Role of the Ankle-jerk in the Diagnosis and Management of Thyroid Disease

Miles, D. W.; Surveyor, Ivor

doi:10.1136/bmj.1.5428.158

Cited by 18 publications

(7 citation statements)

References 5 publications

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“…In our preliminary study' of the 30 euthermic patients, we confirmed the findings of many previous workers that hypothyroidism prolongs both the contraction and the relaxation phases of the Achilles tendon reflex (Ord, 1884; Lambert et al., 1951; Fogel et al, 1962;Sherman et al, 1963;Miles and Surveyor, 1965;Abraham et a!., 1966;Nuki and Bayliss, 1968). The relaxation phase was prolonged more than the contraction phase, the mean (± 1 S.D.)…”

Section: Resultssupporting

confidence: 90%

“…Slow ankle jerks are characteristic of myxoedema (Ord, 1884) and they have often been studied (Fogel et al, 1962;Sherman et al, 1963;Miles and Surveyor, 1965;Abraham et al, 1966;Nuki and Bayliss, 1968). Indeed, delayed relaxation of the ankle jerk has routinely been used in the Mayo Clinic for about 50 years as an aid in the diagnosis of myxoedema (Lambert et al, 1951).…”

Section: Discussionmentioning

confidence: 99%

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Achilles Tendon Reflex in Accidental Hypothermia and Hypothermic Myxoedema

Maclean¹,

Taig²,

Emslie-Smith³

1973

BMJ

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SummaryThe photomotogram (P.M.G.) of the Achilles tendon reflex was studied in 26 patients with hypothermia (rectal temperature 33 3°C or less), 10 of whom also had myxoedema (serum protein bound iodine 2-8 Fg/100 ml or less). No reflex could be elicited in eight (31%) ofthese patients, including three ofthose with myxoedema. Hypothermia increases both the contraction and the relaxation times of the reflex, the relaxation phase being particularly prolonged in those with myxoedema. In those patients from whom the reflex was elicited the ratio of the contraction time to the "half-relaxation time" in the P.M.G. was less than unity in six of the seven with myxoedema, and considerably greater than unity in eight of the 11 (73%) who were euthyroid.

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Section: Resultssupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Achilles Tendon Reflex in Accidental Hypothermia and Hypothermic Myxoedema

Maclean¹,

Taig²,

Emslie-Smith³

1973

BMJ

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“…The photomotogram (or some other measure of the ankle-jerk), although less reliable than most other tests and hence less suitable as a screening procedure, is not to be abandoned, because it is easy to perform, it measures a different parameter than other tests, i.e. the response of peripheral tissues to thyroid hormones and thus the metabolic status of the patient (16), and so it is suitable for the assessment of patients under treatment (24,25,37). Under these circumstances, the main thyroid hormone may be triiodothyronine and so the value of the serum PB I or thyroxine determinations is severely limited (8), whereas in vivo uptake measurements can not be used at all, except for very early uptake measurements, for which there is no evidence that they correlate closely with the metabolic status.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Diagnostic Value of Several Tests of Thyroid Function

Koutras¹,

Mantzos²,

Sfontouris³

et al. 1973

Nuklearmedizin

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Les valuers normales, la sensitivité, la spécificité et la précision diagnostique ainsi que le chevauchement des épreuves suivantes de la fonction thyroïdienne ont été définis par une étude prospective dans 300 cas. La captation thyroïdienne de l’131I à 2, 4, 10 et 24 h, le PB131I à 48 h, la captation de la T3 marquée sur éponge de résine et la RUR (Resin-Uptake Ratio), la thyroxine sérique (Tetrasorb), le PBI (Protein-Bound Iodine) du sérum, les indices de la thyroxine libre (FTI = Free Thyroxine Index) calculés comme FTI1 = PBI · RUR et FTI2= thyroxine · RUR et le photomotogramme du réflexe achilléen ont été étudiés. Le chevauchement a été considérable pour toutes les épreuves effectuées. Le PB131I a été 1’ épreuve la plus fidèle pour l’hyperthyroïdie, et le FTI2 pour l’hypothyroïdie. Ce dernier est considéré comme le procédé de choix pour l’examen préliminaire de tous les sujets contrôlés. Les malades hyper- ou hypo-thyroïdiens, avec un syndrome clinique franchement manifeste présentaient, en général, des valeurs plus anormales pour les diverses épreuves que les malades présentant un tableau clinique plus modéré. De même les sujets euthyroïdiens sans signes cliniques de maladie thyroïdienne présentaient au cours des divers épreuves des valeurs qui étaient plus franchement normales par rapport aux malades euthyroïdiens ayant des signes clinique suspects d’une maladie thyroïdienne, ce qui rendait le diagnostic du laboratoire plus facile. Les indications pour chaque épreuve thyroïdienne et l’interprétation des résultats sont discutés.

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“…Examples include testing capillary blood glucose concentration during insulin treatment and testing blood clotting times during warfarin therapy. An early example of systematic monitoring to ensure that treatment was within a therapeutic range was the measurement of ankle reflex time as a surrogate for thyroid status [5].…”

Section: Monitoring In Therapeuticsmentioning

confidence: 99%

Monitoring for adverse drug reactions

Coleman

Ferner

Evans

2006

Brit J Clinical Pharma

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Monitoring describes the prospective supervision, observation, and testing of an ongoing process. The result of monitoring provides reassurance that the goal has been or will be achieved, or suggests changes that will allow it to be achieved. In therapeutics, most thought has been given to Therapeutic Drug Monitoring, that is, monitoring of drug concentrations to achieve benefit or avoid harm, or both. Patients and their clinicians can also monitor the progress of a disease, and adjust treatment accordingly, for example, to achieve optimum glycaemic control. Very little consideration has been given to the development of effective schemes for monitoring for the occurrence of adverse effects, such as biochemical or haematological disturbance. Significant harm may go undetected in controlled clinical trials. Even where harm is detected, published details of trials are usually insufficient to allow a practical monitoring scheme to be introduced. The result is that information available to prescribers, such as the Summary of Product Characteristics, frequently provides advice that is incomplete or impossible to follow. We discuss here the elements of logical schemes for monitoring for adverse drug reactions, and the possible contributions that computerized decision support can make. We should require evidence that if a monitoring scheme is proposed, it can be put into practice, will prove effective, and is affordable.

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Role of the Ankle-jerk in the Diagnosis and Management of Thyroid Disease

Cited by 18 publications

References 5 publications

Achilles Tendon Reflex in Accidental Hypothermia and Hypothermic Myxoedema

Achilles Tendon Reflex in Accidental Hypothermia and Hypothermic Myxoedema

A Comparison of the Diagnostic Value of Several Tests of Thyroid Function

Monitoring for adverse drug reactions

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