The Origin of Antithyroid Drugs.

When the antithyroid drugs were discovered in the early 1940s, they were immediately recognized as a revolutionary new treatment for hyperthyroidism. Although much has been learned about their mechanism of action and clinical utility, they continue to be used today in much the same way as they have been since their introduction. In 1995, Dr.

Estradiol, testosterone, and the risk for hip fractures in elderly men from the Framingham Study.

Background: Low serum estradiol has been more strongly associated with low bone mineral density in elderly men than has testosterone, but its association with incident hip fracture is unknown. We examined whether low estradiol increases the risk for future hip fracture among men and explored whether testosterone levels influence this risk.

Methods: We examined 793 men (mean age = 71 years) evaluated between 1981 and 1983, who had estradiol measures and no history of hip fracture, and followed until the end of 1999.

Health-related quality of life in the VA Feasibility Study on glycemic control and complications in type 2 diabetes mellitus.

Objective: The Veterans Affairs Cooperative Study in Diabetes Mellitus Type 2 Feasibility Trial (VA CSDM) studied standard and intensive glycemic treatment groups, achieving and maintaining for 27 months a difference in HbA1c of 2.1% (9.2% vs.

Diabetes process and outcome measures in the Department of Veterans Affairs.

Objective: To evaluate performance of process and outcome measures in the care of patients with diabetes seen in Department of Veterans Affairs (VA) facilities.

Research Design And Methods: Retrospective audits of records and databases were conducted on randomly selected patients with diabetes over 5 years (1995 [baseline] and 1997-2000) in 22 VA networks. Performance on diabetes-specific and preventive processes was measured.

Development of evidence-based clinical practice guidelines for diabetes: the Department of Veterans Affairs/Department of Defense guidelines initiative.

Objective: To describe the Veterans Affairs (VA)/Department of Defense (DoD) Clinical Practice Guidelines for diabetes and contrast selected recommendations with those of the American Diabetes Association (ADA).

Research Design And Methods: We summarize the general structure of the VA/DoD Guidelines and describe the rationale for recommendations issued in 2003 for glycemic control, management of hypertension, and retinopathy screening. We compare the synthesis of evidence and resulting recommendations for these content areas with the 2004 American Diabetes Association Clinical Practice Recommendations.

Pharmacy costs and glycemic control in the Department of Veterans Affairs.

Objective: To determine pharmacy costs for glycemic treatment and its relationship to glycemic control in the Department of Veterans Affairs (VA) between 1994 and 2000.

Research Design And Methods: Patients with diabetes in the VA in FY1994, FY1996, FY1998, and FY2000 were identified using an ambulatory care pharmacy-derived database. Total drug acquisition costs, as well as expenditures for insulin, oral glycemic control agents, and self-blood glucose monitoring strips, were determined for these veterans.

Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.

Context: Patients with serum thyroid-stimulating hormone (TSH) levels outside the reference range and levels of free thyroxine (FT4) and triiodothyronine (T3) within the reference range are common in clinical practice. The necessity for further evaluation, possible treatment, and the urgency of treatment have not been clearly established.

Objectives: To define subclinical thyroid disease, review its epidemiology, recommend an appropriate evaluation, explore the risks and benefits of treatment and consequences of nontreatment, and determine whether population-based screening is warranted.

Subclinical hyperthyroidism and atrial fibrillation.

Subclinical hyperthyroidism is characterized by a clearly low serum concentration of thyrotropin (TSH) and the absence of obvious symptoms of hyperthyroidism. Whether or not all persons with a low value for serum TSH can be considered subclinically hyperthyroid is uncertain, but the low serum TSH per se is a risk factor for atrial fibrillation and perhaps other cardiovascular disease. Screening all persons, even in the older age groups, for subclinical hyperthyroidism may not be justified in and of itself but such persons would likely be screened for subclinical hypothyroidism and so those with subclinical hyperthyroidism identified.