バセドウ ビョウ ト ハカイセイ コウジョウセン エン ノ ショシンジ ニオケル ジンソク カンベツホウ

[目的]バセドウ病 (GD) と破壊性甲状腺炎 (DT) の迅速鑑別法にはTSHレセプター抗体の有無,甲状腺エコー検査,遊離T3/T4 (FT3/FT4),総T3/T4比 (T3/T4),総ALP (T-ALP),甲状腺血流が有用とされている.そのうち最も鋭敏な指標となりうる項目を検討した.[方法]2007年から未治療で当科を受診したGD:15名,無痛性甲状腺炎(PT):8名,亜急性甲状腺炎( SAT):10名( DT:18名) を対象として,FT3/FT4,T3/T4,T-ALP,上甲状腺動脈平均血流速度( mean velocity STA) を測定した.[結果]年齢:GD51.2± 18.8歳,DT49.3±21.0歳,FT3/FT4:GD3.3±1.0,DT2.9±1.9,T3/T4:GD15.9±4.7,DT15.2± 3.3,T-ALP( U/l):GD431.3 ±196.6,DT299.1±163.2,mean velocitySTA( cm/s):GD65.0±8.7,DT41.0± 7.0,(P < 0.0001).[結論]今回の検討ではmean velocity STA がGD とDT の鑑別に最も有用であった.It is important to make a rapid differentialdiagnosis of Graves\u27Diseases (GD) and Destructive Thyroiditis(DT). However, it is often difficult to make a distinctionwithout measurement of radioactive iodine uptake(RAIU). Instead of measurement of RAIU, measuringFreeT3/FT4ratio (FT3/FT4), totalT3/T4ratio (T3/T4),total alkaline phosp hatase activity( T-ALP), blood flow inthe thyroid, is useful for differential diagnosis. We searchedfor the parameters is most sensitive parameter for rapiddifferential diagnosis.Patients and Methods:We investigated on 33 patientswith untreated hyperthyroidism (15 with GD and 18 withDT). When 33 patients were first seen in our hospital, wemeasured FT3/FT4, T3/T4, T-ALP, and mean velocity inthe superior thyroid arteries( STA).Results:In comparison between GD and DT, mean velocitySTA was significantly increased in patients with GD.In the group of GD, FT3/FT4 and T-ALP tend to be higherin patients with GD but without statistical significance.Conclusion:Mean velocity STA might be the most sensitiveparameter for rapid differential diagnosis of GD andDT

Severe Hypoglycemia Accompanied with Thyroid Crisis

We report a 32-year-old Japanese women with severe hypoglycemia accompanied with thyroid crisis. She complained of dyspnea, general fatigue, and leg edema. She was diagnosed with hyperthyroidism with congestive heart failure and liver dysfunction. Soon after admission, sudden cardiopulmonary arrest occurred. She was then transferred to the intensive care unit. Her serum glucose level was 7 mg/dl. Intravenous glucose, hydrocortisone, diuretics, and continuous hemodiafiltration (CHDF) saved her. We considered that hypoglycemia occurred due to heart failure and liver dysfunction due to thyroid crisis

Long-Term Tailor-Made Exercise Intervention Reduces the Risk of Developing Cardiovascular Diseases and All-Cause Mortality in Patients with Diabetic Kidney Disease

This study aimed to determine the effect of long-term exercise on the risk of developing cardiovascular diseases (CVD) and all-cause mortality in patients with diabetic kidney disease (DKD). A single-center, prospective intervention study using propensity score matching was performed over 24 months. The intervention group (n = 67) received six months of individual exercise instruction from a physical therapist, who performed aerobic and muscle-strengthening exercises under unsupervised conditions. New events were defined as the composite endpoint of stroke or CVD requiring hospitalization, initiation of hemodialysis or peritoneal dialysis, or all-cause mortality. The cumulative survival rate without new events at 24 months was significantly higher in the intervention group (0.881, p = 0.016) than in the control group (n = 67, 0.715). Two-way analysis of variance revealed a significant effect of the group factor on high density lipoprotein-cholesterol (HDL-C) which was higher in the intervention group than in the control group (p = 0.004); eGFRcr showed a significant effect of the time factor, which was lower at 24 months than before intervention (p = 0.043). No interactions were observed for all items. In conclusion, aerobic exercises combined with upper and lower limb muscle strengthening for six months reduce the risk of developing CVD and all-cause mortality in patients with DKD

Long-term safety and efficacy of alogliptin, a DPP-4 inhibitor, in patients with type 2 diabetes: a 3-year prospective, controlled, observational study (J-BRAND Registry)

Introduction Given an increasing use of dipeptidyl peptidase-4 (DPP-4) inhibitors to treat patients with type 2 diabetes mellitus in the real-world setting, we conducted a prospective observational study (Japan-based Clinical Research Network for Diabetes Registry: J-BRAND Registry) to elucidate the safety and efficacy profile of long-term usage of alogliptin.Research design and methods We registered 5969 patients from April 2012 through September 2014, who started receiving alogliptin (group A) or other classes of oral hypoglycemic agents (OHAs; group B), and were followed for 3 years at 239 sites nationwide. Safety was the primary outcome. Symptomatic hypoglycemia, pancreatitis, skin disorders of non-extrinsic origin, severe infections, and cancer were collected as major adverse events (AEs). Efficacy assessment was the secondary outcome and included changes in hemoglobin A1c (HbA1c), fasting blood glucose, fasting insulin and urinary albumin.Results Of the registered, 5150 (group A: 3395 and group B: 1755) and 5096 (3358 and 1738) were included for safety and efficacy analysis, respectively. Group A patients mostly (&gt;90%) continued to use alogliptin. In group B, biguanides were the primary agents, while DPP-4 inhibitors were added in up to ~36% of patients. The overall incidence of AEs was similar between the two groups (42.7% vs 42.2%). Kaplan-Meier analysis revealed the incidence of cancer was significantly higher in group A than in group B (7.4% vs 4.8%, p=0.040), while no significant incidence difference was observed in the individual cancer. Multivariate Cox regression analysis revealed that the imbalanced patient distribution (more elderly patients in group A than in group B), but not alogliptin usage per se, contributed to cancer development. The incidence of other major AE categories was with no between-group difference. Between-group difference was not detected, either, in the incidence of microvascular and macrovascular complications. HbA1c and fasting glucose decreased significantly at the 0.5-year visit and nearly plateaued thereafter in both groups.Conclusions Alogliptin as a representative of DPP-4 inhibitors was safe and durably efficacious when used alone or with other OHAs for patients with type 2 diabetes in the real world setting