Remission of Grave's disease after oral anti-thyroid drug treatment

To evaluate remission rate of anti-thyroid drug treatment in patients with Grave's disease, and to study the factors associated with remission. A cross sectional study. The Endocrine Department of the Aga Khan University Hospital, Karachi from 1999 to 2000. Seventy four patients of Grave's disease were recruited who were prescribed medical treatment. Grave's disease was diagnosed in the presence of clinical and biochemical hyperthyroidism along with anti-microsomal [AMA] and anti-thyroglobulin antibodies [ATA] and thyroid scan. These patients were prescribed oral anti-thyroid drugs using titration regime and followed at 3, 6, 12 and 18 months. Patients were categorized into two groups: "remission group" and "treatment failure group" and results were compared using a chi-square test, t-test and logistic regression model with significance at p < 0.05. A majority of the patients were females [62.6%, n=46]. During the follow-up period of 18 months, 41.9% patients went into remission. Univariate analysis showed that the initial free T4 level was significantly different [p < 0.05] in patients in remission and treatment failure groups. Multivariate analysis showed only initial free T4 level was a significant predictor of outcome. Positive AMA patients [n=27] had higher treatment failure [odds ratio: 2.55: 95%, CI 0.69 - 9:31], although the difference was not statistically significant [p = 0.13]. Remission rates with oral anti-thyroid agents is markedly high. Patients should be offered alternate treatment options to those who do not enter remission during a period of 12-18 months of treatment, those who develop relapse, and those who have aggressive disease on initial presentation

Plasma fibrinogen - a coronary risk factor

This study was carried out to measure the levels of fibrinogen in patients of ischaemic heart disease. Fibrinogen levels were determined in 43 patients of ischaemic heart disease and compared with thirty clinically healthy non-smoker controls. Levels of fibrinogen [mean +/- SEM] in patients were 431.51 +/- 7.89 Mg/dl and in controls 241.83 +/- 3.03 Mg/dl [P<0.001]. Patients were also sub-grouped as smokers and non-smokers. Plasma fibrinogen in thirty one non-smokers was 421.51 +/- 9.3 Mg/dl and in twelve smokers fibrinogen was 457.92 +/- 11.59 Mg/dl [P<0.001 when compared to controls] and P<0.05 when smoker patients were compared with non-smoker patients. Fibrinogen can be considered as coronary risk factor. It should be included in the assessment of coronary risk profile alongwith lipid profile and efforts should be made to reduce the elevated levels of fibrinogen. Clinical studies with agents which may reduce fibrinogen levels are needed to reduce the prevalence of coronary artery disease