Timing of Levothyroxine in the Treatment of Primary Hypothyroidism.

Aim: Timing of levothyroxine (L-thyroxine) administration seems beneficial for early obtaining thyroid state. The present study aimed at investigating the best time of L-thyroxine administration that can achieve earlier normalization of thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels in patients with primary hypothyroidism. Study Design: Eighty two patients with primary hypothyroidism were recruited between November 2012 and July 2013 during their consultation to Al-Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, Iraq. The patients were divided into two equal groups; group A were receiving L-thyroxine daily, one hour before breakfast, group B: the dose of L-thyroxine was given at the evening. TSH, FT4, Body mass index (BMI), blood pressure, lipid profile were measured before, 30, 60 and 90 days after treatment with L-thyroxine. Results: The mean reduction in TSH from baseline for the evening treatment was 13.6±22.2 mIU/ml which was slightly and insignificantly higher than the value of the morning treatment (11.3±22.5 mIU/ml), P = .63, df = 80, 95% CI: -12.17, 7.5). The mean increase in FT4 from baseline for the evening treatment was 5.7±4.9 pmol/l which was lower than 7.6±6 pmol/l in the morning treatment, (P = .12, df = 80, 95% CI: - 0.5, 4.3). There was no effect of treatment timing on lipid profile, blood pressure, and BMI. Conclusions: There were no differences between the morning and evening treatment with L-thyroxine on early normalization of TSH and FT4.

Predictors of Diabetic Ketoacidosis among Patients with Type 1 Diabetes Mellitus Seen in the Emergency Unit.

Aims: To identify the factors that can predict the development of diabetic ketoacidosis (DKA) among patients with type 1 diabetes mellitus (T1DM) in Basrah. Materials and Methods: Place and Duration of Study: The study was conducted in the emergency units of Al-Faiha General Hospital and Al-Basrah General Hospital for the period from June 2013 to June 2014. Methodology: This study was cross-sectional enrolled four hundred patients with T1DM seen in the emergency unit were selected; patients and their families were subjected to specific questionnaires prepared for this study. Results: In this study, 400 patients with T1DM enrolled, 160 patients were having DKA (40%), 240 (60%) were not. Factors that predict DKA include,age, gender, school level of both the patients and their parents, address of the patients, the early initiation of the proper insulin regimen after diagnosis of T1DM, presence of acute recent illness, missing insulin doses and frequency of the dose missing, number of previous DKA attacks, using of syringes or pens as a tool of insulin delivery, however, the most important two predictors are the source of insulin supply to patients, presence of glucometer at homes and frequency of its uses. Conclusion: This result provided evidence that multiple factors interact together to play a vital role in the development of DKA among patients with T1DM in Basrah.