Assessment of comorbidities in patients with deranged thyroid hormone levels

Background: There is association of deranged thyroid hormone levels with various co-morbidities. Drugs for comorbidity may interact with each other and affect the outcome of treatment. So, this study was planned to find out comorbidities with deranged thyroid hormone levels and various possible drug interactions.Methods: It was a prospective, observational study carried out at tertiary care hospital from November 2017 to June 2018. Thyroid hormonal levels reports were followed in OPD and online information system facility. Drugs interactions were checked by referring standard pharmacology textbooks, review articles and Medscape drug interaction checker. Approval from the Institutional Ethics Committee was taken before initiation of the study. Patients with deranged thyroid hormone levels were included in the study.Results: Study was conducted in 111 patients of thyroid disorders. Spondylitis, asthma, acne cases were seen in hypothyroid patients whereas hypokalemic periodic paralysis, thyroid ophthalmopathy statistically significantly seen in hyperthyroid patients. Various concurrent medications such as calcium, carbamazepine decreases the effects of levothyroxine. For management of comorbidities various drugs are given which also interact among themselves significantly.Conclusions: Diabetes mellites, obesity, spondylitis, lichen planus were more common in hypothyroidism while comorbidities like hypertension, hypokalemic periodic paralysis, thyroid ophthalmopathy were found to be more in hyperthyroidism. Incidence of drug interactions is found to be more with increased use of medications for comorbidities, so physicians should be careful while prescribing them. Due to drug interactions desired effects of drugs given for thyroid disorders may not be observed.

Intraorbital Steroid Injection for Active Thyroid Ophthalmopathy

Purpose: To evaluate the effect of orbital steroid injections in patients with active thyroid ophthalmopathy resistant to or dependent on systemic steroids, or with complications related to systemic steroid use. Methods: This prospective non-comparative case series includes 31 eyes of 17 patients with active thyroid ophthalmopathy and clinical activity score (CAS) of 3 or more, without compressive optic neuropathy or overt exposure keratopathy. All subjects had a history of previous systemic steroid use (with steroid resistance or dependence) or had developed complications related to steroids. A combination of steroids including triamcinolone acetonide 20 mg and dexamethasone 4 mg was injected in the upper and lower retroseptal orbital spaces three or four times at one-month intervals. The patients were examined periodically after each injection and at least three months after the last injection. Results: Mean pre-injection CAS was 5.2 ± 1.3 which was improved to 1.6 ± 1 after the fourth injection (P < 0.001). Upper and lower lid retraction improved in 100% and 68.2% of the affected eyes, respectively. Strabismus completely resolved in one of five affected patients and the most significant improvement was observed in supraduction. Mean improvement in exophthalmos was 1.2 ± 1.1 mm. Visual acuity did not significantly change after the injections. Eyelid ecchymosis and/or subconjunctival hemorrhage was observed in 7.1% and intraocular pressure rise occurred in 8.8% of eyes. Conclusion: Orbital steroid injections can be used for the treatment of active thyroid ophthalmopathy when the patient is resistant to or dependent on systemic steroids or has developed complications of systemic steroids.