Prognostic significance of high free T4 and low free T3 levels in non-thyroidal illness syndrome.

BACKGROUND: Non-thyroidal illness syndrome is characterized by decreased serum free T3 (FT3) level and associates with long term mortality. Serum free T4 (FT4) may affect on mortality with FT3 in course of chronic illness. This study performed to evaluate the association between both decreased FT3 with elevated FT4 levels and mortality risk. METHODS: This study is a retrospective cohort analysis and consisted up 1164 (571 male, 593 female) patients with a 36 months follow up period. Patients divided into four groups according to thyroid functions. Patients with euthyroidism were in Group A, elevated FT3 in group B, decreased FT3 in group C and both decreased FT3 and elevated FT4 levels in group D. The levels of thyroid hormones and all cause mortality were compared between four groups. RESULTS: Mortality rate was elevated between Groups A and B, A and C, A and D, B and C, B and D, C and D, (p < .001, p < .001, p < .001, p < .001, p < .001, p:0.019, respectively). A multivariate Cox proportional hazards model was performed to evaluate the mortality risk between groups. A close relationship was observed in Group C and D patients for the mortality risk (OR:1.561, 95% CI:1.165-2.090, p:0.003 and OR:2.224, 95% CI:1.645-3.006, p:0.0001, respectively). CONCLUSION: Both decreased FT3 and elevated FT4 levels are independent predictor for long term mortality risk in hospitalized chronic patients with non-thyroidal illness syndrome.

Coexistence of the POEMS syndrome with hepatitis B: a rare case report.

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) is a rare multisystemic disease of unknown pathogenesis. Proinflammatory and proangiogenic cytokines play important roles in its pathogenesis. POEMS syndrome is a rare cause of ascites. Until now, the coexistence of POEMS syndrome and hepatitis B has not been reported. In this case report, we present a 48-year-old male patient who presented with malaise, fatigue, diarrhea, and abdominal swelling. Organomegaly, endocrinopathy, ascites, skin changes, and polyneuropathy were identified, and we arrived at a diagnosis of POEMS syndrome. The patient was administered methylprednisolone 64 mg/day, lamivudine 100 mg/day, calcium 1.5 g/day, and calcitriol 0.5 µg/day. The patient's clinical manifestations had moderately resolved at the follow-up visits. At the end of 6 months of follow-up, his ascites was minimally reduced, and his neurologic manifestations had not lessened. The present case shows that accurate diagnosis is required for the management of patients with coexisting POEMS syndrome and hepatitis B.

Fenofibrate-induced rhabdomyolysis in a patient with chronic renal failure due to nephrotic syndrome: a rare case report.

OBJECTIVES: Fenofibrate is a fibric acid derivative that is used alone or combination with statins in the treatment of hyperlipidemia. These drugs have potential risks, including rhabdomyolysis and acute renal failure. Despite reports of rhabdomyolysis with the use of fenofibrate alone or with statin-fibrate combinations, there have been no cases of rhabdomyolysis described when fenofibrate was used alone to treat patients with chronic renal failure owing to nephrotic syndrome. DESIGN AND METHODS: We report on a 26-year-old male who presented with fenofibrate-induced rhabdomyolysis with chronic renal failure due to nephrotic syndrome. RESULTS: After the discontinuation of fenofibrate, the patient was treated with intravenous fluid replacement and urine alkalization. Subsequently, his clinical and biochemical findings improved. CONCLUSIONS: Before starting fenofibrate therapy, the causes of secondary hyperlipidemia, especially nephrotic syndrome, should be investigated. In the presence of chronic renal failure and hypoalbuminemia, the fenofibrate dose should be adjusted. Physicians should be aware of the potential toxicities of fenofibrate, and patients should be informed about its potential side effects.

Fenofibrate-induced rhabdomyolysis in a patient with stage 4 chronic renal failure due to diabetes mellitus.

Rhabdomyolysis is defined as a pathological condition of skeletal muscle cell damage leading to the release of toxic intracellular components into the circulation. Several factors may lead to rhabdomyolysis. Fenofibrate is a fibric acid derivative agent that is used in the treatment of hyperlipidaemia. Although several case reports of rhabdomyolysis have been reported due to the combination of statin and fenofibrate, fenofibrate alone rarely causes rhabdomyolysis. When administering fenofibrate in chronic renal failure, dose should be adjusted. Here, we report a case with fenofibrate-induced rhabdomyolysis in a patient with chronic renal failure.

Syndrome of inappropriate secretion of antidiuretic hormone cholestasis and pericardial effusion due to brucellosis infection: a case report.

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is an extremely rare complication of infectious diseases. A rare case of brucellosis complicated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH) cholestasis and pericardial involvement is reported. A 27-year-old woman was admitted for fever, abdominal pain, and scleral icterus. Her medical history revealed no recent use of diuretic agents. In addition to cholestasis and elevated liver enzymes, euvolemic hyponatremia, hypouricemia, low plasma osmolality, and high urinary osmolality were also detected. Surrenal and thyroid tests were also within normal range. Echocardiography revealed minimal pericardial effusion with normal cardiac functions. The final diagnosis was SIADH due to Brucellosis. Hyponatremia, cholestasis, and pericardial disease were resolved with effective antibrucellar treatment with streptomycine and doxycycline. After completing treatment of brucellosis, there was not any more evidence of cholestasis and pericardial fluid.