1002 within a few weeks (see figure) and was 0.02 gll after 24 weeks of treatment; the concentration of secretory IgA in her saliva was also found to be depressed (after 16 weeks of therapy). This, as far as we are aware, is the first complication of this kind with gold therapy. The other patient showing signs of IgA deficiency is a 61-year-old woman taking 750 mg D-penicillamine orally per day. Her latest serum-IgA was only 0 - 36 g/l (see figure). These findings are important in view of reports’of IgA deficiency in two cases of Wilson’s disease treated with D-penicillamine. Our limited observations on treated rheumatoid patients, suggest a drug-induced deficiency of this immunoglobulin class in about 7% (3/45 cases), which could explain why Forrest et al.4 did not find low serum-IgA levels in three cases of Wilson’s disease (assuming that the frequency of penicillamine-induced IgA deficiency is the same in the two diseases). A striking association has been observed between selective IgA deficiency and disorders of the T-cell system,S and we have suggested3 that D-penicillamine could affect immunoglobulin production at the T-cell level. Moreover, myocrisin is also a thiol compound (sodium aurothiomalate), and could have a similar effect on T-cell function. It would be instructive, therefore, to monitor the serum-IgA in patients treated with these

matically

tients

tively.

examined 5-15 years (average 9 years) postopera7 have had hypothyroidism and 9 have relapsed. Details

were

will be published elsewhere.7 The serum-calcium was measured by atomic-absorption spectrophotometry (Perkin Elmer 403) and serum-proteins were estimated by refractometry. The serum-calcium was corrected to a constant serum-protein.8 The coefficients of variation of duplicate measurements were 1.1% for serum-calcium and 0-4% for serum-proteins. 194 controls served as reference group of protein-corrected serum-calcium.9

The remaining 165euthyroid patients had slightly lower serum-calcium concentrations (97-4±0-3) compared with con-

drugs. Department of Experimental Pathology, Medical School, University of Birmingham,

D. R. STANWORTH

P. JOHNS N. WILLIAMSON

Birmingham B15 2TJ Queen Elizabeth Hospital, Birmingham

M. SHADFORTH D. FELIX-DAVIES R. THOMPSON

East Birmingham Hospital

Serum-calcium in 165 after operation.

HYPOCALCÆMIA AFTER THYROIDECTOMY

SIR,-Patients with thyrotoxicosis,

hypercalcsemia, 2 causing

a

as

a

group,

develop

Values given

as

euthyroid patients

meanis.E.M.

(hatched

as

function of time

area=normal

mean±s.t.ni.)

3

secondary hypoparathyroidism.

Furthermore, the serum-calcium falls during antithyroid-drug treatment.4 Laitinen5 and Skrabanek6 have discussed serumcalcium concentrations after thyroidectomy, and both claim that the postoperative hypocalcsemia is transient. RELATION BETWEEN THYROID FUNCTION AND SERUM-CALCIUM

T.S.H.=thyroid-stimulating hormone T4=thyroxine T 3=tniodothyronine

trols

(98-9+0-4), values being given as meanis.E.M. in mg/) (P