 69 76 69 | 64 75 61 6c 20 70 61 74 |..indivi|dual pat|
|00005250| 69 65 6e 74 73 2e 20 62 | 75 74 20 74 68 65 20 66 |ients. b|ut the f|
|00005260| 6f 6c 6c 6f 77 69 6e 67 | 20 70 61 70 65 72 20 69 |ollowing| paper i|
|00005270| 73 20 61 20 63 6c 65 61 | 72 20 65 78 63 65 70 74 |s a clea|r except|
|00005280| 69 6f 6e 20 74 6f 20 74 | 68 69 73 20 72 75 6c 65 |ion to t|his rule|
|00005290| 2e 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |.....Abs|tract...|
|000052a0| 0a 20 20 20 20 20 54 6f | 20 64 65 74 65 72 6d 69 |. To| determi|
|000052b0| 6e 65 20 74 68 65 20 72 | 65 6c 61 74 69 76 65 20 |ne the r|elative |
|000052c0| 69 6d 70 6f 72 74 61 6e | 63 65 20 6f 66 20 76 61 |importan|ce of va|
|000052d0| 72 69 6f 75 73 20 70 72 | 6f 67 6e 6f 73 74 69 63 |rious pr|ognostic|
|000052e0| 61 74 6f 72 73 2c 20 31 | 2c 30 37 34 0d 0a 70 61 |ators, 1|,074..pa|
|000052f0| 74 69 65 6e 74 73 20 77 | 69 74 68 20 70 61 70 69 |tients w|ith papi|
|00005300| 6c 6c 61 72 79 20 74 68 | 79 72 6f 69 64 20 63 61 |llary th|yroid ca|
|00005310| 6e 63 65 72 20 61 6e 64 | 20 35 30 34 20 77 69 74 |ncer and| 504 wit|
|00005320| 68 20 66 6f 6c 6c 69 63 | 75 6c 61 72 20 74 68 79 |h follic|ular thy|
|00005330| 72 6f 69 64 20 63 61 6e | 63 65 72 0d 0a 77 65 72 |roid can|cer..wer|
|00005340| 65 20 61 73 73 65 73 73 | 65 64 20 72 65 74 72 6f |e assess|ed retro|
|00005350| 73 70 65 63 74 69 76 65 | 6c 79 2e 20 20 54 77 65 |spective|ly. Twe|
|00005360| 6c 76 65 20 70 6f 73 73 | 69 62 6c 65 20 70 72 6f |lve poss|ible pro|
|00005370| 67 6e 6f 73 74 69 63 20 | 66 61 63 74 6f 72 73 20 |gnostic |factors |
|00005380| 77 65 72 65 0d 0a 69 6e | 76 65 73 74 69 67 61 74 |were..in|vestigat|
|00005390| 65 64 20 75 73 69 6e 67 | 20 75 6e 69 76 61 72 69 |ed using| univari|
|000053a0| 61 74 65 20 61 6e 61 6c | 79 73 69 73 2e 20 20 4d |ate anal|ysis. M|
|000053b0| 75 6c 74 69 76 61 72 69 | 61 74 65 20 61 6e 61 6c |ultivari|ate anal|
|000053c0| 79 73 69 73 20 61 6c 73 | 6f 20 77 61 73 20 63 61 |ysis als|o was ca|
|000053d0| 72 72 69 65 64 0d 0a 6f | 75 74 20 75 73 69 6e 67 |rried..o|ut using|
|000053e0| 20 63 61 75 73 65 2d 73 | 70 65 63 69 66 69 63 20 | cause-s|pecific |
|000053f0| 73 75 72 76 69 76 61 6c | 20 72 61 74 65 73 2e 20 |survival| rates. |
|00005400| 20 44 61 74 61 20 77 65 | 72 65 20 74 68 65 6e 20 | Data we|re then |
|00005410| 72 65 65 78 61 6d 69 6e | 65 64 20 62 79 0d 0a 6d |reexamin|ed by..m|
|00005420| 75 6c 74 69 76 61 72 69 | 61 74 65 20 61 6e 61 6c |ultivari|ate anal|
|00005430| 79 73 69 73 20 75 73 69 | 6e 67 20 63 61 75 73 65 |ysis usi|ng cause|
|00005440| 2d 73 70 65 63 69 66 69 | 63 20 64 65 61 74 68 20 |-specifi|c death |
|00005450| 61 73 20 74 68 65 20 63 | 72 69 74 65 72 69 6f 6e |as the c|riterion|
|00005460| 2e 0d 0a 20 20 20 20 20 | 4f 6e 20 75 6e 69 76 61 |... |On univa|
|00005470| 72 69 61 74 65 20 61 6e | 61 6c 79 73 69 73 2c 20 |riate an|alysis, |
|00005480| 69 6e 20 64 65 73 63 65 | 6e 64 69 6e 67 20 6f 72 |in desce|nding or|
|00005490| 64 65 72 20 6f 66 20 69 | 6d 70 6f 72 74 61 6e 63 |der of i|mportanc|
|000054a0| 65 2c 20 70 6f 73 74 6f | 70 65 72 61 74 69 76 65 |e, posto|perative|
|000054b0| 0d 0a 73 74 61 74 75 73 | 2c 20 61 67 65 20 61 74 |..status|, age at|
|000054c0| 20 64 69 61 67 6e 6f 73 | 69 73 2c 20 65 78 74 72 | diagnos|is, extr|
|000054d0| 61 74 68 79 72 6f 69 64 | 61 6c 20 69 6e 76 61 73 |athyroid|al invas|
|000054e0| 69 6f 6e 2c 20 64 69 73 | 74 61 6e 74 20 6d 65 74 |ion, dis|tant met|
|000054f0| 61 73 74 61 73 65 73 2c | 20 6e 6f 64 61 6c 0d 0a |astases,| nodal..|
|00005500| 69 6e 76 6f 6c 76 65 6d | 65 6e 74 2c 20 64 69 66 |involvem|ent, dif|
|00005510| 66 65 72 65 6e 74 69 61 | 74 69 6f 6e 2c 20 73 65 |ferentia|tion, se|
|00005520| 78 2c 20 74 75 6d 6f 72 | 20 73 69 7a 65 2c 20 61 |x, tumor| size, a|
|00005530| 6e 64 20 70 61 74 68 6f | 6c 6f 67 69 63 20 74 79 |nd patho|logic ty|
|00005540| 70 65 20 77 65 72 65 0d | 0a 73 74 61 74 69 73 74 |pe were.|.statist|
|00005550| 69 63 61 6c 6c 79 20 73 | 69 67 6e 69 66 69 63 61 |ically s|ignifica|
|00005560| 6e 74 2e 20 20 4f 6e 20 | 6d 75 6c 74 69 76 61 72 |nt. On |multivar|
|00005570| 69 61 74 65 20 61 6e 61 | 6c 79 73 69 73 20 75 73 |iate ana|lysis us|
|00005580| 69 6e 67 20 63 61 75 73 | 65 2d 73 70 65 63 69 66 |ing caus|e-specif|
|00005590| 69 63 0d 0a 73 75 72 76 | 69 76 61 6c 20 72 61 74 |ic..surv|ival rat|
|000055a0| 65 73 2c 20 69 6e 64 65 | 70 65 6e 64 65 6e 74 6c |es, inde|pendentl|
|000055b0| 79 20 69 6d 70 6f 72 74 | 61 6e 74 20 70 72 65 64 |y import|ant pred|
|000055c0| 69 63 74 69 76 65 20 66 | 61 63 74 6f 72 73 20 69 |ictive f|actors i|
|000055d0| 6e 20 70 61 70 69 6c 6c | 61 72 79 2d 63 61 6e 63 |n papill|ary-canc|
|000055e0| 65 72 0d 0a 70 61 74 69 | 65 6e 74 73 20 77 65 72 |er..pati|ents wer|
|000055f0| 65 20 61 67 65 20 61 74 | 20 64 69 61 67 6e 6f 73 |e age at| diagnos|
|00005600| 69 73 2c 20 65 78 74 72 | 61 74 68 79 72 6f 69 64 |is, extr|athyroid|
|00005610| 61 6c 20 69 6e 76 61 73 | 69 6f 6e 2c 20 61 6e 64 |al invas|ion, and|
|00005620| 20 68 69 73 74 6f 6c 6f | 67 69 63 0d 0a 64 69 66 | histolo|gic..dif|
|00005630| 66 65 72 65 6e 74 69 61 | 74 69 6f 6e 2e 20 20 49 |ferentia|tion. I|
|00005640| 6e 20 70 61 74 69 65 6e | 74 73 20 77 69 74 68 20 |n patien|ts with |
|00005650| 66 6f 6c 6c 69 63 75 6c | 61 72 20 63 61 6e 63 65 |follicul|ar cance|
|00005660| 72 2c 20 66 61 63 74 6f | 72 73 20 77 65 72 65 0d |r, facto|rs were.|
|00005670| 0a 65 78 74 72 61 74 68 | 79 72 6f 69 64 61 6c 20 |.extrath|yroidal |
|00005680| 69 6e 76 61 73 69 6f 6e | 2c 20 64 69 73 74 61 6e |invasion|, distan|
|00005690| 74 20 6d 65 74 61 73 74 | 61 73 65 73 2c 20 70 72 |t metast|ases, pr|
|000056a0| 69 6d 61 72 79 20 74 75 | 6d 6f 72 20 73 69 7a 65 |imary tu|mor size|
|000056b0| 2c 20 6e 6f 64 61 6c 0d | 0a 69 6e 76 6f 6c 76 65 |, nodal.|.involve|
|000056c0| 6d 65 6e 74 2c 20 61 67 | 65 20 61 74 20 64 69 61 |ment, ag|e at dia|
|000056d0| 67 6e 6f 73 69 73 2c 20 | 61 6e 64 20 70 6f 73 74 |gnosis, |and post|
|000056e0| 6f 70 65 72 61 74 69 76 | 65 20 73 74 61 74 75 73 |operativ|e status|
|000056f0| 2e 20 20 4f 6e 20 6d 75 | 6c 74 69 76 61 72 69 61 |. On mu|ltivaria|
|00005700| 74 65 0d 0a 61 6e 61 6c | 79 73 69 73 20 75 73 69 |te..anal|ysis usi|
|00005710| 6e 67 20 63 61 75 73 65 | 2d 73 70 65 63 69 66 69 |ng cause|-specifi|
|00005720| 63 20 64 65 61 74 68 2c | 20 68 6f 77 65 76 65 72 |c death,| however|
|00005730| 2c 20 6f 6e 6c 79 20 61 | 67 65 20 61 74 20 64 69 |, only a|ge at di|
|00005740| 61 67 6e 6f 73 69 73 2c | 0d 0a 65 78 74 72 61 74 |agnosis,|..extrat|
|00005750| 68 79 72 6f 69 64 61 6c | 20 69 6e 76 61 73 69 6f |hyroidal| invasio|
|00005760| 6e 2c 20 61 6e 64 20 64 | 69 66 66 65 72 65 6e 74 |n, and d|ifferent|
|00005770| 69 61 74 69 6f 6e 20 77 | 65 72 65 20 70 72 65 64 |iation w|ere pred|
|00005780| 69 63 74 69 76 65 20 6f | 66 20 73 75 72 76 69 76 |ictive o|f surviv|
|00005790| 61 6c 20 69 6e 0d 0a 70 | 61 74 69 65 6e 74 73 20 |al in..p|atients |
|000057a0| 77 69 74 68 20 70 61 70 | 69 6c 6c 61 72 79 20 63 |with pap|illary c|
|000057b0| 61 6e 63 65 72 2e 20 20 | 49 6e 20 70 61 74 69 65 |ancer. |In patie|
|000057c0| 6e 74 73 20 77 69 74 68 | 20 66 6f 6c 6c 69 63 75 |nts with| follicu|
|000057d0| 6c 61 72 20 63 61 6e 63 | 65 72 2c 20 36 20 66 61 |lar canc|er, 6 fa|
|000057e0| 63 74 6f 72 73 0d 0a 65 | 6d 65 72 67 65 64 2c 20 |ctors..e|merged, |
|000057f0| 77 69 74 68 20 65 78 74 | 72 61 74 68 79 72 6f 69 |with ext|rathyroi|
|00005800| 64 61 6c 20 69 6e 76 61 | 73 69 6f 6e 20 74 68 65 |dal inva|sion the|
|00005810| 20 6d 6f 73 74 20 69 6d | 70 6f 72 74 61 6e 74 2c | most im|portant,|
|00005820| 20 66 6f 6c 6c 6f 77 65 | 64 20 62 79 20 64 69 73 | followe|d by dis|
|00005830| 74 61 6e 74 0d 0a 6d 65 | 74 61 73 74 61 73 65 73 |tant..me|tastases|
|00005840| 20 61 6e 64 20 70 72 69 | 6d 61 72 79 20 74 75 6d | and pri|mary tum|
|00005850| 6f 72 20 73 69 7a 65 2e | 20 20 4e 6f 64 61 6c 20 |or size.| Nodal |
|00005860| 69 6e 76 6f 6c 76 65 6d | 65 6e 74 2c 20 61 67 65 |involvem|ent, age|
|00005870| 2c 20 61 6e 64 20 70 72 | 65 73 65 6e 63 65 20 6f |, and pr|esence o|
|00005880| 66 0d 0a 67 72 6f 73 73 | 20 72 65 73 69 64 75 61 |f..gross| residua|
|00005890| 6c 20 64 69 73 65 61 73 | 65 20 77 65 72 65 20 6c |l diseas|e were l|
|000058a0| 65 73 73 20 69 6d 70 6f | 72 74 61 6e 74 20 62 75 |ess impo|rtant bu|
|000058b0| 74 20 73 74 69 6c 6c 20 | 73 74 61 74 69 73 74 69 |t still |statisti|
|000058c0| 63 61 6c 6c 79 20 73 69 | 67 6e 69 66 69 63 61 6e |cally si|gnifican|
|000058d0| 74 2e 0d 0a 20 20 20 20 | 20 4d 6f 73 74 20 70 72 |t... | Most pr|
|000058e0| 65 76 69 6f 75 73 6c 79 | 20 72 65 70 6f 72 74 65 |eviously| reporte|
|000058f0| 64 20 70 72 6f 67 6e 6f | 73 74 69 63 20 66 61 63 |d progno|stic fac|
|00005900| 74 6f 72 73 20 61 72 65 | 20 69 6d 70 6f 72 74 61 |tors are| importa|
|00005910| 6e 74 2c 20 62 75 74 20 | 6e 6f 74 20 65 71 75 61 |nt, but |not equa|
|00005920| 6c 6c 79 0d 0a 73 6f 2e | 20 20 50 68 79 73 69 63 |lly..so.| Physic|
|00005930| 69 61 6e 73 20 73 68 6f | 75 6c 64 20 63 6f 6e 73 |ians sho|uld cons|
|00005940| 69 64 65 72 20 74 68 65 | 20 72 65 6c 65 76 61 6e |ider the| relevan|
|00005950| 63 65 20 6f 66 20 74 68 | 65 73 65 20 70 72 65 64 |ce of th|ese pred|
|00005960| 69 63 74 69 76 65 20 64 | 61 74 61 20 69 6e 20 74 |ictive d|ata in t|
|00005970| 68 65 0d 0a 70 6f 73 74 | 6f 70 65 72 61 74 69 76 |he..post|operativ|
|00005980| 65 20 6d 61 6e 61 67 65 | 6d 65 6e 74 20 6f 66 20 |e manage|ment of |
|00005990| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 70 61 |patients| with pa|
|000059a0| 70 69 6c 6c 61 72 79 20 | 6f 72 20 66 6f 6c 6c 69 |pillary |or folli|
|000059b0| 63 75 6c 61 72 20 63 61 | 6e 63 65 72 73 2e 0d 0a |cular ca|ncers...|
|000059c0| 0d 0a 50 6f 73 74 2d 43 | 6f 6d 6d 65 6e 74 0d 0a |..Post-C|omment..|
|000059d0| 0d 0a 20 20 20 20 20 50 | 72 6f 76 69 64 65 64 20 |.. P|rovided |
|000059e0| 74 68 65 72 65 20 69 73 | 20 6e 6f 20 6c 6f 63 61 |there is| no loca|
|000059f0| 6c 20 65 78 74 65 6e 73 | 69 6f 6e 20 6f 66 20 74 |l extens|ion of t|
|00005a00| 68 65 20 74 75 6d 6f 72 | 20 61 6e 64 20 6e 6f 20 |he tumor| and no |
|00005a10| 6c 79 6d 70 68 20 6e 6f | 64 65 0d 0a 6d 65 74 61 |lymph no|de..meta|
|00005a20| 73 74 61 73 65 73 2c 20 | 32 30 2d 79 65 61 72 20 |stases, |20-year |
|00005a30| 73 75 72 76 69 76 61 6c | 20 61 70 70 72 6f 61 63 |survival| approac|
|00005a40| 68 65 73 20 39 30 25 2e | 20 20 49 6e 20 63 6f 6e |hes 90%.| In con|
|00005a50| 74 72 61 73 74 2c 20 64 | 69 66 66 65 72 65 6e 74 |trast, d|ifferent|
|00005a60| 69 61 74 65 64 0d 0a 74 | 68 79 72 6f 69 64 20 63 |iated..t|hyroid c|
|00005a70| 61 72 63 69 6e 6f 6d 61 | 20 69 6e 20 63 68 69 6c |arcinoma| in chil|
|00005a80| 64 72 65 6e 20 63 61 72 | 72 69 65 73 20 61 20 77 |dren car|ries a w|
|00005a90| 6f 72 73 65 20 70 72 6f | 67 6e 6f 73 69 73 2e 20 |orse pro|gnosis. |
|00005aa0| 5b 31 5d 20 20 53 74 61 | 67 65 20 6f 66 20 64 69 |[1] Sta|ge of di|
|00005ab0| 73 65 61 73 65 0d 0a 69 | 73 20 61 6c 73 6f 20 61 |sease..i|s also a|
|00005ac0| 20 6d 61 6a 6f 72 20 70 | 72 6f 67 6e 6f 73 74 69 | major p|rognosti|
|00005ad0| 63 20 66 61 63 74 6f 72 | 20 69 6e 20 6d 65 64 75 |c factor| in medu|
|00005ae0| 6c 6c 61 72 79 20 63 61 | 72 63 69 6e 6f 6d 61 2e |llary ca|rcinoma.|
|00005af0| 20 5b 32 5d 20 20 49 74 | 20 69 73 20 61 6c 73 6f | [2] It| is also|
|00005b00| 20 63 6c 65 61 72 0d 0a | 74 68 61 74 20 74 68 65 | clear..|that the|
|00005b10| 20 67 65 6f 67 72 61 70 | 68 69 63 61 6c 20 61 72 | geograp|hical ar|
|00005b20| 65 61 20 69 6e 20 77 68 | 69 63 68 20 6f 6e 65 20 |ea in wh|ich one |
|00005b30| 6c 69 76 65 73 20 70 6c | 61 79 73 20 61 20 72 6f |lives pl|ays a ro|
|00005b40| 6c 65 20 69 6e 20 74 68 | 65 20 6f 76 65 72 61 6c |le in th|e overal|
|00005b50| 6c 0d 0a 69 6d 70 6f 72 | 74 61 6e 63 65 20 6f 66 |l..impor|tance of|
|00005b60| 20 70 72 6f 67 6e 6f 73 | 74 69 63 20 66 61 63 74 | prognos|tic fact|
|00005b70| 6f 72 73 2c 20 70 65 72 | 73 6f 6e 73 20 66 72 6f |ors, per|sons fro|
|00005b80| 6d 20 69 6f 64 69 6e 65 | 2d 64 65 66 69 63 69 65 |m iodine|-deficie|
|00005b90| 6e 74 20 61 72 65 61 73 | 20 77 69 74 68 20 63 6f |nt areas| with co|
|00005ba0| 6c 64 0d 0a 6e 6f 64 75 | 6c 65 73 20 62 65 69 6e |ld..nodu|les bein|
|00005bb0| 67 20 6c 65 73 73 20 6c | 69 6b 65 6c 79 20 74 6f |g less l|ikely to|
|00005bc0| 20 68 61 76 65 20 74 68 | 79 72 6f 69 64 20 6d 61 | have th|yroid ma|
|00005bd0| 6c 69 67 6e 61 6e 63 79 | 2e 20 5b 33 5d 20 20 57 |lignancy|. [3] W|
|00005be0| 69 74 68 20 72 65 67 61 | 72 64 20 74 6f 20 74 68 |ith rega|rd to th|
|00005bf0| 65 0d 0a 63 6f 6e 73 65 | 72 76 61 74 69 76 65 20 |e..conse|rvative |
|00005c00| 6d 61 6e 61 67 65 6d 65 | 6e 74 20 6f 66 20 63 61 |manageme|nt of ca|
|00005c10| 72 63 69 6e 6f 6d 61 20 | 6f 66 20 74 68 65 20 74 |rcinoma |of the t|
|00005c20| 68 79 72 6f 69 64 2c 20 | 74 68 65 20 75 6c 74 72 |hyroid, |the ultr|
|00005c30| 61 73 65 6e 73 69 74 69 | 76 65 20 61 73 73 61 79 |asensiti|ve assay|
|00005c40| 20 6f 66 0d 0a 74 68 79 | 72 6f 74 72 6f 70 69 6e | of..thy|rotropin|
|00005c50| 20 70 72 6f 76 69 64 65 | 73 20 61 20 73 65 6e 73 | provide|s a sens|
|00005c60| 69 74 69 76 65 20 6d 65 | 61 6e 73 20 6f 66 20 64 |itive me|ans of d|
|00005c70| 65 74 65 72 6d 69 6e 69 | 6e 67 20 73 75 70 70 72 |etermini|ng suppr|
|00005c80| 65 73 73 69 76 65 20 64 | 6f 73 65 73 20 6f 66 0d |essive d|oses of.|
|00005c90| 0a 6c 65 76 6f 74 68 79 | 72 6f 78 69 6e 65 20 61 |.levothy|roxine a|
|00005ca0| 72 65 20 61 64 65 71 75 | 61 74 65 2e 20 5b 34 5d |re adequ|ate. [4]|
|00005cb0| 20 20 49 74 20 69 73 20 | 6f 66 20 69 6e 74 65 72 | It is |of inter|
|00005cc0| 65 73 74 20 74 68 61 74 | 20 47 72 61 76 65 73 27 |est that| Graves'|
|00005cd0| 20 64 69 73 65 61 73 65 | 20 64 65 76 65 6c 6f 70 | disease| develop|
|00005ce0| 73 0d 0a 69 6e 20 61 70 | 70 72 6f 78 69 6d 61 74 |s..in ap|proximat|
|00005cf0| 65 6c 79 20 31 25 20 6f | 66 20 70 61 74 69 65 6e |ely 1% o|f patien|
|00005d00| 74 73 20 77 69 74 68 20 | 74 68 79 72 6f 69 64 20 |ts with |thyroid |
|00005d10| 63 61 6e 63 65 72 2c 20 | 5b 35 5d 20 61 6e 64 20 |cancer, |[5] and |
|00005d20| 69 6e 20 74 68 69 73 20 | 73 75 62 73 65 74 20 6f |in this |subset o|
|00005d30| 66 0d 0a 70 61 74 69 65 | 6e 74 73 20 74 68 65 20 |f..patie|nts the |
|00005d40| 74 68 79 72 6f 69 64 2d | 73 74 69 6d 75 6c 61 74 |thyroid-|stimulat|
|00005d50| 69 6e 67 20 69 6d 6d 75 | 6e 6f 67 6c 6f 62 75 6c |ing immu|noglobul|
|00005d60| 69 6e 73 20 6d 61 79 20 | 70 6c 61 79 20 61 20 72 |ins may |play a r|
|00005d70| 6f 6c 65 20 69 6e 20 74 | 68 65 0d 0a 70 72 6f 67 |ole in t|he..prog|
|00005d80| 72 65 73 73 69 6f 6e 20 | 69 66 20 6e 6f 74 20 69 |ression |if not i|
|00005d90| 6e 20 74 68 65 20 70 61 | 74 68 6f 67 65 6e 65 73 |n the pa|thogenes|
|00005da0| 69 73 20 6f 66 20 74 68 | 65 20 63 61 6e 63 65 72 |is of th|e cancer|
|00005db0| 2e 20 5b 36 5d 2d 2d 4a | 2e 44 2e 20 57 69 6c 73 |. [6]--J|.D. Wils|
|00005dc0| 6f 6e 2c 20 4d 2e 44 2e | 0d 0a 24 55 6e 69 71 75 |on, M.D.|..$Uniqu|
|00005dd0| 65 5f 49 44 7b 59 52 42 | 30 36 39 30 36 7d 0d 0a |e_ID{YRB|06906}..|
|00005de0| 24 54 69 74 6c 65 7b 46 | 69 6e 65 20 4e 65 65 64 |$Title{F|ine Need|
|00005df0| 6c 65 20 41 73 70 69 72 | 61 74 69 6f 6e 20 6f 66 |le Aspir|ation of|
|00005e00| 20 74 68 65 20 54 68 79 | 72 6f 69 64 3a 20 20 55 | the Thy|roid: U|
|00005e10| 73 65 20 69 6e 20 61 6e | 20 41 76 65 72 61 67 65 |se in an| Average|
|00005e20| 20 48 65 61 6c 74 68 20 | 43 61 72 65 20 46 61 63 | Health |Care Fac|
|00005e30| 69 6c 69 74 79 7d 0d 0a | 24 41 75 74 68 6f 72 7b |ility}..|$Author{|
|00005e40| 41 73 70 2c 20 41 41 0d | 0a 47 65 6f 72 67 69 74 |Asp, AA.|.Georgit|
|00005e50| 69 73 2c 20 57 0d 0a 57 | 61 6c 64 72 6f 6e 2c 20 |is, W..W|aldron, |
|00005e60| 45 4a 0d 0a 53 69 6d 73 | 2c 20 4a 45 0d 0a 4b 69 |EJ..Sims|, JE..Ki|
|00005e70| 64 64 2c 20 47 53 20 49 | 49 7d 0d 0a 24 41 66 66 |dd, GS I|I}..$Aff|
|00005e80| 69 6c 69 61 74 69 6f 6e | 7b 46 69 74 7a 73 69 6d |iliation|{Fitzsim|
|00005e90| 6f 6e 73 20 41 72 6d 79 | 20 4d 65 64 20 43 74 72 |ons Army| Med Ctr|
|00005ea0| 2c 20 41 75 72 6f 72 61 | 2c 20 43 6f 6c 6f 7d 0d |, Aurora|, Colo}.|
|00005eb0| 0a 24 53 75 62 6a 65 63 | 74 7b 54 68 79 72 6f 69 |.$Subjec|t{Thyroi|
|00005ec0| 64 20 61 73 70 69 72 61 | 74 69 6f 6e 20 6f 66 2c |d aspira|tion of,|
|00005ed0| 20 66 69 6e 65 20 6e 65 | 65 64 6c 65 3b 20 4e 65 | fine ne|edle; Ne|
|00005ee0| 65 64 6c 65 20 61 73 70 | 69 72 61 74 69 6f 6e 20 |edle asp|iration |
|00005ef0| 6f 66 20 74 68 79 72 6f | 69 64 3b 0d 0a 41 73 70 |of thyro|id;..Asp|
|00005f00| 69 72 61 74 69 6f 6e 20 | 6f 66 20 74 68 79 72 6f |iration |of thyro|
|00005f10| 69 64 2c 20 66 69 6e 65 | 20 6e 65 65 64 6c 65 7d |id, fine| needle}|
|00005f20| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 41 6d 20 4a 20 |..$Journ|al{Am J |
|00005f30| 4d 65 64 7d 0d 0a 24 56 | 6f 6c 75 6d 65 7b 38 33 |Med}..$V|olume{83|
|00005f40| 7d 0d 0a 24 50 61 67 65 | 7b 34 38 39 2d 34 39 33 |}..$Page|{489-493|
|00005f50| 7d 0d 0a 24 44 61 74 65 | 7b 53 65 70 74 65 6d 62 |}..$Date|{Septemb|
|00005f60| 65 72 20 31 39 38 37 7d | 0d 0a 24 59 42 56 6f 6c |er 1987}|..$YBVol|
|00005f70| 7b 31 39 38 39 20 59 65 | 61 72 20 42 6f 6f 6b 20 |{1989 Ye|ar Book |
|00005f80| 6f 66 20 4d 65 64 69 63 | 69 6e 65 2c 20 50 61 72 |of Medic|ine, Par|
|00005f90| 74 20 53 69 78 7d 0d 0a | 24 43 68 61 70 74 65 72 |t Six}..|$Chapter|
|00005fa0| 7b 34 35 2d 38 7d 0d 0a | 24 59 42 45 64 69 74 6f |{45-8}..|$YBEdito|
|00005fb0| 72 7b 44 72 73 2e 20 52 | 6f 67 65 72 73 2c 20 44 |r{Drs. R|ogers, D|
|00005fc0| 65 73 20 50 72 65 7a 2c | 20 43 6c 69 6e 65 2c 20 |es Prez,| Cline, |
|00005fd0| 42 72 61 75 6e 77 61 6c | 64 2c 20 47 72 65 65 6e |Braunwal|d, Green|
|00005fe0| 62 65 72 67 65 72 2c 20 | 57 69 6c 73 6f 6e 2c 20 |berger, |Wilson, |
|00005ff0| 45 70 73 74 65 69 6e 2c | 20 61 6e 64 20 4d 61 6c |Epstein,| and Mal|
|00006000| 61 77 69 73 74 61 7d 0d | 0a 24 54 61 62 6c 65 7b |awista}.|.$Table{|
|00006010| 7d 0d 0a 24 43 6f 6d 6d | 65 6e 74 61 74 6f 72 7b |}..$Comm|entator{|
|00006020| 4a 2e 44 2e 20 57 69 6c | 73 6f 6e 2c 20 4d 2e 44 |J.D. Wil|son, M.D|
|00006030| 2e 7d 0d 0a 0d 0a 43 6f | 70 79 72 69 67 68 74 20 |.}....Co|pyright |
|00006040| 28 63 29 20 59 65 61 72 | 20 42 6f 6f 6b 20 4d 65 |(c) Year| Book Me|
|00006050| 64 69 63 61 6c 20 50 75 | 62 6c 69 73 68 65 72 73 |dical Pu|blishers|
|00006060| 2c 20 49 6e 63 2e 2c 20 | 31 39 38 39 0d 0a 0d 0a |, Inc., |1989....|
|00006070| 31 39 38 39 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1989 Yea|r Book o|
|00006080| 66 20 4d 65 64 69 63 69 | 6e 65 20 28 52 29 0d 0a |f Medici|ne (R)..|
|00006090| 0d 0a 50 61 72 74 20 53 | 69 78 3a 20 20 45 6e 64 |..Part S|ix: End|
|000060a0| 6f 63 72 69 6e 6f 6c 6f | 67 79 20 61 6e 64 20 4d |ocrinolo|gy and M|
|000060b0| 65 74 61 62 6f 6c 69 73 | 6d 0d 0a 0d 0a 43 68 61 |etabolis|m....Cha|
|000060c0| 70 74 65 72 20 34 35 2d | 2d 54 68 65 20 54 68 79 |pter 45-|-The Thy|
|000060d0| 72 6f 69 64 0d 0a 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |roid....|--------|
|000060e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000060f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006100| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006110| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006120| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 46 69 6e 65 20 4e |--------|..Fine N|
|00006130| 65 65 64 6c 65 20 41 73 | 70 69 72 61 74 69 6f 6e |eedle As|piration|
|00006140| 20 6f 66 20 74 68 65 20 | 54 68 79 72 6f 69 64 3a | of the |Thyroid:|
|00006150| 20 20 55 73 65 20 69 6e | 20 61 6e 20 41 76 65 72 | Use in| an Aver|
|00006160| 61 67 65 20 48 65 61 6c | 74 68 20 43 61 72 65 20 |age Heal|th Care |
|00006170| 46 61 63 69 6c 69 74 79 | 0d 0a 0d 0a 41 73 70 20 |Facility|....Asp |
|00006180| 41 41 2c 20 47 65 6f 72 | 67 69 74 69 73 20 57 2c |AA, Geor|gitis W,|
|00006190| 20 57 61 6c 64 72 6f 6e | 20 45 4a 2c 20 53 69 6d | Waldron| EJ, Sim|
|000061a0| 73 20 4a 45 2c 20 4b 69 | 64 64 20 47 53 20 49 49 |s JE, Ki|dd GS II|
|000061b0| 0d 0a 28 46 69 74 7a 73 | 69 6d 6f 6e 73 20 41 72 |..(Fitzs|imons Ar|
|000061c0| 6d 79 20 4d 65 64 20 43 | 74 72 2c 20 41 75 72 6f |my Med C|tr, Auro|
|000061d0| 72 61 2c 20 43 6f 6c 6f | 29 0d 0a 41 6d 20 4a 20 |ra, Colo|)..Am J |
|000061e0| 4d 65 64 20 38 33 3a 34 | 38 39 2d 34 39 33 2c 20 |Med 83:4|89-493, |
|000061f0| 53 65 70 74 65 6d 62 65 | 72 20 31 39 38 37 0d 0a |Septembe|r 1987..|
|00006200| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006210| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006220| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006230| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006240| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006250| 0d 0a 0d 0a 50 72 65 2d | 43 6f 6d 6d 65 6e 74 0d |....Pre-|Comment.|
|00006260| 0a 0d 0a 20 20 20 20 20 | 54 68 65 20 72 6f 6c 65 |... |The role|
|00006270| 20 6f 66 20 61 73 70 69 | 72 61 74 69 6f 6e 20 62 | of aspi|ration b|
|00006280| 69 6f 70 73 79 20 6f 66 | 20 74 68 65 20 74 68 79 |iopsy of| the thy|
|00006290| 72 6f 69 64 20 69 6e 20 | 74 68 65 20 64 69 61 67 |roid in |the diag|
|000062a0| 6e 6f 73 69 73 20 6f 66 | 20 63 61 72 63 69 6e 6f |nosis of| carcino|
|000062b0| 6d 61 0d 0a 6f 66 20 74 | 68 65 20 74 68 79 72 6f |ma..of t|he thyro|
|000062c0| 69 64 20 68 61 73 20 62 | 65 65 6e 20 64 69 73 63 |id has b|een disc|
|000062d0| 75 73 73 65 64 20 69 6e | 20 74 68 65 20 31 39 38 |ussed in| the 198|
|000062e0| 36 2c 20 31 39 38 37 2c | 20 61 6e 64 20 31 39 38 |6, 1987,| and 198|
|000062f0| 38 20 59 45 41 52 20 42 | 4f 4f 4b 53 20 4f 46 0d |8 YEAR B|OOKS OF.|
|00006300| 0a 4d 45 44 49 43 49 4e | 45 2c 20 62 75 74 20 6d |.MEDICIN|E, but m|
|00006310| 61 6e 79 20 61 73 70 65 | 63 74 73 20 6f 66 20 69 |any aspe|cts of i|
|00006320| 74 73 20 75 73 65 20 61 | 72 65 20 73 74 69 6c 6c |ts use a|re still|
|00006330| 20 75 6e 72 65 73 6f 6c | 76 65 64 2e 0d 0a 0d 0a | unresol|ved.....|
|00006340| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|.... |
|00006350| 20 54 68 65 20 71 75 65 | 73 74 69 6f 6e 20 61 73 | The que|stion as|
|00006360| 20 74 6f 20 77 68 65 74 | 68 65 72 20 66 69 6e 65 | to whet|her fine|
|00006370| 2d 6e 65 65 64 6c 65 20 | 61 73 70 69 72 61 74 69 |-needle |aspirati|
|00006380| 6f 6e 20 6f 66 20 74 68 | 65 20 74 68 79 72 6f 69 |on of th|e thyroi|
|00006390| 64 20 73 68 6f 75 6c 64 | 20 62 65 0d 0a 72 65 73 |d should| be..res|
|000063a0| 65 72 76 65 64 20 66 6f | 72 20 63 65 6e 74 65 72 |erved fo|r center|
|000063b0| 73 20 77 68 65 72 65 20 | 6d 61 6e 79 20 73 70 65 |s where |many spe|
|000063c0| 63 69 6d 65 6e 73 20 61 | 72 65 20 6f 62 74 61 69 |cimens a|re obtai|
|000063d0| 6e 65 64 20 6f 72 20 63 | 61 6e 20 62 65 20 64 6f |ned or c|an be do|
|000063e0| 6e 65 20 69 6e 20 73 6d | 61 6c 6c 65 72 0d 0a 69 |ne in sm|aller..i|
|000063f0| 6e 73 74 69 74 75 74 69 | 6f 6e 73 20 69 73 20 75 |nstituti|ons is u|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.