scholarly journals Effect of once weekly oral levothyroxine therapy

2021 ◽  
Vol 2021 ◽  
Author(s):  
Andrea del Toro-Diez ◽  
Ernesto Solá-Sánchez ◽  
Michelle Mangual-García
Keyword(s):  
Case Series ◽  
Cost Effective ◽  
Primary Hypothyroidism ◽  
Endocrine Disorders ◽  
List Type ◽  
Common Cause ◽  
Cost Effective Approach ◽  
Alternative Approach ◽  
Learning Points ◽  
Tsh Levels

Summary Primary hypothyroidism is one of the most common endocrine disorders with widely available treatment. A minority of patients remain with uncontrolled hypothyroidism despite therapy. The objective of this case series was to demonstrate that medication non-adherence, rather than malabsorption, should be sought as the most common cause of unsuppressed TSH levels in patients receiving treatment for this condition. Non-adherence is often considered as a diagnosis of exclusion. Nonetheless, a diagnosis of malabsorption requires a more extensive workup, including imaging and invasive procedures, which increase healthcare costs and burden to the patient. The findings of this study allow for a cost-effective approach to uncontrolled hypothyroidism. Learning points Medication non-adherence is a common cause of insuppressible TSH levels. Once weekly levothyroxine is an alternative approach to non-compliant patients. Assessing compliance is more cost-effective and less burdensome than testing for malabsorption.

scholarly journals Two patients with atypical low triiodothyronine syndrome: primary deiodinase abnormalities?

2014 ◽  
Vol 2014 ◽  
Author(s):  
Gerald J M Tevaarwerk
Keyword(s):  
Reference Range ◽  
Primary Hypothyroidism ◽  
Response To Treatment ◽  
List Type ◽  
Deiodinase Activity ◽  
Encoding Genes ◽  
Learning Points ◽  
Tsh Levels ◽  
Secondary Causes ◽  
Biochemical Abnormalities

Summary Low triiodothyronine (T3) concentrations in the presence of normal thyroxine (T4) and TSH levels, referred to as the low T3 syndrome (LT3S), are common. LT3S may be caused by starvation, various non-thyroidal illnesses (NTIs) and some medications. Reverse T3 (rT3) concentrations are elevated in the more severely ill, and they characteristically fail to respond to exogenous levothyroxine (l-T4) therapy. The biochemical abnormalities have been explained on the basis of altered peripheral deiodinase activities. Herein, we report on two patients with hypothyroid symptoms who on testing were found to have LT3S. They were atypical clinically in not having LT3S due to any of the usual causes, had no increased rT3 concentrations, and had a normal negative TSH feedback response to l-T4. One (patient 1) had previously been diagnosed with Hashimoto's autoimmune primary hypothyroidism and was on l-T4 therapy. Both had T4 concentrations in the reference range. TSH levels were elevated in patient 1 and in the reference range in patient 2. Starting or increasing l-T4 doses resulted in no clinical improvement and no increase in T3 levels in spite of a marked increase in T4 levels. It is suggested that in the absence of the usual causes, lack of elevated rT3 levels, response to treatment and intact negative TSH feedback these two patients differ from the usual secondary causes of decreases in deiodinase activity. It is speculated that they may represent primary alterations in deiodinase enzymes possibly due to genetic variations in the deiodinase-encoding genes. Learning points LT3S is commonly found secondary to starvation, NTIs and use of some medications. Low T3 levels are the result of alterations in the activity of deiodinase enzymes. LT3S without the usual causes may represent a primary disturbance in deiodinase activity.

An Innovative Cost-Effective Approach for Characterization of Removable Prosthesis - Case Series

2021 ◽  
Author(s):  
Tushar
Keyword(s):  
Case Series ◽  
Cost Effective ◽  
Functional Rehabilitation ◽  
Denture Base ◽  
Cost Effective Approach ◽  
Removable Denture ◽  
Removable Prosthesis ◽  
Cost Effective Alternative ◽  
The Aesthetic ◽  
The Cost

Esthetics plays a crucial role in rehabilitation of removable dentures to achieve a pleasant smile. Denture esthetics is the effect produced, which improves the beauty and attractiveness of a person. With the advances of implants and ceramics, the conventional removable denture needs to be updated. denture characterization is a must in avoiding denture look and giving natural look. Giving the prosthesis as close as possible to the natural apparatus before the tooth loss is the key to a successful prosthetic, esthetic and functional rehabilitation. As a prosthodontist dealing in fulfilling the aesthetic challenges an economical alternative to high-end costly procedures is a must considering the Indian scenario, keeping in mind the biocompatibility and longevity of the treatment. As per literature light cure, gum staining is one of the techniques for masking denture base color and imparting natural color to mucosa but considering the cost involved many patients requiring aesthetic enhancement of prosthesis avoid going for such treatment thereby compromising their aesthetic. the present case series describe an innovative cost-effective alternative to the previously describe technique for masking the denture base color by using composite mixed with stains to replicate the natural apparatus.

scholarly journals Pituitary injury and persistent hypofunction resulting from a peripartum non-hemorrhagic, vaso-occlusive event

2015 ◽  
Vol 2015 ◽  
Author(s):  
Anita Kuriya ◽  
David V Morris ◽  
Michael H Dahan
Keyword(s):  
Literature Review ◽  
Pituitary Gland ◽  
Dopamine Agonists ◽  
List Type ◽  
Fetal Demise ◽  
Common Cause ◽  
The Past ◽  
Vascular Accidents ◽  
Learning Points ◽  
Do So

Summary Cerebral vascular accidents are caused by vasospasm when induced by preeclampsia or by dopamine agonists. However, six arteries nourish the pituitary and prevent against vasospasm-induced damage, which up until now has not been thought to occur. Bromocriptine was used to arrest lactation in a 31-year-old with secondary amenorrhea following preeclampsia and fetal demise at 28 weeks gestation. Tests and history revealed panhypopituitarism not associated with hemorrhage or mass infarction but instead caused by vasospasm. The present study is the first report of pituitary damage from a non-hemorrhagic, vaso-occlusive event in the literature. In keeping with Sheehan's and Simon's syndromes, we have named pituitary damage resulting from vaso-occlusion as Dahan's syndrome, and a literature review suggests that it may be a common and previously overlooked disorder. Learning points Vasospasm can cause damage to the pituitary gland, although it was not previously believed to do so. Preeclampsia and the use of a dopamine agonist, particularly in the peripartum state, may trigger vasospasm. Vasospasm resulting from dopamine agonists may be a common cause of injury to the pituitary gland, and it may have been overlooked in the past.

scholarly journals Protection of computers from side electromagnetic radiation during monitor images formation

2021 ◽  
Vol 4 (4) ◽  
pp. 377-385
Author(s):  
Volodymyr M. Lucenko ◽  
Dmytro O. Progonov
Keyword(s):  
Electromagnetic Radiation ◽  
Ad Hoc ◽  
Low Cost ◽  
Cost Effective ◽  
Switching Speed ◽  
Cost Effective Approach ◽  
Alternative Approach ◽  
Confidential Data ◽  
The Cost ◽  
Communication Lines

Reliable protection of confidential data processed in critical information infrastructure elements of public institutions and private organizations is topical task today. Of particular interest are methods to prevent the leakage of confidential data by localizing informative (dangerous) signals that both carry an informative component, and have a signal level higher than predefined threshold. The increase in signal energy from personal computers is caused by increasing of its transistors switching speed. Modern passive shielding methods for secured computers, similar to the well-known program TEMPEST, require either costly and large shielding units or technological simplification by using of low-cost fragmentary shielding of computer’s individual elements. Therefore, localization of side electromagnetic radiation produced by personal computer is needed. The paper presents a cost-effective approach to reducing the level of computer’s electromagnetic radiation by passive method. The radiation are localized and measured by its estimation on personal computer’s elements, namely unshielded communication lines between video processor and a monitor, fragments of electric tracks on motherboards, etc. During experiments authors used ad-hoc miniature electric (ball antenna) and magnetic (Hall sensor) antennas connected to selective voltmeters. This approach significantly reduces the cost of equipment and measurements as well as requirements to analytics’ qualification for improving computer’s protection. Also, the alternative approach for computer protection is proposed. The approach is based on image content protection by distorting the image on the monitor instead of reducing electromagnetic radiation caused by signals from the monitor. The protection includes image scrambling using Arnold transform that randomly “shuffle” the lines in each frame.

scholarly journals EFFECTIVENESS OF KANCHANARA KWATHA IN THE MANAGEMENT OF PRIMARY HYPOTHYROIDISM: CASE SERIES

2020 ◽  
Vol 11 (5) ◽  
pp. 9-14
Author(s):  
Anju S Lal ◽  
Arun Pratap ◽  
Arjun Chand C.P ◽  
Miharjan K
Keyword(s):  
Thyroid Gland ◽  
Hormone Secretion ◽  
Case Series ◽  
Clinical Score ◽  
Primary Hypothyroidism ◽  
P Value ◽  
Slow Movement ◽  
Cold Intolerance ◽  
Tsh Levels

Primary hypothyroidism is a condition that results due to the decreased ability of thyroid gland to produce its hormones Tri-iodothyronine (T3) and Thyroxin (T4) and results in increased TSH production from the Pituitary gland. This decreased hormone secretion may result in reduced metabolism and in Ayurveda, this metabolism may be explained in terms of Dhatu Parinama Siddhanta and this reduced metabolism with Dhatva agnimandya condition. Ten subjects having high TSH levels and one or multiplicity of the symptoms like Lethargy, hairfall, dryness of skin, less appetite, cold intolerance, puffiness of face, hoarseness of voice, muscle aches, menstrual disturbances were selected for the study. They were gradually developing these symptoms since 1 year. They all were given Kanchanara Kwatha 24 ml with 1.5 g Shunthi Choorna as Prakshepaka Dravya twice daily before food for 60 days. Follow up was done on 30th day after the intervention. Assessment of subjects was done by using TSH levels and Zulewski’s clinical score for on 0th, 61th and 90th day. The results were analysed statistically. Statistically highly significant result (i.e. p-value = 0.003) were obtained for TSH. When the subjective criteria is analysed, statistically highly significant result (p-value < 0.001) were obtained for the criteria slow movement and statistically significant results (p value < 0.05) were obtained for the criteria’s hoarseness of voice, constipation, weight increase, periorbital puffiness. The change obtained for symptoms after the treatment was maintained in the follow-up period too. Above results showed that the drug Kanchanara Kwathais effective in primary hypothyroidism.

scholarly journals Euthyroid athyroxinemia – a novel endocrine syndrome

2017 ◽  
Vol 2017 ◽  
Author(s):  
Nicholas Woodhouse ◽  
Fatima Bahowairath ◽  
Omayma Elshafie
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Function ◽  
Urinary Iodine ◽  
Free Thyroxine ◽  
List Type ◽  
Thyroid Function Tests ◽  
Thyroxine Level ◽  
Learning Points ◽  
Free Thyroxine Level ◽  
Tsh Levels

Summary A 55-year-old female was referred with abnormal thyroid function tests (TFTs); the free thyroxine level (FT4) was undetectable <3.3 pmol/L (normal: 7.9–14.4), while her FT3, TSH and urinary iodine levels were normal. She was clinically euthyroid with a large soft lobulated goitre that had been present for more than thirty years. She received an injection of recombinant human TSH (rhTSH) following which there was a progressive rise of the FT3 and TSH levels to 23 pmol/L and >100 mIU/L respectively at 24 h, The FT4 however remained undetectable throughout. Being on thyroxine 100 µg/day for one month, her FT4 level increased to 15 pmol/L and TSH fell to 0.08 mIU/L. Four years earlier at another hospital, her FT4 level had been low (6.8 pmol/L) with a normal TSH and a raised Tc-99 uptake of 20% (normal<4%). We checked the TFTs and Tc-99 scans in 3 of her children; one was completely normal and 2 had euthyroid with soft lobulated goitres. Their Tc-99 scan uptakes were raised at 17% and 15%, with normal TFTs apart from a low FT4 7.2 pmol/L in the son with the largest thyroid nodule. This is a previously unreported form of dyshormonogenesis in which, with time, patients gradually lose their ability to synthesize thyroxine (T4) but not triiodothyroxine (T3). Learning points: This is a previously unreported form of dyshormonogenetic goitre. This goitre progressively loses its ability to synthesize T4 but not T3. The inability to synthesize T4 was demonstrated by giving rhTSH.

scholarly journals Emergence of a latent TSHoma pituitary macroadenoma on a background of primary autoimmune hypothyroidism

2018 ◽  
Vol 2018 ◽  
Author(s):  
Yew Wen Yap ◽  
Steve Ball ◽  
Zubair Qureshi
Keyword(s):  
Anterior Pituitary ◽  
Primary Hypothyroidism ◽  
Alpha Subunit ◽  
Serum Prolactin ◽  
List Type ◽  
Pituitary Macroadenoma ◽  
Free T4 ◽  
Autoimmune Hypothyroidism ◽  
Levothyroxine Treatment ◽  
Tsh Levels

Summary The coexistence of primary hypothyroidism and thyroid-stimulating hormone (TSH)-stimulating pituitary macroadenoma can be a rare occurrence and can make diagnosis very challenging. We describe a case of a 44-year-old female with a history of fatigue, poor concentration, weight gain and amenorrhoea together with biochemical evidence of primary autoimmune hypothyroidism. Her initial TSH levels were elevated with low normal free thyroxine (T4) levels. Levothyroxine treatment was initiated and the dose was gradually titrated to supraphysiologic doses. This led to the normalisation of her TSH levels but her free T4 and triiodothyronine (T3) levels remained persistently elevated. This prompted a serum prolactin check which returned elevated at 2495 µ/L, leading onto pituitary imaging. A MRI of the pituitary gland revealed a pituitary macroadenoma measuring 2.4 × 2 × 1.6 cm. Despite starting her on cabergoline therapy with a reduction in her prolactin levels, her TSH levels began to rise even further. Additional thyroid assays revealed that she had an abnormally elevated alpha subunit at 3.95 (age-related reference range <3.00). This corresponded to a thyroid-secreting hormone pituitary macroadenoma. She went on to have a transphenoidal hypophysectomy. Histology revealed tissues staining for TSH, confirming this to be a TSH-secreting pituitary macroadenoma. This case highlighted the importance of further investigations with thyroid assay interferences, heterophile antibodies, alpha subunit testing and anterior pituitary profile in cases of resistant and non-resolving primary hypothyroidism. Learning points: Levothyroxine treatment in primary hypothyroidism can potentially unmask the presence of a latent TSH-secreting pituitary macroadenoma, which can make diagnosis very challenging. A high index of suspicion should prompt clinicians to further investigate cases of primary hypothyroidism which despite increasing doses of levothyroxine treatment with normalisation of TSH, the free T4 and T3 levels remain persistently elevated. Clinicians should consider investigating for adherence to levothyroxine, thyroid assay interference, heterophile antibodies, TSH dilution studies, alpha subunit and anterior pituitary profile testing to further clarity the diagnosis in these patients. Although coexistent cases of TSHoma with primary hypothyroidism are rare, it should always be in the list of differential diagnoses in cases of unresolving primary hypothyroidism.

scholarly journals Combined Application of Bacteriophages and Carvacrol in the Control of Pseudomonas syringae pv. actinidiae Planktonic and Biofilm Forms

2020 ◽  
Vol 8 (6) ◽  
pp. 837
Author(s):  
Peien Ni ◽  
Lei Wang ◽  
Bohan Deng ◽  
Songtao Jiu ◽  
Chao Ma ◽  
...  
Keyword(s):  
Pseudomonas Syringae ◽  
Phage Therapy ◽  
Combined Treatment ◽  
Cost Effective ◽  
Resistance Development ◽  
Combined Application ◽  
Cost Effective Approach ◽  
Alternative Approach ◽  
Actinidia Spp

Pseudomonas syringae pv. actinidiae (Psa) is the causative agent of the bacterial canker of kiwifruit (Actinidia spp.). Phage therapy has been suggested as a viable alternative approach to controlling this disease, but its efficacy is limited by the emergence of phage-resistant mutants. Carvacrol is an essential oil that may be useful for the control of Psa. Combination therapies can be used to overcome resistance development. Here, the combination of phages (single phage suspensions of phages PN05 and PN09, and a cocktail of both phages) and carvacrol was investigated in controlling Psa planktonic and biofilm forms in vitro. The phage therapy alone (with phages PN05 and PN09), and the carvacrol alone (minimum inhibitory concentration 2.0 mg/mL), inhibited Psa growth, but the combined effect of both therapies was more effective. The phages alone effectively inhibited Psa growth for 24 h, but Psa regrowth was observed after this time. The carvacrol (2.0 mg/mL) alone prevented the biofilm formation for 48 h, but did not destroy the pre-formed biofilms. The combined treatment, phages and carvacrol (2.0 mg/mL), showed a higher efficacy, preventing Psa regrowth for more than 40 h. In conclusion, the combined treatment with phages and carvacrol may be a promising, environment-friendly and cost-effective approach to controlling Psa in the kiwifruit industry.

scholarly journals Pituitary hyperplasia: case series and literature review of an under-recognised and heterogeneous condition

2015 ◽  
Vol 2015 ◽  
Author(s):  
Sunita M C De Sousa ◽  
Peter Earls ◽  
Ann I McCormack
Keyword(s):  
Polycystic Ovary ◽  
Case Series ◽  
Primary Hypothyroidism ◽  
List Type ◽  
Close Monitoring ◽  
Gnrh Analogues ◽  
Pituitary Hyperplasia ◽  
Pituitary Enlargement ◽  
And Gender ◽  
Trophic Hormone

Summary Pituitary hyperplasia (PH) occurs in heterogeneous settings and remains under-recognised. Increased awareness of this condition and its natural history should circumvent unnecessary trans-sphenoidal surgery. We performed an observational case series of patients referred to a single endocrinologist over a 3-year period. Four young women were identified with PH manifesting as diffuse, symmetrical pituitary enlargement near or touching the optic apparatus on MRI. The first woman presented with primary hypothyroidism and likely had thyrotroph hyperplasia given prompt resolution with thyroxine. The second and third women were diagnosed with pathological gonadotroph hyperplasia due to primary gonadal insufficiency, with histopathological confirmation including gonadal-deficiency cells in the third case where surgery could have been avoided. The fourth woman likely had idiopathic PH, though she had concomitant polycystic ovary syndrome which is a debated cause of PH. Patients suspected of PH should undergo comprehensive hormonal, radiological and sometimes ophthalmological evaluation. This is best conducted by a specialised multidisciplinary team with preference for treatment of underlying conditions and close monitoring over surgical intervention. Learning points Normal pituitary dimensions are influenced by age and gender with the greatest pituitary heights seen in young adults and perimenopausal women. Pituitary enlargement may be seen in the settings of pregnancy, end-organ insufficiency with loss of negative feedback, and excess trophic hormone from the hypothalamus or neuroendocrine tumours. PH may be caused or exacerbated by medications including oestrogen, GNRH analogues and antipsychotics. Management involves identification of cases of idiopathic PH suitable for simple surveillance and reversal of pathological or iatrogenic causes where they exist. Surgery should be avoided in PH as it rarely progresses.

Sign in / Sign up

Export Citation Format

Share Document