Population need for renal replacement therapy in Thames regions: ethnic dimension.

OBJECTIVES--To determine the use of renal replacement therapy by ethnic origin and to ascertain the variation in provision of such therapy and to relate this to the distribution of ethnic minority populations. DESIGN--Analysis of retrospective and cross sectional data from 19 renal units. SETTING--All four Thames regional health authorities. SUBJECTS--Patients resident in the Thames regions who were accepted as new patients for renal replacement therapy during 1991 and 1992 and the patients who were already undergoing such treatment between December 1992 and April 1993. MAIN OUTCOME MEASURES--Rates of acceptance for and prevalence of renal replacement therapy among white, black, and Asian people. RESULTS--The average annual acceptance rates per million in 1991-2 were 61 for white people, 175 for black people, and 178 for Asians, and the prevalences per million were 351, 918, and 957 respectively. The relative risks increased with age. A threefold increase in the acceptance rate occurred in people aged under 55 in both the black and Asian populations, suggesting that the higher rates are probably not due to factors related to access alone. Treatment rates varied considerably among districts, reflecting both the distribution of ethnic minority populations and access to services. CONCLUSION--Black and Asian people receive and have a greater need for renal replacement therapy, and the need will increase as these populations age. These findings have important implications for the provision of renal services in districts with a high proportion of ethnic minorities and for the management of diabetes mellitus and hypertension, two important causes of end stage renal failure in these populations.     

Incidence of advanced chronic renal failure and the need for end stage renal replacement treatment.

OBJECTIVE--To determine the age related incidence of advanced chronic renal failure in two areas of England. DESIGN--Prospective study of patients newly identified as having advanced chronic renal failure within a two year period; subsequent monitoring of patients'' clinical course for a further 26 months. SETTING--Devon and Blackburn. SUBJECTS--Those patients in a population of 708,997 who developed advanced chronic renal failure (serum creatinine concentration greater than 500 mumol/l) for the first time during a two year period. MAIN OUTCOME MEASURES AND RESULTS--210 Patients (148 per million population per year) developed advanced chronic renal failure, 117 (51%) of whom were over 70. The age related incidence rose from 58 per million per year in those aged 20-49 to 588 per million per year in those aged 80 or over. Only 54% (113) of patients were referred to a nephrologist; 120 patients (57%) needed dialysis or died within three months of presenting without receiving dialysis, and 187 (89%) died or needed dialysis within three years. After those unsuitable for further treatment had been excluded, 78 patients per million population per year aged under 80 needed to start long term renal replacement treatment. CONCLUSIONS--Many patients suitable for renal replacement treatment are still not referred for nephrological opinion and are denied treatment. If the treatment rate in the United Kingdom rose from the 1988 rate of 55.1 per million per year to 78 per million per year then the number of patients receiving treatment would rise to about 800 per million. This is double the present number and has considerable but predictable resource implications for the NHS.     

Prediction of resources needed to achieve the national target for treatment of renal failure.

A model of the treatment of end stage renal failure has been primed with observed survival statistics and used to predict the steady state that will be achieved when the present annual target of at least 40 new patients per million population is in equilibrium with the death rate. The number of patients expected to receive each type of dialysis or a transplant is given per million of population. The personnel and facilities required to care for these patients and the costs of each programme were derived using analyses of workloads and costs in the North Western Regional Health Authority. The study has documented the considerable need for "back up" beds for patients on dialysis who require temporary care as inpatients. The cost effectiveness of transplantation has been demonstrated; at steady state it is calculated that each successful graft saves the service pounds 30,000. Implementation of the minister''s minimum target requires a build up to some three times the resources currently allocated, with parallel increases in numbers of medical, nursing, and other essential staff.     

Une évaluation des besoins en transplantation d'organes au Québec.

OBJECTIVES: To evaluate the demand for organs for transplantation and to recommend a reorganization of transplantation services in Quebec. DESIGN: Retrospective study. SETTING: Province of Quebec, 1988 to 1992. PATIENTS: All patients on waiting lists for organ transplantation and patients who received transplants registered in national data banks. MAIN OUTCOME MEASURES: The actual annual demand for organ transplantation and the rate of transplantations performed. RESULTS: The rates of heart transplantation were lower than the actual annual demand, which resulted in many patients dying while awaiting transplantation. The actual annual demand for heart transplantation decreased during the last 5 years from 10.9 per million people in 1987 to 6.7 in 1992. The rates of heart transplantation in Quebec were higher than the Canadian average. The actual demand for lung transplantation was only 2.9 per million people on average in 1992. Demand for liver transplantation increased annually, reaching 8.6 per million in 1992. The rate of transplantation increased likewise but remained insufficient. The demand for kidney transplantation reached 27.2 per million people in 1992, and the transplantation rate was 17.8. CONCLUSIONS: Taking into account the actual demand for and supply of organ transplantation, to insure high-quality service and to control costs associated with organ transplantation, we recommend that the present system in Quebec be reorganized so that transplantations are performed in 12 centres: 7 for kidney transplantation, 2 for hearts, 2 for livers and 1 for lungs.     

Diabetes and hypertension in Britain's ethnic minorities: implications for the future of renal services.

Diabetes and hypertension are much more prevalent among Britain''s 2.5 million Asian and African-Caribbean population than among the white population and are major contributors to end stage renal failure. Asians and African-Caribbeans have threefold to fourfold higher acceptance rates on to renal replacement therapy than white people, and in some districts they comprise up to half of all patients receiving such treatment. Their greater need for renal replacement treatment is accompanied by difficulties of tissue matching in cross racial transplants and a shortage of donor organs. The aging of ethnic minority populations will increase local need for renal services significantly. Measures to control diabetes, hypertension, and secondary complications in Asian and African-Caribbean communities will contribute both to safeguarding health and to economies in spending on renal services. Education about diabetes and hypertension, modification of behavioural risk factors, early diagnosis, effective glycaemic and blood pressure control, and early referral for signs of renal impairment are essential preventive measures. Primary and community health care professionals have a critical role to play here.     

未来气候变化情景下河南省粮食安全气候承载力评估

为探究未来气候变化对河南省粮食生产的影响,基于夏玉米和冬小麦两种主粮作物的生产潜力和气候资源承载力,结合1961—2017年河南省111个气象站的观测数据以及区域气候模式输出的2041—2080年RCP4.5和RCP8.5两种排放情景下的气象资料,采用农业生态区域法(AEZ模型)计算了河南省气候生产潜力及其变化特征,并根据不同生活水平下的粮食需求指标,分析了河南省的气候承载力和剩余空间。结果表明: 1961—2017年,河南省夏玉米气候生产潜力平均为18408.87 kg·hm^-2,表现为中东部高、西部低;与基准时段(1981—2010年)相比,RCP4.5和RCP8.5情景下分别下降13.0%和8.0%,高值中心由豫东地区向豫西南地区转移。1961—2017年,冬小麦气候生产潜力平均值为10889.79 kg·hm^-2,呈中部高、北部低;与基准时段相比,RCP4.5和RCP8.5情景下分别减少18.6%、21.7%。当前,在温饱水平和小康水平粮食需求条件下,最大气候资源承载力分别平均养活人口2.52亿和1.83亿。2070s(2071—2080年)最大气候资源承载力平均养活人口有所减少,与基准时段相比,RCP4.5情景下小康水平和温饱水平分别下降9.7%和18.4%,RCP8.5情景下小康水平和温饱水平分别下降7.7%和16.6%。当前气候条件下,河南省气候资源相对剩余率在-93.0%～356.9%,与基准时段相比,未来气候资源相对剩余率减少近40%。     

HIV testing in patients with end stage renal disease.

One hundred and twenty eight British and Irish nephrologists were questioned about their policy for HIV testing of patients with end stage renal failure being considered for renal replacement therapy. A total of 101 (79%) replied. In the case of candidates for dialysis roughly one third of respondents tested only people they considered at risk of infection with HIV and nearly one fifth considered testing unnecessary. In the case of candidates for transplantation routine HIV testing was carried out by 68 of 100 nephrologists; 22 tested only patients "at risk" and 10 did not test. A positive HIV test result was considered by most but not all respondents (63/86) to exclude patients from transplantation. Twenty four of 88 nephrologists considered that HIV positivity should exclude patients from haemodialysis, but only seven of 87 would exclude such patients from peritoneal dialysis. Similar attitudes pertained for patients with end stage renal failure who refused HIV testing. Testing with the patient''s knowledge and consent was the policy of two thirds of nephrologists, but a patient''s signature was obtained by only 24 of 88. There should be a consensus on practice for HIV testing of patients with end stage renal failure.     

Nortriptyline plus nicotine replacement versus placebo plus nicotine replacement for smoking cessation: pragmatic randomised controlled trial

Objective To test the efficacy of nortriptyline plus nicotine replacement therapy compared with placebo plus nicotine replacement therapy for smoking cessation.Design Pragmatic randomised controlled trial.Setting National Health Service stop smoking service clinics.Participants 901 people trying to stop smoking.Interventions Participants chose their nicotine replacement product, including combinations of nicotine replacement therapy, and received behavioural support. Nortriptyline was started one to two weeks before quit day, with the dose increased from 25 mg to 75 mg daily for eight weeks and reduced if not tolerated.Main outcome measures Primary outcome was prolonged confirmed abstinence at six months. Secondary outcomes were prolonged abstinence at 12 months, drug use, severity of side effects, nicotine withdrawal symptoms, and urges to smoke.Results 72 of 445 (16%) people using nortriptyline and 55 of 456 (12%) using placebo achieved prolonged abstinence at six months (relative risk 1.34, 95% confidence interval 0.97 to 1.86). At 12 months the corresponding values were 49 (11%) for nortriptyline and 40 (9%) for placebo (1.26, 0.84 to 1.87). 337 (79%) people in the nortriptyline arm and 325 (75%) in the placebo arm were taking combination treatment on quit day, median 75 mg per day in both groups. More people in the nortriptyline arm than in the placebo arm took lower doses. The nortriptyline arm had noticeably higher severity ratings for dry mouth and constipation than the placebo arm, with slightly higher ratings for sweating and feeling shaky. Both groups had similar urges to smoke, but nortriptyline reduced depression and anxiety. Overall, withdrawal symptom scores did not differ.Conclusions Nortriptyline and nicotine replacement therapy are both effective for smoking cessation but the effect of the combination is less than either alone and evidence is lacking that combination treatment is more effective than either alone.Trial registration Current Controlled Trials ISRCTN57852484.     

Quantifying and Mapping the Supply of and Demand for Carbon Storage and Sequestration Service from Urban Trees

Studies that assess the distribution of benefits provided by ecosystem services across urban areas are increasingly common. Nevertheless, current knowledge of both the supply and demand sides of ecosystem services remains limited, leaving a gap in our understanding of balance between ecosystem service supply and demand that restricts our ability to assess and manage these services. The present study seeks to fill this gap by developing and applying an integrated approach to quantifying the supply and demand of a key ecosystem service, carbon storage and sequestration, at the local level. This approach follows three basic steps: (1) quantifying and mapping service supply based upon Light Detection and Ranging (LiDAR) processing and allometric models, (2) quantifying and mapping demand for carbon sequestration using an indicator based on local anthropogenic CO₂ emissions, and (3) mapping a supply-to-demand ratio. We illustrate this approach using a portion of the Twin Cities Metropolitan Area of Minnesota, USA. Our results indicate that 1735.69 million kg carbon are stored by urban trees in our study area. Annually, 33.43 million kg carbon are sequestered by trees, whereas 3087.60 million kg carbon are emitted by human sources. Thus, carbon sequestration service provided by urban trees in the study location play a minor role in combating climate change, offsetting approximately 1% of local anthropogenic carbon emissions per year, although avoided emissions via storage in trees are substantial. Our supply-to-demand ratio map provides insight into the balance between carbon sequestration supply in urban trees and demand for such sequestration at the local level, pinpointing critical locations where higher levels of supply and demand exist. Such a ratio map could help planners and policy makers to assess and manage the supply of and demand for carbon sequestration.     

Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

Introduction

Family planning contributes significantly to the prevention of maternal and child mortality. However, many women still do not use modern contraception and the numbers of unintended pregnancies, abortions and subsequent deaths are high. In this paper, we estimate the service delivery costs of scaling up modern contraception, and the potential impact on maternal, newborn and child survival in South Africa.

Methods

The Family Planning model in Spectrum was used to project the impact of modern contraception on pregnancies, abortions and births in South Africa (2015-2030). The contraceptive prevalence rate (CPR) was increased annually by 0.68 percentage points. The Lives Saved Tool was used to estimate maternal and child deaths, with coverage of essential maternal and child health interventions increasing by 5% annually. A scenario analysis was done to test impacts when: the change in CPR was 0.1% annually; and intervention coverage increased linearly to 99% in 2030.

Results

If CPR increased by 0.68% annually, the number of pregnancies would reduce from 1.3 million in 2014 to one million in 2030. Unintended pregnancies, abortions and births decrease by approximately 20%. Family planning can avert approximately 7,000 newborn and child and 600 maternal deaths. The total annual costs of providing modern contraception in 2030 are estimated to be US$33 million and the cost per user of modern contraception is US$7 per year. The incremental cost per life year gained is US$40 for children and US$1,000 for mothers.

Conclusion

Maternal and child mortality remain high in South Africa, and scaling up family planning together with optimal maternal, newborn and child care is crucial. A huge impact can be made on maternal and child mortality, with a minimal investment per user of modern contraception.     

Angiogenesis: What can it offer for future medicine?

Modulation of angiogenesis for disease therapy was proposed nearly 40 years ago and today various protein and chemical molecules are available for the treatment of human malignant and ophthalmological disorders. Angiogenesis research has emerged, as one of the most comprehensive research areas, in biomedicine and development of novel drugs by targeting angiogenesis has become one of the main focuses among pharmaceutical giants. If 30% of annually 12 million new cancer cases worldwide receive antiangiogenic therapy, over 60 million cancer patients would be treated by the end of 2060. In this mini-review, I discuss current available antiangiogenic drugs and future therapeutic options based on the angiogenesis principle.     

Impact of changing wood demand,climate and land use on European forest resources and carbon stocks during the 21st century

We used the European Forest Information Scenario Model (EFISCEN) to project the development of forest resources for 15 European countries from 2000 to 2100 under a broad range of climate scenarios, which were based on the a1fi, a2, b1 and b2 storylines of the Special Report on Emissions Scenarios of the Intergovernmental Panel on Climate Change. Each climate scenario was associated with consistent land-use change and wood demand assumptions. Climate change-induced growth changes were incorporated into the calculations by scaling inventory-based stem growth in EFISCEN by net primary productivity estimated from the Lund–Potsdam–Jena dynamic global vegetation model. The impact of changes in wood demand, climate and forest area were studied separately, and in combination, in order to assess their respective effects. For all climate scenarios under consideration, climate change resulted in increased forest growth, especially in Northern Europe. In Southern Europe, higher precipitation in spring and the projected increased water-use efficiency in response to rising atmospheric CO₂ concentrations mitigated the effects of increasing summer drought. Climate change enhanced carbon sequestration in tree biomass. The climate change-induced increase in tree growth led to a faster increase in growing stocks compared with the simulation using current climate. As productivity decreased in higher stocked forests, the positive impact of climate change began to level off during the second half of the 21st century in the scenarios where wood demand was low. Afforestation measures had the potential to increase growing stock and annual increment; however, large areas were needed to obtain notable effects. Despite noticeable differences in the growth response between the climate scenarios, changes in wood demand proved to be the crucial driving force in forest resource development. Tree carbon stocks increased by 33–114% between 2000 and 2100 when only changes in wood demand were regarded. Climate change added another 23–31% increase, while changes in forest area accounted for an additional increase of 2–40%. Our results highlight potential future pathways of forest resource development resulting from different scenarios of wood demand, land use and climate changes, and stress the importance of resource utilization in the European forest carbon balance.     

Dialysis-Requiring Acute Kidney Injury in Denmark 2000-2012: Time Trends of Incidence and Prevalence of Risk Factors—A Nationwide Study

Introduction

Dialysis-requiring acute kidney injury is a severe illness associated with poor prognosis. However, information pertaining to incidence rates and prevalence of risk factors remains limited in spite of increasing focus. We evaluate time trends of incidence rates and changing patterns in prevalence of comorbidities, concurrent medication, and other risk factors in nationwide retrospective cohort study.

Materials and Methods

All patients with dialysis-requiring acute kidney injury were identified between January 1^st 2000 and December 31^st 2012. By cross-referencing data from national administrative registries, the association of changing patterns in dialysis treatment, comorbidity, concurrent medication and demographics with incidence of dialysis-requiring acute kidney injury was evaluated.

Results

A total of 18,561 adult patients with dialysis-requiring AKI were identified between 2000 and 2012. Crude incidence rate of dialysis-requiring AKI increased from 143 per million (95% confidence interval, 137–144) in 2000 to 366 per million (357–375) in 2006, and remained stable hereafter. Notably, incidence of continuous veno-venous hemodialysis (CRRT) and use of acute renal replacement therapy in elderly >75 years increased substantially from 23 per million (20–26) and 328 per million (300–355) in 2000, to 213 per million (206–220) and 1124 per million (1076–1172) in 2012, respectively. Simultaneously, patient characteristics and demographics shifted towards increased age and comorbidity.

Conclusions

Although growth in crude incidence rate of dialysis-requiring AKI stabilized in 2006, continuous growth in use of CRRT, and acute renal replacement therapy of elderly patients >75 years, was observed. Our results indicate an underlying shift in clinical paradigm, as opposed to unadulterated growth in incidence of dialysis-requiring AKI.     

Resource and Climate Implications of Landfill Mining

This study analyzes the amount of material deposited in Swedish municipal solid waste landfills, how much is extractable and recyclable, and what the resource and climate implications are if landfill mining coupled with resource recovery were to be implemented in Sweden. The analysis is based on two scenarios with different conventional separation technologies, one scenario using a mobile separation plant and the other using a more advanced stationary separation plant. Further, the approach uses Monte Carlo simulation to address the uncertainties attached to each of the different processes in the scenarios. Results show that Sweden's several thousand municipal landfills contain more than 350 million tonnes (t) of material. If landfill mining combined with resource recovery is implemented using a contemporary stationary separation plant, it would be possible to extract about 7 million t of ferrous metals and 2 million t of nonferrous metals, enough to meet the demand of Swedish industry for ferrous and nonferrous metals for three and eight years, respectively. This study further shows that landfill mining could potentially lead to the equivalent of a one‐time reduction of about 50 million t of greenhouse gas emissions (carbon‐dioxide equivalents), corresponding to 75% of Sweden's annual emissions.     

A GIS simulation of potential vegetation in China under different climate scenarios at the end of the 21st century

The study of potential vegetation can reveal the impact of climate on changes in vegetation patterns. It is the starting point for studying vegetation-environmental classification and relationships, and it is the key point for studying global change and terrestrial ecosystems. By using the Comprehensive Sequential Classification System (CSCS) and the meteorological data under the four climate change scenarios from the IPCC5 publication, the present paper carries out a GIS simulation study of the spatial distribution of potential vegetation in China at the end of the 21st century. The results indicate that under the four climate scenarios at the end of the 21st century: (1) The potential vegetation in China shows significant horizontal and vertical distribution, which corresponds well to those of natural topographic features. (2) There are 40 classes of potential vegetation in China. Tropical-extrarid tropical desert (VIIA), which has no corresponding condition of growth in China, is commonly lacking, and differences exist among the potential vegetation classes and among the ratios of the classes under different scenarios. (3) From the perspective of categories, temperate forest is the most widely distributed, and savanna is the least widely distributed. Together with the strengthening of the radiation intensity according to RCP2.6 → RCP4.5 → RCP6.0 → RCP8.5, the area covered by cold-dry potential vegetation decreases as the area covered by warm-humid potential vegetation increases. As a result, the areas of tundra and alpine steppe, frigid desert, steppe, and temperate humid grassland tend to decrease, and those of semi-desert, temperate forest, sub-tropical forest, tropical forest, warm desert, and savanna tend to increase. Moreover, the potential vegetation in China at the end of the 21st century would change at different levels and in different directions when compared with that at the end of the 20th century. (4) In the same period, potential vegetation in different regions shows differences in their sensitivity to climate change, and by the end of the 21st century, 30.73% of land in China would be classified as a sensitive region, which highly corresponds to the current ecologically vulnerable zone, and whose potential vegetation easily evolves along with changes of climate scenarios.     

Prevalence of advanced renal failure in Northern Ireland.

OBJECTIVE--To determine the prevalence of advanced chronic renal failure in Northern Ireland as part of an assessment by the Renal Association of the level of service provision for treatment of such patients. DESIGN--Prospective notification of patients reaching a defined level of advanced chronic renal failure (serum creatinine concentration greater than or equal to 500 mumol/l or blood urea concentration greater than or equal to 25 mmol/l) within one year and follow up for at least three, and, at most, four years after notification. SETTING--Northern Ireland. PATIENTS--122 Patients with a serum creatinine or blood urea concentration higher than the defined level newly detected from 1 March 1985 to 28 February 1986. MAIN OUTCOME MEASURE--Survival after notification. RESULTS--77 Patients of all ages/million population/year had advanced chronic renal failure compared with 67/million/year between the ages of 5 and 80 found in an earlier study of the same population. 62% Of the patients were older than 50 years. Seventeen (14%) of the patients either required dialysis or died within one month of notification, 51 (42%) survived for at least three months, and 23 (19%) for one year or longer. Three patients, all of whom were attending a renal clinic, survived for periods of 43, 45, and 46 months respectively without renal replacement treatment. CONCLUSIONS--The increased number of new patients disclosed in this survey compared with the earlier survey is mainly owing to an increased number of older patients. Such patients often have disabilities other than renal failure, are less likely to be capable of self treatment, may develop complications more often and require more frequent hospital admissions, and may not be suitable for transplantation and consequently have considerable resource implications for the NHS.     

Availability of corn stover as a sustainable feedstock for bioethanol production

The amount of corn stover that can be sustainably collected is estimated to be 80-100 million dry tonnes/yr (t/yr), a majority of which would be available to ethanol plants in the near term as only a small portion is currently used for other applications. Potential long-term demand for corn stover by non-fermentative applications in the United States is estimated to be about 20 million dry t/yr, assuming that corn stover-based products replace 50% of both hardwood pulp and wood-based particleboard, and that 50% of all furfural production is from corncobs. Hence, 60-80 million dry t/yr of corn stover should be available to fermentative routes. To achieve an ethanol production potential of 11 billion L (3 billion gal) per year (a target level for a non-niche feedstock), about 40% of the harvestable corn stover is needed. This amount should be available as long as the diversion of corn stover to non-ethanol fermentative products remains limited.     

Preservation of red blood cells with purines and nucleosides. II. Uptake and utilization of purines and nucleosides by stored red blood cells

The uptake of adenine, guanine, guanosine and inosine by stored red cells was investigated in whole blood and red cell resuspensions at initial concentrations of 0.25, 0.5 and 0.75 mM for adenine and 0.5 mM for the other additives using a rapid ion-exchange chromatographic microanalysis of purines and nucleosides in plasma and whole blood. Increasing adenine concentrations from 0.25 to 0.75 mM in blood elevated the adenine uptake from 0.3 up to 0.8 mmol/l red cells during 2 hours after collecting blood. The intra-/extracellular distribution ratio changed from 1 : 1.3 to 1: 1.7. Some 2 hours after withdrawing blood into CPD--solution with purines and nucleosides the uptake of adenine and guanine resulted in 40 per cent and 70 per cent respectively and of guanosine and inosine in 80 and 90 per cent respectively. The replacement of plasma by a resuspending solution gave the same uptake rates for purines and nucleosides. The nucleosides were rapidly split to purines and R-1-P and disappeared from blood during one week. Adenine and guanine were utilized to 80 to 90 per cent only after 3 weeks. During the same period the utilization of guanine was smaller by 40 per cent than that of adenine due to the different activity of the purine nucleoside phosphorylase for these substrates. The plasma of all analyzed blood samples contained hypoxanthine and inosine, but guanine and guanosine were detected only in those samples to which one of them was added. After 3 weeks of storage the highest concentration of hypoxanthine was found in CPD-AI blood with 600 microM in plasma and the highest concentration of synthesized inosine in CPD-AG blood with a concentration of 100 microM in plasma. Three ways of utilization of purines by stored red cells were discussed : the synthesis of nucleotide monophosphates, the formation of nucleosides, and the deamination. The portions of these ways change during storage. The most effective concentrations of adenine and guanosine in stored blood seems to be 0.25 and 0.5 mM respectively. The full utilization of the nucleoside requires the addition of inorganic phosphate.     

Clinical importance of reversibility in primary goitrous hypothyroidism.

Twenty seven hypothyroid patients with a serum concentration of thyroid stimulating hormone (TSH) of over 40 mU/1 were followed up for three to 20 weeks without replacement therapy. The serum thyroid hormone concentrations increased with a dramatic decrease in serum TSH values in 14 patients (reversible group) but there was no significant change in the other 13 (irreversible group). Fourteen out of 19 patients with goitre but none of the eight patients without goitre belonged to the reversible group. All of the 11 patients with a high uptake of iodide by the thyroid, three of the six with a normal uptake, and none of the 10 with a low uptake belonged to the reversible group. These observations indicate that patients with goitrous hypothyroidism with a preserved thyroid uptake of iodide are likely to become euthyroid spontaneously without replacement therapy.