ITALIAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS STATEMENT–REPLACEMENT THERAPY FOR PRIMARY HYPOTHYROIDISM: A BRIEF GUIDE FOR CLINICAL PRACTICE

2016 ◽  
Vol 22 (11) ◽  
pp. 1319-1326 ◽  
Author(s):  
Rinaldo Guglielmi ◽  
Andrea Frasoldati ◽  
Michele Zini ◽  
Franco Grimaldi ◽  
Hossein Gharib ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Replacement Therapy ◽  
Primary Hypothyroidism ◽  
Italian Association

Impact of different hemodiafiltration solutions on ionemia in long-term CRRT

2021 ◽  
pp. 039139882110432
Author(s):  
Federico Nalesso ◽  
Francesco Garzotto ◽  
Leda Cattarin ◽  
Georgie Innico ◽  
Laura Gobbi ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Balance Control ◽  
Kidney Injury ◽  
Critical Issue ◽  
University Hospital ◽  
Electrolyte Balance ◽  
Standard Clinical Practice ◽  
The Impact

Critical patients with Acute Kidney Injury (AKI) requiring renal replacement therapy are in most cases eligible only for continuous modalities where the electrolyte balance control is a critical issue. The standard solutions used for hemodiafiltration, containing potassium at 2 mmol/L and no phosphorus, determines during the extended renal replacement therapy hypokalemia and hypophosphatemia. Therefore, solutions containing potassium and phosphate in physiological concentrations were formulated to avoid electrolyte imbalances and reduce ion alterations in prolonged treatments, these solutions are not routinely used in the standard clinical practice. To avoid electrolyte imbalances, we have first introduced in our practice two different solutions and then we have retrospectively analyzed the electrolyte balance upon these two solutions in order to identity the impact of these solutions on potassium and phosphate according to our clinical practice. We retrospectively analyzed 96 patients treated with Continuous Renal Replacement Therapy (CRRT) in the intensive care units (ICU) at Padua’s University Hospital to evaluate the role on electrolyte balance of Phoxilium® and Prismasol 2® that differ in their composition and the need for electrolytes infusions. In the Phoxilium group the frequency of hypokalemia, hypophosphatemia, and the need of potassium and phosphate replacement were significantly reduced resulting in a reduction in complications, workload, and clinical risk associated with infusions of electrolytes. Our data demonstrated that the use of these two different hemodiafiltration solutions can reduce the occurrence of hypokalemia and hypophosphatemia during CRRT performing personalized treatments without the use of potassium and phosphate infusions.

National German Audit of Diagnosis, Treatment, and Teaching in Secondary Adrenal Insufficiency

2017 ◽  
Vol 49 (08) ◽  
pp. 580-588 ◽  
Author(s):  
Stephan Petersenn ◽  
Jürgen Honegger ◽  
Marcus Quinkler
Keyword(s):  
Clinical Practice ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Diagnostic Testing ◽  
Treatment Strategies ◽  
Serum Cortisol ◽  
National Audit ◽  
Secondary Adrenal Insufficiency ◽  
Endocrine Society ◽  
Great Heterogeneity

AbstractGreat heterogeneity seems to exist regarding diagnosis, therapy, and teaching of patients with secondary adrenal insufficiency (SAI) across Germany resulting in different diagnosis and treatment strategies. The aim of the work was to present the first national audit on diagnosis, treatment, and patient teaching of SAI reflecting common clinical practice in Germany. A self-designed questionnaire was sent via e-mail to all members of the German Endocrine Society (approx. 120 centers). Returned questionnaires (response rate 38.3%) were checked for duplicity of institutions and analyzed. Diagnostic testing focuses on those patients with relevant risk for adrenal insufficiency. Basal serum cortisol is mostly used as screening test. Short synacthen and CRH tests are the preferred confirmatory tests, however, cut-off values vary due to different assays used. Patients with radiation, second surgery, progressive disease or new symptoms are followed by serial re-testing. Perioperative management and frequency of postoperative re-evaluations differ among centers. Hydrocortisone is the preferred glucocorticoid for replacement therapy, but daily doses vary considerably (10–30 mg/day). Some centers perform hormone measurements for dose adjustment of glucocorticoid replacement therapy whereas others rely on clinical judgement. Patients’ teaching is done in 84% of centers, but only half of the centers include patients’ relatives. Homogeneity exists in patients’ teaching regarding intercurrent illnesses (fever, diarrhoea). Recommendations regarding dose adaptations in situations such as sport-activities, dental-procedures, or coughing are highly variable. This first national audit reveals great heterogeneity among German centers and could improve patients’ care in SAI, for example, by initiating new trials and developing clinical practice guidelines.

Patients receiving renal replacement therapy with hemodialysis and taking NSAIDS: real clinical practice

Nephrology ◽  
2021 ◽  
Vol 4_2021 ◽  
pp. 43-47
Author(s):  
A.P. Rebrov Rebrov ◽  
E.V. Grigoryeva Grigoryeva ◽  
G.S. Petrov Petrov ◽  
J.I. Vorobieva Vorobieva ◽  
M.S. Sitnikova Sitnikova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Real Clinical Practice

Resting Energy Expenditure in Obese Women with Primary Hypothyroidism and Appropriate Levothyroxine Replacement Therapy

2020 ◽  
Vol 105 (4) ◽  
pp. e1741-e1748 ◽  
Author(s):  
Emanuele Muraca ◽  
Stefano Ciardullo ◽  
Alice Oltolini ◽  
Francesca Zerbini ◽  
Eleonora Bianconi ◽  
...  
Keyword(s):  
Body Composition ◽  
Energy Expenditure ◽  
Replacement Therapy ◽  
Resting Energy Expenditure ◽  
Primary Hypothyroidism ◽  
Normal Serum ◽  
Fat Free Mass ◽  
Model Assessment ◽  
Obese Women ◽  
Resting Energy

Abstract Context Growing evidence suggests that appropriate levothyroxine (LT4) replacement therapy may not correct the full set of metabolic defects afflicting individuals with hypothyroidism. Objective To assess whether obese subjects with primary hypothyroidism are characterized by alterations of the resting energy expenditure (REE). Design Retrospective analysis of a set of data about obese women attending the outpatients service of a single obesity center from January 2013 to July 2019. Patients A total of 649 nondiabetic women with body mass index (BMI) > 30 kg/m2 and thyrotropin (TSH) level 0.4–4.0 mU/L were segregated into 2 groups: patients with primary hypothyroidism taking LT4 therapy (n = 85) and patients with normal thyroid function (n = 564). Main outcomes REE and body composition assessed using indirect calorimetry and bioimpedance. Results REE was reduced in women with hypothyroidism in LT4 therapy when compared with controls (28.59 ± 3.26 vs 29.91 ± 3.59 kcal/kg fat-free mass (FFM)/day), including when adjusted for age, BMI, body composition, and level of physical activity (P = 0.008). This metabolic difference was attenuated only when adjustment for homeostatic model assessment of insulin resistance (HOMA-IR) was performed. Conclusions This study demonstrated that obese hypothyroid women in LT4 therapy, with normal serum TSH level compared with euthyroid controls, are characterized by reduced REE, in line with the hypothesis that standard LT4 replacement therapy may not fully correct metabolic alterations related to hypothyroidism. We are not able to exclude that this feature may be influenced by the modulation of insulin sensitivity at the liver site, induced by LT4 oral administration.

scholarly journals Hypothyroidism with Ascites

1970 ◽  
Vol 10 (2) ◽  
pp. 121-123
Author(s):  
Md Titu Miah ◽  
Raihan Rotap Khan ◽  
Zannatun Nur ◽  
Syed Mohammad Ali Romel ◽  
Md Kamal Hossain Patwary ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Complete Resolution ◽  
Hormone Replacement ◽  
Primary Hypothyroidism ◽  
Thyroid Hormone Replacement ◽  
Thyroid Hormone Replacement Therapy ◽  
Unnecessary Procedures ◽  
Liver Biopsies ◽  
High Index Of Suspicion ◽  
Key Words Ascites

Primary hypothyroidism is a common clinical condition. Ascites caused by hypothyroidism is rare. So its diagnosis is often delayed and patients frequently receive unnecessary procedures such as liver biopsies and exploratory laparotomies. We report a male person of 58 years with hypothyroidism with ascites who responded well with thyroid hormone replacement therapy with complete resolution of ascites. Analyses of ascites from patients in this condition usually shows exudative ascites with high protein (>2.5 g/dL) and SAAG < 1.1 gm/dl. High index of suspicion is required to reach at such diagnosis. Though it is a rare but prognosis is excellent with replacement therapy. Key words: Ascites, Hypothyroidism.   doi: 10.3329/jom.v10i2.2828   J MEDICINE 2009; 10 : 121-123

Serum T4, T3, and TSH levels in primary hypothyroidism during replacement therapy with thyroxine

Metabolism ◽  
1983 ◽  
Vol 32 (8) ◽  
pp. 745-747 ◽  
Author(s):  
I.E. Brajkovich ◽  
K. Mashiter ◽  
G.F. Joplin ◽  
J. Cassar
Keyword(s):  
Replacement Therapy ◽  
Primary Hypothyroidism ◽  
Serum T4 ◽  
Tsh Levels

scholarly journals Patient Selection and Timing of Continuous Renal Replacement Therapy

2016 ◽  
Vol 42 (3) ◽  
pp. 224-237 ◽  
Author(s):  
Marlies Ostermann ◽  
Michael Joannidis ◽  
Antonello Pani ◽  
Matteo Floris ◽  
Silvia De Rosa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Patient Selection ◽  
Kidney Injury ◽  
Practice Variation ◽  
Standards Of Care ◽  
Future Research ◽  
Controversial Topic

When and in whom to initiate continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) remains a highly controversial topic with large practice variation around the world. Even within countries, practice variation exists and recommendations for clinical practice are not specific. In this article, we report the consensus recommendations for timing and patient selection for CRRT - the results of the 2016 Acute Disease Quality Initiative XVII conference on ‘precision CRRT'. We suggest that these recommendations could serve to develop the best clinical practice and standards of care for use of CRRT in patients with AKI. Finally, we identify and highlight the areas of ongoing uncertainty and propose an agenda for future research.

Sign in / Sign up

Export Citation Format

Share Document