BACKGROUND: To determine the thyroid ultrasound findings in association with anti-TPO positivity among patients with diffuse goiter.
DESIGN AND METHODS: We performed a cross-sectional study on patients with diffuse goiter seen at Makati Medical Center out-patient Endocrine clinics from October 1, 2011 to October 1, 2012. Patients with anti-TPO (thyroid peroxidase) above 100 pmol/L were considered anti-TPO positive and below this level were considered negative. After excluding patients with other possible causes of thyroiditis, thyroid ultrasound of anti-TPO positive and anti-TPO negative patients were reviewed and compared based on size, echogenicity, echopattern and vascularity of the thyroid parenchyma.
RESULTS: In 94 patients who qualified for the study, 43.6% were anti-TPO positive. A higher proportion of anti-TPO positive was seen among females compared to males by almost twofold (49.7% vs 25%, p0.05). Stratified according to age group for female patients, anti-TPO positivity is relatively higher among 31-50 years old (51.1%, p =0.753). Among male, anti-TPO positivity is present in all 18-2 years old which is significantly higher compared to other age group (p <0.01). Based on thyroid ultrasound findings, those with positive anti-TPO has
larger thyroid size in all measurement parameters (p= 0.0053). Among anti-TPO positive patients, frequent ultrasound findings were: hypoechoic (79% vs. 21%, p 0.001); heterogenous parenchyma (71% vs. 29%, p 0.001) and increased vascularity (93% vs. 7%, p 0.001). Of note is the absence of homogenous prenchyma fnding among anti-TPO positive. All 23 (100%) patients who showed combined findings of hypoechoic, heterogenous parenchyma and increased vascularity were anti-TPO positive.
CONCLUSION: Thyroid ultrasound findings that are found frequently among anti-TPO positive are increased thyroid size, parenchyma that are hypoechoiec and heterogenous and increased vascularity. Homogenous echotexture was not seen among anti-TPO positive. The combined sonographic characteristics of hypoechoic, heterogenous pattern and increased vascularity are highly suggestive of presence of anti-TPO (100%).

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Tpo Protein, Human ; Iodide Peroxidase ; Iron-binding Proteins ; Autoantigens ; Thyroiditis ; Goiter

Objective: To determine the association between serum 25-hydroxyvitamin D (25(OH)D) and measures of glycemic control, hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG), in adult patients with diabetes mellitus. Methodology: This is an analytical cross-sectional study of 270 patients with diabetes admitted to a tertiary hospital. Serum 25(OH)D levels were categorized as follows: sufficient (>30 ng/mL), insufficient (20 to 30 ng/mL), and deficient (<20 ng/mL). The correlation of HbA1c and FPG with serum 25(OH)D and other variables was determined using Spearman’s rho (ρ) coefficient. The risk factors associated with HbA1c ≥7% and FPG ≥126 mg/dL were determined using logistic regression analysis to generate crude and adjusted odds ratios. The null hypothesis was rejected at 0.05 α-level of significance. Results: The median serum 25(OH)D was 18.92 (range 3.56–56.3) ng/mL. Ninety percent (245 patients) had vitamin D levels below 30 ng/mL. This study showed that vitamin D level is significantly but weakly correlated with patient’s age (ρ=0.339) and duration of diabetes (ρ=0.147), whereas it had inverse correlations with BMI (ρ=-0.134), HbA1c (ρ=-0.261), and FPG (ρ=-0.198). Conclusion In this study, we found a possible association between vitamin D levels and measures of glycemic control among this group of adult Filipino patients with diabetes mellitus, but further investigations in other cohorts of individuals with diabetes are needed.
Vitamin D ; diabetes mellitus ; glycemic control

A 19-year-old Filipino male presents with recurrent respiratory tract symptoms every 4 to 5 months since childhood and sudden onset of diabetes type 1 with ketoacidosis. He had patchy hair loss which started at 7 years old, and was diagnosed with alopecia universalis. Thyroid antibodies and 21-hydroxylase antibody were normal. Common Variable Immunodeficiency with Polyglandular Autoimmune Syndrome IV was considered. The patient is on monthly intravenousimmunoglobulin therapy and basal bolus insulin regimen.
Common Variable Immunodeficiency ; Diabetes Mellitus

OBJECTIVES: The study examined the prevalence of elevated thyroid stimulating hormone (TSH) and its association with dyslipidemia and non-alcoholic fatty liver disease (NAFLD) among Filipino adults undergoing executive check-up.

METHODS: Clinical characteristics such as age, vital signs, anthropometrics, FBS, lipid profile, liver function tests, TSH and hepatobiliary ultrasound were reviewed from the charts of 580 patients to determine the prevalence of elevated TSH, NAFLD, and dyslipidemia. Binary logistic regression analysis was performed to determine association between TSH levels, NAFLD, and dyslipidemia.

RESULTS: The prevalence of elevated TSH was 3.10%. Patients with increased total cholesterol was approximately 4.18 times as likely (95% CI 1.20 to 14.61%, p = 0.025) to have elevated TSH. However, after adjusting for age and sex, we had insufficient evidence to demonstrate an association between NAFLD and lipid levels with elevated TSH levels.

CONCLUSION: The prevalence of elevated TSH in this group of patients from a highly urbanized area was 3.1%. We had insufficient evidence to demonstrate an association between NAFLD, lipid levels, and elevated TSH levels after adjusting for age and sex.

Human ; Male ; Female ; Middle Aged ; Thyrotropin ; Non-alcoholic Fatty Liver Disease ; Prevalence ; Liver Function Tests ; Dyslipidemias ; Hypercholesterolemia ; Digestive System ; Cholesterol ; Lipids

Objective: To identify factors independently associated with incomplete response to therapy based on the 2015 ATA guidelines in surgically treated Filipino patients with papillary thyroid carcinoma (PTC). Methodology: This is a retrospective cohort study of adults aged 21-74 years with papillary thyroid carcinoma (PTC) treated with surgery with or without radioactive iodine therapy (RAI) in Makati Medical Center from 2013 to 2017. We collected the following factors through a review of charts: age at diagnosis, gender, family history of thyroid cancer, date of surgery, tumor size, capsular/lymphovascular invasion, lymph node/distant metastases, stage, risk of recurrence, dose of post-surgical RAI therapy, initial post-treatment serum Thyroglobulin (Tg) and anti-Tg antibody levels (Negative Tg level: suppressed non-stimulated Tg <0.2 ng/mL or TSH-stimulated Tg <1 ng/mL; Positive Tg level: suppressed Tg ≥1 ng/mL or a TSH-stimulated Tg ≥10 ng/mL or rising anti-Tg antibody levels), thyroid stimulating hormone suppression, post-operative imaging studies and levothyroxine dose. Response to therapy was checked 6-24 months post-therapy. Results: We analyzed a total of 115 patients with PTC who underwent thyroidectomy. Patients who had family history of thyroid cancer were less likely to have an incomplete or indeterminate response (p=0.045). None of the patients with excellent response had lymphovascular invasion. Having a positive Tg (p=0.001) and positive anti-Tg postoperatively (p<0.001) were strongly associated with incomplete or indeterminate response. Conclusion Patients who were positive for thyroglobulin and anti-thyroglobulin post-operatively were strongly associated with incomplete or indeterminate response to therapy in PTC.
Thyroid Cancer, Papillary

INTRODUCTION: Dietary intervention remains an important factor in the management of diabetes mellitus, and many patients have employed herbs and oils to help manage their chronic diseases. Extra virgin olive oil (EVOO) is widely known for its cardio-vascular benefits. However, its effect on the blood glucose of type 2 diabetes mellitus patients has not been extensively studied. In this study, we aimed to determine if the addition of EVOO to meals results in a lower postprandial blood glucose among type 2 diabetes mellitus patients. METHODS: Thirteen patients were included in this randomized controlled cross-over trial. They were randomized to receive a meal with or without EVOO followed by a one week washout period, where they were given the other intervention. The primary outcome is the trans-meal blood glucose, which was calculated as the percent change in two-hour postprandial blood glucose. RESULTS: In group A, there was a noted 88.55% increase in two-hour postprandial blood glucose in taking meals with EVOO, versus 72.11% change in meals without EVOO. The same was observed in Group B, with a 71.08% and 49.22% increase in two-hour postprandial blood glucose in meals with EVOO and without EVOO, respectively. The difference was significant with a p-value of 0.044. Free fatty acids inhibit glucose transport and insulin secretion, this effect may be more predominant in asian type 2 diabetes mellitus patients. CONCLUSION: This study found that adding extra virgin olive oil on top of meals provided no additional benefit in terms of post-prandial glucose excursion.
Diet, Diabetic

Objectives: The study aimed to identify whether pre-operative glycosylated hemoglobin level (HbA1c) and fasting blood sugar (FBS) can be used as markers for the development of acute kidney injury (AKI) in the immediate post-operative period of type 2 diabetic patients after elective abdominal surgery.

Methods: This retrospective cohort pilot study included seventy-four diabetic patients who underwent elective abdominal surgery from 2015 to 2018. HbA1c and FBS, demographic data, comorbidities, type and indication of surgery, and treatment history were correlated with the development of AKI using logistic regression analysis.

Results: In this cohort, 12% of subjects developed AKI. Univariate and multivariate logistic regression analysis, however, showed that neither HbA1c and FBS nor other studied factors were predictive for the occurrence of AKI (OR 2.55, p= 0.26 and OR 0.64, p= 0.72 respectively).

Conclusion: Pre-operative HbA1c and one-time FBS values in diabetic patients undergoing elective abdominal surgery procedures were not statistically predictive of AKI in the present data. However, the observed trend towards the risk of AKI among the elevated HbA1c subset of patients should drive further studies with a greater sample size and of a prospective nature looking at other metabolic factors contributing to AKI.

Pre-operative Glycosylated Hemoglobin Level ; Fasting Blood Sugar ; Acute Kidney Injury

OBJECTIVE: To review cases of adult patients who develop Hungry Bone Syndrome (HBS) after parathyroidectomy for Primary Hyperparathyroidism (PHPT) in a tertiary care center in the Philippines and describe the clinical features, pre-operative preventive measures done and risk factors for HBS.
METHODS:
Design: Retrospective Case Note Review
Setting: Tertiary Private Hospital
Participants: Chart review of adult Filipino patients who underwent parathyroidectomy for PHPT at Makati Medical Center from January 2011 to December 2016 was conducted and evaluated according to the inclusion and exclusion criteria. Medical information obtained included clinical parameters, biochemical results, operation performed, pathology, length of hospital stay and complications if with any.
RESULTS: From among 20 adult Filipino patients (mean age 55 years; 13, 65% female) who underwent parathyroidectomy for PHPT, HBS was found in 7 (35%). Most common pre-operative symptoms of hypercalcemia were musculoskeletal complaints. To prevent HBS, all were hydrated prior to surgery while some were given bisphosphonates and diuretics. The most common parathyroid gland imaging used for pre-procedure localization was Tc 99m Sestamibi scan with single photon emission computed tomography (SPECT) and 19 (95%) had parathyroid adenoma on post-operative histopathologic report. Among biochemical and clinical factors that may be risk factors for HBS, those with HBS had significantly lower pre-operative 25-hydroxyvitamin D, higher BUN, phosphate and alkaline phosphatase (ALP) than those without HBS. Of these, only ALP showed significant association with HBS (OR = 107.17, p = <0.0001). Length of hospital stay was longer among those with HBS although not statistically significant.
CONCLUSION: Knowledge on post-parathyroidectomy HBS for PHPT may aid clinicians on preoperative prevention and post-operative monitoring. Thirty-five percent (7) of our patients presented with HBS post-parathyroidectomy for PHPT from 2011 to 2016. An abnormal ALP level pre-operatively may be a risk factor in developing HBS post-parathyroidectomy for PHPT

Human ; Male ; Female ; Middle Aged ; Adult ; Hyperparathyroidism, Primary ; Parathyroidectomy ; Parathyroid Neoplasms ; Alkaline Phosphatase ; Parathyroid Glands ; Hypercalcemia ; Diphosphonates ; Diuretics ; Blood Urea Nitrogen ; Calcifediol ; 25-hydroxyvitamin D ; Vitamin D

Background: Although elevated glucose levels are associated with adverse outcomes in the critically ill, HbA1c-based adjusted glycemic variables have not been extensively utilized as a tool to evaluate patients in the acute critical condition. Objective: This study aims to determine whether glycemic gap can predict adverse outcomes in patients with type 2 diabetes diagnosed with COVID-19. Methodology: A single center and retrospective study of adult patients with type 2 diabetes diagnosed with COVID- 19. Glycemic gap was calculated as the difference between the admission blood glucose and A1c‐derived average glucose. Logistic regression was used to determine association of glycemic gap and several adverse clinical outcomes. A decision curve analysis was used to determine the clinical utility of a clinical decision model based on this cut-off. Results: A total of 150 diabetic patients with COVID-19 were analyzed. Median baseline HbA1c was 7.5% (range 4.79–18.42), while median admitting blood glucose was 196 (range 71–506) mg/dL. From these, computed glycemic gaps ranged from -180.5 to 312.8 mg/dL, with a median of 13.75 mg/dL. On univariate analysis, for every unit increase in glycemic gap, odds of developing ARDS increased five times (cOR 4.798, 95% CI 2.08 to 11.09); odds of developing shock increased four times (cOR 4.48, 95% CI 1.48 to 13.44). No single cut-off value for glycemic gap was able to discriminate patients with favorable outcome from those with adverse outcome. The decision curve analysis graphically shows that glycemic gap has a positive net benefit for threshold risk of 50% or higher. Conclusion Higher glycemic gaps were significantly associated with increased risk for poor outcomes in diabetic patients with COVID-19. Glycemic gap should be correlated with clinical status and other laboratory parameters to make it a more powerful discriminant among COVID-19 infected patients.
Diabetes Mellitus, Type 2 ; COVID-19