To evaluate whether patients with subclinical hypothyroidism have a disturbance in lipid metabolism, and whether supplemental L-thyroxine (L-T4) therapy would improve their lipid parameters, we measured serum levels of thyroid hormones, TSHand lipid parameters in 34 patients with subclinical hypothyroidism before and 2 months after treatment with L-T4. Before treatment, patients with subclinical hypothyroidism had elevated serum low density lipoprotein cholesterol (LDL-C) concentrations compared with control subjects (P<0.05). Overall, L-T4 therapy significantly decreased the serum level of TSH (P<0.01), total cholesterol (TC; P<0.02), high density lipoprotein cholesterol (P<0.02), LDL-C (P<0.05), and the ratio of apolipoprotein B to apolipoprotein Al (P<0.05). Lipid values in patients with basal serum TSHlevels below 10 mU/ 1 were not affected by L-T4 therapy, whereas serum levels ofTC and LDL-Cdecreases significantly (P<0.01) in patients with serum TSH levels above 10 mU/1. Thus, the L-T4 treatment appears to have a preventive effect on the disturbance of lipid metabolism in patients with subclinical hypothyroidism, especially in patients with serum TSHlevels above 10 mU/1. (Internal Medicien 33: 413-417, 1994)

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Objective: To investigate the possible influence of single-dose 2.0 g azithromycin (AZ-ER) on anticoagulation in patients taking warfarin.Study design: Eighteen consecutive patients receiving long-term stable warfarin therapy were enrolled in this study. AZ-ER was administered 1-hour prior to tooth extraction.The International Normalized Ratio (INR) value was measured prior to AZ-ER administration, during, one-day after, and seven-days after the tooth extraction.Additionally, the azithromycin concentration in the extraction wound as well as in peripheral venous blood was assessed.Results: The changes in INR throughout the study period were not statistically significant (two-factor ANOVA, N.S.). The azithromycin concentration in extraction wounds was higher than that in peripheral veins. Conclusion:The results of this study suggest that prophylactic administration of AZ-ER to patients receiving daily warfarin therapy with a stable coagulation status has no relevant effect on the anticoagulant effect of warfarin.3

To study the factors involved in the low thyroid hormone levels in patients with chronic renal failure (CRF), we investigated thyroid functions just before and after hemodialysesl (HD) in 32 such patients who were on maintenance HD. In addition, we measured serum thyroid hormone binding inhibitor activities (THBI) in another set of 37 patients.None of the patients had been suspected of having thyroid diseases. HD duration and aging did not have a significant effect on the results of the thyroid function tests. Before each HD, the serum concentrations of T3, T4, FT3, FT4, rT3., PBI, FT3I, FT4I, FT3/T3, FT4/T4, T4/TBG, T4/TSH and FT4/TSH were lower, and those of TSH, TBG, and thyroglobulin (Tg) were higher in the patients than in normal controls.The thyroid hormone concentrations were negatively correlated with the BUN and creatinine levels. The Tg levels were positively correlated with the BUN levels. After each HD, almost all the thyroid function tests including T4/TBG ratio showed improvements, which indicated that hemodilution and a decrease in the T4-binding affinity of TBG with thyroid hormones were the major factors in the low thyroid hormone levels in CRF patients. However, even after HD, T3, FT3, rT3, T4/TSH and FT4/TSH were still lower and TSH and Tg were still higher in the patients. These data suggested that the CRF patients were in a subclinical hypothyroid state.THBI was high in patients with CRF and did not change following HD. NEFA did not seem to contribute to the high THBI before HD, because they were in the normal range. However, as NEFA became very high after HD and possessed THBI, we calculated the corrected THBI (C-THBI) by subtractng the effect of NEFA from total THBI. C-THBI was high before HD and decreased after HD. Therefore, it was suggested that this C-THBI contributed to the abnormalities in the affinity of TBG with thyroid hormones.From these studies, it is concluded that (1) the patients with CRF may be in a suclinical hypothyroid state, although hemodilution was seen to have a strong effect on the thyroid hormone concentrations, and (2) C-THBI may have an effect on the affinity of TBG with thyroid hormones and play an additional role in low thyroid hormone levels in these patients. The mechanisms of hypothyroidism and the nature of C-THBI remain to be clarified.