Revista Colombiana de Endocrinología, Diabetes & Metabolismo, Mar 31, 2022
Contexto: la disforia de género (DG) o la incongruencia de género (IG) es la insatisfacción de un... more Contexto: la disforia de género (DG) o la incongruencia de género (IG) es la insatisfacción de un individuo con su género asignado y su identificación con un género distinto al asociado con su sexo de nacimiento, basado en las características sexuales físicas y dado por su genitalidad al nacer. La "disforia" se refiere también a la angustia y al malestar psicológico experimentado, solo algunas personas con DG/IG experimentan disforia en algún momento de sus vidas. La DG/IG es una condición, la cual no debe ser evaluada como inherentemente patológica o negativa. Consenso sobre disforia de género o incongruencia de género AM Sierra Osorio et al.
In this chapter, the routine application of thyroid function tests for hypothyroidism detection i... more In this chapter, the routine application of thyroid function tests for hypothyroidism detection is evaluated, with a focus on the problems of overdiagnosis and unnecessary treatment, especially in subclinical scenarios. It critically assesses the lack of solid evidence behind common interventions, like the widespread prescription of levothyroxine without definitive clinical need. Highlighting evidence-based guidelines for hypothyroidism screening, the chapter argues against indiscriminate thyroid testing. It advocates for a thoughtful approach to thyroid disorder management, urging cautious use of TSH tests to reduce needless medical actions and improve patient outcomes.
Objetivo: Determinar las dosis de levotiroxina necesarias para alcanzar control bioquímico del hi... more Objetivo: Determinar las dosis de levotiroxina necesarias para alcanzar control bioquímico del hipotiroidismo según su etiología, peso corporal, TSH inicial y tiempo desde su diagnóstico. Población y métodos: Estudio de cohorte retrospectivo en pacientes hipotiroideos mayores de 14 años con control bioquímico de la enfermedad. Resultados: Se incluyeron 518 pacientes, 90% mujeres. El hipotiroidismo primario fue la forma más común (66,3%), seguido por el hipotiroidismo postiroidectomía total (13,1%), poshemitiroidectomía (6,1%), central (5,9%), posyodo radioactivo (5,7%) y postiroiditis subaguda (2,5%). Los requerimientos respectivos de levotiroxina (µg/kg/día) en ese mismo orden fueron:
Context: In 2022, the Colombian Association of Endocrinology, Diabetes, and Metabolism (ACE) join... more Context: In 2022, the Colombian Association of Endocrinology, Diabetes, and Metabolism (ACE) joined the Choosing Wisely initiative to prevent low-value medical practices.
Objective: To generate five evidence-based recommendations to decrease inappropriate clinical practices.
Methodology: A reviewing committee was established to identify "do not do" recommendations from ACE members. The most frequent recommendations were pre-selected, and a systematic literature search was conducted. Subsequently iterative rounds were conducted using the Delphi methodology to select the five recommendations that achieved the highest consensus among the panel of experts.
Results: Between October 2022 and April 2023, 117 active ACE members submitted a total of 211 recommendations. Of these, 109 were selected for further analysis. Subsequently, a Delphi panel identified five key recommendations, four of which addressed the excessive use of diagnostic tests, while the remaining one focused on therapeutic intervention.
Conclusions: To avoid unnecessary procedures, routine thyroid ultrasounds should not be performed on the general population or on hypothyroid individuals without changes in their physical examination. Requesting markers of bone turnover in patients with osteoporosis is also discouraged. Additionally, measuring basal insulin and/or post-glucose load in individuals who are overweight, obese, or have signs of insulin resistance is discouraged, along with indiscriminate measurements of vitamin D and unnecessary prescription of vitamin D supplements in the general population. The implementation of these recommendations could lead to a reduction in overdiagnosis and overtreatment of patients with endocrine conditions. This would help to improve resource management, quality of care, and clinical outcomes, benefiting both patients and the healthcare system
Hypothyroidism commonly presents with dermatological and hair-related symptoms, although the loss... more Hypothyroidism commonly presents with dermatological and hair-related symptoms, although the loss of eyelashes and eyebrows is considered uncommon in clinical practice. Here, we present a case of milphosis secondary to uncontrolled hypothyroidism.
A 24-year-old female with a history of hypothyroidism following total thyroidectomy and poor medication adherence presented with significant eyelash loss, accompanied by symptoms of dysphonia, bradyphrenia, bradylalia, constipation, pronounced fatigue, and drowsiness. Physical examination revealed periorbital edema and extensive eyelash loss affecting the upper eyelids. Laboratory analysis demonstrated a markedly elevated thyroid-stimulating hormone (TSH) level of 240.8 µIU/mL (normal range 0.38 to 5.33 µIU/L), confirming severe uncontrolled hypothyroidism. Levothyroxine treatment was reintroduced, leading to complete resolution of periorbital edema and regrowth of eyelashes after 12 weeks, coinciding with improvement in TSH levels.
This clinical case adds to the limited literature on madarosis and milphosis as manifestations of hypothyroidism, emphasizing the importance of clinician awareness regarding their potential presentation in the context of the disease. Understanding these manifestations and their differential diagnoses is crucial for ensuring prompt and accurate diagnosis and treatment.
In this chapter, the routine application of thyroid function tests for hypothyroidism detection i... more In this chapter, the routine application of thyroid function tests for hypothyroidism detection is evaluated, with a focus on the problems of overdiagnosis and unnecessary treatment, especially in subclinical scenarios. It critically assesses the lack of solid evidence behind common interventions, like the widespread prescription of levothyroxine without definitive clinical need. Highlighting evidence-based guidelines for hypothyroidism screening, the chapter argues against indiscriminate thyroid testing. It advocates for a thoughtful approach to thyroid disorder management, urging cautious use of TSH tests to reduce needless medical actions and improve patient outcomes.
Complicaciones asociadas a la hiperglucemia en pacientes trasplantados de riñón, 2014
Introduction: Hyperglycemia has been considered as a negative factor in hospitalized patients, bo... more Introduction: Hyperglycemia has been considered as a negative factor in hospitalized patients, both diabetic and non-diabetic, and has been related to the presence of diverse adverse out- comes. In kidney transplant patients, surgical stress, immunosuppressive drugs and prolonged hospital stays may be factors that promote hyperglycemia. However, has not been studied whether hyperglycemia during transplantation is associated with increased risk of rejection.
Population and methods: A retrospective cohort study in patients older than 15 years who received a kidney transplant and that included measurements of glucose in the first 48 hours after transplantation. We evaluated the presence of hyperglycemia defined in three different ways (as a single value, as averaged value and as time-weighted value) in patients undergoing renal transplantation and its relationship to the risk of acute rejection and length of hospital stay.
Results: While a large number of patients (91%) had some form of hyperglycemia during the first 48 hours after transplantation regardless of how it was defined, there was no an increased risk of rejection (OR=0.35; 95%CI=0.11-1.08) or a difference in length of stay (13.2 vs. 8.9 days, P = .958).
Conclusions: It is common to find some form of hyperglycemia during the first 48 hours after kidney transplantation, but its presence does not entail increased risk of transplant rejection or longer hospital stay when compared with patients who did not present it.
Background
Hyperglycemia is a frequent phenomenon in hospitalized patients that is associated wit... more Background Hyperglycemia is a frequent phenomenon in hospitalized patients that is associated with negative outcomes. It is common in liver transplant patients as a result of stress and is related to immunosuppressant drugs. Although studies are few, a history of diabetes and the presentation of hyperglycemia during liver transplantation have been associated with a higher risk for rejection.
Aims To analyze whether hyperglycemia during the first 48 hours after liver transplantation was associated with a higher risk for infection, rejection, or longer hospital stay.
Methods A retrospective cohort study was conducted on patients above the age of 15 years that received a liver transplant. Hyperglycemia was defined as a value above 140 mg/dl and it was measured in three different manners (as an isolated value, as a mean value, and as a weighted value over time). The relation of hyperglycemia to a risk for acute rejection, infection, or longer hospital stay was evaluated.
Results Some form of hyperglycemia was present in 94% of the patients during the first 48 post-transplantation hours, regardless of its definition. There was no increased risk for rejection (OR: 1.49; 95% CI: 0.55-4.05), infection (OR: 0.62; 95% CI: 0.16-2.25), or longer hospital stay between the patients that presented with hyperglycemia and those that did not.
Conclusions Hyperglycemia during the first 48 hours after transplantation appeared to be an expected phenomenon in the majority of patients and was not associated with a greater risk for rejection or infection and it had no impact on the duration of hospital stay.
Consenso médico de biopsia por aspiración con aguja fina de tiroides. Reporte de citología tiroidea basado en el sistema de Bethesda
Consenso médico de biopsia por aspiración con aguja fina de tiroides. Reporte de citología tiroid... more Consenso médico de biopsia por aspiración con aguja fina de tiroides. Reporte de citología tiroidea basado en el sistema de Bethesda Medical consensus of fine-needle aspiration biopsy of the thyroid. Conflicto de intereses: los autores declaran que no tienen conflicto de intereses. Medicina & Laboratorio 2013; 19: xxx-xxx Módulo 20 (Temas libres), número 10.
Factores clínicos pronósticos de enfermedad grave y mortalidad en pacientes con COVID-19 Clinical factors for the prognosis of severe illness and death in patients with COVID-19
Background: Parathyroid cyst is an infrequent and unsuspected disease. There are more than 300 hu... more Background: Parathyroid cyst is an infrequent and unsuspected disease. There are more than 300 hundred cases reported in the world literature, a few of them are from Latin America. The experience of our centers and a review of the cases are presented. Methods: Case report of a series of patients with parathyroid cyst from our institutions according to the CARE guidelines (Case Reports). A search of Medline, Embase, BIREME (Biblioteca Regional de Medicina) LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), Google Scholar and Scielo (Scientific Electronic Library on Line) databases and telephonic or email communications with other experts from Latin-America was performed. Results: Six patients with parathyroid cyst were found in our centers in Colombia. Most of them were managed with aspiration of the cyst. Two of them required surgery. Only one case was functional. Twelve reports from Latin America were found for a total of 18 cases in our region adding ours. Conclusions: Parathyroid cysts are uncommonly reported in Latin America. Most of them are diagnosed postoperatively. Suspicion for parathyroid cyst should be raised when a crystal clear fluid is aspirated from a cyst. The confirmation of the diagnosis may be easily done if parathyroid hormone (PTH) level is measured in the cyst fluid.
Revista Colombiana de Endocrinología, Diabetes & Metabolismo, Mar 31, 2022
Contexto: la disforia de género (DG) o la incongruencia de género (IG) es la insatisfacción de un... more Contexto: la disforia de género (DG) o la incongruencia de género (IG) es la insatisfacción de un individuo con su género asignado y su identificación con un género distinto al asociado con su sexo de nacimiento, basado en las características sexuales físicas y dado por su genitalidad al nacer. La "disforia" se refiere también a la angustia y al malestar psicológico experimentado, solo algunas personas con DG/IG experimentan disforia en algún momento de sus vidas. La DG/IG es una condición, la cual no debe ser evaluada como inherentemente patológica o negativa. Consenso sobre disforia de género o incongruencia de género AM Sierra Osorio et al.
In this chapter, the routine application of thyroid function tests for hypothyroidism detection i... more In this chapter, the routine application of thyroid function tests for hypothyroidism detection is evaluated, with a focus on the problems of overdiagnosis and unnecessary treatment, especially in subclinical scenarios. It critically assesses the lack of solid evidence behind common interventions, like the widespread prescription of levothyroxine without definitive clinical need. Highlighting evidence-based guidelines for hypothyroidism screening, the chapter argues against indiscriminate thyroid testing. It advocates for a thoughtful approach to thyroid disorder management, urging cautious use of TSH tests to reduce needless medical actions and improve patient outcomes.
Objetivo: Determinar las dosis de levotiroxina necesarias para alcanzar control bioquímico del hi... more Objetivo: Determinar las dosis de levotiroxina necesarias para alcanzar control bioquímico del hipotiroidismo según su etiología, peso corporal, TSH inicial y tiempo desde su diagnóstico. Población y métodos: Estudio de cohorte retrospectivo en pacientes hipotiroideos mayores de 14 años con control bioquímico de la enfermedad. Resultados: Se incluyeron 518 pacientes, 90% mujeres. El hipotiroidismo primario fue la forma más común (66,3%), seguido por el hipotiroidismo postiroidectomía total (13,1%), poshemitiroidectomía (6,1%), central (5,9%), posyodo radioactivo (5,7%) y postiroiditis subaguda (2,5%). Los requerimientos respectivos de levotiroxina (µg/kg/día) en ese mismo orden fueron:
Context: In 2022, the Colombian Association of Endocrinology, Diabetes, and Metabolism (ACE) join... more Context: In 2022, the Colombian Association of Endocrinology, Diabetes, and Metabolism (ACE) joined the Choosing Wisely initiative to prevent low-value medical practices.
Objective: To generate five evidence-based recommendations to decrease inappropriate clinical practices.
Methodology: A reviewing committee was established to identify "do not do" recommendations from ACE members. The most frequent recommendations were pre-selected, and a systematic literature search was conducted. Subsequently iterative rounds were conducted using the Delphi methodology to select the five recommendations that achieved the highest consensus among the panel of experts.
Results: Between October 2022 and April 2023, 117 active ACE members submitted a total of 211 recommendations. Of these, 109 were selected for further analysis. Subsequently, a Delphi panel identified five key recommendations, four of which addressed the excessive use of diagnostic tests, while the remaining one focused on therapeutic intervention.
Conclusions: To avoid unnecessary procedures, routine thyroid ultrasounds should not be performed on the general population or on hypothyroid individuals without changes in their physical examination. Requesting markers of bone turnover in patients with osteoporosis is also discouraged. Additionally, measuring basal insulin and/or post-glucose load in individuals who are overweight, obese, or have signs of insulin resistance is discouraged, along with indiscriminate measurements of vitamin D and unnecessary prescription of vitamin D supplements in the general population. The implementation of these recommendations could lead to a reduction in overdiagnosis and overtreatment of patients with endocrine conditions. This would help to improve resource management, quality of care, and clinical outcomes, benefiting both patients and the healthcare system
Hypothyroidism commonly presents with dermatological and hair-related symptoms, although the loss... more Hypothyroidism commonly presents with dermatological and hair-related symptoms, although the loss of eyelashes and eyebrows is considered uncommon in clinical practice. Here, we present a case of milphosis secondary to uncontrolled hypothyroidism.
A 24-year-old female with a history of hypothyroidism following total thyroidectomy and poor medication adherence presented with significant eyelash loss, accompanied by symptoms of dysphonia, bradyphrenia, bradylalia, constipation, pronounced fatigue, and drowsiness. Physical examination revealed periorbital edema and extensive eyelash loss affecting the upper eyelids. Laboratory analysis demonstrated a markedly elevated thyroid-stimulating hormone (TSH) level of 240.8 µIU/mL (normal range 0.38 to 5.33 µIU/L), confirming severe uncontrolled hypothyroidism. Levothyroxine treatment was reintroduced, leading to complete resolution of periorbital edema and regrowth of eyelashes after 12 weeks, coinciding with improvement in TSH levels.
This clinical case adds to the limited literature on madarosis and milphosis as manifestations of hypothyroidism, emphasizing the importance of clinician awareness regarding their potential presentation in the context of the disease. Understanding these manifestations and their differential diagnoses is crucial for ensuring prompt and accurate diagnosis and treatment.
In this chapter, the routine application of thyroid function tests for hypothyroidism detection i... more In this chapter, the routine application of thyroid function tests for hypothyroidism detection is evaluated, with a focus on the problems of overdiagnosis and unnecessary treatment, especially in subclinical scenarios. It critically assesses the lack of solid evidence behind common interventions, like the widespread prescription of levothyroxine without definitive clinical need. Highlighting evidence-based guidelines for hypothyroidism screening, the chapter argues against indiscriminate thyroid testing. It advocates for a thoughtful approach to thyroid disorder management, urging cautious use of TSH tests to reduce needless medical actions and improve patient outcomes.
Complicaciones asociadas a la hiperglucemia en pacientes trasplantados de riñón, 2014
Introduction: Hyperglycemia has been considered as a negative factor in hospitalized patients, bo... more Introduction: Hyperglycemia has been considered as a negative factor in hospitalized patients, both diabetic and non-diabetic, and has been related to the presence of diverse adverse out- comes. In kidney transplant patients, surgical stress, immunosuppressive drugs and prolonged hospital stays may be factors that promote hyperglycemia. However, has not been studied whether hyperglycemia during transplantation is associated with increased risk of rejection.
Population and methods: A retrospective cohort study in patients older than 15 years who received a kidney transplant and that included measurements of glucose in the first 48 hours after transplantation. We evaluated the presence of hyperglycemia defined in three different ways (as a single value, as averaged value and as time-weighted value) in patients undergoing renal transplantation and its relationship to the risk of acute rejection and length of hospital stay.
Results: While a large number of patients (91%) had some form of hyperglycemia during the first 48 hours after transplantation regardless of how it was defined, there was no an increased risk of rejection (OR=0.35; 95%CI=0.11-1.08) or a difference in length of stay (13.2 vs. 8.9 days, P = .958).
Conclusions: It is common to find some form of hyperglycemia during the first 48 hours after kidney transplantation, but its presence does not entail increased risk of transplant rejection or longer hospital stay when compared with patients who did not present it.
Background
Hyperglycemia is a frequent phenomenon in hospitalized patients that is associated wit... more Background Hyperglycemia is a frequent phenomenon in hospitalized patients that is associated with negative outcomes. It is common in liver transplant patients as a result of stress and is related to immunosuppressant drugs. Although studies are few, a history of diabetes and the presentation of hyperglycemia during liver transplantation have been associated with a higher risk for rejection.
Aims To analyze whether hyperglycemia during the first 48 hours after liver transplantation was associated with a higher risk for infection, rejection, or longer hospital stay.
Methods A retrospective cohort study was conducted on patients above the age of 15 years that received a liver transplant. Hyperglycemia was defined as a value above 140 mg/dl and it was measured in three different manners (as an isolated value, as a mean value, and as a weighted value over time). The relation of hyperglycemia to a risk for acute rejection, infection, or longer hospital stay was evaluated.
Results Some form of hyperglycemia was present in 94% of the patients during the first 48 post-transplantation hours, regardless of its definition. There was no increased risk for rejection (OR: 1.49; 95% CI: 0.55-4.05), infection (OR: 0.62; 95% CI: 0.16-2.25), or longer hospital stay between the patients that presented with hyperglycemia and those that did not.
Conclusions Hyperglycemia during the first 48 hours after transplantation appeared to be an expected phenomenon in the majority of patients and was not associated with a greater risk for rejection or infection and it had no impact on the duration of hospital stay.
Consenso médico de biopsia por aspiración con aguja fina de tiroides. Reporte de citología tiroidea basado en el sistema de Bethesda
Consenso médico de biopsia por aspiración con aguja fina de tiroides. Reporte de citología tiroid... more Consenso médico de biopsia por aspiración con aguja fina de tiroides. Reporte de citología tiroidea basado en el sistema de Bethesda Medical consensus of fine-needle aspiration biopsy of the thyroid. Conflicto de intereses: los autores declaran que no tienen conflicto de intereses. Medicina & Laboratorio 2013; 19: xxx-xxx Módulo 20 (Temas libres), número 10.
Factores clínicos pronósticos de enfermedad grave y mortalidad en pacientes con COVID-19 Clinical factors for the prognosis of severe illness and death in patients with COVID-19
Background: Parathyroid cyst is an infrequent and unsuspected disease. There are more than 300 hu... more Background: Parathyroid cyst is an infrequent and unsuspected disease. There are more than 300 hundred cases reported in the world literature, a few of them are from Latin America. The experience of our centers and a review of the cases are presented. Methods: Case report of a series of patients with parathyroid cyst from our institutions according to the CARE guidelines (Case Reports). A search of Medline, Embase, BIREME (Biblioteca Regional de Medicina) LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), Google Scholar and Scielo (Scientific Electronic Library on Line) databases and telephonic or email communications with other experts from Latin-America was performed. Results: Six patients with parathyroid cyst were found in our centers in Colombia. Most of them were managed with aspiration of the cyst. Two of them required surgery. Only one case was functional. Twelve reports from Latin America were found for a total of 18 cases in our region adding ours. Conclusions: Parathyroid cysts are uncommonly reported in Latin America. Most of them are diagnosed postoperatively. Suspicion for parathyroid cyst should be raised when a crystal clear fluid is aspirated from a cyst. The confirmation of the diagnosis may be easily done if parathyroid hormone (PTH) level is measured in the cyst fluid.
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Papers by Karen Palacios
Objective: To generate five evidence-based recommendations to decrease inappropriate clinical practices.
Methodology: A reviewing committee was established to identify "do not do" recommendations from ACE members. The most frequent recommendations were pre-selected, and a systematic literature search was conducted. Subsequently iterative rounds were conducted using the Delphi methodology to select the five recommendations that achieved the highest consensus among the panel of experts.
Results: Between October 2022 and April 2023, 117 active ACE members submitted a total of 211 recommendations. Of these, 109 were selected for further analysis. Subsequently, a Delphi panel identified five key recommendations, four of which addressed the excessive use of diagnostic tests, while the remaining one focused on therapeutic intervention.
Conclusions: To avoid unnecessary procedures, routine thyroid ultrasounds should not be performed on the general population or on hypothyroid individuals without changes in their physical examination. Requesting markers of bone turnover in patients with osteoporosis is also discouraged. Additionally, measuring basal insulin and/or post-glucose load in individuals who are overweight, obese, or have signs of insulin resistance is discouraged, along with indiscriminate measurements of vitamin D and unnecessary prescription of vitamin D supplements in the general population. The implementation of these recommendations could lead to a reduction in overdiagnosis and overtreatment of patients with endocrine conditions. This would help to improve resource management, quality of care, and clinical outcomes, benefiting both patients and the healthcare system
A 24-year-old female with a history of hypothyroidism following total thyroidectomy and poor medication adherence presented with significant eyelash loss, accompanied by symptoms of dysphonia, bradyphrenia, bradylalia, constipation, pronounced fatigue, and drowsiness. Physical examination revealed periorbital edema and extensive eyelash loss affecting the upper eyelids. Laboratory analysis demonstrated a markedly elevated thyroid-stimulating hormone (TSH) level of 240.8 µIU/mL (normal range 0.38 to 5.33 µIU/L), confirming severe uncontrolled hypothyroidism. Levothyroxine treatment was reintroduced, leading to complete resolution of periorbital edema and regrowth of eyelashes after 12 weeks, coinciding with improvement in TSH levels.
This clinical case adds to the limited literature on madarosis and milphosis as manifestations of hypothyroidism, emphasizing the importance of clinician awareness regarding their potential presentation in the context of the disease. Understanding these manifestations and their differential diagnoses is crucial for ensuring prompt and accurate diagnosis and treatment.
Population and methods: A retrospective cohort study in patients older than 15 years who received a kidney transplant and that included measurements of glucose in the first 48 hours after transplantation. We evaluated the presence of hyperglycemia defined in three different ways (as a single value, as averaged value and as time-weighted value) in patients undergoing renal transplantation and its relationship to the risk of acute rejection and length of hospital stay.
Results: While a large number of patients (91%) had some form of hyperglycemia during the first 48 hours after transplantation regardless of how it was defined, there was no an increased risk of rejection (OR=0.35; 95%CI=0.11-1.08) or a difference in length of stay (13.2 vs. 8.9 days, P = .958).
Conclusions: It is common to find some form of hyperglycemia during the first 48 hours after kidney transplantation, but its presence does not entail increased risk of transplant rejection or longer hospital stay when compared with patients who did not present it.
Hyperglycemia is a frequent phenomenon in hospitalized patients that is associated with negative outcomes. It is common in liver transplant patients as a result of stress and is related to immunosuppressant drugs. Although studies are few, a history of diabetes and the presentation of hyperglycemia during liver transplantation have been associated with a higher risk for rejection.
Aims
To analyze whether hyperglycemia during the first 48 hours after liver transplantation was associated with a higher risk for infection, rejection, or longer hospital stay.
Methods
A retrospective cohort study was conducted on patients above the age of 15 years that received a liver transplant. Hyperglycemia was defined as a value above 140 mg/dl and it was measured in three different manners (as an isolated value, as a mean value, and as a weighted value over time). The relation of hyperglycemia to a risk for acute rejection, infection, or longer hospital stay was evaluated.
Results
Some form of hyperglycemia was present in 94% of the patients during the first 48 post-transplantation hours, regardless of its definition. There was no increased risk for rejection (OR: 1.49; 95% CI: 0.55-4.05), infection (OR: 0.62; 95% CI: 0.16-2.25), or longer hospital stay between the patients that presented with hyperglycemia and those that did not.
Conclusions
Hyperglycemia during the first 48 hours after transplantation appeared to be an expected phenomenon in the majority of patients and was not associated with a greater risk for rejection or infection and it had no impact on the duration of hospital stay.
Objective: To generate five evidence-based recommendations to decrease inappropriate clinical practices.
Methodology: A reviewing committee was established to identify "do not do" recommendations from ACE members. The most frequent recommendations were pre-selected, and a systematic literature search was conducted. Subsequently iterative rounds were conducted using the Delphi methodology to select the five recommendations that achieved the highest consensus among the panel of experts.
Results: Between October 2022 and April 2023, 117 active ACE members submitted a total of 211 recommendations. Of these, 109 were selected for further analysis. Subsequently, a Delphi panel identified five key recommendations, four of which addressed the excessive use of diagnostic tests, while the remaining one focused on therapeutic intervention.
Conclusions: To avoid unnecessary procedures, routine thyroid ultrasounds should not be performed on the general population or on hypothyroid individuals without changes in their physical examination. Requesting markers of bone turnover in patients with osteoporosis is also discouraged. Additionally, measuring basal insulin and/or post-glucose load in individuals who are overweight, obese, or have signs of insulin resistance is discouraged, along with indiscriminate measurements of vitamin D and unnecessary prescription of vitamin D supplements in the general population. The implementation of these recommendations could lead to a reduction in overdiagnosis and overtreatment of patients with endocrine conditions. This would help to improve resource management, quality of care, and clinical outcomes, benefiting both patients and the healthcare system
A 24-year-old female with a history of hypothyroidism following total thyroidectomy and poor medication adherence presented with significant eyelash loss, accompanied by symptoms of dysphonia, bradyphrenia, bradylalia, constipation, pronounced fatigue, and drowsiness. Physical examination revealed periorbital edema and extensive eyelash loss affecting the upper eyelids. Laboratory analysis demonstrated a markedly elevated thyroid-stimulating hormone (TSH) level of 240.8 µIU/mL (normal range 0.38 to 5.33 µIU/L), confirming severe uncontrolled hypothyroidism. Levothyroxine treatment was reintroduced, leading to complete resolution of periorbital edema and regrowth of eyelashes after 12 weeks, coinciding with improvement in TSH levels.
This clinical case adds to the limited literature on madarosis and milphosis as manifestations of hypothyroidism, emphasizing the importance of clinician awareness regarding their potential presentation in the context of the disease. Understanding these manifestations and their differential diagnoses is crucial for ensuring prompt and accurate diagnosis and treatment.
Population and methods: A retrospective cohort study in patients older than 15 years who received a kidney transplant and that included measurements of glucose in the first 48 hours after transplantation. We evaluated the presence of hyperglycemia defined in three different ways (as a single value, as averaged value and as time-weighted value) in patients undergoing renal transplantation and its relationship to the risk of acute rejection and length of hospital stay.
Results: While a large number of patients (91%) had some form of hyperglycemia during the first 48 hours after transplantation regardless of how it was defined, there was no an increased risk of rejection (OR=0.35; 95%CI=0.11-1.08) or a difference in length of stay (13.2 vs. 8.9 days, P = .958).
Conclusions: It is common to find some form of hyperglycemia during the first 48 hours after kidney transplantation, but its presence does not entail increased risk of transplant rejection or longer hospital stay when compared with patients who did not present it.
Hyperglycemia is a frequent phenomenon in hospitalized patients that is associated with negative outcomes. It is common in liver transplant patients as a result of stress and is related to immunosuppressant drugs. Although studies are few, a history of diabetes and the presentation of hyperglycemia during liver transplantation have been associated with a higher risk for rejection.
Aims
To analyze whether hyperglycemia during the first 48 hours after liver transplantation was associated with a higher risk for infection, rejection, or longer hospital stay.
Methods
A retrospective cohort study was conducted on patients above the age of 15 years that received a liver transplant. Hyperglycemia was defined as a value above 140 mg/dl and it was measured in three different manners (as an isolated value, as a mean value, and as a weighted value over time). The relation of hyperglycemia to a risk for acute rejection, infection, or longer hospital stay was evaluated.
Results
Some form of hyperglycemia was present in 94% of the patients during the first 48 post-transplantation hours, regardless of its definition. There was no increased risk for rejection (OR: 1.49; 95% CI: 0.55-4.05), infection (OR: 0.62; 95% CI: 0.16-2.25), or longer hospital stay between the patients that presented with hyperglycemia and those that did not.
Conclusions
Hyperglycemia during the first 48 hours after transplantation appeared to be an expected phenomenon in the majority of patients and was not associated with a greater risk for rejection or infection and it had no impact on the duration of hospital stay.