WILLIAM GROSSMAN, M.D.; NOEL I. ROBIN, M.D.; LEWIS W. JOHNSON, M.D.; HAROLD BROOKS, M.D.; HERBERT A. SELENKOW, M.D., F.A.C.P.; LEWIS DEXTER, M.D., F.A.C.P.
A double-blind controlled study was conducted in 10 patients to determine the effects of beta adrenergic blockade with sotalol on the peripheral manifestations of thyrotoxicosis. After sotalol administration prompt and significant decreases were noted in tremor frequency (8.2 ± 0.4 cps to 7.1 ± 0.4 cps, P < 0.01), stare (22.9 ± 1.4 mm to 19.7 ± 1.3 mm, P < 0.01), lid-lag (decreased in three of four patients), and globe-lag (decreased in all of three patients). A decrease in hyperreflexia after beta adrenergic blockade was documented by prolongation of the ankle jerk T½ (235 ± 12 msec to 271 ± 16 msec, P < 0.01) as measured with a photomotogram. Definite subjective improvement was reported by six patients after sotalol but by only one patient after saline administration. No significant changes occurred in exophthalmos or serum thyroxine levels after sotalol, and only minimal changes were noted in tremor amplitude (3.64 ± 0.7 to 2.94 ± 0.5, 0.05 < P < 0.1). It is concluded that the tremor, stare, hyperreflexia, lid-lag, and globe-lag of thyrotoxicosis are mediated by the beta adrenergic nervous system. Important physiologic considerations, however, suggest that caution be exercised in the use of beta adrenergic blockade over prolonged periods in patients with thyrotoxicosis.
GROSSMAN W, ROBIN NI, JOHNSON LW, et al. Effects of Beta Blockade on the Peripheral Manifestations of Thyrotoxicosis. Ann Intern Med. 1971;74:875–879. doi: https://doi.org/10.7326/0003-4819-74-6-875
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Published: Ann Intern Med. 1971;74(6):875-879.
Endocrine and Metabolism, Thyroid Disorders.
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