MyMedR

Fulltext The Prevalence of Advanced Liver Fibrosis Among Patients With Type 2 Diabetes Mellitus: A Single-Centre Experience in Penang, Malaysia

Lee XH, Nor LM, Ang CS, Yeow TP, Lim SL

J ASEAN Fed Endocr Soc, 2023;38(1):52-61.

PMID: 37252406 DOI: 10.15605/jafes.038.01.08

OBJECTIVES: Type 2 diabetes mellitus (T2DM) is an important risk factor for Non-alcoholic fatty liver disease (NAFLD). It worsens the course of NAFLD. We investigated the prevalence of advanced liver fibrosis among patients with T2DM. Our secondary objectives were to describe patient demographics, to explore associated clinical factors, and to compare FIB-4 Index and liver stiffness measurement (LSM).

METHODOLOGY: This was a cross-sectional study on 258 patients with T2DM duration of at least 10 years. Transient elastography (FibroScan®) was performed on all subjects. Advanced liver fibrosis was diagnosed based on LSM results. The FIB-4 index formula was used.

RESULTS: The prevalence of advanced liver fibrosis was 22.1%. Associated factors were body mass index (BMI), alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT), triglyceride (TG) and high-density lipoprotein (HDL) cholesterol. Independent factors were BMI and GGT (p=0.003 and p<0.001). FIB-4 index has 30.0% sensitivity, 85.0% specificity, 38.7% positive predictive value, and 79.4% negative predictive value in detecting advanced liver fibrosis by LSM criteria.

CONCLUSION: Our study confirmed the high prevalence of advanced liver fibrosis among patients with long-standing T2DM. This study suggests the benefit of advanced liver fibrosis screening in patients with a minimum of 10 years of T2DM, especially those with high BMI and GGT.

Fulltext Thyroid Storm with Acute Flaccid Quadriparesis due to Thyrotoxic Myopathy: A Case Report

Tee HC, Khoo SSK, Fung YK

J ASEAN Fed Endocr Soc, 2020;35(1):118-121.

PMID: 33442179 DOI: 10.15605/jafes.035.01.20

Thyrotoxicosis is a well-recognized cause of myopathy, but rarely presents as acute flaccid quadriparesis. We report a 25-year-old female with underlying uncontrolled Graves' disease who presented with thyroid storm and acute flaccid quadriparesis due to thyrotoxic myopathy. She showed marked clinical improvement with subsequent normalization of her thyroid parameters. Besides highlighting this rare association, this report underscores the importance of considering thyrotoxic myopathy in the evaluation of patients with acute flaccid quadriparesis.

Fulltext Transient Pseudohypoaldosteronism in an Infant: A Case Report

Latt TN, Rahman SI, Nor NSM

J ASEAN Fed Endocr Soc, 2018;33(1):45-48.

PMID: 34400852 DOI: 10.15605/jafes.033.01.07

Transient pseudohypoaldosteronism is strongly linked to urinary tract infections complicating structural urinary tract anomalies. A 3-month-old baby girl with hyponatremia, hyperkalemia and metabolic acidosis associated with urinary tract infection and structural urinary tract anomalies was diagnosed with transient pseudohypoaldosteronism following elevated serum aldosterone and normal 17-hydroxyprogesterone level. Electrolytes normalized with corrections and antibiotic therapy. Clinicians should have a high index of suspicion for transient pseudohypoaldosteronism in an infant presenting with hyponatremia, hyperkalemia and urinary tract infection with or without associated urinary tract anomalies.

Fulltext Use of Combination of Oral Levothyroxine and Liothyronine in Severe Hypothyroidism With Massive Pericardial Effusion

Wong PS, Lim SW, Tong CV, Mohamad M, Hussein Z

J ASEAN Fed Endocr Soc, 2022;37(2):106-112.

PMID: 36578894 DOI: 10.15605/jafes.037.02.17

Thyroid hormone plays an important role in cardiovascular function. Pericardial effusions are commonly seen in cases of severe hypothyroidism. However, large to massive pericardial effusions with cardiac tamponade are exceptionally rare. Herein, we present two cases of severe hypothyroidism with massive pericardial effusion. Our first case demonstrates that a patient with large pericardial effusion can be managed conservatively with aggressive thyroid hormone replacement therapy. In our second case, pericardiocentesis was performed in addition to thyroid hormone replacement therapy as the underlying aetiology of effusion could not be reasonably limited to hypothyroidism. These two cases served to highlight and demonstrate rapid normalisation of thyroid function test by using aggressive oral thyroid hormone replacement therapy using liothyronine, in combination with levothyroxine, which led to resolution of pericardial effusion and prevent its re-accumulation.

Fulltext Weathering the Crisis: A Case of Thyroid Crisis with Propranolol-Induced Circulatory Collapse Successfully Treated with Therapeutic Plasma Exchange

Cheah JM, Ng D, Low MY, Foo SH

J ASEAN Fed Endocr Soc, 2019;34(2):206-209.

PMID: 33442157 DOI: 10.15605/jafes.034.02.12

Thyroid crisis is a life-threatening form of thyrotoxicosis characterized by multi-system dysfunction. Therapeutic plasma exchange has been reported to be effective in removing excessive circulating thyroid hormones. We present a 46-year-old female with recently diagnosed Graves' disease associated with thyrotoxic cardiomyopathy admitted for thyroid crisis complicated by propranolol-induced circulatory collapse, acute kidney injury and ischemic hepatitis. The tachyarrhythmia was refractory to conventional therapy. Initiation of TPE resulted in rapid clinical and biochemical stabilization.

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