(1965) A CRITICAL EVALUATION OF THE TENDONREFL... - Thyroid UK

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(1965) A CRITICAL EVALUATION OF THE TENDONREFLEX MEASUREMENT AS AN INDEX OF THYROID FUNCTION

tattybogle profile image
23 Replies

"The simplicity and economy of the Lawson Kinemometer makes it a utilitarian device for use in the clinic....... " (The case for Euthyroid Hypometabolism, Marshall Goldberg MD, American Journal of Medical Science October 1960 tpauk.com/downloads/EUTHROI... )

It's a shame there isn't still a KINEMOMETER in the 21st Century GP's toolkit .

When i was diagnosed in 2003 my GP had a go at assessing the speed of mine by eye, which was interesting, and led him to order further tests that led to diagnosis.. but obviously not very accurate by eye .

Typing " Lawson kinemometer tracing " into 'a search engine' produces some interesting stuff about tendon reflex testing in hypo / hyper / euthyroidism ..... eg. this one :

pmj.bmj.com/content/postgra...

POSTGRAD. MED. J., (1965), 41, 518 A CRITICAL EVALUATION OF THE TENDON

REFLEX MEASUREMENT AS AN INDEX OF THYROID FUNCTION

A. M. ROBSON, M.D. Ncle., M.R.C.P. Luccock Research Fellow

R. HALL, M.D., B.Sc., Durh., M.R.C.P. Wellcome Senior Research Fellow in Clinical Science

and Honorary Lecturer in Medicine

G. A. SMART, M.D., B.Sc., Durh., F.R.C.P. Professor of Medicine The Department of Medicine, University of Newcastle upon Tyne

"It is now accepted that the tendon reflex is prolonged in patients with hypothyroidism.

Chaney (1924) was the first worker to record the Achilles tendon reflex and prove what had

previously been detected clinically. Since then several systems have been devised for recording the ankle jerk....."

"Despite its limitations, the technique can be helpful in the diagnosis of hypothyroidism and it is especially

useful in assessing 'the effect of treatment and in regulating the dosage of thyroid replacement therapy

given to hypothyroid patients."

Interesting to see comment in print re. it's utility/ accuracy for assessing dose , rather than just for diagnosis.

( *note the dose sizes of levo they were using at this time ... "don't feel better on 300mcg .. ok, have 400mcg" ..... feel better ? great~ carry on )

They found some link to hypEthyroidism too ( speeded up, as opposed to slowed down) , but not in everyone.... hence their "...despite it's limitations" comment ........ but i strongly suspect this speeding up when hyper would have held true for me , because when was overmedicated with thyroid hormone , i was literally 'jumping' in response to unexpected noises in the street.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"The delayed relaxation of the tendon-jerk in myxoedema was first described by Ord (1884), and in 1924 Chaney, using a pneumatic recording system, measured the tendon-reflex time in myxoedema and showed that it returned to normal with treatment. In 1929 Mussio Fournier demonstrated rapid tendon reflexes in thyrotoxicosis. Various techniques have since been devised for timing the ankle-jerk...... "

".....Though previous authors (Lambert et al., 1951; Fogel et al., 1962) have reported that return of the reflex speed to normal during treatment of hyperthyroidism or hypothyroidism correlates well with the clinical state of the patient, we have not been able to confirm this. Indeed, in our series, in both thyrotoxic and myxoedematous patients, the VP measurements returned to normal values within a few days of starting treatment and long before any subjective or objective clinical improvement. Furthermore, during treatment of myxoedema or thyrotoxicosis the tendon-jerk time became abnormal some days before clinical evidence of overdosage or underdosage appeared. Hence it is of great value in the regulation of treatment." bmj.com/content/bmj/1/5491/...

(Value of Ankle-jerk Timing in the Assessment of Thyroid Function, British Medical Journal, 1966, 1, 830-833 )

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tattybogle
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23 Replies
Star13 profile image
Star13

One of my “old” Consultants who always used to check my reflexes, always used to tell me mine were totally absent! As far as I can remember no one has ever found them!😱

tattybogle profile image
tattybogle

.....

Hyper/ Euthyroid / Hypo Kinemometer Tracings
tattybogle profile image
tattybogle in reply to tattybogle

Star13 yes .. i think i read somewhere that some people just don't have any .... Kinemometer won't be much use on you then ... lol.

TSH110 profile image
TSH110 in reply to tattybogle

well these no mixing up those 3 graphs is there? I did have mine tested but I don’t think a machine was used just a hammer and a white coat - he was a very good white coat I hasten to add.

tattybogle profile image
tattybogle in reply to TSH110

i had the "hammer and jacket with courderoy elbow patches and puzzled face test" ... he had about 5 goes ... very glad he did though.

SarahJane1471 profile image
SarahJane1471

both my Achilles have been rock solid for 4 years. It was one of my first symptoms ( and being freezing).

Guess what T3 added and they have gone back to almost normal.

I thought the Achilles Reflex was named after a man called Walton or Wharton ?

Woltman

tattybogle profile image
tattybogle in reply to SarahJane1471

yes..... "Woltman's sign " ~ Lawson was just one of several people who made machines to test the speed.

TSH110 profile image
TSH110 in reply to tattybogle

so it was cool 😎 once upon a time to make these machines

helvella profile image
helvellaAdministratorThyroid UK

I'd be amazed if someone couldn't produce a pretty effective measurement technique using something like a mobile phone.

Image analysis has become incredibly sophisticated. Maybe just using the camera and a hammer for tapping - plus software, of course.

helvella profile image
helvellaAdministratorThyroid UK in reply to helvella

Looks like it already exists - though not as a commercial product:

A Smart Tendon Hammer System for Remote Neurological Examination

frontiersin.org/articles/10...

Diagram of smart tendon reflex hammer system
tattybogle profile image
tattybogle in reply to helvella

Cool ~ very "21st century "

TSH110 profile image
TSH110 in reply to helvella

why isn’t it being used on us? Is it just a theoretical device?

TSH110 profile image
TSH110 in reply to helvella

Seemingly not….it sounds really interesting, especially where it states it’s so cheap each patient could have their own device and I presume self test. It could revolutionise thyroid hormone therapy if this was used instead of invasive dubious TSH blood tests. It would free us of the TSH tyranny wrecking correct optimisation of thyroid hormones. Where is novel thinking in endocrinology? Seems neurologists have far more enquiring minds and approaches than the lumpen T4 monotherapy gaslighting rabble we have to kowtow to

helvella profile image
helvellaAdministratorThyroid UK in reply to TSH110

Correct! Though I think we need multiple measurements - maybe temperature, resting heart rate, and some others. Just one factor is not sufficiently reliable and suitable for all. That is one of the lessons to be learned from TSH - the single factor that misleads everyone!

And, if adopted for mass production, even the retail price might be reasonably affordable.

However, that paper appears to have been ignored. No cites for it at all.

TSH110 profile image
TSH110 in reply to helvella

couldn’t agree more with the proviso it would allow gps/endos multiple hiding places to allow them to do nothing as they do now with just TSH as their lazy doctor shield. It’s just so much easier to label us as hysterics needing antidepressants, than actually do some real doctoring.

TSH110 profile image
TSH110 in reply to helvella

You should get on the case we’d all get the helvella TRF app on here !

SarahJane1471 profile image
SarahJane1471

A classic sign of hypothyroidism: a video demonstration

ncbi.nlm.nih.gov/pmc/articl...

SarahJane1471 profile image
SarahJane1471

I’m just showing off now I can send links 😂

tattybogle profile image
tattybogle in reply to SarahJane1471

good innit :)

now you can get up to some advanced nuisanceing ....

helvella profile image
helvellaAdministratorThyroid UK in reply to SarahJane1471

Well done!

I've added the title of the paper because that helps members to know whether the link will be interesting to them. And I think it will encourage some to have a look.

SarahJane1471 profile image
SarahJane1471 in reply to helvella

See now I’m going to struggle. Your just testing me 😂

nightingale-56 profile image
nightingale-56

Dr Peatfield tested my ankle reflex and neither he nor I saw/felt anything, and at 4.5 (3.1 - 6.8) I knew my FT3 was too low for me. He helped me improve on this with some added T3.

Brightness14 profile image
Brightness14

Back in 2015 I had a brilliant GP here in France. Every appointment was 30/45 minutes. during that time I had my BP tested properly in both arms, which had never happened before she also checked eyes, ears mouth etc.etc. Finally she tapped everything going i.e. reflex test. She was interested in how I felt which was very unusual for a GP. I missed her when she retired.

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