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1.
Dis Esophagus ; 28(6): 505-11, 2015.
Article in English | MEDLINE | ID: mdl-24827543

ABSTRACT

Eosinophilic esophagitis (EoE) is a rapidly emerging chronic immune-mediated condition affecting children and adults, both genders, and all races. A large variation in the prevalence of EoE exists in the literature. The aim of this study is to establish the prevalence of EoE in a military health-care population in the United States using a comprehensive electronic medical record search. Using the International Classification for Diseases-9 code for EoE (530.13), the total number of EoE patients enrolled in the military health-care system from October 1, 2008 to September 30, 2009 including active-duty military, dependents of military personnel, and retirees were identified. For each case of EoE identified, demographic data (age, gender, and race) and geographic location was obtained. The overall prevalence of EoE was calculated as well as the prevalence within subgroups. The geographic regional locations were reported per the U.S. Census Bureau regions (Northeast, South, Midwest, and West). A total of 987 EoE patients were identified from 10,180,515 military health-care beneficiaries, establishing an overall prevalence of 9.7 per 100,000 (95% confidence interval [CI] 9.1-10.3). Seven hundred twenty-eight out of 7,707,372 adult patients were identified, establishing a prevalence of 9.5 per 100,000 (95% CI 8.8-10.1). Two hundred fifty-nine out of 2,473,143 pediatric patients were identified, establishing a prevalence of 10.5/100,000 (95% CI 9.2-11.8). EoE was more prevalent in males (odds ratio [OR] 2.03 [95% CI 1.78-2.32]) and higher in Caucasian versus African Americans (18.1 vs. 5.2/100,000, OR 3.47 [95% CI 2.40-5.03]). EoE was more prevalent in the Western region of the United States compared with the Northeast, South, and Midwest regions, with a prevalence of 11.9 versuss 5.2, 9.6, and 9.2 per 100,000, respectively. When comparing Northern with Southern states, there was an increased prevalence in the North (10.9 vs. 7.2/100,000, P < 0.05). In this large nationwide study, increase in prevalence of EoE was seen in younger adults, with a higher prevalence in Caucasians. Geographically, the western United States had a significantly higher prevalence with a slightly higher prevalence in the Northern latitude.


Subject(s)
Eosinophilic Esophagitis/epidemiology , Military Personnel/statistics & numerical data , Adult , Black or African American/statistics & numerical data , Age Distribution , Female , Humans , Male , Middle Aged , Prevalence , Sex Distribution , United States/epidemiology , White People/statistics & numerical data
2.
Aliment Pharmacol Ther ; 37(10): 1011-8, 2013 May.
Article in English | MEDLINE | ID: mdl-23560727

ABSTRACT

BACKGROUND: Combined with 24-h pH monitoring, the use of impedance is the most sensitive method available for detecting oesophageal reflux. Normal values for impedance have been previously established in healthy controls studied on and off proton pump inhibitors (PPI). AIMS: To determine the effects of PPIs on the total number of reflux episodes in the distal oesophagus measured by impedance in patients with and without gastro-oesophageal reflux disease (GERD). METHODS: In this prospective randomised double-blinded placebo controlled crossover study, all patients underwent two 24-h pH with impedance studies at least 2 weeks apart. Based on a randomisation scheme, patients received either 40 mg of esomeprazole twice daily for 1 week or identical capsule placebo for 1 week, then all patients were crossed over to the other treatment arm. GERD was defined by the validated Johnson-DeMeester score. Reflux by impedance was defined as a 50% decrease from baseline in retrograde movement of liquid between two impedance sites. RESULTS: Sixty-three patients were enrolled and 41 patients completed the study [mean age 52 ± 12 years, 42% (17/41) men, 56% (23/41) Caucasian and 34% (14/41) African American]. Overall, there was no significant decrease in the total number of distal impedance episodes with esomeprazole compared with placebo (mean change 6.1 ± 22, P = 0.100). When analysed separately by GERD status, among GERD-positive patients, there was a significant decrease in distal impedance episodes while on esomeprazole compared with placebo (mean change -16 ± 22, P = 0.023), but not in GERD-negative patients (mean change -0.35 ± 20, P = 0.872). CONCLUSION: Esomeprazole decreases significantly the number of reflux episodes detected by impedance, but only in patients with GERD.


Subject(s)
Anti-Ulcer Agents/therapeutic use , Esomeprazole/therapeutic use , Esophageal pH Monitoring , Gastroesophageal Reflux/drug therapy , Adult , Cross-Over Studies , Double-Blind Method , Electric Impedance , Female , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/physiopathology , Humans , Male , Middle Aged , Prospective Studies , Proton Pump Inhibitors/therapeutic use , Treatment Outcome
3.
J Endocrinol Invest ; 34(10): 781-7, 2011 Nov.
Article in English | MEDLINE | ID: mdl-22234178

ABSTRACT

Pioglitazone has an important role in the treatment of patients with Type 2 diabetes. The drug can help patients to achieve sustained glycemic control and may delay the requirement for insulin. Pioglitazone may provide benefits beyond its effects on glycemia, with data suggesting it may confer anti-atherosclerotic and cardioprotective properties. Attention should be given to possible side effects relating to class effects of TZD, and selection of appropriate patients to be prescribed pioglitazone will enable optimum benefits to be derived from pioglitazone treatment.


Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Thiazolidinediones/therapeutic use , Algorithms , Animals , Atherosclerosis/prevention & control , Blood Glucose/drug effects , Cardiotonic Agents/therapeutic use , Humans , Insulin/therapeutic use , Insulin Resistance , Pioglitazone , Thiazolidinediones/adverse effects
4.
Int J Clin Pract ; 56(9): 663-71, 2002 Nov.
Article in English | MEDLINE | ID: mdl-12469980

ABSTRACT

Sexual activity is no more stressful to the heart when compared with a number of other natural daily activities, e.g. walking one mile on the level in 20 minutes. The cardiac risk of sexual activity in patients diagnosed with cardiovascular disease is minimal in properly assessed and advised patients. Erectile dysfunction (ED) is extremely common, affecting over half of men aged 40-70 years, and increases in frequency with age. ED and cardiovascular disease share many of the same risk factors and commonly coexist. ED in the otherwise asymptomatic man may be a marker for underlying coronary artery disease. ED in the diagnosed cardiovascular patient should be identified by routine questioning in general practice. Modern therapies can restore a sexual relationship in the majority of patients with ED and can lead to a substantial improvement in quality of life. The majority of patients assessed to be at low or intermediate cardiac risk, as defined later in this paper, can be effectively managed in primary care. Primary care treatment for ED in patients defined as high risk can be initiated following a specialist opinion and/or confirmation that the patient's cardiovascular condition is stabilised. There is no evidence that currently licensed treatments for ED add to the overall cardiovascular risk in patients with or without diagnosed cardiovascular disease. If one form of therapy is not effective, follow-up will identify the need for alternative approaches. The pro-active management of ED in the cardiovascular patient provides an ideal and effective opportunity to address other cardiovascular risk factors and improve treatment outcomes.


Subject(s)
Cardiovascular Diseases/complications , Impotence, Vasculogenic/therapy , Activities of Daily Living , Chronic Disease , Consensus , Exercise , Family Practice , Humans , Impotence, Vasculogenic/etiology , Male , Medical History Taking , Practice Guidelines as Topic , Referral and Consultation , Risk Assessment
5.
Int J Clin Pract ; 55(9): 614-8, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11770359

ABSTRACT

There is now significant evidence that erectile dysfunction (ED) can be a symptom of cardiovascular disease, and can act as a marker for disease progression. National Health Service (NHS) prescribing restrictions on treatments for ED have recently been reviewed by the Department of Health, and current arrangements will not change. Unrestricted availability of licensed treatments for ED on the NHS, irrespective of the cause of the ED, may encourage men to present for investigation, enabling early detection of cardiovascular disease. Sildenafil citrate (Viagra), an effective treatment for ED, can also have a direct beneficial effect on cardiovascular disease. Unrestricted NHS availability of ED treatments such as sildenafil could facilitate greater achievement of National Service Framework targets for coronary heart disease.


Subject(s)
Cardiovascular Diseases/complications , Erectile Dysfunction/etiology , Adult , Aged , Algorithms , Cardiovascular Diseases/prevention & control , Erectile Dysfunction/drug therapy , Humans , Male , Middle Aged , Patient Selection , Piperazines/therapeutic use , Purines , Sildenafil Citrate , Sulfones , Vasodilator Agents/therapeutic use
6.
Can HIV AIDS Policy Law Rev ; 6(1-2): 65-9, 2001.
Article in English, French | MEDLINE | ID: mdl-11837034

ABSTRACT

Michael Joseph LeBlanc probably became infected with HIV and Hepatitis C while incarcerated in a federal penitentiary. On 18 November 1999, he died at the Regional Hospital in Kingston Penitentiary of complications relating to hepatitis C. Mr LeBlanc died inhumanely, in extreme physical, psychological and emotional distress. His death raises the issues of transmission and prevention of HIV and hepatitis C, compassionate release, and health care and palliative care in federal prisons. An Inquest under the Coroners Act was held in Kingston, Ontario from 30 January to 1 February 2001. These same issues had been raised previously at the October 1997 coroners inquest into the death of William Bell, a person living with AIDS who died while incarcerated in another federal penitentiary.


Subject(s)
Death , HIV Infections/complications , Hepatitis C/complications , Prisoners , HIV Infections/epidemiology , HIV Infections/prevention & control , Hepatitis C/epidemiology , Hepatitis C/prevention & control , Humans , Ontario/epidemiology , Palliative Care
7.
Circulation ; 102(20): 2473-8, 2000 Nov 14.
Article in English | MEDLINE | ID: mdl-11076819

ABSTRACT

BACKGROUND: Mental stress has been linked to increased morbidity and mortality in coronary artery disease and to atherosclerosis progression. Experimental studies have suggested that damage to the endothelium may be an important mechanism. METHODS AND RESULTS: Endothelial function was studied in 10 healthy men (aged 50. 4+/-9.6 years) and in 8 non-insulin-dependent diabetic men (aged 52. 0+/-7.2 years). Brachial artery flow-mediated dilation (FMD, endothelium dependent) and response to 50 microg of sublingual glyceryl trinitrate (GTN, endothelium independent) were measured noninvasively by use of high-resolution ultrasound before and after (30, 90, and 240 minutes) a standardized mental stress test. The same protocol without mental stress was repeated on a separate occasion in the healthy men. In healthy subjects, FMD (5.0+/-2.1%) was significantly (P:<0.01) reduced at 30 and 90 minutes after mental stress (2.8+/-2.3% and 2.3+/-2.4%, respectively) and returned toward normal after 4 hours (4.1+/-2.0%). Mental stress had no effect on the response to GTN. In the repeated studies without mental stress, FMD did not change. The diabetic subjects had lower FMD than did the control subjects (3.0+/-1.5% versus 5.0+/-2.1%, respectively; P:=0.02) but showed no changes in FMD (2.7+/-1.1% after 30 minutes, 2.8+/-1.9% after 90 minutes, and 3.1+/-2.3% after 240 minutes) or GTN responses after mental stress. CONCLUSIONS: These findings suggest that brief episodes of mental stress, similar to those encountered in everyday life, may cause transient (up to 4 hours) endothelial dysfunction in healthy young individuals. This might represent a mechanistic link between mental stress and atherogenesis.


Subject(s)
Diabetes Mellitus, Type 2/complications , Endothelium, Vascular/physiopathology , Stress, Psychological/complications , Adult , Blood Flow Velocity/drug effects , Blood Glucose , Brachial Artery/diagnostic imaging , Brachial Artery/drug effects , Brachial Artery/physiopathology , Cytokines/blood , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/physiopathology , Electrocardiography , Endothelium, Vascular/metabolism , Heart Rate , Humans , Hydrocortisone/analysis , Lipids/blood , Male , Middle Aged , Nitroglycerin/pharmacology , Saliva/chemistry , Stress, Psychological/blood , Stress, Psychological/physiopathology , Ultrasonography , Vasodilation/drug effects , Vasodilator Agents/pharmacology
10.
Lancet ; 353(9170): 2111-5, 1999 Jun 19.
Article in English | MEDLINE | ID: mdl-10382695

ABSTRACT

BACKGROUND: Radioiodine is used increasingly as first-line treatment for hyperthyroidism, but concerns remain about subsequent risk of cancer, especially in those treated at a young age. We investigated cancer incidence and mortality in patients treated with radioiodine for hyperthyroidism. METHODS: We did a population-based study in 7417 patients treated in Birmingham, UK, between 1950 and 1991. We compared details of all cancer diagnoses and deaths in 1971-91 from the UK Office for National Statistics with data on cancer incidence and mortality for England and Wales specific for age, sex, and period. FINDINGS: During 72,073 person-years of follow-up, 634 cancer diagnoses were made, compared with an expected number of 761 (standardised incidence ratio [SIR] 0.83 [95% CI 0.77-0.90]). The relative risk of cancer mortality was also decreased (observed cancer deaths 448, expected 499; standardised mortality ratio [SMR] 0.90 [0.82-0.98]). Incidence of cancers of the pancreas, bronchus, trachea, bladder, and lymphatic and haemopoietic systems was lowered. Mortality from cancers at all these sites was also reduced but findings were significant only for bronchus and trachea. There were significant increases in incidence and mortality for cancers of the small bowel (SIR 4.81 [2.16-10.72], SMR 7.03 [3.16-15.66]) and thyroid (SIR 3.25 [1.69-6.25], SMR 2.78 [1.16-6.67]), although absolute risk of these cancers was small. INTERPRETATION: The decrease in overall cancer incidence and mortality in those treated for hyperthyroidism with radioiodine is reassuring. The absolute risk of cancers of the small bowel and thyroid remain low, but the increased relative risk shows the need for long-term vigilance in those receiving radioiodine.


Subject(s)
Hyperthyroidism/radiotherapy , Iodine Radioisotopes/adverse effects , Neoplasms, Radiation-Induced/epidemiology , Aged , England/epidemiology , Female , Humans , Incidence , Iodine Radioisotopes/therapeutic use , Male , Middle Aged , Mortality , Risk , Wales/epidemiology
11.
Int J Clin Pract ; 53(6): 445-51, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10622072

ABSTRACT

Sexual activity is no more stressful to the heart when compared with a number of other natural daily activities, e.g. walking one mile on the level in 20 minutes. The cardiac risk of sexual activity in patients diagnosed with cardiovascular disease is minimal in properly assessed and advised patients. Erectile dysfunction (ED) is common, affecting 10% of men aged 40-70 years and increases in frequency with age. ED and cardiovascular disease share many of the same risk factors and often coexist. ED in the diagnosed cardiovascular patient should be identified by routine questioning in general practice. Modern therapies can restore a sexual relationship in the majority of patients with ED and can lead to a substantial improvement in quality of life. The majority of patients assessed to be at low or intermediate cardiac risk, as defined later in this paper (Table 4), can be effectively managed in primary care. Primary care treatment for ED in patients defined as high risk can be initiated following a specialist opinion and/or confirmation that the patient's cardiovascular condition is stabilised. There is no evidence that currently licensed treatments for ED add to the overall cardiovascular risk in patients with or without diagnosed cardiovascular disease.


Subject(s)
Cardiovascular Diseases/complications , Impotence, Vasculogenic/complications , Adult , Aged , Cardiovascular Diseases/physiopathology , Chronic Disease , Family Practice , Humans , Impotence, Vasculogenic/physiopathology , Male , Middle Aged , Risk Factors
12.
J Rheumatol ; 25(5): 864-8, 1998 May.
Article in English | MEDLINE | ID: mdl-9598881

ABSTRACT

OBJECTIVE: Rheumatoid arthritis (RA) is a polygenic disease characterized by localized joint destruction and generalized osteoporosis resulting in increased fracture risk. The pathogenetic mechanisms that determine the severity of generalized bone loss in RA are poorly understood. Polymorphisms in the vitamin D receptor (VDR) gene have been described as a significant determinant of bone turnover and mass. In this prospective study we describe VDR gene allele effects on bone loss in patients with early RA. METHODS: We recruited 232 patients with early RA. Bone mineral density measurements were repeated in 167 patients. Serial clinical and laboratory measures were recorded during the period of followup. DNA extraction, polymerase chain reaction amplification, and restriction fragment length polymorphism analysis of VDR alleles were performed using standard techniques. Presence of the Taq restriction site for both alleles was denoted "tt", and absence "TT". RESULTS: In women with RA the tt genotype group lost bone more rapidly than subjects with TT genotype at both the lumbar spine (-0.1 vs -4.9% p.a, respectively; p < 0.05) and femoral neck (-3.9 vs -9.6%, respectively; p < 0.01). The effect was independent of other disease characteristics. CONCLUSION: The presence of the VDR gene "t" allele in female patients with RA was associated with accelerated bone loss.


Subject(s)
Arthritis, Rheumatoid/genetics , Osteoporosis/genetics , Receptors, Calcitriol/genetics , Alleles , Arthritis, Rheumatoid/physiopathology , Bone Density/genetics , Female , Genetic Markers/genetics , Genotype , HLA-DR Antigens/genetics , Humans , Male , Middle Aged , Polymorphism, Genetic , Prospective Studies
13.
N Engl J Med ; 338(11): 712-8, 1998 Mar 12.
Article in English | MEDLINE | ID: mdl-9494147

ABSTRACT

BACKGROUND: Hyperthyroidism affects many organ systems, but the effects are usually considered reversible. The long-term effects of hyperthyroidism on mortality are not known. METHODS: We conducted a population-based study of mortality in a cohort of 7209 subjects with hyperthyroidism who were treated with radioactive iodine in Birmingham, United Kingdom, between 1950 and 1989. The vital status of the subjects was determined on March 1, 1996, and causes of death were ascertained for those who had died. The data on the causes of death were compared with data on age-specific mortality in England and Wales. The standardized mortality ratio was used as a measure of relative risk, and the effect of covariates on mortality was assessed by regression analysis. RESULTS: During 105,028 person-years of follow-up, 3611 subjects died; the expected number of deaths was 3186 (standardized mortality ratio, 1.1; 95 percent confidence interval, 1.1 to 1.2; P<0.001). The risk was increased for deaths due to thyroid disease (106 excess deaths; standardized mortality ratio, 24.8; 95 percent confidence interval, 20.4 to 29.9), cardiovascular disease (240 excess deaths; standardized mortality ratio, 1.2; 95 percent confidence interval, 1.2 to 1.3), and cerebrovascular disease (159 excess deaths; standardized mortality ratio, 1.4; 95 percent confidence interval, 1.2 to 1.5), as well as fracture of the femur (26 excess deaths; standardized mortality ratio, 2.9; 95 percent confidence interval, 2.0 to 3.9). The excess mortality was most evident in the first year after radioiodine therapy and declined thereafter. CONCLUSIONS: Among patients with hyperthyroidism treated with radioiodine, mortality from all causes and mortality due to cardiovascular and cerebrovascular disease and fracture are increased.


Subject(s)
Hyperthyroidism/mortality , Iodine Radioisotopes/therapeutic use , Mortality , Cardiovascular Diseases/mortality , Cerebrovascular Disorders/mortality , Cohort Studies , Dose-Response Relationship, Radiation , England/epidemiology , Female , Fractures, Bone/mortality , Humans , Hyperthyroidism/radiotherapy , Iodine Radioisotopes/administration & dosage , Iodine Radioisotopes/adverse effects , Male , Middle Aged , Reference Values , Survival Analysis , Wales/epidemiology
15.
Hum Mutat ; 10(6): 465-73, 1997.
Article in English | MEDLINE | ID: mdl-9401010

ABSTRACT

The aim of this study was to identify mutations in the lipoprotein lipase (LPL) gene in 20 unrelated patients with familial lipoprotein deficiency (FLLD) and to investigate the genotype/phenotype relationship. The previously reported G188E mutation (Monsalve et al., J Clin Invest 86:728-734, 1990) was screened for and found to be present in seven individuals (12/40 alleles). In addition, three patients were heterozygous for the 2.0 kb insertion (Langlois et al., Proc Nalt Acad Sci US 86:948-952, 1989). Two approaches were taken for new mutation detection; single-strand conformation polymorphism and sequencing to identify micro-mutations in the proximal promoter and exons 1-9 of the LPL gene and Southern blotting to identify gross mutations. Ten different point mutations were found (W86G, A158T, H183Q, G188E, S193R, P207L, L252X, N291S, M301T, L303P). Additionally, a two nucleotide deletion in exon 6 (delta1006-1007), a six nucleotide deletion in exon 8 (delta1441-1447), and a silent substitution in the wobble position of codon E118 were identified. In vitro mutagenesis and expression in COS-B cells suggested that the A158T and S193R substitutions virtually abolished enzyme activity. In analysing the genotype/phenotype relationship, there was no strong association between age at diagnosis, severity of symptoms, lipid levels, and the nature/position of the mutation. Triglyceride levels, however, were higher in compound heterozygotes compared to true homozygotes, possibly reflecting increased instability of heterodimers. Overall, 29 of 40 (72.5%) mutant alleles were identified. Failure to identify the mutation in 11 alleles might reflect the inadequacy of the method or the possibility that mutations lie within regions of the gene not screened in the study because of lack of availability of sequence.


Subject(s)
Hyperlipoproteinemia Type I/genetics , Lipoprotein Lipase/genetics , Mutation/genetics , Adult , Animals , COS Cells , Child , Child, Preschool , DNA Mutational Analysis , Genes/genetics , Genetic Carrier Screening , Genetic Heterogeneity , Genotype , Humans , Hyperlipoproteinemia Type I/blood , Infant , Infant, Newborn , Italy , Lipoprotein Lipase/deficiency , Lipoprotein Lipase/metabolism , Middle Aged , Phenotype , Polymorphism, Single-Stranded Conformational , Sweden , Triglycerides/blood , United Kingdom
19.
Thyroid ; 5(5): 359-63, 1995 Oct.
Article in English | MEDLINE | ID: mdl-8563472

ABSTRACT

We have shown that previous thyrotoxicosis and subsequent levothyroxine (L-T4) therapy are together associated with reduction in femoral and lumbar vertebral bone mineral density (BMD) in postmenopausal women. To determine whether estrogen replacement therapy exerts a beneficial effect upon bone loss in this situation, we performed a cross-sectional study comparing BMD measurements of the femur and lumbar spine in four groups of women (n = 15 in each group) matched for age and duration of menopause: (i) those with a previous history of thyrotoxicosis who were subsequently receiving both L-T4 and estrogen replacement therapy for at least 3 years (L-T4 + HRT group), (ii) previously thyrotoxic women matched to group (i) for L- dose and duration who had never used estrogen replacement (L-T4 alone group), (iii) those with no history of thyroid disease who had received estrogen replacement therapy for at least 3 years (HRT alone group), and (iv) those with no history of thyroid disease who had never received estrogen replacement therapy (control group). BMD measurements were higher at each site in the HRT alone group than in controls (6.0-13.6% increases in BMD, p < 0.05 for measurements at femoral neck, Ward's triangle, and trochanter) while measurements of BMD were lower at each site in the L-T4 alone group than in controls (3.3-6.1% reductions in BMD), although values did not reach statistical significance. Measurements at each site in the L-T4 + HRT group were higher than those from the L-T4 alone group (2.2-16.1% increases in BMD, p < 0.05 for measurements at lumbar spine), although lower than in the group receiving HRT alone (p < 0.05 for femoral neck and Ward's triangle) and similar to those in untreated controls. Our results indicate that estrogen replacement therapy abolishes reduction in femoral and vertebral BMD in postmenopausal women with previous thyrotoxicosis and subsequent L-T4 therapy. This potentially beneficial influence of estrogen replacement upon both BMD and fracture risk in postmenopausal women with a history of thyroid disease suggests that estrogen administration should be encouraged in this group.


Subject(s)
Bone Density , Estrogen Replacement Therapy , Postmenopause , Thyrotoxicosis/drug therapy , Thyroxine/adverse effects , Body Mass Index , Calcium/blood , Female , Femur , Humans , Middle Aged , Phosphates/blood , Spine , Thyrotropin/blood , Thyroxine/blood , Thyroxine/therapeutic use
20.
Clin Endocrinol (Oxf) ; 41(4): 425-32, 1994 Oct.
Article in English | MEDLINE | ID: mdl-7955453

ABSTRACT

OBJECTIVE: The results of studies examining the influence of T4 therapy upon bone mineral density (BMD) are conflicting. This conflict may, in part, reflect inclusion of patients with varying thyroid disorders. We have therefore examined the influence of preceding thyroid history and T4 therapy on BMD. DESIGN: Case-control studies of patients on long-term T4 therapy who have or have not previously received radioiodine treatment for thyrotoxicosis, as well as previously thyrotoxic patients who have not required T4 replacement. PATIENTS: Twenty-seven premenopausal and 60 postmenopausal females with a past history of thyrotoxicosis and subsequent T4 treated hypothyroidism (group 1), 39 post-menopausal females with a past history of radioiodine treated thyrotoxicosis not receiving T4 (group 2) and 22 post-menopausal females with primary hypothyroidism on T4 (group 3). Female controls individually matched to patients by age and menopausal status. MEASUREMENTS: BMD measured by dual-energy X-ray absorptiometry. Serum biochemistry and tests of thyroid function. RESULTS: No significant differences were found in femoral or lumbar spine BMD measurements between premenopausal patients and controls in group 1 or between group 2 patients and controls. Measurements of BMD at all sites were lower in post-menopausal patients in groups 1 and 2 than in controls; when allowance was made for differences in BMD due to body mass index by analysis of variance, significant reductions in femoral trochanter BMD (3.9%, P < 0.05) and lumbar spine (5.6-8.5%, P < 0.01) BMD results were found in post-menopausal females in group 1 and reductions in femoral trochanter (3.9%, P < 0.01), Ward's triangle (5.6%, P < 0.05) and lumbar spine (8.5%, P < 0.01) BMD results in group 2. Separate analysis of BMD results of those with normal or reduced serum TSH did not affect outcome. BMD measurements were not significantly correlated with duration of T4 therapy, T4 dose, or serum free T4 or TSH in any patient group. CONCLUSIONS: Thyroxine therapy alone does not represent a significant risk factor for loss of bone mineral density but there is a risk of bone loss in post-menopausal (but not premenopausal) females with a previous history of thyrotoxicosis treated with radioiodine.


Subject(s)
Bone Density/drug effects , Hypothyroidism/drug therapy , Iodine Radioisotopes/therapeutic use , Thyrotoxicosis/radiotherapy , Thyroxine/therapeutic use , Absorptiometry, Photon , Adult , Aged , Bone Density/radiation effects , Bone and Bones/metabolism , Case-Control Studies , Female , Humans , Hypothyroidism/metabolism , Middle Aged , Postmenopause/metabolism , Risk Factors , Thyrotoxicosis/metabolism , Time Factors
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