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Cao C, Jasim S, Cherian A, Nassar A, Chindris AM, Rivas AM, Bonnett S, Caserta M, Stan MN, Bernet VJ. Patient Discomfort in Relation to Thyroid Nodule Fine-Needle Aspiration (FNA) Performed with or without Parenteral and/or Topical Anesthetic. Endocr Pract 2021; 26:1497-1504. [PMID: 33471742 DOI: 10.4158/ep-2020-0403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE There is much reported variation in the impact of local anesthesia on thyroid fine-needle aspiration (FNA) related discomfort. We compare patients undergoing thyroid FNA with subcutaneous injection or topical anesthetic to no anesthetic. METHODS We conducted a retrospective review of 585 sequential ultrasound guided thyroid FNA procedures in Mayo Clinic. Group 1 (n = 200), no anesthetic; Group 2 (n = 185), subcutaneous injection anesthetic; and Group 3 (n = 200), topical anesthetic. Patient demographics, number of FNA passes, needle gauge, and cytopathology were recorded plus a discomfort score (0 to 10) before and immediately post procedure in all 3 groups and peak discomfort during the FNA in Groups 1 and 2. RESULTS There were no differences among the 3 groups in age, sex, FNA sufficiency rate, cytopathology, and FNA passes number. There was no significant difference between Groups 1 and 2 in peak discomfort score during the FNA: 0 (45%, 42.2%), 1 to 2 (19%, 24.9%), 3 to 5 (23.5%, 20.5%), 6 to 8 (9.5%, 10.8%), 9 to 10 (3%, 1.6%), respectively. Discomfort score post procedure: 0 (78.5%, 77.8%, 53.5%), 1 to 2 (13%, 13%, 36.5%), 3 to 5 (7%, 7%, 9%), 6 to 8 (1.5%, 2.2%, 1%), 9 to 10 (0%, 0%, 0%) for groups 1, 2, and 3, respectively. There were no significant differences among the 3 groups for a discomfort score ≥3. CONCLUSION FNA associated patient discomfort was comparable during and after the procedure regardless of the use of anesthetic or the type utilized. Approximately 90% of patients experienced mild to moderate discomfort during the procedure. And 90% reported no more than a level 2 discomfort post procedure. ABBREVIATIONS End = endocrinology; FNA = fine-needle aspiration; MCF = Mayo Clinic Florida; MCR = Mayo Clinic Rochester.
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Affiliation(s)
- Chenxiang Cao
- From the (1)Department of Endocrinology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri
| | - Amrita Cherian
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Aziza Nassar
- Department of Pathology, Mayo Clinic, Jacksonville, Florida
| | | | - Ana Marcella Rivas
- Division of Endocrinology, Texas Tech University of Health Sciences Center, Lubbock, Texas, and the
| | | | | | - Marius N Stan
- Division of Endocrinology, Mayo Clinic Rochester, Minnesota
| | - Victor J Bernet
- Division of Endocrinology, Mayo Clinic, Jacksonville, Florida.
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2
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Rivas AM, Nugent K. Hyperglycemia, Insulin, and Insulin Resistance in Sepsis. Am J Med Sci 2020; 361:297-302. [PMID: 33500122 DOI: 10.1016/j.amjms.2020.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/18/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023]
Abstract
Critically ill patients frequently have hyperglycemia. This event may reflect severe stress with an imbalance between anabolic hormones and catabolic hormones. Alternatively, it may reflect alterations in either insulin levels or insulin function. Insulin is a pleiotropic hormone with multiple important metabolic effects. In patients with sepsis, insulin levels are increased but insulin sensitivity is decreased. However, there is variability in insulin sensitivity, and this creates variability in glucose levels and insulin requirements and increases the frequency of hypo- and hyperglycemia. The factors that influence insulin sensitivity are complex and include inhibition of tyrosine kinase activity of the beta subunit, increased proteolytic activity resulting in loss of receptors from the plasma membrane, and possibly the transfer of insulin receptors into the nucleus where they bind to gene promoters. Better understanding of the role of insulin in critically ill patients requires prospective studies measuring insulin levels in various patient groups and the development of a simple measure of insulin sensitivity.
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Affiliation(s)
- Ana Marcella Rivas
- The Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States.
| | - Kenneth Nugent
- The Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
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Lado-Abeal J, Diaz C, Berdine G, Iwuji K, Araujo-Vilar D, Lampon-Fernandez N, Wang M, Lojo S, Rodriguez-Perez A, Rivas AM. High prevalence of non-thyroidal illness syndrome in patients at long-term care facilities. Endocrine 2020; 70:348-355. [PMID: 32346815 DOI: 10.1007/s12020-020-02321-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients in acute care hospitals are often transferred to long-term care (LTC) when there is an expectation for a lengthy recovery. Prolonged non-thyroidal illness syndrome (NTIS) creates a state of hypothyroidism. We aimed to investigate the prevalence of NTIS in patients at LTC facilities. METHODS A cross-sectional study at University Hospitals and Rehabilitation and Skilled Nursing facility was performed. Four groups: control (n:33), intensive care unit (ICU) (n:34), long-term care hospital (LTCH) (n:50), and long-term care on chronic ventilatory support (LTCVS) (n:30). Serum levels of TSH, free T4 (FT4), free T3 (FT3), and interleukin 6 (IL6) measured at admission day in controls, within 48 h of admission in the intensive care group, between days 31 and 120 in the LTC hospital group and days 31 and 6 years in the LTC on chronic ventilatory support group. RESULTS Serum FT3 levels were lower in groups intensive care unit ICU, LTCH, and LTCVS than control. Low serum FT3 levels were observed in 80% ICU, 54% LTCH, 37% LTCVS, and 6% control patients. Low serum FT4 levels were observed in 32% ICU, 16% LTCH, and 20% LTCVS patients. Both low serum FT4 and FT3 levels were observed in 32% ICU, 16% LTCH, and 13% LTCVS patients. Serum IL6 and FT3 levels showed a negative correlation. CONCLUSIONS NTIS is highly prevalent in patients in LTC, creating a state of persistent hypothyroidism. The effects of thyroid hormone replacement in patients at LTC with non-thyroidal illness deserve further investigation.
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Affiliation(s)
- Joaquin Lado-Abeal
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Truman Medical Centers and University of Missouri Kansas City, Kansas City, MO, USA.
| | - Carmen Diaz
- Division of Endocrinology and Nutrition, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
| | - Gilbert Berdine
- Department of Internal Medicine, Division of Pulmonary Disease and Critical Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Iwuji
- Department of Internal Medicine, Division of General Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - David Araujo-Vilar
- Division of Endocrinology and Nutrition, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
- Thyroid and Metabolic Diseases Unit (UETeM), Department of Psychiatry, Radiology, Public Health, Nursing and Medicine (Medicine Area), Centre for Research in Molecular Medicine and Chronic Diseases (CIMUS)-IDIS, University of Santiago de Compostela School of Medicine, Santiago de Compostela, Spain
| | - Natalia Lampon-Fernandez
- Division of Clinical Analysis, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
| | - Min Wang
- Department of Management Science and Statistics, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Santiago Lojo
- Division of Clinical Analysis, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
| | - Alfonso Rodriguez-Perez
- Division of Anaesthesia and Reanimation, Complexo Hospitalario Universitario de Santiago (CHUS), SERGAS, Santiago de Compostela, Spain
| | - Ana Marcella Rivas
- Department of Internal Medicine, Division of Endocrinology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Rivas AM, Larumbe-Zabala E, Diaz-Trastoy O, Schurr RN, Jones C, Abdulrahman R, Dar N, Lado-Abeal J. Effect of chemoradiation on the size of the thyroid gland. Proc AMIA Symp 2020; 33:541-545. [PMID: 33100524 DOI: 10.1080/08998280.2020.1786227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We aimed to evaluate changes in thyroid gland size during the treatment of malignancies outside the head and neck with chemotherapy and/or external beam radiation. We performed a retrospective review of records of adult patients treated at our institution with external beam radiation to the chest and/or chemotherapy with taxanes, alkylating agents, and/or a topoisomerase II inhibitor. Neck and chest computed tomography (CT) images were used to calculate thyroid gland volume before and after therapy, using Vitrea® software or the volumetric ellipsoid method. Thirty-seven patients were included. After treatment, there was a significant reduction in thyroid gland volume of 14.0% (P < 0.01) using Vitrea and 17.1% (P < 0.05) using the volumetric ellipsoid method. Exposure to radiation or chemotherapy was not found to be associated with the degree of thyroid gland reduction, nor was the number of days between CT scans or the stage of the malignancy being treated. Finally, the degree of thyroid gland size reduction did not predict mortality. Our results showed that the treatment of malignancies outside the head and neck with chemotherapy and/or external beam radiation results in a reduction in thyroid gland size. The impact on thyroid gland function remains unknown.
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Affiliation(s)
- Ana Marcella Rivas
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Eneko Larumbe-Zabala
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Olaia Diaz-Trastoy
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Ryan Nicholas Schurr
- CTSI Oncology Solutions, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Catherine Jones
- Division of Medical Oncology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ramzi Abdulrahman
- Division of Radiation Oncology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Nabeel Dar
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joaquin Lado-Abeal
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.,Division of Endocrinology, Department of Internal Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, Missouri
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Edwards S, Bijlani S, Fairley H, Lloyd N, Rivas AM, Payne JD. Frequency and prevalence of obesity and related comorbidities in West Texas. Proc AMIA Symp 2019; 33:1-4. [PMID: 32063754 DOI: 10.1080/08998280.2019.1668667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022] Open
Abstract
The aim of this cross-sectional study was to estimate the frequency and prevalence of obesity and its association with diabetes mellitus, systemic hypertension, hyperlipidemia, coronary artery disease, myocardial infarction, and obstructive sleep apnea in West Texas adults. Data were extracted from 9528 clinic patients: 2287 (24.4%) were normal weight or underweight, and 7057 (75.5%) were overweight or obese (28.9% and 46.6%, respectively). We observed a lower prevalence of any degree of obesity in men compared to women (43.8% vs 48.6%). Diabetes mellitus (odds ratio [OR] = 2.56; 95% confidence interval [CI], 2.30-2.85), hypertension (OR = 2.28; 95% CI, 2.06-2.53), hyperlipidemia (OR = 1.90; 95% CI, 1.71-2.10), and obstructive sleep apnea (OR = 7.18; 95% CI, 5.84-8.83) were associated with obesity. The association of coronary artery disease (OR = 1.17; 95% CI, 1.03-1.33) with obesity was small, and myocardial infarction did not show any association with weight status. The frequency and prevalence of obesity are progressively increasing in West Texas adults and are linked to significant comorbidities, especially in low-income areas. Access to preventive interventions and further investigations are needed to slow the rising prevalence of obesity and its comorbidities.
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Affiliation(s)
- Samantha Edwards
- School of Medicine, Texas Tech Health Sciences CenterLubbockTexas
| | - Sharan Bijlani
- School of Medicine, Texas Tech Health Sciences CenterLubbockTexas
| | - Hannah Fairley
- School of Medicine, Texas Tech Health Sciences CenterLubbockTexas
| | - Nathan Lloyd
- School of Medicine, Texas Tech Health Sciences CenterLubbockTexas
| | - Ana Marcella Rivas
- Department of Internal Medicine, Texas Tech Health Sciences CenterLubbockTexas
| | - J Drew Payne
- Department of Internal Medicine, Texas Tech Health Sciences CenterLubbockTexas
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Iwuji K, Jaroudi S, Bansal A, Rivas AM. Acute necrotizing esophagitis presenting with severe lactic acidosis and shock. Proc (Bayl Univ Med Cent) 2018; 31:457-459. [PMID: 30948978 DOI: 10.1080/08998280.2018.1488494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/05/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023] Open
Abstract
Acute necrotizing esophagitis, also known as "black esophagus," is typically characterized by a circumferential, friable black mucosal surface and preferentially involves the distal esophagus. It predominantly affects elderly men and presents as an upper gastrointestinal bleed. We describe a 60-year-old man with an acute upper gastrointestinal bleed and sepsis and subsequently acute necrotizing esophagitis.
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Affiliation(s)
- Kenneth Iwuji
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Sarah Jaroudi
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Arpana Bansal
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Ana Marcella Rivas
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
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7
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Thavaraputta S, Rivas AM. Giant craniopharyngioma in an adult presenting with new onset seizure. BMJ Case Rep 2018; 2018:bcr-2018-227244. [PMID: 30232210 DOI: 10.1136/bcr-2018-227244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Subhanudh Thavaraputta
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Ana Marcella Rivas
- Division of Endocrinology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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8
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Rivas AM, Nassar A, Zhang J, Casler JD, Chindris AM, Smallridge R, Bernet V. ThyroSeq ®V2.0 Molecular Testing: A Cost-Effective Approach for the Evaluation of Indeterminate Thyroid Nodules. Endocr Pract 2018; 24:780-788. [PMID: 30084677 DOI: 10.4158/ep-2018-0212] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Approximately 15 to 30% of thyroid nodules have indeterminate cytology. Many of these nodules are treated surgically, but only 5 to 30% are malignant. Molecular testing can further narrow the risk of malignancy of these nodules. Our objective was to assess the cost effectiveness of ThyroSeq®V2.0 compared to diagnostic thyroidectomy for the evaluation of indeterminate nodules. METHODS Cytology and histopathology slides of Bethesda category III and IV (suspicious for follicular neoplasia [SFN]) nodules obtained between January 1, 2014 and November 30, 2016 were re-reviewed by 2 endocrine cytopathologists. Costs for a diagnostic approach using ThyroSeq® were calculated and compared to those of diagnostic thyroidectomy. RESULTS We included 8 Bethesda category III nodules that underwent ThyroSeq® and 8 that underwent diagnostic surgery. Of those submitted for ThyroSeq®, 4 were positive for mutations and underwent thyroid surgery. The average cost per nodule evaluated was $14,669 using ThyroSeq®, compared to $23,338 for diagnostic thyroid surgery. The cost per thyroid cancer case detected was $58,674 using ThyroSeq® compared to $62,233 for diagnostic thyroid surgery. We included 13 nodules Bethesda category IV that underwent ThyroSeq® and 11 that underwent diagnostic surgery. Of those submitted for ThyroSeq®, 6 were positive for mutation and underwent thyroid surgery. The average costs per nodule evaluated were $14,641 using ThyroSeq® and $24,345 using diagnostic thyroidectomy. The cost per thyroid cancer case detected was $31,721 when using ThyroSeq® compared to $53,560 for diagnostic thyroidectomy. CONCLUSION The use of ThyroSeq® in our institution is cost effective compared to diagnostic thyroid surgery for the evaluation of Bethesda categories III and IV (SFN) nodules. ABBREVIATIONS FNA = fine-needle aspiration; GEC = gene expression classifier; NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features; PTC = papillary thyroid cancer; SFN = suspicious for follicular neoplasia.
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Suchartlikitwong S, Ratanasrimetha P, Thavaraputta S, Jasti R, Lado-Abeal J, Rivas AM. BILATERAL ADRENAL MYELOLIPOMAS PRESENTING AS ACUTE ADRENAL INSUFFICIENCY IN AN ADULT WITH CONGENITAL ADRENAL HYPERPLASIA. AACE Clin Case Rep 2018. [DOI: 10.4158/accr-2017-0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sakolwan Suchartlikitwong
- From: 1Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Praveen Ratanasrimetha
- From: 1Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Subhanudh Thavaraputta
- From: 1Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Rahul Jasti
- Department of Radiology, University Medical Center, Lubbock, Texas, USA
| | - Joaquin Lado-Abeal
- Division of Endocrinology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Ana Marcella Rivas
- Division of Endocrinology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Akturk HK, Sotello D, Ameri A, Abuzaid AS, Rivas AM, Vashisht P. Toxoplasma Infection in an Immunocompetent Host: Possible Risk of Living with Multiple Cats. Cureus 2017; 9:e1103. [PMID: 28435763 PMCID: PMC5398893 DOI: 10.7759/cureus.1103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 32-year-old man presented with agitation, headache, and confusion. He was immunocompetent and had been living with multiple cats for many years. His vital signs were stable. He was afebrile. Multiple blood tests did not show any serious problem. Brain magnetic resonance imaging (MRI) revealed multiple ring-enhancing white matter lesions. Cerebrospinal fluid analysis did not show any signs of infection. Based on a presumptive diagnosis of multiple sclerosis, high-dose corticosteroid treatment was started. However, this caused worsening of the symptoms and increased the size of the lesions. Corticosteroids were discontinued and biopsy was done. Biopsy of the lesions confirmed Toxoplasma gondii infection, and treatment with pyrimethamine/sulfadiazine was initiated. Treatment decreased the size of the lesions dramatically. Toxoplasma infection of the central nervous system (CNS) is rare in immunocompetent hosts. Living with multiple cats is believed to be a risk factor for Toxoplasma infection in immunocompetent hosts.
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Affiliation(s)
- Halis Kaan Akturk
- Barbara Davis Center for Diabetes, University of Colorado-Anschutz Medical Campus
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11
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Abstract
The syndrome of impaired sensitivity to thyroid hormone, also known as syndrome of thyroid hormone resistance, is an inherited condition that occurs in 1 of 40,000 live births characterized by a reduced responsiveness of target tissues to thyroid hormone due to mutations on the thyroid hormone receptor. Patients can present with symptoms of hyperthyroidism or hypothyroidism. They usually have elevated thyroid hormones and a normal or elevated thyroid-stimulating hormone level. Due to their nonspecific symptomatic presentation, these patients can be misdiagnosed if the primary care physician is not familiar with the condition. This can result in frustration for the patient and sometimes unnecessary invasive treatment such as radioactive iodine ablation, as in the case presented herein.
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Affiliation(s)
- Ana Marcella Rivas
- Department of Medicine, Division of Endocrinology and Metabolism, Mayo Clinic, Jacksonville, Florida (Rivas); and the Department of Medicine, Division of Endocrinology, Texas Tech University Health Science Center, Lubbock, Texas (Lado-Abeal)
| | - Joaquin Lado-Abeal
- Department of Medicine, Division of Endocrinology and Metabolism, Mayo Clinic, Jacksonville, Florida (Rivas); and the Department of Medicine, Division of Endocrinology, Texas Tech University Health Science Center, Lubbock, Texas (Lado-Abeal)
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Abstract
We describe a 26-year-old man with metastatic choriocarcinoma who presented with hyperthyroidism associated with elevated β-human chorionic gonadotropin (B-HCG) and respiratory failure secondary to diffuse lung metastasis. After the first cycle of chemotherapy, the concentration of B-HCG dramatically decreased and the patient became euthyroid, allowing us to discontinue antithyroid medications. The patient's hyperthyroidism was caused by stimulation of the thyroid gland by high B-HCG levels, as shown by the marked improvement of the patient's thyroid function panel after chemotherapy.
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Affiliation(s)
- David Sotello
- Department of Internal Medicine (Sotello, Rivas), Division of Pulmonary/Critical Care Medicine (Test), and Division of Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
| | - Ana Marcella Rivas
- Department of Internal Medicine (Sotello, Rivas), Division of Pulmonary/Critical Care Medicine (Test), and Division of Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
| | - Victor J Test
- Department of Internal Medicine (Sotello, Rivas), Division of Pulmonary/Critical Care Medicine (Test), and Division of Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
| | - Joaquin Lado-Abeal
- Department of Internal Medicine (Sotello, Rivas), Division of Pulmonary/Critical Care Medicine (Test), and Division of Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
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Abstract
Measuring testosterone levels became easier in the 1970s, and it wasn't long before levels were being checked in men across all age groups. At that time, several authors reported an age-associated decline of serum testosterone levels beginning in the fourth or fifth decades of life. Other studies found that the decline in testosterone with age might be more related to comorbidities that develop in many aging men. Aggressive marketing campaigns by pharmaceutical companies have led to increased awareness of this topic, and primary care physicians are seeing more patients who are concerned about "low T." Unfortunately, testosterone replacement therapy has not been straightforward. Many men with low testosterone levels have no symptoms, and many men with symptoms who receive treatment and reach goal testosterone levels have no improvement in their symptoms. The actual prevalence of hypogonadism has been estimated to be 39% in men aged 45 years or older presenting to primary care offices in the United States. As the US population ages, this number is likely to increase. This article, targeted to primary care physicians, reviews the concept of late-onset hypogonadism, describes how to determine the patients who might benefit from therapy, and offers recommendations regarding the workup and initiation of treatment.
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Affiliation(s)
- Ana Marcella Rivas
- Departments of Internal Medicine (Rivas, Mulkey, Yarbrough) and Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
| | - Zachary Mulkey
- Departments of Internal Medicine (Rivas, Mulkey, Yarbrough) and Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
| | - Joaquin Lado-Abeal
- Departments of Internal Medicine (Rivas, Mulkey, Yarbrough) and Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
| | - Shannon Yarbrough
- Departments of Internal Medicine (Rivas, Mulkey, Yarbrough) and Endocrinology (Lado-Abeal), Texas Tech University Health Science Center, Lubbock, Texas
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Rivas AM, Rosales A, Sotello D, Lado-Abeal J. A Case of Thyrotoxicosis Complicated with Takotsubo Cardiomyopathy. VideoEndocrinology 2014. [DOI: 10.1089/ve.2014.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ana Marcella Rivas
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Alvaro Rosales
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - David Sotello
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joaquin Lado-Abeal
- Division of Endocrinology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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15
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Sotello D, Rivas AM, Nugent KM. Newly Diagnosed Acromegaly Presenting with Hypertriglyceridemic Pancreatitis with Normal Amylase and Lipase Levels. Proc (Bayl Univ Med Cent) 2014; 27:16-8. [DOI: 10.1080/08998280.2014.11929038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Fendrik AJ, Rivas AM, Sánchez MJ. Decay of quasibounded classical Hamiltonian systems and their internal dynamics. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 1994; 50:1948-1958. [PMID: 9962196 DOI: 10.1103/physreve.50.1948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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