Presentation of anaplastic thyroid carcinoma with thyrotoxicosis is extremely rare and its occurrence in a patient with Wegener's granulomatosis has not been reported previously. We describe an elderly lady with Wegener's granulomatosis who developed a rapidly growing anaplastic thyroid carcinoma in a preexisting multinodular goiter and discuss the mechanism of thyrotoxicosis in this patient.
OBJECTIVE
Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease trial. We explored whether baseline HbA1c level and insulin treatment influenced outcomes.
RESEARCH DESIGN AND METHODS
Patients with T2D, urine albumin-to-creatinine ratio (UACR) of 30–5,000 mg/g, estimated glomerular filtration rate (eGFR) of 25 to <75 mL/min/1.73 m2, and treated with optimized renin–angiotensin system blockade were randomly assigned to receive finerenone or placebo. Efficacy outcomes included kidney (kidney failure, sustained decrease ≥40% in eGFR from baseline, or renal death) and cardiovascular (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) composite endpoints. Patients were analyzed by baseline insulin use and by baseline HbA1c <7.5% (58 mmol/mol) or ≥7.5%.
RESULTS
Of 5,674 patients, 3,637 (64.1%) received insulin at baseline. Overall, 5,663 patients were included in the analysis for HbA1c; 2,794 (49.3%) had baseline HbA1c <7.5% (58 mmol/mol). Finerenone significantly reduced risk of the kidney composite outcome independent of baseline HbA1c level and insulin use (Pinteraction = 0.41 and 0.56, respectively). Cardiovascular composite outcome incidence was reduced with finerenone irrespective of baseline HbA1c level and insulin use (Pinteraction = 0.70 and 0.33, respectively). Although baseline HbA1c level did not affect kidney event risk, cardiovascular risk increased with higher HbA1c level. UACR reduction was consistent across subgroups. Adverse events were similar between groups regardless of baseline HbA1c level and insulin use; few finerenone-treated patients discontinued treatment because of hyperkalemia.
CONCLUSIONS
Finerenone reduces kidney and cardiovascular outcome risk in patients with CKD and T2D, and risks appear consistent irrespective of HbA1c levels or insulin use.
Although Graves' disease (GD) is common in endocrine practices worldwide, global differences in diagnosis and management remain. We sought to assess the current practices for GD in countries across Asia and the Paci c (APAC), and to compare these with previously published surveys from North-America and Europe.
MethodsA web-based survey on GD management was conducted on a pool of practicing physicians. Responses from 542 eligible physicians were received and subsequently analysed and compared to outcomes from other, similar surveys.
ResultsDuring initial work-up, majority of respondents would request thyroid-stimulating hormone (TSH; 73%) and free thyroxine assays (75%), as well as TSH-receptor autoantibodies (68%). Thyroid ultrasound would be requested by about half of respondents (53%), while the use of nuclear medicine scans was very limited. The preferred rst-line treatment was antithyroid drug (ATD) therapy (79%) with methimazole (MMI) or carbimazole (CBZ), followed by radioiodine (RAI; 19%) and surgery (2%). In case of surgery, onethird of respondents would opt for a subtotal rather than a total thyroidectomy. In case of mild Graves orbitopathy (GO), ATDs (67%) remained the preferred treatment, but a larger proportion would prefer surgery (20%). For a patient with a pregnancy (wish), the overall preferred treatment pattern remained unchanged, although propylthiouracil (PTU) became the preferred ATD-agent during the rst trimester.While on most issues choices of the physicians from APAC fell between European and American practices, marked differences were noted in the relatively infrequent usage of nuclear medicine scans and the overall higher concomitant use of a ATDs and β-blockers and adjunctive ATD-treatment during RAI.
ConclusionAlthough regional differences regarding the diagnosis and management of GD are apparent in this rst pan-Asia-Paci c survey, the overall approach to the management of this disease in APAC to generally fall between the trends appreciated in the American and European cohorts.
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