Follow up testing of hyperglycaemia during hospital admission: combined use of fasting plasma glucose and HbA1c.

AIM: To follow up patients without known diabetes, but with hyperglycaemia in hospital for diabetes at one year. METHODS: 159 patients with a random plasma glucose > or = 7.8 mmol/L recorded during hospital admission were sent a questionnaire and invited to have the following test one year following discharge: fasting plasma glucose, HbA1c and fasting lipid profile. Those with a fasting plasma glucose > or = 5.5 and < 7.0 mmol/L, and/or those with a HbA1c > or = 6.0%, were asked to have an oral glucose tolerance test. Those with a fasting plasma glucose > or = 7.0 mmol/L were defined as having diabetes. RESULTS: There were 88 full responses. Nineteen (21.6%) had diabetes and nine impaired glucose tolerance. Hb1Ac was > or = 6% in five subjects with a fasting plasma glucose < 5.5 mmol/L. Two had impaired glucose tolerance and one diabetes. If a random plasma glucose in-hospital of 10 mmol/L is used as a threshold for later testing, as suggested by previous studies, then 25% of those with an abnormal result would have been missed. CONCLUSIONS: A high proportion of those with hyperglycaemia in hospital have diabetes or impaired glucose tolerance at one year. Initial testing with fasting plasma glucose and HbA1c avoided oral glucose tolerance test in 76% of cases. Use of HbA1c detected otherwise missed diabetes and impaired glucose tolerance. A random plasma glucose of > or = 7.8 mmol/L in hospital targets patients who should be tested for impaired glucose tolerance or diabetes following discharge.

A randomized trial of short-term treatment of Graves' disease with high-dose carbimazole plus thyroxine versus low-dose carbimazole.

OBJECTIVE: The optimal treatment regimen with thionamide drugs remains a matter for debate. We have investigated whether high doses of carbimazole, when compared with low doses, reduce relapse rates of Graves' disease. DESIGN: In an open label, randomized, prospective trial of treatment of Graves' disease we compared high doses of carbimazole (6 months of 100 mg carbimazole per day plus thyroxine) to low-dose carbimazole treatment (starting at 25 mg and titrating the carbimazole dose with the aim to maintain serum thyroid function test results within the normal reference range). PATIENTS: Thirty-seven patients with a first episode of Graves' disease were enrolled. MEASUREMENTS: During the 6 months of treatment we evaluated the rate of normalization of serum thyroid function tests, changes in serum thyroid auto-antibody levels and the rate of side-effects during treatment. After completion of the 6-month treatment course patients were observed for 2 years for evidence of relapse of Graves' disease. RESULTS: There were no differences between the two groups either in the rate of normalization of serum thyroid function tests or in serum thyroid auto-antibody levels during treatment. Of the 17 patients randomized to high-dose treatment seven suffered treatment side-effects, compared to only one of the 20 patients receiving low-dose treatment (P < 0.006). There was no significant difference in 2-year post-treatment remission rates on an intention-to-treat basis between the two treatment groups (18.7% vs. 5.9%, P = NS). However, for those patients who completed 6 months of treatment (high-dose group = 9, low-dose group = 16), multivariate survival analysis demonstrated a significantly longer median relapse-free interval (P < 0.04) in the high-dose group (27 weeks; 25th percentile: 9.6 weeks, 75th percentile: 75 weeks) versus the low-dose group (6 weeks; 25th percentile: 4.8 weeks, 75th percentile: 13.1 weeks). CONCLUSIONS: High-dose carbimazole treatment delays, but does not prevent, relapse from Graves' disease in those patients able to tolerate the treatment. However, it leads to more frequent side-effects than conventional dose treatment.

Parathyroid imaging with thallium-201 subtraction scintigraphy: a report of 33 cases.

Thallium-201 subtraction scintigraphy has been used in Wellington Hospital for preoperative localisation of parathyroid adenomas since 1984. The technique wa audited by comparing the scan reports with the outcome at operation in 33 patients, 30 of whom underwent a primary exploration. In our unselected patients we found the technique to have poor sensitivity (45.4%) with a high false positive rate (21%). There was no difference in the mean size of the glands correctly identified compared to those that were missed. Our experience has led us to believe that thallium-201 subtraction scintigraphy has not lived up to its early promise and is not a useful technique for routine preoperative localisation of parathyroid adenomas.

Mean platelet volume is increased in hyperthyroidism.

In 28 unselected patients with hyperthyroidism, platelet count, platelet hematocrit, mean platelet volume, and platelet distribution width were measured at the time of presentation and again when the patients were euthyroid. On return to the euthyroid state, there were highly significant falls in the mean values of the mean platelet volume (16% decline, P less than 0.001) and the platelet hematocrit (16% decline, P less than 0.001) and a slight but highly significant increase in the mean value of the platelet distribution width (2% increase, P less than 0.01). A decline in mean platelet volume was observed in 24 of 28 patients (86%); three patients showed no change. There was no significant change in the mean value of the platelet count. The observed effects of thyrotoxicosis on platelets appeared to be largely independent of the well-known effects on erythrocytes and white blood cells. An increase in mean platelet volume is a regular feature of hyperthyroidism that has not previously been described.

Renal failure following methoxyflurane analgesia.

Two patients given methoxyflurane for analgesia over 14 and 16 days developed renal failure and died. The inhaler was withdrawn from the New Zealand market in 1984.