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• A variety of metabolic and endocrine abnormalities are encountered in chronic renal failure. Nontoxic goiter and laboratory results suggesting hypothyroidism are known. Less well known are thyroid function tests suggesting hyperthyroidism in clinically euthyroid patients. To our knowledge, ours is the first documented case of a patient who experienced both clinical and biochemical hyperthyroidism after four years of long-term hemodialysis therapy. (Arch Intern Med140:708-709, 1980)

An extended study of the basal metabolism in its relation to the clinical features of toxic goiter 1 has been in progress in this clinic since June, 1914. As a by-product of this work there has been collected a considerable amount of data on patients with clinically nontoxic goiter and on patients without frank hyperthyroidism or hypothyroidism, but in whom the possibility of one of these conditions was suspected, and also on patients with a variety of pathologic states not including the thyroid. Since the use of the basal metabolism determination as a test of thyroid function has come into rather wide use in the last two or three years, it has seemed to us advisable to place these data on record. A large amount of data on normal persons, which, as regards the thyroid problem, serves as normal control data, has been secured by Benedict of his associates. 2 Our own

The relationship between blood pressure and hyperthyroidism is significant if some views of the present day are true. It is common knowledge that there is an increased pulse pressure in hyperthyroidism. Statements have been made that if this were continued over a sufficient time, cardiovascular changes and permanent arterial hypertension might ensue. Furthermore, it is the belief of some writers that the nontoxic adenomatous goiter can lead to similar changes over a period of years. There has been no adequate survey, as far as I am aware, to show that either active hyperthyroidism or prolonged but slight over-activity of the thyroid in otherwise clinically nontoxic goiter leads to permanent cardiovascular degeneration, hypertension or cardiac enlargement. In observing patients who have been operated on for toxic goiter, one frequently finds the blood pressure higher after operation than before, although the basal metabolic rate is normal and the patient is clinically free

In December, 1930, Mason, Hunt and I 1 published observations on the blood cholesterol in hyperthyroidism and hypothyroidism. The results of forty-seven determinations of the blood cholesterol in patients with toxic goiter were reported, and it was definitely shown that low values were found in severe cases, although there appeared to be no individual reciprocal relationship between the elevation of the basal metabolic rate and the lowering of the blood cholesterol. The present study was begun on a larger group of patients to determine whether our impression that the degree of clinical toxicity is reflected more accurately in the lowering of the blood cholesterol than by the basal metabolic rate is correct. Furthermore, the behavior of the blood cholesterol as the result of the various therapeutic procedures warranted further study. METHOD OF STUDY The cases studied were unselected, specimens of the blood having been taken as a routine in all

This monograph on thyroidology has been prepared by two German internists with the collaboration of two Austrian surgeons and two Swiss pathologists. According to the principal authors' foreword, they have intended primarily to assemble the results of clinical and experimental studies since 1955 rather than to present a comprehensive treatise; much of the data are derived from their ten years of experience at the clinic and polyclinic in Dusseldorf (a city of 700,000). They need not be so modest. The experience which they cite is impressive: 3,000 cases of nontoxic goiter, 644 cases of thyrotoxicosis, etc. The information and opinions are consistent with those prevailing in the United States; it is well organized and clearly stated in text and tables. Each chapter, and in some instances subsection, has a bibliography in which the world literature is well represented and up-to-date. Minor points that are not fully discussed are supported with