Effective laboratory evaluation of thyroid status

Children's mental health emergencies-part 3: special situations: child maltreatment, violence, and response to disasters

OBJECTIVE

Children may be exposed to or even be the victims of a violent situation, or a disaster, and the likelihood of a child's exposure to a violent situation or a disaster is increasing.

METHODS

A review of the literature was done to address key mental health issues occurring with child maltreatment, violence in the home, community, in the emergency department, and disasters.

RESULTS

Although pediatric mental health issues regarding violence, disasters, and child maltreatment have often been overlooked or unrecognized, the consequences for the child in such situations can be devastating. However, recognition and appropriate treatment can favorably impact the child's recovery from exposure to such violent events or disasters.

CONCLUSIONS

Recognition and early intervention to address the mental health issues of children in violent situations or disasters can help ameliorate the negative psychological sequelae of such events. The importance of providing mental health and social services to children exposed to disasters was recognized by the Pediatric Institute of Medicine Report.

Endocrine Heart Disease

With the increasing prevalence of obesity and diabetes mellitus in the United States, associated cardiovascular disease is reaching epidemic proportions with staggering economic and societal impact. Numerous studies have demonstrated the poorer prognosis associated with chronic coronary artery disease and acute coronary syndromes in patients with diabetes compared with nondiabetic patients. Although the therapeutic strategy is largely the same for the two populations, proper management of the diabetic patient with cardiovascular disease must account for the associated metabolic disturbances. Thyroid disease is the next most common endocrine disorder that affects proper function of cardiovascular patients; all patients presenting with coronary artery disease or cardiac arrhythmias should undergo screening with a sensitive thyroid-stimulating hormone assay and appropriate treatment when necessary. Though these areas are the most common points of intersection between the cardiologist and endocrinologist, a thorough understanding of the impacts of each endocrine system on cardiac function is essential to recognize disease entities that often present with a cardiovascular manifestation or affect patients with a primary cardiovascular disease.

Hypothyroidism in elderly people

Abnormal thyroid function tests are common for older adults, but the clinical significance of abnormal results and the need for treatment vary. Nonthyroidal illness (eg, low T3 and T4 syndromes) needs to be ruled out before making the diagnosis of hypothyroidism. Overt hypothyroidism and myxedema coma always require treatment, but treatment of subclinical hypothyroidism is not as clear. The purpose of this review article is to summarize existing data in the elderly population on the etiology, diagnosis, and management of overt hypothyroidism and subclinical hypothyroidism.

Canine thyrotropin beta-subunit gene: cloning and expression in Escherichia coli, generation of monoclonal antibodies, and transient expression in the Chinese hamster ovary cells

The gene encoding the mature beta subunit of canine thyroid stimulating hormone (cTSH beta) was cloned, sequenced and expressed in Escherichia coli and in Chinese hamster ovary (CHO) cells, and monoclonal antibodies against the recombinant cTSH beta purified from E. coli were generated. The gene fragment that encodes mature TSH beta was cloned from the canine genomic DNA by direct polymerase chain reaction (PCR) using primers that were designed based on the consensus sequences from other species. The resulting 891 basepairs (bp) of genomic DNA consisted of two coding exons of the canine TSH beta gene and an intron of 450 bp. The two exons, which encode the mature cTSH beta subunit, was joined together by an overlap PCR and was expressed in E. coli as 6xHis-tagged protein. The purified recombinant cTSH beta with a molecular weight of about 15 kDa was recognized by the polyclonal antibodies prepared against the native canine TSH in Western blot. Monoclonal antibodies were raised against the purified cTSH beta and subsequently characterized. For transient expression in CHO cells that are permanently transfected with the bovine common alpha gene, a 60-oligonucleotide signal peptide coding sequence was added to the 5' end of the cTSH beta gene before it was cloned into the mammalian expression vector pRSV and used to transfect CHO cells. The medium from these transfected cells, presumably containing the bovine alpha and canine TSH beta in heterodimeric confirmation, exhibited TSH bioactivity as indicated by the stimulation of cAMP production in the cultured FRTL-5 thyrocytes.

cDNA cloning of canine common alpha gene and its co-expression with canine thyrotropin beta gene in baculovirus expression system

The common alpha gene of the canine glycoprotein hormones was cloned, sequenced and co-expressed with the canine thyrotropin beta (TSH beta) gene in the baculovirus expression system, and a bioactive recombinant canine TSH was purified. The canine common alpha gene was cloned from the total RNA extracted from the canine pituitary gland by the reverse transcription polymerase chain reaction (RT-PCR) using primers that were designed based on the consensus sequences from other species. The resulting 476 bp PCR product is consisted of the full coding sequence for the 96 amino acid mature alpha subunit, and a sequence encoding a 24 amino acid signal peptide. Homology analysis with other species revealed that the canine common alpha subunit potentially contains five disulfide bonds and two oligosaccharide chains N-linked to Asn residues located at positions 56 and 82. For expression in the baculovirus expression system, the common alpha gene was cloned downstream of the p10 promoter of the pAcUW51 transfer vector, and the previously cloned canine TSH beta gene was inserted under the polyhedrin promoter of the same vector. The recombinant virus containing both alpha and beta genes was generated and propagated before being used to transfect the Sf9 insect cells for expression. The medium from the Sf9 cultures, presumably containing canine TSH alpha and beta in native heterodimer confirmation, exhibited TSH bioactivity as indicated in the cAMP stimulation assay in FRTL-5 cells. The expressed recombinant protein was purified from the culture medium with an affinity column that was coupled with IgG purified from the polyclonal antibodies generated against the partially purified native canine TSH.

Serum thyroid hormone and thyroid gland weight measurements in protein-energy malnutrition

Protein-energy malnutrition (PEM) is a problem which concerns about half the world's children. We investigated the effects of malnutrition on thyroid gland weight and thyroid hormone levels. 22 children suffering from malnutrition (14 children suffering from marasmus and 8 children suffering from kwashiorkor) and 7 healthy controls were studied. Malnutrition was confirmed clinically and according to the Wellcome classification definition of malnutrition. Serum thyroid hormone concentrations were measured by radioimmunoassay and the weights of the thyroid gland were evaluated scintigraphically. In the groups with marasmus and kwashiorkor the mean TT4, TT3 and FT3 levels were significantly lower, and TSH levels were significantly higher, compared to controls. FT4 was not influenced by PEM. The mean thyroid gland weights of the groups with marasmus and kwashiorkor were higher than that of the control group. We found no significant differences in all these parameters between groups with marasmus and kwashiorkor. In each of the three groups, the most marked positive correlation was between thyroid gland weight and ratio of thyroid gland weight to body surface area.

Chemosensory event-related potentials in response to trigeminal and olfactory stimulation in idiopathic Parkinson's disease

Decrease of olfactory function in patients with Parkinson's disease (PD) has been reported by several authors. The current study investigated olfaction in PD patients using olfactory event-related potentials (OERPs) as an electrophysiologic correlate of olfactory function in combination with psychophysical testing. A specific focus was the influence of antiparkinsonian drugs. We investigated PD patients treated with antiparkinsonian drugs (n = 13) and PD patients who received no pharmacologic treatment (n = 18). They were compared to age- and sex-matched control subjects (n = 38). To obtain OERPs, stimulants were chosen to stimulate specifically the olfactory nerve (2.1 ppm vanillin, 0.8 ppm H2S). In addition, chemosomatosensory event-related potentials were recorded after trigeminal stimulation with 52% v/v CO2. Moreover, the subjects' ability to identify and to discriminate odorants was tested by means of a "squeeze bottle" technique. The study yielded the following major results: (1) Odor identification was impaired in PD patients. It was not influenced by treatment with antiparkinsonian drugs. (2) The OERP latencies were prolonged in both PD patients taking and not taking antiparkinsonian drugs; however, this effect was more pronounced in PD patients taking antiparkinsonian drugs. (3) The intranasal chemosensory trigeminal system seemingly was neither affected by the neuronal degeneration seen in PD nor by treatment with antiparkinsonian drugs.

Thyrotoxicosis and the heart

Many patients with thyrotoxicosis have clinical features that reflect the effects of excess thyroid hormone on the cardiovascular system. Thyrotoxicosis can aggravate preexisting cardiac disease and can also lead to atrial fibrillation, congestive heart failure, or worsening of angina pectoris. In elderly patients, these cardiac manifestations may dominate the clinical picture and warrant the measurement of the serum thyrotropin concentration. In the absence of preexisting cardiac disease, treatment of thyrotoxicosis usually results in a return of normal cardiac function.

The sense of taste: neurobiology, aging, and medication effects

The sense of taste is an oral chemical sense in mammals that is involved in the choice of foods. Initial transduction of taste stimuli occurs in taste buds, which are distributed in four discrete fields in the oral cavity. Medications can affect the taste buds and ion channels in taste-bud cell membranes involved in stimulus transduction. The sense of taste gradually declines with aging, with bitter taste most affected. Neural circuits that mediate taste in primates include cranial nerves VII, IX, and X, the solitary nucleus in the brain stem, the ventroposteromedial nucleus of the thalamus, and the insular-opercular cortex. The central taste pathways process taste information about sweet, salty, sour, and bitter stimuli serially and in parallel. Medications associated with "metallic" dysgeusia and taste losses affect the taste system via unknown mechanisms.