A randomized double-blind comparison of fixed versus calculated radioiodine dose in the treatment of Graves' hyperthyroidism

INTRODUCTION:Radioactive iodine(I131) therapy is an established definitive treatment for Graves' hyperthyroidism.However,the optimal method of determining the radioiodine treatment dose remains controversial.OBJECTIVE: To compare the efficacy of fixed dose versus  calculated  dose  regimen  in  the  treatment  of  Graves'  hyperthyroidism  among  Filipinos  METHODOLOGY: Diagnosed   Graves'   disease   patients underwent  thyroid  ultrasound  to  estimate  thyroid  size. Patients  were  randomized  to  either  fixed  or  calculated dose  of  radioiodine  treatment.  For  fixed  dose  group,the  WHO  goiter  grading  was  utilized:  Grade   0   (5mCi),  Grade   1  (7mCi),  Grade2  (10mCi),  Grade  3  (15mCi).  For calculated  dose  group  the  following  formula  was  used:                    Dose(mCi)= 160uCi/g thyroid x thyroid gland weight in grams x 100  /  24-hour RAIU(%)Thyroid function test (TSH,FT4)  was monitored every  three  months  for  one  year.  RESULTS: Of  the  60  patients  enrolled,  45  (fixed  dose;  n= 27,  calculated  dose;  n=  18)  completed  the  six  months follow-up  study.  Analysis  was  done  by  application  of  the  intention-to-treat  principle.  The  percentage  failure  rate  at  third  month  in  the  fixed  vs.  calculated  dose  group  was:  26  v.  28%  with  a  relative  risk  (RR)  value  of  0.93.  At  six  months  post-therapy,  there  was  a  noted  reduction  in  the  failure  rates  for  both  study  groups  (11  vs.  22%,  respectively),  with   a   further   reduction   in   the   relative   risk   value (0.67),  favoring  the  fixed  dose  group.CONCLUSION: Fixed   dose   radioiodine   therapy   for Graves'   disease   is   observed   to   have   a   lower   risk   of   treatment   failure   (persistent   hyperthyroidism)   at   three  and  six  months  post-therapy  compared  to  the calculated  dose.

The Philippine thyroid diseases study (PhilTiDeS): Prevalence of thyroid disorders among adults in the Philippines / Journal of the ASEAN Federation of Endocrine Societies

BACKGROUND:The national prevalence of goiters in the Philippines was 3.7% in 1987 and 6.7% in 1993. Since then, there has been no follow-up survey on goiter prevalence, nor has there been any national survey on the prevalence of abnormal thyroid dysfunction. The PhilTiDeS is a survey on the prevalence of both goiters and thyroid disorders in the Philippines.OBJECTIVES:To determine the prevalence of various categories of abnormal thyroid dysfunction among the Filipino non-pregnant adult population and to describe the prevalence of thyroid enlargement in the Philippines in relation to thyroid dysfunction status.MATERIALS AND METHODS:The PhilTiDes was a substudy of the 2008 National Nutrition and Health Survey (NNHeS), which covered all 17 regions and 80 provinces of the Philippines. It included all Filipino adults 20 years and older, who are non-pregnant and non-lactating. A standard questionnaire was used to collect data on previous diagnosis and current treatment for thyroid disorders, and neck examination by trained field personnel was done to assess the presence of goiter. Blood was extracted, processed and sent to an accredited laboratory for free T4 and TSH testing using micro-particle enzyme immunoassay.RESULTS: A total of 4897 persons had thyroid function tests. Of these, 417 (8.53%) had thyroid function abnormalities with the most common abnormality being subclinical hyperthyroidism occurring in 5.33%. The other categories had the following prevalence: true hyperthyroidism 0.61% ; true hypothyroidism 0.41%; and subclinical hypothyroidism 2.18%. Majority of the population 4480 (91.47%) had normal thyroid function tests. Of those with subclinical hyperthyroidism, 55% are females with mean age of 48 years (95% CI 45.9-50.1 years) compared with the volunteers with normal thyroid function who were younger (mean age of 43.1, 95% CI 42.5-43.6 years). Out of the 7,227 volunteers who responded to the survey and clinical examination, a total of 674 (8.9%) had goiters. Out of the 674 subjects with goiters, 379 had diffuse enlargement (56%) while the rest had nodular goiter (44%). Among the sub-population (n= 4897) who underwent thyroid function testing, 9% of those with normal thyroid function tests have goiters.CONCLUSION: The prevalence of thyroid function abnormalities in the Philippines is 8.53% with the greatest proportion of volunteers having subclinical thyroid disease. There is a low prevalence of both true or overt hyperthyroidism and hypothyroidism. In the larger survey, it was found that 8.9% of volunteers who were examined had goiters. The etiology of these goiters will need to be ascertained in future studies.

Prevalence and risk factors of gestational diabetes mellitus at the University of Santo Tomas Hospital

BACKGROUND: Gestational diabetes mellitus (GDM) has been as sociated with adverse maternal and fetal outcomes that extend beyond the postpartum period. Knowledge of its prevalence and risk factors can lead to possible preventive strategies.OBJECTIVE: To determine the prevalence and risk factors for GDM at the University of Santo Tomas Hospital-Clinical Division (USTH-CD).METHODS: A cross-sectional study was performed between January to December 2009 at the USTH-CD. Simple and multivariate logistic regressions were used to estimate the odds ratios with 95% confidence intervals, and to control for confounding variables.RESULTS: We reported the prevalence of GDM at USTH-CD to be 7.5%. The risk for GDM was significantly associated with increasing BMI (OR 1.54; 95% CI 1.06, 2.24), family history of diabetes (OR 6.27; 95% CI 2.63, 14.96) and hormonal contraceptive use (OR 8.48; 1.55, 46.52). Mothers with GDM were also at increased risk of delivering via cesarean section (OR 2.76; 95% CI 1.13, 6.72). The 1-minute APGAR score of infants born to mothers with GDM were also lower (OR 0.31; 95% CI 0.12, 0.83).CONCLUSION: Higher BMI, family history of diabetes and hormonal contraceptive use were strongly associated with GDM. Presence of GDM increases the risk of having cesarean deliveries and a poor fetal 1-minute APGAR score. The presence of these findings may be helpful in identifying those at risk for GDM who might benefit from heightened surveillance during pregnancy.