The Effect of Iodine on Creatinuria in Hyperthyroidism.

Abstract

The urine of normal human adults taking a diet free from meat, fish, peas and beans, contains no creatine. The only known exception to this is in women during the menstrual period when small amounts of creatine may appear in the urine. A very high creatine-free protein diet may produce creatinuria in women but has not been obtained in men. Creatinuria has been observed in starvation, wasting diseases generally, during carbohydrate deprivation, diabetes mellitus, Graves' disease, fevers and the muscular atrophies and dystrophies. 1 Studies made on 21 cases of Graves' disease with or without a nodular thyroid gland confirm in general previous observations regarding the appearance of creatine in urine of individuals with hyperthyroidism.

In observing the effect of iodine on creatinuria in hyperthyroidism the cases have been studied in a specially organized metabolism ward under rigid metabolic conditions. Each patient was given a creatine-free diet with a caloric value equivalent to 100% above the actually determined basal requirement, with a protein intake of 11/2 gm. per kilo and the carbohydrate and fat distributed according to the likes and dislikes of the individual. Usually, however, the carbohydrates were taken more freely than fats. Such a diet brings the patient into nitrogen equilibrium within a few days. After three days to a week Lugols solution, 1 to 3 cc., is given, in most instances as part of the program in preparation for operation.

Out of 16 cases of true Graves' disease all except one have shown a daily excretion of creatine varying from 200 to 1000 mg. On the exhibition of iodine in the form of Lugous there is a striking diminution of creatine excretim to less than 100 mg. This is usually accompanied by an improvement in symptoms and a fall in the basal metabolism rate. In one case there was no improvement in symptoms or fall in basal but a remarkable drop in creatine excretion occurred.