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. 1973 Apr 14;2(5858):87–90. doi: 10.1136/bmj.2.5858.87

Achilles Tendon Reflex in Accidental Hypothermia and Hypothermic Myxoedema

D Maclean, D R Taig, D Emslie-Smith
PMCID: PMC1589087  PMID: 4121692

Abstract

The photomotogram (P.M.G.) of the Achilles tendon reflex was studied in 26 patients with hypothermia (rectal temperature 33·3°C or less), 10 of whom also had myxoedema (serum protein bound iodine 2·8 μg/100 ml or less). No reflex could be elicited in eight (31%) of these patients, including three of those with myxoedema. Hypothermia increases both the contraction and the relaxation times of the reflex, the relaxation phase being particularly prolonged in those with myxoedema. In those patients from whom the reflex was elicited the ratio of the contraction time to the “half-relaxation time” in the P.M.G. was less than unity in six of the seven with myxoedema, and considerably greater than unity in eight of the 11 (73%) who were euthyroid. Thus, analysis of the Achilles tendon reflex P.M.G. correctly predicted the thyroid status in 14 of the 18 hypothermic patients in whom the Achilles tendon reflex was present (78%). The wider use of this rapid test of thyroid function would allow a more rational use of thyroid hormones in hypothermic patients and so lead to a better assessment of their value.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abraham A. S., Atkinson M., Roscoe B. Value of Ankle-jerk Timing in the Assessment of Thyroid Function. Br Med J. 1966 Apr 2;1(5491):830–833. doi: 10.1136/bmj.1.5491.830. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Berry J. N. A new method for recording cardiac, hepatic, and other pulsations, movements, and thrills. Am Heart J. 1966 Jan;71(1):17–25. doi: 10.1016/0002-8703(66)90651-x. [DOI] [PubMed] [Google Scholar]
  3. Berry J. N., Mago L. Normal cardiogram in the pulmonary area. Br Heart J. 1967 May;29(3):405–410. doi: 10.1136/hrt.29.3.405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. CATZ B., RUSSELL S. Myxedema, shock and coma. Seven survival cases. Arch Intern Med. 1961 Sep;108:407–417. doi: 10.1001/archinte.1961.03620090079010. [DOI] [PubMed] [Google Scholar]
  5. DUGUID H., SIMPSON R. G., STOWERS J. M. Accidental hypothermia. Lancet. 1961 Dec 2;2(7214):1213–1219. doi: 10.1016/s0140-6736(61)92588-0. [DOI] [PubMed] [Google Scholar]
  6. Davies D. M., Millar E. J., Miller I. A. Accidental hypothermia treated by extracorporeal blood warming. Lancet. 1967 May 13;1(7498):1036–1037. doi: 10.1016/s0140-6736(67)91546-2. [DOI] [PubMed] [Google Scholar]
  7. EMSLIE-SMITH D. Accidental hypotherimia; a common condition with a pathognomic electrocardiogram. Lancet. 1958 Sep 6;2(7045):492–495. doi: 10.1016/s0140-6736(58)91283-2. [DOI] [PubMed] [Google Scholar]
  8. FOGEL R. L., EPSTEIN J. A., STOPAK J. H., KUPPERMAN H. S. Archilles tendon reflex test (photomotogram) as a measure of thyroid function. N Y State J Med. 1962 Apr 15;62:1159–1168. [PubMed] [Google Scholar]
  9. GILSON W. E. Achilles-reflex recording with a simple photomotograph. N Engl J Med. 1959 May 14;260(20):1027–1028. doi: 10.1056/NEJM195905142602008. [DOI] [PubMed] [Google Scholar]
  10. Gooding G. T. Delayed relaxation of the ankle jerk in anorexia nervosa. Br J Clin Pract. 1969 Jan 1;23(1):40–41. [PubMed] [Google Scholar]
  11. Griffiths P. D. Serum enzymes in diseases of the thyroid gland. J Clin Pathol. 1965 Sep;18(5):660–663. doi: 10.1136/jcp.18.5.660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. HUBBLE D. Endocrine relations. Lancet. 1955 Jan 1;268(6853):1–5. doi: 10.1016/s0140-6736(55)93207-4. [DOI] [PubMed] [Google Scholar]
  13. Hurwitz L. J., McCormick D., Allen I. V. Reduced muscle alpha-glucosidase (acid-maltase) activity in hypothyroid myopathy. Lancet. 1970 Jan 10;1(7637):67–69. doi: 10.1016/s0140-6736(70)91849-0. [DOI] [PubMed] [Google Scholar]
  14. LAMBERT E. H., UNDERDAHL L. O., BECKETT S., MEDEROS L. O. A study of the ankle jerk in myxedema. J Clin Endocrinol Metab. 1951 Oct;11(10):1186–1205. doi: 10.1210/jcem-11-10-1186. [DOI] [PubMed] [Google Scholar]
  15. MILES D. W., SURVEYOR I. ROLE OF THE ANKLE-JERK IN THE DIAGNOSIS AND MANAGEMENT OF THYROID DISEASE. Br Med J. 1965 Jan 16;1(5428):158–161. doi: 10.1136/bmj.1.5428.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. MOULOPOULOS S. D., KOUTRAS D. A., KRALIOS A. C. A SIMPLE INEXPENSIVE METHOD FOR RECORDING ACHILLES TENDON REFLEXES. Lancet. 1964 Jan 11;1(7324):85–86. doi: 10.1016/s0140-6736(64)91398-4. [DOI] [PubMed] [Google Scholar]
  17. Maclean D., Griffiths P. D., Emslie-Smith D. Serum-enzymes in relation to electrocardiographic changes in accidental hypothermia. Lancet. 1968 Dec 14;2(7581):1266–1270. doi: 10.1016/s0140-6736(68)91761-3. [DOI] [PubMed] [Google Scholar]
  18. Mathews J. A. Thyroid function in accidental hypothermia. Postgrad Med J. 1966 Aug;42(490):495–498. doi: 10.1136/pgmj.42.490.495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. NORDQVIST P., DHUNER K. G., STENBERG K., ORNDAHL G. Myxoedema coma and carbon dioxide-retention. Acta Med Scand. 1960 Mar 10;166:189–194. [PubMed] [Google Scholar]
  20. Nuki G., Bayliss R. I. The Achilles tendon reflex as an index of thyroid function. Postgrad Med J. 1968 Jan;44(507):97–102. doi: 10.1136/pgmj.44.507.97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. PETAJAN J. H., WATTS N. Effects of cooling on the triceps surae reflex. Am J Phys Med. 1962 Dec;41:240–251. [PubMed] [Google Scholar]
  22. REES J. R. Accidental hypothermia. Lancet. 1958 Mar 15;1(7020):556–559. doi: 10.1016/s0140-6736(58)91193-0. [DOI] [PubMed] [Google Scholar]
  23. SHERMAN L., GOLDBERG M., LARSON F. C. The Achilles reflex. A diagnostic test of thyroid dysfunction. Lancet. 1963 Feb 2;1(7275):243–245. doi: 10.1016/s0140-6736(63)90953-x. [DOI] [PubMed] [Google Scholar]
  24. Sprunt J. G., Maclean D., Browning M. C. Plasma-corticosteroid levels in accidental hypothermia. Lancet. 1970 Feb 14;1(7642):324–326. doi: 10.1016/s0140-6736(70)90702-6. [DOI] [PubMed] [Google Scholar]
  25. TAYLOR G. THE PROBLEM OF HYPOTHERMIA IN THE ELDERLY. Practitioner. 1964 Dec;193:761–767. [PubMed] [Google Scholar]
  26. WILLIAMS G. E., MEYNELL M. J. Atromid, phenindione, and blood coagulation. Lancet. 1963 Feb 23;1(7278):443–443. doi: 10.1016/s0140-6736(63)92330-4. [DOI] [PubMed] [Google Scholar]
  27. Waal-Manning H. J. Effect of propranolol on the duration of the Achilles tendon reflex. Clin Pharmacol Ther. 1969 Mar-Apr;10(2):199–206. doi: 10.1002/cpt1969102199. [DOI] [PubMed] [Google Scholar]
  28. Zingg W. The management of accidental hypothermia. Can Med Assoc J. 1967 Jan 28;96(4):214–218. [PMC free article] [PubMed] [Google Scholar]

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