Hyperthyroidism Due to Graves Disease After Radiofrequency Ablation.

Management options for benign, autonomously functioning, and malignant thyroid nodules were limited to surgery or targeting by radioactive iodine before the availability of radiofrequency ablation (RFA). Despite being a relatively new technique, RFA may be favored for patients of high surgical risk, and for those who wish to avoid hypothyroidism. Although insurance coverage for the procedure can be a significant barrier, several groups of investigators have shown improved quality of life for RFA compared to surgery, due to the less invasive nature and favorable risk profile.

Sleep Apnea, Obesity, and Diabetes - an Intertwined Trio.

Purpose Of Review: To synthesize the existing literature regarding the complex interplay between sleep disturbance, obesity, and diabetes. The review emphasizes the three pillars of health being diet, exercise, and sleep, with the notion that if one is ignored, then the other two could suffer.

Recent Findings: Sleep deprivation is associated with incident obesity, perhaps mediated by dysregulation in leptin and ghrelin - hormones important in regulation of appetite.

Voice Outcomes From Direct Vocal Fold Testosterone Injections, a Case Report.

Here we provide the first demonstration of targeted vocal fold testosterone injection to achieve voice masculinization in 2 transgender male patients. Successful voice outcome was achieved in 2-3 weeks, without side effects, and continues to be durable. Laryngoscope, 133:1211-1213, 2023.

Inpatient use of metformin and acarbose is associated with reduced mortality of COVID-19 patients with type 2 diabetes mellitus.

Aims: Type 2 diabetes mellitus (T2DM) is a strong risk factor for complications of coronavirus disease 2019 (COVID-19). The effect of T2DM medications on COVID-19 outcomes remains unclear. In a retrospective analysis of a cohort of 131 patients with T2DM hospitalized for COVID-19 in Wuhan, we have previously found that metformin use prior to hospitalization is associated with reduced mortality.

Inappropriate requesting of parathyroid scintigraphy at an academic medical center.

Background: Primary hyperparathyroidism is a biochemical, not radiologic diagnosis. Parathyroid scintigraphy should only be requested for surgical planning, not to confirm diagnosis. Here we determined reasons for inappropriately ordered parathyroid scintigraphy.

Fasting hypoglycaemia secondary to carnitine deficiency: a late consequence of gastric bypass.

Twelve years following gastric bypass surgery, a cachectic 69-year-old woman presented with both fasting and postprandial hypoglycaemia. Postprandial symptoms were relieved by dietary modification and acarbose, as is common in such cases. During a supervised fast, symptomatic hypoglycaemia occurred.

Inpatient Use of Metformin and Acarbose Is Associated with Reduced Mortality of COVID-19 Patients with Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) is a strong risk factor for complications of coronavirus disease 2019 (COVID-19). The effect of T2DM medications on COVID-19 outcomes remains unclear. In a retrospective analysis of a cohort of 131 patients with T2DM hospitalized for COVID-19 in Wuhan, we have previously found that metformin use prior to hospitalization is associated with reduced mortality.

Metformin Use in Diabetes Prior to Hospitalization: Effects on Mortality in Covid-19.

Objective: Although type 2 diabetes mellitus (T2DM) has been reported as a risk factor for coronavirus disease 2019 (COVID-19), the effect of pharmacologic agents used to treat T2DM, such as metformin, on COVID-19 outcomes remains unclear. Metformin increases the expression of angiotensin converting enzyme 2, a known receptor for severe acute respiratory syndrome coronavirus 2. Data from people with T2DM hospitalized for COVID-19 were used to test the hypothesis that metformin use is associated with improved survival in this population.

ACE2, Metformin, and COVID-19.

COVID-19 is becoming a leading cause of mortality throughout the world, and few effective therapies are currently available. Angiotensin converting enzyme 2 (ACE2) is essential to COVID-19 pathogenesis, as the binding of SARS-CoV-2 spike protein (S protein) is required for viral entry and development of COVID-19. ACE2 regulates the protective arm of the renin-angiotensin-aldosterone system (RAAS) that endows anti-hypertensive and anti-inflammatory effects in the cardiovascular and pulmonary systems.

Rapid onset type 1 diabetes with anti-PD-1 directed therapy.

Type 1 diabetes is a rare immune-related adverse event (irAE) caused by checkpoint inhibitors with serious risk for diabetic ketoacidosis (DKA). Using our electronic medical record, we identified 1327 adult patients who received PD-(L)1 or CTLA-4 inhibitors from 2013 to 2018. Of the patients who received immunotherapy, 5 (0.

Rebound Vertebral Fractures in a Patient With Lung Cancer After Oncology-Dose Denosumab Discontinuation: A Cautionary Tale.

We describe a 55-year-old woman with lung cancer complicated by bone metastases. Treatment with denosumab (120 mg monthly) was interrupted after 9 doses because of concern for potential osteonecrosis of the jaw during upcoming dental work. Fifteen months after receiving the last dose of denosumab, the patient presented with 7 atraumatic spinal compression fractures requiring kyphoplasty for symptom relief.

Sleep apnea, metabolic disease, and the cutting edge of therapy.

Obstructive sleep apnea (OSA) is common, and many cross-sectional and longitudinal studies have established OSA as an independent risk factor for the development of a variety of adverse metabolic disease states, including hypertension, insulin resistance, type 2 diabetes, nonalcoholic fatty liver disease, dyslipidemia, and atherosclerosis. Nasal continuous positive airway pressure (CPAP) has long been the mainstay of therapy for OSA, but definitive studies demonstrating the efficacy of CPAP in improving metabolic outcomes, or in reducing incident disease burden, are lacking; moreover, CPAP has variable rates of adherence. Therefore, the future of OSA management, particularly with respect to limiting OSA-related metabolic dysfunction, likely lies in a coming wave of alternative approaches to endophenotyping OSA patients, personalized care, and defining and targeting mechanisms of OSA-induced adverse health outcomes.

Dermoid cyst of the lateral neck associated with the thyroid gland: a case report and review of the literature.

Dermoid cysts are the most common teratomatous lesion; however, they infrequently arise in the head and neck region. Very rarely, dermoid cysts have been described in the thyrohyoid region, masquerading as a thyroid nodule. We describe the case of a 31-year-old woman with a lateral neck mass, associated with the thyroid gland inferiorly, which was excised and found to be a dermoid cyst.

A simple method of supplementation of omega-3 polyunsaturated fatty acids: use of fortified yogurt in healthy volunteers.

Background: A relative dietary ω-3 fatty acid deficiency exists in Western diets, and this deficiency may be associated with some chronic diseases. The aim of the present study was to supplement yogurt with docosahexaenoic acid and assess whether this fatty acid could be incorporated into plasma lipids.

Methods: We developed a stable emulsion of docosahexaenoic acid that was incorporated into yogurt.

Effect of a fish oil-containing beverage on changes in plasma lipid fatty acids in patients with malabsorption.

Background: The aim of this pilot study was to assess tolerance of a beverage containing ω-3 fatty acids (fish oil) in patients with malabsorption receiving chronic parenteral nutrition (PN). The authors wanted to determine whether fish oil could be absorbed and incorporated into plasma fatty acids and reduce markers of inflammation.

Methods: This was a small intervention study in home-dwelling PN-dependent patients with chronic malabsorption.

Drug-induced endocrine disorders in the intensive care unit.

The neuroendocrine response to critical illness is key to the maintenance of homeostasis. Many of the drugs administered routinely in the intensive care unit significantly impact the neuroendocrine system. These agents can disrupt the hypothalamic-pituitary-adrenal axis, cause thyroid abnormalities, and result in dysglycemia.

Nutritional and metabolic support in the adult intensive care unit: key controversies.

Objective: To discuss certain important features of nutrition and metabolism in the intensive care unit.

Data Source: Prospective clinical trials examining issues related to glucose control, immunonutrition, and comparison of enteral and parenteral nutrition.

Conclusions: It remains unclear which glycemic threshold should be used in many patients for insulin initiation, but surgical patients receiving adequate nutrition should probably be treated to true normoglycemia.

Liver and skeletal muscle lipids have differing fatty acid profiles in short-gut rats fed via parenteral nutrition.

Background: In short-gut rats, we showed marked abnormalities in plasma lipid fatty acids using parenteral nutrition (PN) with lipid vs sham surgery rats. This suggests that either sensing or metabolism of parenteral lipid is abnormal in malabsorption. The goal of this study was to determine fatty acid profiles in skeletal muscle and liver in short-gut rats treated with PN compared with sham rats.

Hyperglycemia and nutrition support: theory and practice.

Hyperglycemia has long been known to portend a worse short-term prognosis than euglycemia in hospitalized patients. Hyperglycemia reflects illness severity and results in deleterious consequences for certain patient groups. In a surgical intensive care unit population, normalization of morning glucose values using insulin infusions improved mortality vs controls.