Background: Low free T4 and normal/low TSH concentrations are often noted in clinical practice and denote presence of “Euthyroid Sick Syndrome” or Central Hypothyroidism. However, accurate diagnosis is difficult eve...Background: Low free T4 and normal/low TSH concentrations are often noted in clinical practice and denote presence of “Euthyroid Sick Syndrome” or Central Hypothyroidism. However, accurate diagnosis is difficult even with determination of free T3 being low/normal in both. Repeated determination of these tests may help differentiate between these disorders. Objective: Evaluation of reverse T3 to differentiate between “Euthyroid Sick Syndrome” and Central Hypothyroidism. Subjects and Methods: Free T3 and Reverse T3 were determined as “add on” tests using previously drawn blood samples of 78 consecutive adults showing low free T4, 0.80 ± 0.02 and low/normal TSH, 1.29 ± 0.40 [normal ranges, 0.89 - 1.70 mcg/dl;0.45 - 4.67 uU/ml]. Free T4, free T3, TSH and reverse T3 levels were also determined in age-matched 35 healthy volunteers and reassessed in study group. Statistical analyses for comparisons were conducted between groups. All data are reported as Mean ± SEM. Results: Reverse T3 established two distinct groups: 1) subnormal concentrations, 8.31 ± 0.52 [range, 11 - 14 ng/dl];2) supernormal levels;32 ± 4 [normal Range 12 - 26]. Free T3 concentrations were subnormal or normal, 1.6 - 2.9 [normal range, 2.3 - 4.2 ng/ml] in individuals amongst both groups. On reassessment after 3 - 6 weeks, free T4, free T3, TSH and reverse T3 normalized in group with normal or elevated reverse T3 indicating recovery from “Euthyroid Sick Syndrome” whereas free T4 and reverse T3 remained subnormal in the other group suggesting presence of Central Hypothyroidism. Conclusion: Reverse T3 is a reliable laboratory test differentiating between Central Hypothyroidism and “Euthyroid Sick Syndrome” in subjects with low free T4 and low/normal TSH levels.展开更多
Background: The major effect of Exenatide is attributed to lowering of post-prandial glycemia, whereas insulin glargine mainly improves fasting glycemia [FPG]. Objective: Therefore, we assessed effect of Exenatide adm...Background: The major effect of Exenatide is attributed to lowering of post-prandial glycemia, whereas insulin glargine mainly improves fasting glycemia [FPG]. Objective: Therefore, we assessed effect of Exenatide administration at 6 months and for at 1 year on glycemic control, lipids, body weight [BW], daily insulin dose and hypoglycemic events. Methods: Records of 164 subjects, 126 men and 38 women administered Exenatide between January 2011 and December 2013 are included in this report. Exenatide was initiated at 5 mcg subcutaneously twice daily [BID] in obese subjects, BMI > 30 kg/m2, with C-peptide > 1 ng/d, and HbA1c 7.5% - 9.5%, while receiving daily metformin 2000 mg, Sulfonylurea Glimepiride 8 mg and insulin Glargine [GLAR]. Exclusion criteria were creatinine > 1.5 mg/dL and liver enzymes > 2.5 times upper limit of normal. Indices of glycemic control include fasting plasma glucose levels and HbA1c. Lipids include serum concentrations of total, LDL and HDL cholesterol. Other endpoints are body weight, daily insulin dose and number of hypoglycemic events per patient during 4 weeks prior to initiation of Exenatide, at 6 months and 1 year of therapy. Results: In 37 subjects, Exenatide was discontinued within 1 - 3 weeks;29 due to onset of nausea and vomiting. Seven of these also complained of abdominal pain and in these, serum amylase and lipase were elevated indicating presence of acute pancreatitis. One subject discontinued because of chest pain. Fasting plasma Glucose remained unchanged following Exenatide administration. However, HbA1c declined significantly denoting improvement in overall glycemic control without significant changes in body weight, daily insulin dose and hypoglycemic events. Lipid panel improved as well. Conclusion: Exenatide may be an appropriate adjuvant option in obese subjects with Type 2 diabetes mellitus with lack of desirable glycemic control while receiving therapy with Metformin, Glimepiride, and insulin Glargine. Moreover, improvement in glycemic control is likely to be secondary to lowering of post prandial hyperglycemia induced by Exenatide.展开更多
文摘Background: Low free T4 and normal/low TSH concentrations are often noted in clinical practice and denote presence of “Euthyroid Sick Syndrome” or Central Hypothyroidism. However, accurate diagnosis is difficult even with determination of free T3 being low/normal in both. Repeated determination of these tests may help differentiate between these disorders. Objective: Evaluation of reverse T3 to differentiate between “Euthyroid Sick Syndrome” and Central Hypothyroidism. Subjects and Methods: Free T3 and Reverse T3 were determined as “add on” tests using previously drawn blood samples of 78 consecutive adults showing low free T4, 0.80 ± 0.02 and low/normal TSH, 1.29 ± 0.40 [normal ranges, 0.89 - 1.70 mcg/dl;0.45 - 4.67 uU/ml]. Free T4, free T3, TSH and reverse T3 levels were also determined in age-matched 35 healthy volunteers and reassessed in study group. Statistical analyses for comparisons were conducted between groups. All data are reported as Mean ± SEM. Results: Reverse T3 established two distinct groups: 1) subnormal concentrations, 8.31 ± 0.52 [range, 11 - 14 ng/dl];2) supernormal levels;32 ± 4 [normal Range 12 - 26]. Free T3 concentrations were subnormal or normal, 1.6 - 2.9 [normal range, 2.3 - 4.2 ng/ml] in individuals amongst both groups. On reassessment after 3 - 6 weeks, free T4, free T3, TSH and reverse T3 normalized in group with normal or elevated reverse T3 indicating recovery from “Euthyroid Sick Syndrome” whereas free T4 and reverse T3 remained subnormal in the other group suggesting presence of Central Hypothyroidism. Conclusion: Reverse T3 is a reliable laboratory test differentiating between Central Hypothyroidism and “Euthyroid Sick Syndrome” in subjects with low free T4 and low/normal TSH levels.
文摘Background: The major effect of Exenatide is attributed to lowering of post-prandial glycemia, whereas insulin glargine mainly improves fasting glycemia [FPG]. Objective: Therefore, we assessed effect of Exenatide administration at 6 months and for at 1 year on glycemic control, lipids, body weight [BW], daily insulin dose and hypoglycemic events. Methods: Records of 164 subjects, 126 men and 38 women administered Exenatide between January 2011 and December 2013 are included in this report. Exenatide was initiated at 5 mcg subcutaneously twice daily [BID] in obese subjects, BMI > 30 kg/m2, with C-peptide > 1 ng/d, and HbA1c 7.5% - 9.5%, while receiving daily metformin 2000 mg, Sulfonylurea Glimepiride 8 mg and insulin Glargine [GLAR]. Exclusion criteria were creatinine > 1.5 mg/dL and liver enzymes > 2.5 times upper limit of normal. Indices of glycemic control include fasting plasma glucose levels and HbA1c. Lipids include serum concentrations of total, LDL and HDL cholesterol. Other endpoints are body weight, daily insulin dose and number of hypoglycemic events per patient during 4 weeks prior to initiation of Exenatide, at 6 months and 1 year of therapy. Results: In 37 subjects, Exenatide was discontinued within 1 - 3 weeks;29 due to onset of nausea and vomiting. Seven of these also complained of abdominal pain and in these, serum amylase and lipase were elevated indicating presence of acute pancreatitis. One subject discontinued because of chest pain. Fasting plasma Glucose remained unchanged following Exenatide administration. However, HbA1c declined significantly denoting improvement in overall glycemic control without significant changes in body weight, daily insulin dose and hypoglycemic events. Lipid panel improved as well. Conclusion: Exenatide may be an appropriate adjuvant option in obese subjects with Type 2 diabetes mellitus with lack of desirable glycemic control while receiving therapy with Metformin, Glimepiride, and insulin Glargine. Moreover, improvement in glycemic control is likely to be secondary to lowering of post prandial hyperglycemia induced by Exenatide.
