The relationship between serum cholesterol, thyrotropin, thyroxine and tri-iodothyronine was investigated in 1018 female patients over 40 years of age with suspected hypothyroidism. The correlation between serum thyrotropin and cholesterol (r = 0.398) and between thyroxine and cholesterol (r = -0.217) were both highly significant (P less than 0.001), but the correlation between tri-iodothyronine and cholesterol (r = -0.011) was not significant. Only in patients with a serum thyrotropin in excess of 40 mU/L was there a clinically appreciable increase in the serum cholesterol. In 139 patients treated for hypothyroidism by thyroxine replacement there was a highly significant correlation (P less than 0.001) between the decrease in serum thyrotropin and cholesterol (r = 0.593). The correlation between increase in serum thyroxine and decrease in cholesterol (r = -0.401) was also highly significant (P less than 0.001), but there was an even stronger correlation between the increase in serum tri-iodothyronine and the decrease in serum cholesterol (r = -0.529).

GlasgowSUMMARY Measurements of protein/creatinine ratio in 'spot' urine samples were compared with measurements of 24 hour quantitative proteinuria and side room 'dipstick' testing in 104 samples from 90 patients presenting consecutively to a rheumatology unit. Linear regression analysis showed a highly significant correlation between the random urinary protein/creatinine ratio and total protein excretion in 24 hour urine samples (r=0.92, p<0.001, y=6-55x+0-04). Although an approximation of 24 hour urinary protein excretion could have been made from the regression line: 24 hour urine protein=6-55 xprotein/creatinine ratio+0*04 (g/l), there was a wide scatter of values, particularly in patients with >1 g/24 h urinary protein excretion. Nevertheless, significant proteinuria (>300 mg/24 h) could have been confirmed or excluded with a sensitivity and specificity of 97% by adopting random protein/creatinine values of <0-04 as 'normal'. Specificity and sensitivity could have been increased to 100%, however, by excluding patients with values lying between 0*01 and 0-10 as all the false negatives (n=3) and false positives (n=3) lay within this range. In comparison, dipstick testing, although 100% sensitive, had a poor specificity due to the high false positive rate (40/83 (48%)) in patients with 1+ to 3+ readings. Assessment of random urinary protein/creatinine ratio may obviate the need for 24 hour urine collections in the initial assessment of suspected proteinuria. A wider application of this technique seems indicated in view of the obvious advantages in terms of cost, time, and patient convenience.Screening for proteinuria is a common requirement in rheumatological practice, particularly in patients who are receiving second line agents such as gold and penicillamine. In current clinical practice it is usual to screen for proteinuria by dipstick testing, and when a positive result is obtained to confirm or refute the presence of proteinuria by a 24 hour collection.1 As 24 hour urine collections are laborious, costly, and inconvenient the present study was designed to see if the 24 hour urinary protein excretion could be assessed accurately from the protein/creatinine ratio in random urine samples-a method which has previously been shown to corre-

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