Statistical analysis has shown that long-term lithium therapy is associated with an increased risk of thyrotoxicosis. LiAT is a heterogeneous condition with differing underlying thyroid pathologies and the mechanisms remain uncertain. The management of LiAT should initially be with antithyroid medication, and 131I therapy should be given only to patients who do not obtain long-term remission.

Eighteen female and 22 male college swimmers were flown across four time zones in east-to-west (E-W) and west-to-east (W-E) directions. A pre- and postflight paced swim of 182.9 m at an intensity equal to 90% of the swimmers' maximal velocity was completed, and salivary cortisol, heart rate (HR), and rated perceived exertion were measured. Blood pressure, HR, muscle soreness, and mood were also assessed at rest on the day before and on the day after travel. Because training volumes for both females and males were greater (P less than 0.001) in the week before W-E than E-W travel, the W-E and E-W data were analyzed separately. Two-way repeated-measures analyses of variance revealed that pre- and postexercise cortisol decreased after E-W travel and increased after W-E travel in comparison to preflight values. Resting and exercise HR responses to air travel were small in magnitude, and their significance depended on the direction of travel. Effort sense was not altered by air travel, but significant (P less than 0.001) improvements in mood and reductions in muscle soreness were observed after E-W and W-E travel for both genders. It was concluded that 1) female and male college swimmers have similar responses to air travel and 2) air travel across four time zones during heavy swim training does not have negative physiological, perceptual, or affective consequences.

To determine the neurohormonal response to angiotensin-converting enzyme (ACE) inhibition after acute myocardial infarction, 36 patients presenting within 6 h of the onset of chest pain were studied in a single regional cardiology service. In this double-blind study, 13 patients were randomized to receive captopril, 12 patients received enalapril, and 11 patients received placebo, for 12 months. In patients receiving placebo, acute myocardial infarction was associated with activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, and stimulation of plasma brain natriuretic peptide and atrial natriuretic peptide levels. ACE inhibition did not significantly alter circulating levels of norepinephrine, brain natriuretic peptide or atrial natriuretic peptide. Compared with placebo, enalapril induced a steep decline in plasma ACE activity, and plasma angiotensin II levels were reduced by both ACE inhibitors. Using grouped data, circulating levels of brain natriuretic peptide at the zero sampling time were significantly higher than atrial natriuretic peptide values. Brain natriuretic peptide levels at 72 h were significantly correlated with the radionuclide left ventricular ejection fraction measured 5 days and 3 months after infarction. Similar associations were observed for atrial natriuretic peptide and norepinephrine. We confirm activation of the renin-angiotensin-aldosterone and sympathetic nervous systems after acute myocardial infarction. The atrial natriuretic peptide and brain natriuretic peptide and sympathetic nervous system responses to acute myocardial infarction were not significantly modified by ACE inhibition. Brain natriuretic peptide and atrial natriuretic peptide levels were significantly correlated with the left ventricular ejection fraction measured 5 days and again 3 months after myocardial infarction, and may prove a useful prognostic index.

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This report documents papillary cell carcinoma of the thyroid occurring in a 55-year-old woman after three-and-a-half years of lithium therapy. She presented with unilateral thyroid enlargement causing tracheal deviation. There was no clinical suspicion of malignancy and the histological findings were totally unexpected.