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Hyperthyroxinemia in patients treated with high-dose propranolol
Propranolol use
Decision theory
Medial de&ion making
Probability
Continued
The physician developing a treatment plan for a particular patient often needs to know the life expectancy associated with the outcomes of therapeutic choices. Currently available methcds for estimating life expectancy are cumbersome and of limited clinical use. A simple approximation of life expectancy (the “DEALE”), based on the assumption that swival follows a simple declining exponential function, is described. In this approach, the reciprocal of the age-, sex-, and race-adjusted life expectancy is used to estimate the mortality rate of a healthy person. The life expectancy of a person who also has one or more diseases is obtained by adding disease-specific mortalities to the age-, sex-, and race-adjusted mortality rate and taking the reciprocal of that sum. It is shown that this approximation estimates life expectancy accurately for the great majority of clinical problems.
Beck JR, Kassirer JP, Pauker SG: A convenient approximation of life expectancy. (The “DEALE”). I. Validation of the method. Am J Med 1982; 73: 883-888.
Mortaliiy
Life expectancy
Six patients with hyperthyroxinemia were evaluated for possible hyperthyroidism. All were taking large daily doses of propranolol-480 f 155 (&SE) mg-for treatment of angina pectoris. The patients had no clinical evidence of hyperthyroidism, afthough three had small goiters. Further evaluation revealed elevated serum free thyroxine levels and/or free thyroxine index, low-norr~l serum triiodothyronine levels, and elevated reverse triiodothyronine serum levels in all six. The thyroid-stimulating hormone response to thyrotropin-releasing hormone was normal in two patients, subnormal in three patients, and absent in one patient. One patient was restudied on lowdose propranolol (80 mg a day), with all thyroid functional parameters normal. The data suggest that the abnormalities seen in patients taking high doses of propranolol were due to blockade of iodothyronine deiodination. Signs and symptoms of hyperthyroidism are lacking in patients taking large doses of propranolol. If such a patient has an elevated serum thyroxine level, a more complete evaluation of thyroid function is necessary before the diagnosis of thyrotoxicosis can be made.
in’patients
Thyrotropin-releasing hormone Thyroid-stimulating hormone Thyroxine
Hyperthyroxinemia
Cooper DS, Daniels GH, Ladenson PW, Ridgway EC: Hyperthyroxinemia treated with high-dose propranolol. Am J Med 1982; 73: 867-871.
Triiodothyronine
Estrone Stress
Myocardial infarction
Coronary artery disease
Medical decision-making
Mortality Carcinoma, colonic
on page
A
73
Use of a bedside approximation of life expectancy in quantitative decision-making is demonstrated. This method, the declining exponentiil approximation of life expectancy (DEALE), enables the physician to collate various survival data with information on morbidity to determine a quality-adjusted expected survival for a potential management plan. The keystone in the DEALE approach is the approximation of survival by a simple exponential function. This approximation makes it possible to translate data from various literature sources (life expectancy tables, five-year survival rates, survival curves, median survival) intoa single, unified mortality scale. The DEALE method is used to obtain approximations of quality-adjusted life expectancy. The application of the method illustrated is a quantitative analysis of a clinical decision.
Beck JR, Pauker SG, Gottlieb JE, Klein K, Kassirer JP: A convenient approximation of life expectancy (the “DEALE”). II. Use in medical decision-making. Am J Med 1982; 73: 889-897.
Life expectancy
Decision theory
Serum estradiol and serum estrone levels were assessed in 29 men with acute myocardial infarction; in 17 men with unstable angina; in 14 men in whom myocardial infarction was ruled out; in 12 men without apparent coronary heart disease but hospitalized in an intensive care unit; and in 28 men who were not hospitalized and who acted as control subjects. Ages ranged from 21 to 56 years. Age, height, and weight did not differ significantly among groups. The serum estrone level was significantly elevated in all four patient groups when compared with that in the controls group. Estrone level, then, did not differentiate patients with and without coronary heart disease. Serum estradiol levels were significantly elevated in the groups with myocardial infarction, unstable angina, and in the group in whom myocardial infarction was ruled out. However estradiol levels were not significantly elevated in the group in the intensive care unit without coronary heart disease, when compared with levels in the control group. The potential significance of these serum estradiol elevations is discussed in terms of estradiol’s ability to enhance adrenergic neural activity and the resultant increase in myocardial oxygen demand.
Klaiber EL, Broverman DM, Haffajee Cl, Hochman JS, Sacks GM, Dalen JE: Serum estrogen levels in men with acute myocardial infarction. Am J Med 1982; 73: 872881.
Men
Estradiol
Decision theory
Medial de&ion making
Probability
Continued
The physician developing a treatment plan for a particular patient often needs to know the life expectancy associated with the outcomes of therapeutic choices. Currently available methcds for estimating life expectancy are cumbersome and of limited clinical use. A simple approximation of life expectancy (the “DEALE”), based on the assumption that swival follows a simple declining exponential function, is described. In this approach, the reciprocal of the age-, sex-, and race-adjusted life expectancy is used to estimate the mortality rate of a healthy person. The life expectancy of a person who also has one or more diseases is obtained by adding disease-specific mortalities to the age-, sex-, and race-adjusted mortality rate and taking the reciprocal of that sum. It is shown that this approximation estimates life expectancy accurately for the great majority of clinical problems.
Beck JR, Kassirer JP, Pauker SG: A convenient approximation of life expectancy. (The “DEALE”). I. Validation of the method. Am J Med 1982; 73: 883-888.
Mortaliiy
Life expectancy
Six patients with hyperthyroxinemia were evaluated for possible hyperthyroidism. All were taking large daily doses of propranolol-480 f 155 (&SE) mg-for treatment of angina pectoris. The patients had no clinical evidence of hyperthyroidism, afthough three had small goiters. Further evaluation revealed elevated serum free thyroxine levels and/or free thyroxine index, low-norr~l serum triiodothyronine levels, and elevated reverse triiodothyronine serum levels in all six. The thyroid-stimulating hormone response to thyrotropin-releasing hormone was normal in two patients, subnormal in three patients, and absent in one patient. One patient was restudied on lowdose propranolol (80 mg a day), with all thyroid functional parameters normal. The data suggest that the abnormalities seen in patients taking high doses of propranolol were due to blockade of iodothyronine deiodination. Signs and symptoms of hyperthyroidism are lacking in patients taking large doses of propranolol. If such a patient has an elevated serum thyroxine level, a more complete evaluation of thyroid function is necessary before the diagnosis of thyrotoxicosis can be made.
in’patients
Thyrotropin-releasing hormone Thyroid-stimulating hormone Thyroxine
Hyperthyroxinemia
Cooper DS, Daniels GH, Ladenson PW, Ridgway EC: Hyperthyroxinemia treated with high-dose propranolol. Am J Med 1982; 73: 867-871.
Triiodothyronine
Estrone Stress
Myocardial infarction
Coronary artery disease
Medical decision-making
Mortality Carcinoma, colonic
on page
A
73
Use of a bedside approximation of life expectancy in quantitative decision-making is demonstrated. This method, the declining exponentiil approximation of life expectancy (DEALE), enables the physician to collate various survival data with information on morbidity to determine a quality-adjusted expected survival for a potential management plan. The keystone in the DEALE approach is the approximation of survival by a simple exponential function. This approximation makes it possible to translate data from various literature sources (life expectancy tables, five-year survival rates, survival curves, median survival) intoa single, unified mortality scale. The DEALE method is used to obtain approximations of quality-adjusted life expectancy. The application of the method illustrated is a quantitative analysis of a clinical decision.
Beck JR, Pauker SG, Gottlieb JE, Klein K, Kassirer JP: A convenient approximation of life expectancy (the “DEALE”). II. Use in medical decision-making. Am J Med 1982; 73: 889-897.
Life expectancy
Decision theory
Serum estradiol and serum estrone levels were assessed in 29 men with acute myocardial infarction; in 17 men with unstable angina; in 14 men in whom myocardial infarction was ruled out; in 12 men without apparent coronary heart disease but hospitalized in an intensive care unit; and in 28 men who were not hospitalized and who acted as control subjects. Ages ranged from 21 to 56 years. Age, height, and weight did not differ significantly among groups. The serum estrone level was significantly elevated in all four patient groups when compared with that in the controls group. Estrone level, then, did not differentiate patients with and without coronary heart disease. Serum estradiol levels were significantly elevated in the groups with myocardial infarction, unstable angina, and in the group in whom myocardial infarction was ruled out. However estradiol levels were not significantly elevated in the group in the intensive care unit without coronary heart disease, when compared with levels in the control group. The potential significance of these serum estradiol elevations is discussed in terms of estradiol’s ability to enhance adrenergic neural activity and the resultant increase in myocardial oxygen demand.
Klaiber EL, Broverman DM, Haffajee Cl, Hochman JS, Sacks GM, Dalen JE: Serum estrogen levels in men with acute myocardial infarction. Am J Med 1982; 73: 872881.
Men
Estradiol