Sonographic patterns outlined by the three guidelines displayed high sensitivity and NPV. Although isolated suspicious US features cannot predict malignancy risk, they should be considered when risk stratifying nodules that do not fit into particular sonographic patterns based on current guidelines.
Bisphosphonates are widely used in the treatment of osteoporosis.The Intravenous bisphosphonate, Zoledronic acid (ZA) does not cause the gastrointestinal side effects associated with oral bisphosphonates and can be given as a once yearly infusion. ZA has the rare potential to cause hypophosphatemia. However, when reported, the hypophosphatemia following ZA infusion has been in the setting of treatment of oncological conditions such as hypercalcemia of malignancy and bone metastases. We present a case of severe and prolonged hypophosphatemia in a patient with post-menopausal osteoporosis and mild normocalcemic primary hyperparathyroidism who received a single dose of 5 mg of intravenous ZA. The severe hypophosphatemia manifested itself almost 2 months after the administration of the medication. The patient required very high doses of both oral and intravenous phosphate throughout the duration of her prolonged stay in hospital with failure to normalize the serum phosphate levels even after 13 days.
Background: The ThyPRO-39 questionnaire assesses health-related QoL (HRQoL) in patients with benign thyroid disease and has been validated for use in the local setting. The aim of the study is to investigate disease specific health-related quality of life using ThyPRO-39 in patients with newly diagnosed Graves’ disease treated with antithyroid medications over one year. Methods: Patients with newly diagnosed Graves’ disease were recruited in the outpatient setting. The ThyPRO-39 questionnaire was administered at baseline, 6 and 12 months of antithyroid medication treatment. Relevant demographic and clinical information was collected at the three time points of the study. Results of clinical parameters and various ThyPRO scales were compared between baseline, 6 months and 12 months of treatment. Results: There were 32 patients with newly diagnosed Graves’ disease recruited between April 2018 and May 2019. All except 2 patients completed all 3 time points of the study. Two patients missed their 6 months questionnaire. There were 24 females (75%) and 8 males (25%) in the study. Analysis of the clinical parameters showed significant changes in weight from baseline (59.7 + 17.7kg) to 6 months (59.4 + 9.9kg) to 12 months (63.4 + 17.4Kg), all p<0.001, TSH receptor antibody level from baseline (17.3 + 12.9IU/L) to 12 months (7.1 + 10.8IU/L), NR <1.76IU/L, p<0.001, fT4 levels from baseline (49.9 + 18.1pmol/L) to 6 months (14.3 + 6.9pmol/L) and from baseline to 12 months (11.8 + 2.3pmol/L), NR 8.8-14.4pmol/L, all p<0.001 and TSH levels from baseline (0.011 + 0.009mU/L) to 6 months (1.38 + 1.74mU/L, p=0.001) and from baseline to 12 months (1.80 + 1.72mU/L, p<0.001), NR 0.65-3.70mU/L. After 6 months of treatment, 7 out of 13 ThyPRO scales improved and 9 out of 13 ThyPRO scales improved after 12 months of treatment. Large treatment effects were observed on 2 ThyPRO scales (Hyperthyroid symptoms and Anxiety) while moderate effects were seen in 5 ThyPRO scales (Tiredness, Cognitive complaints, Depressivity, Impaired daily Life and overall QoL) from baseline to 6 months. Large treatment effects were observed on 2 ThyPRO scales (Hyperthyroid symptoms and Anxiety) while moderate effects were seen in 5 ThyPRO scales (Tiredness, Depressivity, Emotional susceptibility, Impaired daily Life and overall QoL) from baseline to 12 months. Small treatment effects were observed in 2 ThyPRO scales (Goiter symptoms and Tiredness) from 6 to 12 months. Conclusion: There are significant improvements in many aspects HRQL during the first 6 months of antithyroid drug treatment, with hyperthyroid symptoms and anxiety showing the most improvements throughout the 12 month treatment period. Our results complement clinical monitoring of patients with Graves’ disease and provide realistic outcome measures of disease impact and treatment outcomes from the patient’s perspective.
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