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BACKGROUND: Hyponatremia developing in hypothyroid patients has been encountered in clinical practice; however, its prevalence has not been well established. METHODS: Thirty patients diagnosed with differentiated thyroid cancer, rendered hypothyroid after surgery and levothyroxine withdrawal, and who are for radioactive iodine (RAI) ablation were included. Serum sodium concentrations were measured twice, at the time of admission for RAI ablation, and before discharge after increased oral fluid intake. The outcome measures were to determine the prevalence of hyponatremia among hypothyroid patients prior to RAI ablation and after oral hydration post-RAI, and to correlate the serum sodium levels pre-RAI and post-RAI with thyroid-stimulating hormone (TSH) concentration and age. RESULTS: Thirty patients were included, with ages from 23 to 65 years old (median, 40). Two patients (6.7%) were hyponatremic prior to RAI ablation, and eight patients (26.7%) had mild hyponatremia (130 to 134 mEq/L) after RAI and hydration. There was no significant correlation between TSH levels and serum sodium levels prior to or after RAI. There was also no significant correlation between pre- and post-RAI sodium concentration and age. CONCLUSIONS: The prevalence of hyponatremia pre-RAI was 6.7%, and 26.7% post-RAI. No significant correlation was noted between TSH concentration and age on pre- or post-RAI sodium concentrations. Routine measurement of serum sodium post-RAI/isolation is still not advised. Measurement of sodium post-RAI may be considered in patients who are elderly, with comorbid conditions or on medications.
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INTRODUCTION:Radioactive iodine(I131) therapy is an established definitive treatment for Graves' hyperthyroidism.However,the optimal method of determining the radioiodine treatment dose remains controversial.OBJECTIVE: To compare the efficacy of fixed dose versus calculated dose regimen in the treatment of Graves' hyperthyroidism among Filipinos METHODOLOGY: Diagnosed Graves' disease patients underwent thyroid ultrasound to estimate thyroid size. Patients were randomized to either fixed or calculated dose of radioiodine treatment. For fixed dose group,the WHO goiter grading was utilized: Grade 0 (5mCi), Grade 1 (7mCi), Grade2 (10mCi), Grade 3 (15mCi). For calculated dose group the following formula was used: Dose(mCi)= 160uCi/g thyroid x thyroid gland weight in grams x 100 / 24-hour RAIU(%)Thyroid function test (TSH,FT4) was monitored every three months for one year. RESULTS: Of the 60 patients enrolled, 45 (fixed dose; n= 27, calculated dose; n= 18) completed the six months follow-up study. Analysis was done by application of the intention-to-treat principle. The percentage failure rate at third month in the fixed vs. calculated dose group was: 26 v. 28% with a relative risk (RR) value of 0.93. At six months post-therapy, there was a noted reduction in the failure rates for both study groups (11 vs. 22%, respectively), with a further reduction in the relative risk value (0.67), favoring the fixed dose group.CONCLUSION: Fixed dose radioiodine therapy for Graves' disease is observed to have a lower risk of treatment failure (persistent hyperthyroidism) at three and six months post-therapy compared to the calculated dose.
Subject(s)
Humans , Male , Female , Middle Aged , Adult , Iodine Radioisotopes , Iodine , Intention to Treat Analysis , Graves Disease , Hyperthyroidism , Goiter , Thyroid Function Tests , Treatment FailureABSTRACT
BACKGROUND:The national prevalence of goiters in the Philippines was 3.7% in 1987 and 6.7% in 1993. Since then, there has been no follow-up survey on goiter prevalence, nor has there been any national survey on the prevalence of abnormal thyroid dysfunction. The PhilTiDeS is a survey on the prevalence of both goiters and thyroid disorders in the Philippines.OBJECTIVES:To determine the prevalence of various categories of abnormal thyroid dysfunction among the Filipino non-pregnant adult population and to describe the prevalence of thyroid enlargement in the Philippines in relation to thyroid dysfunction status.MATERIALS AND METHODS:The PhilTiDes was a substudy of the 2008 National Nutrition and Health Survey (NNHeS), which covered all 17 regions and 80 provinces of the Philippines. It included all Filipino adults 20 years and older, who are non-pregnant and non-lactating. A standard questionnaire was used to collect data on previous diagnosis and current treatment for thyroid disorders, and neck examination by trained field personnel was done to assess the presence of goiter. Blood was extracted, processed and sent to an accredited laboratory for free T4 and TSH testing using micro-particle enzyme immunoassay.RESULTS: A total of 4897 persons had thyroid function tests. Of these, 417 (8.53%) had thyroid function abnormalities with the most common abnormality being subclinical hyperthyroidism occurring in 5.33%. The other categories had the following prevalence: true hyperthyroidism 0.61% ; true hypothyroidism 0.41%; and subclinical hypothyroidism 2.18%. Majority of the population 4480 (91.47%) had normal thyroid function tests. Of those with subclinical hyperthyroidism, 55% are females with mean age of 48 years (95% CI 45.9-50.1 years) compared with the volunteers with normal thyroid function who were younger (mean age of 43.1, 95% CI 42.5-43.6 years). Out of the 7,227 volunteers who responded to the survey and clinical examination, a total of 674 (8.9%) had goiters. Out of the 674 subjects with goiters, 379 had diffuse enlargement (56%) while the rest had nodular goiter (44%). Among the sub-population (n= 4897) who underwent thyroid function testing, 9% of those with normal thyroid function tests have goiters.CONCLUSION: The prevalence of thyroid function abnormalities in the Philippines is 8.53% with the greatest proportion of volunteers having subclinical thyroid disease. There is a low prevalence of both true or overt hyperthyroidism and hypothyroidism. In the larger survey, it was found that 8.9% of volunteers who were examined had goiters. The etiology of these goiters will need to be ascertained in future studies.
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Humans , Male , Female , Middle Aged , Adult , Goiter, Nodular , Health Surveys , Hyperthyroidism , Hypothyroidism , Immunoenzyme Techniques , Philippines , Prevalence , Thyroid Diseases , Thyroid Function Tests , VolunteersABSTRACT
BACKGROUND: Gestational diabetes mellitus (GDM) has been as sociated with adverse maternal and fetal outcomes that extend beyond the postpartum period. Knowledge of its prevalence and risk factors can lead to possible preventive strategies.OBJECTIVE: To determine the prevalence and risk factors for GDM at the University of Santo Tomas Hospital-Clinical Division (USTH-CD).METHODS: A cross-sectional study was performed between January to December 2009 at the USTH-CD. Simple and multivariate logistic regressions were used to estimate the odds ratios with 95% confidence intervals, and to control for confounding variables.RESULTS: We reported the prevalence of GDM at USTH-CD to be 7.5%. The risk for GDM was significantly associated with increasing BMI (OR 1.54; 95% CI 1.06, 2.24), family history of diabetes (OR 6.27; 95% CI 2.63, 14.96) and hormonal contraceptive use (OR 8.48; 1.55, 46.52). Mothers with GDM were also at increased risk of delivering via cesarean section (OR 2.76; 95% CI 1.13, 6.72). The 1-minute APGAR score of infants born to mothers with GDM were also lower (OR 0.31; 95% CI 0.12, 0.83).CONCLUSION: Higher BMI, family history of diabetes and hormonal contraceptive use were strongly associated with GDM. Presence of GDM increases the risk of having cesarean deliveries and a poor fetal 1-minute APGAR score. The presence of these findings may be helpful in identifying those at risk for GDM who might benefit from heightened surveillance during pregnancy.
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Humans , Male , Female , Middle Aged , Adult , Infant, Newborn , Cesarean Section , Contraceptive Agents , Diabetes, Gestational , Mothers , Parturition , Postpartum Period , Prevalence , Risk FactorsABSTRACT
INTRODUCTION: The use of oral hypoglycaemic drugs in pregnancy is not recommended because of reports of foetal anomalies and other adverse outcomes in animal studies and in some human cases. However, recent studies have suggested that some oral hypoglycaemic drugs may be used in pregnancy. This review will examine these studies critically. METHODS: Literature review of articles obtained from a PubMed search of peer-reviewed journals on oral hypoglycaemic drug use in pregnancy. RESULTS: In two prospective studies, one of which was a randomised controlled trial, glibenclamide was as effective and safe as insulin in gestational diabetes. In several studies, metformin did not increase foetal anomalies or malformations when used during pregnancy in women with polycystic ovary syndrome (PCOS). In one prospective study on infants born to mothers who used metformin in pregnancy, follow-up for 18 months showed no adverse effects. In several prospective and retrospective studies on women with PCOS, metformin was shown to prevent early pregnancy loss, decrease insulin resistance, reduce insulin and testosterone levels, and decrease the incidence of gestational diabetes when these women got pregnant while on metformin and continued to take it throughout their pregnancy. In a single small study, acarbose did not cause any adverse effects during pregnancy. CONCLUSIONS: Recent evidence shows promising findings in the safety and efficacy of some oral hypoglycaemic agents in treating pregnant diabetics. However, larger clinical studies will be needed to ensure the safety and efficacy of these drugs in pregnancy.