The risk of hypothyroidism in BC patients after SC-RT depends on the thyroid gland volume and V30 >50% and the risk can be minimized by thyroid gland shielding during RT.
Hyponatremia is the most frequently encountered electrolyte abnormality among hospitalized patients and thiazide users. In this large single-center retrospective study, we aim to determine the prevalence and risk factors of hyponatremia among patients at the King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.To the best of our knowledge, this is the first such study in Saudi Arabia. A chart review was done for the years 2011-2012 of all admitted Saudi patients at KAMC who were treated with indapamide and hydrochlorothiazide. A total of 2000 patients were included [1237 females (629 indapamide and 608 hydrochlorothiazide) and 762 males (371 indapamide and 391 hydrochlorothiazide)]. Majority of the patients had type-2 diabetes mellitus (T2DM) with an overall prevalence of 72.2%. The overall prevalence of hyponatremia, regardless of severity, in the indapamide group was 37.3% versus 38.7% in the hydrochlorothiazide group. Stratification for age revealed that older patients had relatively higher levels of sodium (Na) as compared with younger patients, and this inverse association was significant (R = - 0.123; P <0.001). Increasing age, female gender and presence of T2DM were the significant risk factors for hyponatremia, explaining the 4.7% of the variance perceived (P <0.001). Our study suggests that the prevalence of hyponatremia among Saudi thiazide users is relatively high, and more so for the elderly and for those with T2DM. Early identification of this condition is important and caution should be exercised while prescribing thiazide drugs, particularly to those who are most at risk of developing hyponatremia to prevent related complications.
Thyrotoxic periodic paralysis (TPP) is a potentially lethal complication of hyperthyroidism characterized by recurrent muscle weakness and hypokalemia. It has been commonly reported in non-Asian populations. Four cases were reported in Saudis so far, and one had a life-threatening arrhythmia. We describe an additional case of a 28-year-old apparently healthy Saudi male patient, who presented with acute paraparesis associated with hypokalemia (K: 2.0 mmol/L), complicated by ventricular tachycardia and cardiac arrest. He was successfully resuscitated and his hypokalemia was corrected. A diagnosis of Graves’ disease associated with TPP was made. He was initially treated with carbimazole and β-blockers and then given a definitive therapy with radioactive iodine, which showed a good response. This case highlights the importance of early recognition and prompt treatment of TPP as a differential diagnosis for muscle weakness. A brief review of TPP and associated arrhythmia is included.
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