Case Report and#58; A Rare Case of Central Hyperthyroidism During Pregnancy and#45; Diagnostic And Therapeutic Challenge

Central hyperthyroidism is a rare cause of hyperthyroidism. It causes autonomous TSH secretion and is refractory to the negative feedback of thyroid hormones. Most patients with TSH secreting adenomas are diagnosed around the fifth decade of life. Here we present a case of a TSH secreting adenoma detected during the second trimester of pregnancy. We also present the challenges faced in diagnosing and treating the case because the patient refused neurosurgery till she delivered the baby. She was managed medically and successfully delivered a healthy baby via normal vaginal delivery. She was referred to neurosurgery after delivery.nbs

Obesity, inflammatory and thrombotic markers, and major clinical outcomes in critically ill patients with COVID‐19 in the US

Objective This study aimed to determine whether obesity is independently associated with major adverse clinical outcomes and inflammatory and thrombotic markers in critically ill patients with COVID‐19. Methods The primary outcome was in‐hospital mortality in adults with COVID‐19 admitted to intensive care units across the US. Secondary outcomes were acute respiratory distress syndrome (ARDS), acute kidney injury requiring renal replacement therapy (AKI‐RRT), thrombotic events, and seven blood markers of inflammation and thrombosis. Unadjusted and multivariable‐adjusted models were used. Results Among the 4,908 study patients, mean (SD) age was 60.9 (14.7) years, 3,095 (62.8%) were male, and 2,552 (52.0%) had obesity. In multivariable models, BMI was not associated with mortality. Higher BMI beginning at 25 kg/m2 was associated with a greater risk of ARDS and AKI‐RRT but not thrombosis. There was no clinically significant association between BMI and inflammatory or thrombotic markers. Conclusions In critically ill patients with COVID‐19, higher BMI was not associated with death or thrombotic events but was associated with a greater risk of ARDS and AKI‐RRT. The lack of an association between BMI and circulating biomarkers calls into question the paradigm that obesity contributes to poor outcomes in critically ill patients with COVID‐19 by upregulating systemic inflammatory and prothrombotic pathways