Anaemia of Rheumatic Fever
Authors: J. B. Cochran
Journal: BMJ (1951)

THYROID MEDIBALR 637 in underfunction than on normally controlled subjects or in hormone overfunction.Probably when the thyroid function is already above normal range the amount of thyrotrophic hormone mobilized by the action of E.C.T. is not able to increase thyroid function much further, and is perhaps inhibited from doing so by the simul- taneous mobilization of A.C.T.H.There appears to be an antagonism between thyrotrophic hormone and A.C.T.H., and A.C.T.H. may inhibit the thyroid.Reiss and Peter (1938) described reduction in blood iodine and atrophy of the thyroid in dogs after treatment with A.C.T.H., and an antagonistic action between thyro- trophic hormone and A.C.T.H. on the blood iodine level.At the same time they noted a decrease in blood iodine in six human cases treated with A.C.T.H., of whom three suffered from Graves's disease.Recent evidence of the antithyrotic action of A.C.T.H. has been reported by R. S. Reiss, Riggs, Thorn, and Forsham (1950).Probably in many cases E.C.T. operates therapeutically on the anterior lobe/thyroid or anterior lobe/gonadal relationship.It is known that sex hormones in small doses stimulate the anterior pituitary, but large doses inhibit the production of gonadotrophic hormone.The physiological effect of treatment with sex hormones des- cribed in this paper may be due to suppression of the production as well as of the function of thyrotrophic hormone by sex hormones acting on the anterior pituitary.Normal thyroid activity depends on an equilibrium in the production of stimulating and antagonistic hor- mcnes.E.C.T. can interfere with the mobilization of pituitary anterior lobe hormones and so influence the total hormone equilibrium.Changes in thyroid activity after E.C.T. are only an indicator for changes in the total hormone equilibrium, irrespective of whether these changes take place inside the normal range only or whether increased or decreased thyroid function is being normalized by E.C.T.It is not possible at this stage to correlate the thera- pautic result of E.C.T. with its physiological effect on one gland.To assume that where the thyroid has been influenced this has been responsible for mental improvement ts to imply that a disturbance of thyroid function was originally the cause of the psychiatric illness-an implication not justified without further study.It would be logical to test the supposition by treating psychiatric patients who show a thyroid disturbance from the point of view of this disturbance only.Another way consists in trying to copy the action of the E.C.T. by treating patients with gland concentrates containing all the pituitary anterior lobe hormones.This is now being attempted in our hospital.Never- theless, apart from the question of appropriate dosage and the problem of over-and under-sensitivity to hor- mones, the difficulties are considerable, and deterioration in the progress of the disease and spontaneous remission have to be reckoned with.Our experience shows that thyroid physiology will have to be studied in any further research on the action of E.C.T., and for this the tracer method is convenient and reasonably simple. SummaryThe effect of E.C.T. on thyroid activity has been studied by radioactive tracer technique.E.C.T. reduces pre-shock hyperactivity and raises pre- shock hypoactivity.Normal pre-shock values are influenced only within the normal range.This is due to the effect of E.C.T. on the total endocrine equilibrium and especially to the way it influences the antagonism between adrenal cortex and thyroid function.Relevant problems are discussed and the action of E.C.T. is compared-with that of applied hormone therapy.