The Atorvastatin Goal Achievement Across Risk Levels: (ATGOAL) study in Thailand.

OBJECTIVE: To evaluate the efficacy and safety of atorvastatin at the starting doses of 10, 20, 40 mg and evaluate the effectiveness of 1 step titrate up regimen. MATERIAL AND METHOD: Two hundred and forty two subjects with dyslipidemia were enrolled and assigned the appropriate dose in relation to their individual cardiovascular risk status and baseline LDL-C levels. If the NCEP targets were not achieved, the doses were titrated up at week 4 and the primary efficacy was evaluated at week 8. RESULTS: A majority of subjects (88.8%) achieved their LDL-C goals at week 8. Almost all of the subject's LDL-C levels reached their goals by week 2 and 4 (81.6% and 87.1%, respectively). Only 10.7% (n = 25) required the sole titration. Each dose provided significant decreases in LDL-C (average -46.4%). Only 36 subjects experienced treatment related adverse events, the majority of these were in the high-risk group (n = 22) with only one subject registering a serious adverse event. CONCLUSION: Atorvastatin is effective and safe for Thai patients with dyslipidemia. The appropriate starting dose has contributed in the achievement of cholesterol reduction.

Adrenal crisis due to bilateral adrenal hemorrhage in primary antiphospholipid syndrome.

The authors report a case of a 56-year-old Thai woman with a history of recurrent venous thrombosis, spontaneous abortion and Graves' disease who presented with bilateral flank pain, nausea, vomiting and low-grade fever followed by hypotension. Adrenal crisis from bilateral adrenal hemorrhage was diagnosed by a low serum cortisol level during hypotension and bilateral hyperdense oval masses in each of the adrenal glands in a computerized tomographic study. Her hemostatic and serologic profile was compatible with primary antiphospholipid syndrome. Rapid improvement was observed after the administration of intravenous hydrocortisone. She was discharged on long-term glucocorticoid replacement for her primary adrenal insufficiency as well as an anticoagulant for prevention of thrombosis. The antiphospholipid syndrome should be suspected in a patient presenting with adrenal crisis without a distinct etiology.

A more appropriate algorithm of thyroid function test in diagnosis of hyperthyroidism for Thai patients.

BACKGROUND: Thyroid function test is an essential tool in the diagnosis of thyroid dysfunction. To date, it is still controversial which diagnostic algorithm is best applicable to clinically hyperthyroidism patients. OBJECTIVE: To compare various algorithms of thyroid function tests in the diagnosis of hyperthyroidism. METHOD: Patients from the endocrine clinic, King Chulalongkorn Memorial Hospital were investigated for thyroid function tests (T3, T4, FT3, FT4 and TSH). Hyperthyroidism was defined as an elevated either FT3 or FT4 with suppressed TSH. The authors compared the effectiveness in hyperthyroidism diagnosis among algorithms by using sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: Of all 452 patients in the present study, 94.24 percent were women. There were 206 hyperthyroidism, 30 subclinical hyperthyroidism, 1 subclinical hypothyroidism, 8 primary hypothyroidism and 207 normal subjects. The incidence of T3 toxicosis was 16.02% while that of T4 toxicosis was 2.16%. After the effectiveness analysis of these algorithms, FT3 and TSH is the most optimal test with 97.57% sensitivity and 100% specificity. Compared to FT4 and TSH, it gave 83.98% sensitivity and 100% specificity. CONCLUSION: According to the high incidence of T3 toxicosis in the present study, FT3 and TSH should be the initial test for diagnosis of hyperthyroid patients in an outpatient setting and FT4 should be measured subsequently in case of suspected T4 toxicosis.