Page 500 (image) |
Previous | 547 of 639 | Next |
|
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
|
Loading content ...
Thyroid Problems in Children Judson J. Van Wyk, M.D.* Chapel Hill For the past 75 years disorders of the thyroid gland have been classified and interpreted on the basis of pathologic anatomy. Until recently medical therapy has been based on the empirical use of iodides and thyroid extract in a wide variety of clinical conditions. The practitioner has been understandably confused by the apparently paradoxical use of iodine to treat patients not only with hypothyroidism, but also those with hyperthyroidism, and some with goiter who are euthyroid. We are now in a period in which the emphasis is rightly shifting to a study of thyroid function. By the employment of newer techniques of investigation, largely made possible by the availability of I131, thyroid disorders are being reclassified in terms of specific disturbances of function, and the use of therapeutic agents is being placed on a rational basis. So far in this new era no miracle drugs have been forthcoming and no substitute has been found for clinical acumen on the part of the physician. The astute physician today, however, is in a much better position to make a precise diagnosis and to administer appropriate therapy than was the case even 10 years ago. Thyroid-Pituitary Relationship; Although it has long been known that the thyroid gland is under the control of the anterior pituitary, the mechanisms and quantitative relationships of thyroid function are now becoming clearer. The pituitary, by releasing thyroid stimulating hormone (T.S.H.), induces the thyroid gland to perform three functions — namely, to concentrate inorganic iodides from the circulating blood, to manufacture thyroid hormone from 1-tyrosine and iodide (which has been oxidized to its elemental form), and to release the hormone into the blood stream (fig. 1.) One of these functions may be disturbed without necessarily disturbing the steps preceding it. In normal individ- Read before the Section on Pediatrics, Medical Society of the State of Noi-th Carolina, Pinehurst, May 2, 1956 From the Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill. ♦John and Mary R. Markle Scholar in Medical Science. uals the pituitary secretes just enough trophic hormone so that the circulating thyroid hormone is kept nearly constant. This homeostatic mechanism is remarkably sensitive, and the protein-bound iodine (P.B.I.), which is usually a good measure of circulating thyroid hormone, shows very little fluctuation from day to day in a given individual. It is also difficult to change the "thermostat." Greer, Perlmutter, and others have shown that if thyroid extract is administered in moderate dosage to a normal individual, the output of thyroid hormone is curbed to the extent that exogenous Thyroid is administered(1). This effect is mediated through the pituitary gland, and the iodine uptake falls while the P.B.I, remains nearly constant. There is evidence that pituitary function is also suppressed by iodides(2). Excessive iodine medication, however, alters thyroid function in other ways as well. Not until about 3 grains of desiccated thyroid is given and the patient's own gland is fully suppressed is there a net increase in circulating thyroid hormone. These observations find direct clinical application when the physician is confronted with the obese adolescent or the child who is retarded in either growth or mental development, but who has a normal P.B.I, and who is not truly hypothyroid. In these individuals the only effect of giving thyroid medication will be depression HORMONE RELEASE Fig. 1. The reciprocal relationship between thyroid and pituitary secretions regulates thyroid homeostasis.
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1956 |
Identifier | NCHH-17-017 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 17 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-017.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-017 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | keep |
Description
Fixed Title * | Page 500 (image) |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1956 |
Identifier | NCHH-17-017-0552 |
Form General | Periodicals |
Page Type | all; all images; diagram; article; article title |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncarolinamed171956medi_0552.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 17 |
Issue Number | 11 |
Page Number | 500 |
Health Discipline | Medicine |
Full Text | Thyroid Problems in Children Judson J. Van Wyk, M.D.* Chapel Hill For the past 75 years disorders of the thyroid gland have been classified and interpreted on the basis of pathologic anatomy. Until recently medical therapy has been based on the empirical use of iodides and thyroid extract in a wide variety of clinical conditions. The practitioner has been understandably confused by the apparently paradoxical use of iodine to treat patients not only with hypothyroidism, but also those with hyperthyroidism, and some with goiter who are euthyroid. We are now in a period in which the emphasis is rightly shifting to a study of thyroid function. By the employment of newer techniques of investigation, largely made possible by the availability of I131, thyroid disorders are being reclassified in terms of specific disturbances of function, and the use of therapeutic agents is being placed on a rational basis. So far in this new era no miracle drugs have been forthcoming and no substitute has been found for clinical acumen on the part of the physician. The astute physician today, however, is in a much better position to make a precise diagnosis and to administer appropriate therapy than was the case even 10 years ago. Thyroid-Pituitary Relationship; Although it has long been known that the thyroid gland is under the control of the anterior pituitary, the mechanisms and quantitative relationships of thyroid function are now becoming clearer. The pituitary, by releasing thyroid stimulating hormone (T.S.H.), induces the thyroid gland to perform three functions — namely, to concentrate inorganic iodides from the circulating blood, to manufacture thyroid hormone from 1-tyrosine and iodide (which has been oxidized to its elemental form), and to release the hormone into the blood stream (fig. 1.) One of these functions may be disturbed without necessarily disturbing the steps preceding it. In normal individ- Read before the Section on Pediatrics, Medical Society of the State of Noi-th Carolina, Pinehurst, May 2, 1956 From the Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill. ♦John and Mary R. Markle Scholar in Medical Science. uals the pituitary secretes just enough trophic hormone so that the circulating thyroid hormone is kept nearly constant. This homeostatic mechanism is remarkably sensitive, and the protein-bound iodine (P.B.I.), which is usually a good measure of circulating thyroid hormone, shows very little fluctuation from day to day in a given individual. It is also difficult to change the "thermostat." Greer, Perlmutter, and others have shown that if thyroid extract is administered in moderate dosage to a normal individual, the output of thyroid hormone is curbed to the extent that exogenous Thyroid is administered(1). This effect is mediated through the pituitary gland, and the iodine uptake falls while the P.B.I, remains nearly constant. There is evidence that pituitary function is also suppressed by iodides(2). Excessive iodine medication, however, alters thyroid function in other ways as well. Not until about 3 grains of desiccated thyroid is given and the patient's own gland is fully suppressed is there a net increase in circulating thyroid hormone. These observations find direct clinical application when the physician is confronted with the obese adolescent or the child who is retarded in either growth or mental development, but who has a normal P.B.I, and who is not truly hypothyroid. In these individuals the only effect of giving thyroid medication will be depression HORMONE RELEASE Fig. 1. The reciprocal relationship between thyroid and pituitary secretions regulates thyroid homeostasis. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-017.pdf |
Document Sort | all; nchh-17 |
Article Title | Thyroid Problems In Children |
Article Author | Judson J. Van Wyk |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-017 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | keep |
Tags
Comments
Post a Comment for Page 500 (image)