lnterleukin-6 and color flow doppler sonography in the diagnosis of amiodarone-induced thyroid dysfunction

We aimed at studying the role of measuring serum interleukin-6 and examining the thyroid by color-flow Doppler Sonography [CFDS] in differentiating the various forms of amiodarone-induced thyroid dysfunction. We also measured urinary iodine excretion to determine the extent of iodine sufficiency in the control population and estimate the iodine load the patients on amiodarone are exposed to. We studied 30 patients on chronic amiodarone therapy and 20 age and gender matched healthy control subjects. We examined them and reviewed their clinical and laboratory record in detail. We collected a serum sample for measuring Free T3, Free T4, TSH and interleukin-6 by enzyme immunoassay, and a urine sample for measuring urinary iodine concentration by Sandell-Kolthoff colorimetric method. Twenty of the 30 patients underwent CFDS where the morphology of the thyroid and the pattern of blood flow were identified. Pattern 0 indicated absent blood flow [gland destruction], pattern 1 patchy increased flow, pattern 2 diffuse increased flow and pattern 3 marked diffuse increase in flow [similar to Grave's disease]. 13 patients had goiter while 17 did not. The majority of cases [33.3%] suffered from and was treated for ventricular tachycardia. None of the patients had a past history of previous thyroid illness. Of the 30 patients receiving amiodarone, 14 were euthyroid, 6 were thyrotoxic and 10 were hypothyroid. Serum lL-6 level [in pg/ml] was markedly elevated in hyperthyroid patients [688.3 +/- 481.6] in comparison to controls [167.3 +/- 112; P<0.01], to hypothyroid patients [187.5 +/- 106.8; P<0.01] and euthyroid patients [115.6 +/- 93.9; P<0.01]. 20 cases were examined by CFDS of the thyroid; 6 were normal, 6 had pattern 0, 7 had pattern 1 and one case had pattern 2.20 cases were examined by CFDS of the thyroid; 6 were normal, 6 had pattern 0, 7 had pattern 1 and one case had pattern 2. Most hyperthyroid patients [5/6] had pattern 0 [type II AIT] while one had pattern 1 [type I AIT]. Hyperthyroid patients with pattern 0 in CFDS [gland destruction/thyroiditis] had the highest levels of lL-6 [674.3 +/- 502; P<0.01]. The mean urinary iodine excretion [in microg/I] for cases was highly increased [715.08 +/- 171.7] in comparison to controls [101.4 +/- 9.12; P <0.01]. Serum lL-6 correlated positively with serum free T4 [r=0.526] while urinary iodine correlated inversely with serum free T3 [r=-0.644]. Chronic amiodarone therapy was associated with a high rate of Thyroid dysfunction [16/30]. The control population was iodine replete while the study subjects receiving amiodarone were iodine-loaded. More cases had hypothyroidism than hyperthyroidism [10 vs. 6]. Most cases of AIT [5/6] were type II [thyroiditis]. High levels of serum lnterleukin-6 predicted the presence of type II AIT. lnterieukin-6 and CFDS are useful diagnostic methods for differentiating the two types of AIT, and hence have an important therapeutic implication

Intrapulmonary insulin reduces blood glucose in type 1 diabetic patients

Administration of biosynthetic insulin is the mainstay of treatment of type 1 diabetes. Because of the inconvenience of multiple daily injections, alternative methods are actively sought. Intrapulmonary insulin delivery is a new and promising method. The aim of the present work has been to assess its efficacy and safety. We conducted our study on 11 patients with type1 diabetes mellitus. The patients received in the fasting state 3 units / kg BW of unmodified insulin by inhalation using an air compression nebulizer. Pulmonary function tests [FEV1, FVC and PEF] were measured to rule out immediate side effects on the airways, and blood glucose and insulin were measured before and after insulin inhalation. No significant changes were observed in pulmonary functions. Blood glucose decreased from 289 +/- 107 mg/dl to 218 +/- 106 mg/dl after 120 minutes [P<0.01]. The percent change [d%] reached a maximum of -26 +/- 14.8% [min. 2.9 and max. 52%]. Meanwhile, serum insulin reached a peak of 144 +/- 162 micro lU/ml 10 minutes after the inhalation. The maximum% change in insulin level was observed at 40 minutes [714%]. However, great variability was observed between patients. One can conclude that insulin is absorbed effectively from the pulmonary bed and this route carries a good potential for insulin delivery. However, the great inter- individual variability will be a problem in dose prescription. Further studies are needed to assess the efficiency of intrapulmonary insulin delivery in controlling mealtime glucose peaks.