Thyroid function status and its impact on clinical outcome in patients admitted to critical care

To analyze alterations in thyroid function and the correlation between results of thyroid function test and mortality in medical and surgical intensive care unit [ICU] patients. It also aimed to evaluate the effect of thyroid dysfunction in ICU patients and their need for mechanical ventilation [MV]. A single-center, prospective, observational study was conducted on patients admitted to medical and surgical ICU between 2013-2014. Clinical and paraclinical findings [free triiodothyronine, free thyroxine and thyroid stimulating hormone] were documented for all patients. Regression analysis and chi-square were used for death and MV outcome variables. We included 502 patients. Of these, 340 [67.7%] were admitted to the medical ICU. Results of thyroid function tests were normal in 320 [64%] and 162 [32.3%] medical and surgical ICU patients, respectively. Euthyroid sick syndrome [ESS] was documented in 86 patients [17%]. Mortality was twice higher among surgical ICU patients with ESS compared to those with normal thyroid function [p=0.085], which is not statistically significant. Based on thyroid function status, no differences in the risk to be mechanically ventilated was found between medical or surgical ICU patients. There is a significant association between ESS and mortality in ICU patients. Future studies should determine whether abnormal thyroid function increases the risk for MV in ICU patients

Brown tumor in a patient with ectopic mediastinal parathyroid adenoma: a case report

Brown tumors are uncommon focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients that have hyperparathyroidism. Primary hyperparathyroidism could be caused by ectopic mediastinal parathyroid adenomas. The occurrence of lesions is explainable on embryologic basis. We present a 55-year-old Saudi woman with a rare case of brown tumor of the maxilla due to ectopic mediastinal parathyroid adenoma.

Association between neurological and rheumatological manifestations in vitamin D deficiency and vitamin D levels

We aimed to investigate the associations between the neurological manifestations of vitamin D deficiency and bone profile as well as the levels of 25-hydroxyvitamin D. We conducted a case series on patients with vitamin D deficiency who were followed up at King Abdulaziz Medical City, Jeddah between January 2010 and December 2011. We collected patients' demographic data and gathered information on etiological factors for vitamin D deficiency as well as clinical presentations [typical, neurological and rheumatological] and radiological findings. The t-test was used to determine whether there was an association between the neurological manifestations of vitamin D deficiency and vitamin D levels and bone profile. We enrolled 60 patients with vitamin D deficiency. Of these, 44 [73.3%] had neurological presentations, namely progressive muscle weakness and proximal weakness, which was observed more often than distal weakness. In addition, gait disturbances were observed in 61.7% of all patients with neurological and rheumatological presentations. There was no significant association between neurological and rheumatological manifestations and bone profile or vitamin D levels. We found a significant association between difficulty in walking and the levels of serum calcium and phosphate [P = 0.043 and 0.037, respectively]. Neurological and rheumatologic manifestations of vitamin D deficiency are not associated with 25-hydroxyvitamin D levels or bone profile

Fatty liver overweight and obese patients in western part of Saudi arabia

the aim of the study is to determine the association of fatty liver diagnosed by ultrasound and obesity in patients presented to King Abdul aziz university hospital. A clinical notes review as performed of all patients undergoing evaluation for fatty liver associated with obesity over one year period between April 2003- to April 2004. Data included age, gender, nationality, BMI serum level of alanine [ALT] and aspartate [AST] transaminases, bilurubin, albumin, HbAIc, cholesterol, triglyceride, LDL, and TSH,and clinical presentation of abdominal pain or the presence of hepatomegaly. A total of 235 subjects were enrolled in the study. The mean age of the study group was 46 +/- 14.4 years with 82 males [35%] and 153 females [65%]. Mean +/- SD aspartate aminotransferase level was 43.9 +/- 6.18.1 units/ L, alanine aminotrnsferease was 36.2 +/- 5.1 units/L. Values of transaminase above the normal range was present in 15 [6.4%] patients only. Whereas values of cholesterol and triglyceride above normal range was seen in [7.2%] 17 patients. Over weight and obesity were the main risk factors in our study group. Mean BMI was 33.6 +/- 7.5 Kg/m2. Obesity with diabetes is the most important risk for fatty liver. 78 [33%] of our study group patient were diabetic. Other risk factors associated with fatty liver are metabolic syndrome which reported in 14.9% and hypothrodism in 3.8% subjects. Conclusion and recommendations: Overweight and obesity is the most important risk factor for fatty liver in Saudi Arabia. It is more prevalent in females. Ultrasound appears to be a useful non- invasive tool to determine liver involvement with fatty liver in obese adult even in the absence of hypertraninasemia. We should encourage obese subjects for gradual weight reduction to improve the liver abnormalities

Estimation of Ionized calcium levels after thyroidectomy at King Abdul Aziz University Hospital [Jeddah]

To determine the incidence of hypocalcaemia and the need for calcium supplementation after thyroid surgery in a population of 120 cases. A retrospective study was carried out on 120 patients who underwent thyroidectomy at King Abdul Aziz University hospital from January 1999 to September 2003 to determine the incidence of hypocalcaemia by measuring ionized calcium level. The data included preoperative and postoperative ionized calcium, albumin, free thyroxin, thyrotopin and alkaline phosphatase levels. The medical notes were reviewed for age, gender, type of thyroidectomy and pathological characteristics of resected thyroid tissue and autotransplantion of the parathyroid gland. Treatment of postoperative hypocalcaemia and duration of treatment was recorded. Hypocalcaemia occurred in 15% [18] patients out of a total of 120 patients who underwent total thyroidectomy. They had a significantly lower calcium level [1.78 +/- 0.054 compared to 85% [102] patients with normal calcium level]. Sixteen patients required calcium supplementation with or without oral vitamin D[3]. Three patients developed permanent hypoparathyroidism with PTH level of 23 pg/L. Two patients developed laryngeal stridor and were treated initially by intravenous infusion of calcium gluconate. It is more accurate and appropriate to measure or calculate ionized calcium level in post-thyroidectomy patients to avoid unnecessary calcium supplementation as a result of misdiagnosed hypocalcaemia due to measurement of total calcium alone

Multinodular goiter management in Western Saudi Arabia

The aim of this study was to provide epidemiological data and summarize the different modalities of management of multinodular goiters [MNG] in the Western Province of Saudi Arabia [KSA]. A total of 135 patients had MNG, which were diagnosed by ultrasonography at King Abdul-Aziz University Hospital in Jeddah, KSA between January 2003 and June 2004. The data collected includes the age, gender, physical examination of the thyroid gland [trifluorothymidine, free thyroxine, free triiodothyronine, thyroid stimulating hormone], ultrasonographic findings and Tc99 radioiodine nuclear scan of the thyroid gland, fine needle aspiration [FNA] of the gland and antithyroid antibodies. The study group was divided according to the thyroid status: nontoxic euthyroid MNG, hypothyroid MNG and toxic hyperthyroid MNG. The management of MNGs according to the patients' clinical presentations and thyroid status was reviewed. The mean age was 39 +/- 12.66 years with a range of 10-79 years. Forty-two patients [31%], with no history of thyroid cancer, had ultrasoundguided FNA; 41 [97.6%] of the FNAs were benign. One FNA [2.3%] was positive for papillary carcinoma in a 56-year-old female patient. Thyroid antibodies [anti-microsomal antibodies and anti-thymoglobulin antibodies] were measured in 50 patients [37%]. Thirty-one [62%] were positive, 11 [35%] of which were positive in patients with documented hypothyroidism. All patients with hypothyroidism were treated with levothyroxine; however, only 25.6% with euthyroid MNG were treated with suppressive doses of levothyroxine. Twelve patients [44.4%] with toxic MNG were treated with antithyroid medications. Radioiodine therapy was not given to any patient with nontoxic MNG; however, 48% of those with hyperthyroid MNG received radioactive iodine treatment. Surgery was carried out in 25.6% of patients with euthyroid nontoxic MNG, and in 11 patients with toxic MNG. Nearly half of those with nontoxic MNG [46.5%] and 14.8% of those with a subclinical hyperthyroid MNG refrained from any therapy. They were followed-up by their clinician in the outpatient clinic. Serum thyroid stimulating hormone levels, ultrasound and fine needle biopsy were the cornerstones of the diagnostic evaluation of patients with MNG. Review of the management of these patients was comparable to that found in the literature. The treatment strategy was similar to the recommendations by the American Thyroid Society; however, radioactive iodine treatment was not used as a treatment for patients with nontoxic goiters

Pattern of thyroid malignancy at a University Hospital in Western Saudi Arabia

The aim is to study the incidence of thyroid cancer in surgically treated nodular thyroid disease, clinicopathological characteristics and treatment results. A retrospective review of 45 patients with thyroid malignancy at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia during a 3-years period between January 2000 through to December 2003 was carried out. Analysis of clinicopathologic characteristics, age correlation to different risk factors, outcome of surgery and radioiodine treatment. A total of 120 thyroidectomies were performed during the 3-years period, January 2000 through to December 2003 at King Abdul-Aziz University Hospital. Forty-five [37.5%] patients had histopathology confirmed diagnosis of thyroid cancer. Eighty-two point two% cases of papillary carcinoma, 4.4% follicular type and 6.7% anaplastic and medullary carcinoma of thyroid. Mean age was 40.5 +/- 14.8 years. Male preponderance was seen in this study with males: female's ratio is 1.1:1. Nodular goiter was the most frequent presentation, observed in 30 [66.7%] cases. Fine needle aspiration cytology was suggestive of malignancy in 76% of cases. Ninety-seven patients with papillary carcinoma received ablative dose of radioiodine with average dose of 100-200 mCi. One female patient with follicular carcinoma of thyroid with bone, lung, and brain metastases received 4 doses of radioiodine with total dose of 800 mCi. Mortality rate was [2.2%], one patient died of complication of invasive anaplastic carcinoma with invasion of the trachea. There is a lot of controversy regarding thyroid malignancy investigations and management. We recommend that thyroid cancer patients should be treated by a team of endocrinologist, pathologist, experience thyroid surgeon, nuclear medicine and external radiotherapy physician to achieve an optimum care and good prognosis

Diabetes team as a cost effectiveness in managing type 2 diabetes mellitus

To study retrospectively type - 2diabetic patients who were admitted to a medical unit at KAUH to achieve a glycaemic control. Method:- Medical charts were reviewed for patient's data over two years period between October 2000- October 2002. Patient's data included age, sex, nationality, length of hospital stay, duration of diabetes, BMI and the three different modalities used to achieve glycaemic control. Results:- Total of 75 patients were included in the study in the study. 37% were males, 63% females. There was no statistically significant difference between males and females in the duration of diabetes, blood sugar level at the time of admission or the length of hospital stay. However, females were heavier than males with higher BMI 31.29 compared to 26.7 in males. In 30% of patients. Glycaemic control was achieved by oral anti- diabetic agents in addition to other measures. Fourteen and a half% of the patients required insulin, oral ant- diabetic agents combination therapy, 54.5% required insulin therapy with twice or multiple injection regimens. Mean length of hospital stay was 10 days Conclusion and recommendation: Achieving glycaemic control in type- 2 diabetic patients in this study required prolonged hospitalization. A team work approach of physician, dietician and diabetic educator on an out patient basis to a achieve glycaemic control in diabetics is cost effective and time saving. Diabetic center will provide all the education to outpatients

Estimation of ionized calcium levels after thyroidectomy at King Abdulaziz University Hospital [Jeddah]

This retrospective study included 120 patients who underwent thyroidectomy at King Abdul-Aziz University Hospital between January 1999 and September 2003. The study aimed to determine the incidence of hypocalcemia by measuring ionized calcium level. The data included preoperative and postoperative ionized calcium level, albumin, free thyroxine, thyrotopin and alkaline phosphatase. The medical notes were reviewed for age, gender, type of thyroidectomy and pathological characteristics of resected thyroid tissue and autotransplantion of parathyroid gland. Treatment of postoperative hypocalcemia and duration of treatment were recorded. It was found that measuring ionized calcium level post thyroidectomy to avoid unnecessary calcium supplementation resulting from diagnosing hypocalcemia from measuring total calcium level alone is more accurate and more appropriate

pattern of surgically treated thyroid disease at King Abdulaziz University Hospital

This work aimed to establish the correlation between clinical presentation, histopathology, outcome and complications of thyroid surgery. A retrospective study of 120 patients with surgically treated thyroid disease at King Abdul-Aziz University Hospital during three years period between January 2001 to December 2003 was carried out. A total of 120 cases of thyroid swelling were operated over three years period. There was a female preponderance [2.4:1]. Multinodular goiter was observed in 51.7%, thyroid malignancy in 30.8%, Hashimoto's disease in 10.3% and Grave's disease in 6.7%. The incidence of thyroid malignancy was higher in the expatriates compared to the Saudis; whereas, Hashimoto's disease was commoner in Saudis. Fine needle aspiration [FNA] was performed in 55 cases and positive results were similar to histopathology in 41 cases. Postoperative complications included hypocalcemia [15%] and hemorrhage [0.83%] with no report of laryngeal nerve palsy. Only one patient died of complication of anaplastic carcinoma with mortality rate of 0.83%. The incidence of thyroid cancer in resected thyroid specimens was high, especially amongst non Saudis. This is an important implication for management of patients with solitary or multinodular goiter

Hospital admission to achieve glyceamic control in type 2 diabetic patient at King Abdul Aziz University Hospital, Jeddah, Saudi Arabia

In this study, the medical charts of 75 type 2 diabetic patients [37% were males and 63% were females] were reviewed for their data over a two-year period between October 2000 to October 2002 including age, sex, nationality, length of hospital stay, duration of diabetes, BMI and the three different modalities used to achieve glycemic control. There was no statistically significant difference between males and females in the duration of diabetes, blood sugar level at the time of admission or the length of hospital stay. However, females were significantly heavier than males with higher BMI. In 30% of the patients, a glycemic control was achieved by oral antidiabetic agents, in addition to other measures. 14.5% of the patients required insulin-oral antidiabetic agents combination therapy. 54.5% required insulin therapy with twice or multiple injection regimens. The mean length of the hospital stay was ten days

Bacteremia and septicemia in diabetic patients in Western Saudi Arabia

The present study aims to define the pattern of bacteremia with clinical sepsis in diabetic patients at King Abdul-Aziz University Hospital [KAUH], Jeddah, Kingdom of Saudi Arabia [KSA], in relation to the type of infection, microbial pattern, source, complication, outcome, and the risk factors associated with high mortality. Retrospective study of adult diabetic patients with bacteremia and septicemia admitted to KAUH during a 2 years period between January 2000 through to December 2002 was carried out. A total of 4850 blood culture were submitted to the Microbiology Laboratory of KAUH over a 2 years period. Two hundred and ninety [6%] cases had positive blood cultures, 70 were diabetic patients with an incidence rate of 24% with p-value of 0.043 which is statically significant. Urinary tract infection was the most common source of bacteremia in our study group with Escherichia coli as the most frequent organism in 62%. Mortality rate was 44%. Old age was an important risk factors for high mortality with p-value 0.011, which is statically significant. Other risk factors included comorbidity associated with diabetes, septic shock mechanical ventilation and disseminated intravascular coagulation. Increase age was one of the important risk factors for high mortality rate in our study group. Good empiric antibiotics coverage should be instituted early in high risk groups

Tender neck in a diabetic patient

A 45-year-old Indian patient with a history of type 2 diabetes mellitus presented with history of pain in the left side of the neck associated with sore throat of one month duration. The diagnosis of subacute granulomatous thyroiditis [de Quervains thyroiditis] was made which was confirmed radiologically by depressed radioactive iodine uptake. The patient showed marked clinical response and improvement within 24 hours on anti-inflammatory drugs and corticosteroid

Tender neck in a diabetic patient

A 45-year- old Indian patient with a history of type 2 diabetes mellitus presented with history of pain in his left side of the neck associated with sore throat of one month duration. The diagnosis of sub acute granulmatous thyrooiditis [De Quervain's thyroditis] was made which was confirmed radio logically by depressed radioactive iodine uptake [RAIU] 0%% uptake. Patient showed marked clinical response and improvement within 24 hours on anti- inflammatory drug and corticosteriods

Prevalence and clinical usefulness of thyroid antibodies in different diseases of thyroid

A retrospective study of 200 patients with positive thyroid antibodies was done. The study group who had their thyroid antibodies status analyzed was classified into four groups [primary hypothyroid, Grave's disease, thyrotoxicosis and goiter]. The difference between microsomal TPO and thyroglobulin [Tg] antibodies in the four different groups was calculated by Chi-square test. The results were considered significant if the p value was less than 0.05. The routine measurement of both TPO and Tg antibodies in the assessment of patients with suspected autoimmune thyroid disease was suggested, although Tg antibodies are more sensitive in detecting autoimmune thyroid diseases

spectrum of tuberculosis in King Abdul Aziz University Hospital, Jeddah, Saudi Arabia

A review of 157 patients with active tuberculosis seen at King Abdul Aziz University hospital during the two-year period [July 1999-July 2001]. Method: Retrospective study reviewing medical records of patients with final diagnosis of tuberculosis on discharge. The data included demographic data, spectrum of clinical presentations, diagnostic methods including smear, culture arid histology and the outcome of treatment. A total of 157 patients were admitted with tuberculosis. Median age was 33 [ +/- 15.33] years. A total of 57 [36%] were Saudis arid 100 [64%] were non-Saudis. In patients with pulmonary tuberculosis and pleural effusion, the diagnosis was confirmed by either positive sputum smear for AFB or on pleural biopsy, except in five patients where the diagnosis was based on clinical grounds only arid pleural fluid analysis. There was a wide spectrum of extra pulmonary tuberculosis diagnosed histologically except for five patients where treatment was started empirically based on high clinical suspicious and strongly positive tuberculin test. Conclusions: The use of different modalities of investigations like positive sputum smear, culture, computerized tomographic scanning, histological diagnosis of tissues obtained through fibro optic endoscopy, laparoscopy, liver biopsy and strotactic brain biopsy simplified the diagnosis arid hence the management of extra pulmonary tuberculosis. It is reasonable to start anti-tuberculous medications on strong clinical grounds in conjunction with close outpatient supervision in cases where tissue biopsy is difficult to be obtained, such as mediastinal lymphadenopathy and tuberculoma

Clinical pattern of systemic lupus erythematosus in western Saudi Arabia

The aim of this study is to demonstrate the clinical laboratory, treatment and course of systemic lupus erythematosus [SLE]. A total of 65 patients with positive double strand antibodies were collected at the Immunology Laboratory of King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia over a 2 year period between January 2000 and December 2001. The data included personal data, clinical manifestations, laboratory, results, and different modalities of treatment and outcome of treatment. Group results were presented as median +/- standard deviation or as a percentage. Sixty-five patients with SLE were included in the study. The female to male ratio was 5.5:1. Median age of 23 +/- 11.33 years. Seventy% had a multiple system involvement, 60% presented with arthralgia or arthritis and 55.4% had lupus nephrites, proved by kidney biopsy in 22 patients. Most were treated by intermittent cycolphoamide and steroids with an excellent outcome. Laboratory results and modalities of treatment were similar to previous results. Male SLE is more common in our study group with serious organ damage. Our mortality rate was 3% only. Systemic lupus erythematosus presentation is similar to pervious studies and it is more common in male. Lupus nephritis is a common prevention with excellent outcome

Clinical presentation of adult celiac disease in Western Saudi Arabia

To study the clinical presentation of adult celiac disease. A retrospective study of adult patients who were diagnosed with celiac disease based on findings of small intestinal biopsy, response to gluten free diet and exclusion of other causes of malabsorption or vitamin deficiency over a period of 5 years from 1998-2002. The study was carried out at the King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Sixteen patients were diagnosed with celiac disease. Osteomalacia and iron deficiency anemia were common clinical presentations. Diarrhea, malabsorption associated with growth failure was observed in 3 patients with a mean age of 14.5 years. Celiac disease associated with other autoimmune diseases was reported in 6 patients. Insulin-dependent diabetes mellitus in 3 patients, Hashimoto's hypothyroidism in 2 patients and dermatitis herpetiformis in one patient. No malignancy was observed during the follow-up of our patients. There was a good clinical and biochemical response to gluten free diet in 12 cases. Osteomalacia and iron deficiency anemia were common clinical presentations of celiac disease. Hence, the presence of either one of them in a female patient should raise the possibility of celiac disease