OBJECTIVE Thyroid dysfunction and obesity during pregnancy have been associated with negative neonatal and obstetric outcomes. Thyroid hormone reference ranges have not been established for the pregnant Hispanic population. This study defines thyroid hormone reference ranges during early pregnancy in Chilean women and evaluates associations of BMI with thyroid function. DESIGN, PATIENTS, MEASUREMENTS This is a prospective observational study of 720 healthy Chilean women attending their first prenatal consultation at an outpatient clinic. Thyroid function (TSH, Free T4, Total T4, and TPOAb) and BMI were assessed at 8.8 ± 2.4 weeks of gestational age. RESULTS Median, 2.5th percentile (p2.5), and 97.5th percentile (p97.5) TSH values were higher, while median, p2.5, and p97.5 free T4 values were lower in obese patients compared with normal weight patients. Obesity was associated with a median TSH 16% higher (p=0.035) and a median free T4 6.5% lower (p<0.01) than values from patients with normal weight. BMI had a small, but statistically significant effect on TSH (p=0.04) and free T4 (p<0.01) when adjusted by maternal age, TPO antibodies, parity, sex of the newborn, gestational age, and smoking. In all TPOAb (-) patients, median (p2.5–p.97.5) TSH was: 1.96 mIU/L (0.11 – 5.96 mIU/L) and median (p2.5–p.97.5) free T4 was: 14.54 pmol/L (11.1 – 19.02 pmol/L). Applying these reference limits, we found a prevalence of overt and subclinical hypothyroidism of 0.9% and 3.05%, respectively. CONCLUSIONS TSH distributes at higher values and free T4 at lower values in obese pregnant women compared to normal weight pregnant women. Thyroid hormone reference ranges derived from Chilean patients with negative TPOAb are different from the fixed internationally proposed reference ranges and may be used in the Hispanic population.
We present the case of a 63-year-old woman with an ovarian neoplasm in which mucinous cystadenocarcinoma and choriocarcinoma coexisted. Blood levels of beta-hCG were elevated and bilateral ovarian stromal luteinization was seen. The rarity of this association and its clinical and pathologic implications are discussed.
Background Low flow nasal cannula (LFNC) are frequently used in preterm infants. However, the delivered inspired oxygen concentration and airway pressures are not well established. Objective To determine the fraction of inspired oxygen (FiO2) and hypopharyngeal pressures generated by LFNC at different gas flows, gas mixture concentrations and infant's weight. Design/Methods Serial samples of hypopharyngeal gas were obtained in 33 very low birth weight infants who were receiving oxygen with LFNC. Measurements were obtained with different gas flows and oxygen concentrations. FiO2 was measured using an electrochemical cell analyzer and hypopharyngeal pressures with a pressure transducer. Results 33 infants with a mean BW of 910 ± 284 g and 27 ± 1.7 weeks gestational age were studied at 36 ± 22 days after birth. FiO2 increased proportionally to gas flow, but with large variability: median (range) FiO 2 were 0.33 (0.23‐0.54), 0.44 (0.29‐0.67), 0.57 (0.33‐0.81), and 0.69 (0.51‐0.92) at 0.1, 0.3, 0.5, and 1 L/minute, respectively. Significantly higher mean FiO 2 were observed despite low flows in infants ≤ 1000 g compared to those > 1000 g (0.5 ± 0.1 vs 0.4 ± 0.07 at 0.3 L/minute; 0.66 ± 0.09 vs 0.5 ± 0.08 with 0.5 L/minute, respectively, P < .05). Hypopharyngeal pressures increased proportionally to gas flow with high variability: mean ± standard deviation pressures were 1.5 ± 0.8; 2.8 ± 1.2; 4.6 ± 1.3; 6.1 ± 1.6 cm H 2O at 0.5, 1, 2, and 3 L/minute of gas flow. Peak pressures > 15 cm H 2O were frequently observed with gas flows ≥ 2 L/min. Conclusions Large variability in FiO2 and hypopharyngeal pressures were observed with oxygen administration through LFNC. Very high FiO 2 were observed despite low flows in infants < 1000 g. Excessive peak pressures can be generated with flows ≥ 2 L/minute especially among infants < 1000 g.
Hypophosphatemia induced by carboxymaltose iron and imatinib. Report of two casesHypophosphatemia is a relatively frequent and a potentially serious adverse drug effect. Clinically it is characterized by bone pain and muscle weakness. There are several mechanisms by which a drug can induce hypophosphatemia and they can be classified according to whether or not they are mediated by an excess of Fibroblast Growth Factor 23 (FGF23). We report two patients with the condition: (i) A 49-year-old woman with Chronic Myeloid Leukemia (CML) and gastric sleeve surgery at 46 years of age. After receiving intravenous carboxymaltose iron in one occasion due to refractory anemia, she developed symptomatic hypophosphatemia. Urinary phosphate losses associated with high FGF23 levels were confirmed. Plasma phosphate returned to normal values 90 days after the iron administration. (ii) A 40-year-old man with a history of CML in whom imatinib was started. He developed symptomatic hypophosphatemia due to non FGF23-mediated hyperphosphaturia. As treatment with imatinib could not be interrupted, hypophosphatemia and its symptoms resolved with oral phosphate intake. These cases illustrate the importance of recognizing and treating drug-induced hypophosphatemia in a timely manner, and thus avoid the morbidity associated with this entity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.