Serum TSH Level in Healthy Koreans and the Association of TSH with Serum Lipid Concentration and Metabolic Syndrome

BACKGROUND/AIMS: The proper treatment of subclinical hypothyroidism and the normal range of serum thyroid stimulating hormone (TSH) concentration are intensely debated. However, few reports have investigated TSH concentrations in Asian ethnic groups. Therefore, the present study was designed to define the TSH reference range in a Korean population and to investigate the metabolic significance of TSH concentration. METHODS: We enrolled patients who underwent medical examination at the CHA Bundang Medical Center. Anthropometric data were evaluated, and serum TSH, free T4, and lipid profiles were assayed. RESULTS: A total of 7,270 subjects were included. Mean TSH concentration of the study population was 1.82 +/- 0.95 mU/L, and we observed a sex-related difference in TSH concentration (male, 1.67 +/- 0.87 mU/L; female, 2.02 +/- 1.01 mU/L; p < 0.01). When the 2.5 and 97.5 percentiles were calculated, 95% TSH reference limits were 0.52-4.29 mU/L. TSH concentration was higher in elderly subjects, during winter, in postmenopausal women, and in obese males. Moreover, TSH showed significantly positive correlations with serum total cholesterol, triglyceride, and low density lipoprotein cholesterol regardless of sex, age, season, obesity, or menopausal status (all p < 0.01). Finally, TSH concentration was positively related to the prevalence of metabolic syndrome. CONCLUSIONS: We demonstrated the association between TSH concentration within the normal reference range and serum lipid levels. TSH concentration varies according to sex, age, season, and body mass index (only in males). Moreover, high normal TSH levels were significantly associated with an increased prevalence of metabolic syndrome, which may be of importance when evaluating subjects with high normal TSH concentration.

The Clinical Characteristics of the Newly Diagnosed Early Onset (< 40 Years Old) Diabetes in Outpatients' Clinic / 당뇨병

BACKGROUND: The prevalence of type 2 diabetes in young adults and adolescents has increased in the last decade according to the increasing obese population. The aim of this study was to examine the clinical characteristics of patients diagnosed with diabetes mellitus before the age of 40 years as compared with patients diagnosed at older ages. METHODS: This was a cross-sectional, retrospective study using data from 350 diabetic patients who were diagnosed with diabetes in an outpatient setting between January 2005 and December 2007. Patients were diagnosed according to the criteria set forth by the American Diabetes Association. We examined the clinical characteristics and laboratory data of the patients through review of medical records and compared the early-onset diabetic patients ( or = 40 years old). RESULTS: The frequency of early-onset diabetes and usual-onset diabetes were 31.1% (n=109) and 68.9% (n=241), respectively. The early-onset diabetic patients more often had a positive family history of diabetes; higher HbA1c, fasting glucose, and postprandial glucose levels; experienced typical symptoms more frequently; had microalbuminuria more frequently; and required insulin therapy as initial treatment more frequently as compared to usual-onset diabetic patients, and these differences were significant. Conversely, hypertension was significantly more common in the usual-onset diabetic patients. CONCLUSION: It could be concluded that we should control early onset diabetes more strictly to prevent its complication because early onset diabetic patients represented more severe hyperglycemia and had more prevalent microalbuminuria.

Recurrent Diabetic Muscle Infarction in A Patient on Maintenance Hemodialysis / 대한신장학회지

Diabetic muscle infarction (DMI) is a rare complication that usually occurs in diabetic patients with advanced microvascular complication. DMI presents with abrupt or subacute onset of pain, tenderness and swelling of a localized muscle group in the lower extremities in most instances. It is usually improved by conservative management such as avoiding weight bearing or pain control, but recurs frequently in 50% of the patients. The diagnosis is based on magnetic resonance imaging (MRI), which is not specific but highly indicative. A forty-nine-years-old female on hemodialysis was admitted presenting with severe pain and swelling of right thigh. To evaluate the causes of leg swelling, angiography and MRI in both legs and muscle biopsy at right thigh were performed. There was no deep vein thrombosis and arteriosclerosis in the lower extremities on angiography. The patient was diagnosed to DMI by MRI. After conservative treatment such as administration of analgesics, anti-platelet agent and physical therapy, pain and swelling of thigh was diminished, but frequently recurred. We describe a case of recurrent diabetic muscle infarction in a patient with maintenance hemodialysis therapy.

A Case of Gastric Duplication Cyst / 대한소화기내시경학회지

Duplicated cyst is a rare congenital disease that makes up 4% of all gastrointestinal duplications. It is two times more prevalent in women than in men. The majority of cases are detected by such symptoms as an abdominal mass, nausea, abdominal pain and anemia in infants, but these symptoms are uncommon in adults. Obstruction, hemorrhage and perforation are possible complications and malignancy can develop on rare occasions. Most cases are controlled by surgical resection. We report here on a case of gastric duplication cyst in a 20-year-old woman who presented with severe nausea and vomiting. She was managed by surgical resection after evaluation was done via endoscopic ultrasonography.

A Case of Trichosporon beigelii Fungemia Treated with Amphotericin B and Fluconazole in a Patient with Acute Myelogenous Leukemia / 대한혈액학회지

Trichosporon beigelii is a causative agent of white piedra, an superficial hair shaft infection in immunocompetent individuals, and rarely of disseminated trichosporonosis in immunocompromised patients especially in neutropenic patients with leukemia. Trichosporon infections in immunocompromised patients are frequently fatal despite therapy with amphotericin B. We describe an acute myelogenous leukemia patient with T. beigelii fungemia after remission induction chemotherapy who was successfully treated with amphotericin B and fluconazole.