ABSTRACT
One of the most common thyroid dysfunctions is Hashimoto's disease (HD), characterized by the production of specific antibodies against thyroid gland antigens (Anti-Tg and Anti-TPO). Recent studies have suggested that vitamin D supplementation, associated with levothyroxine, may contribute to the control of this autoimmune disease. However, secondary studies on this topic, such as systematic reviews and meta-analyses, are still scarce. Thus, the present study aimed to evaluate the efficacy and safety of vitamin D in patients with HD through a systematic review with meta-analysis. Randomized clinical trials were selected on the Pubmed, Scopus, and Web of Science databases. Studies comparing groups of HD patients supplemented with vitamin D and non-supplemented HD patients were included. The following outcomes were considered: TSH, T3, T4, Anti-Tg, Anti-TPO, and adverse drug reactions. The risk of bias was performed according to the Cochrane recommendations (RoB v. 2.0), and the quality of evidence was evaluated by the GRADE system. A total of 766 studies were identified in the databases, of which 7 met the eligibility criteria. None of the studies indicated the occurrence of adverse reactions with vitamin D supplementation in any administered dosage. Supplemented patients had a significant reduction in serum TSH levels compared to the control group (mean difference = -0.180 (95% CI [-0.316 to -0.045]), p = 0.009), suggesting that thyroid function was more controlled in the intervention group. However, for the other outcomes, no statistically significant differences were observed between the groups. Additionally, most of included articles (n=5/7) had some concerns or high risk of bias, and the quality of evidence revealed a moderate confidence for almost all outcomes; so the results must be interpreted with caution. Thus, more consistent, and robust clinical trials need to be carried out to confirm the efficacy of vitamin D supplementation in patients with HD.
ABSTRACT
OBJECTIVES: This study aimed to evaluate the impact of pharmacist-provided discharge counseling on mortality rate, hospital readmissions, emergency department visits, and medication adherence at 30 days post discharge. METHODS: This randomized controlled trial was approved by the local ethics committee and included patients aged 18 years or older admitted to the cardiology ward of a Brazilian tertiary hospital. The intervention group received a pharmacist-led medication counseling session at discharge and a telephone follow-up three and 15 days after discharge. The outcomes included the number of deaths, hospital readmissions, emergency department visits, and medication adherence. All outcomes were evaluated during a pharmacist-led ambulatory consultation performed 30 days after discharge. RESULTS: Of 133 patients, 104 were included in the analysis (51 and 53 in the intervention and control groups, respectively). The intervention group had a lower overall readmission rate, number of emergency department visits, and mortality rate, but the differences were not statistically significant (p>0.05). However, the intervention group had a significantly lower readmission rate related to heart disease (0% vs. 11.3%, p=0.027), despite the small sample size. Furthermore, medication counseling contributed significantly to improved medication adherence according to three different tools (p<0.05). CONCLUSIONS: Pharmacist-provided discharge medication counseling resulted in better medication adherence scores and a lower incidence of cardiovascular-associated hospital readmissions, thus representing a useful service for cardiology patients.