MedicoTips.Com

Amiodarone has high iodine content, because of the high iodine content it may affect the thyroid gland. It can either cause hypothyroidism or thyrotoxicosis. Approximately 1 out of every 6 patients who are using amiodarone develops thyroid dysfunction. 1. Amiodarone-induced hypothyroidism (AIH).  If a patient's TSH is high and Free T4 is low, it means the patient has developed hypothyroidism. In this situation, start thyroxine and if possible amiodarone should be stopped, but it is not necessary, if the patient still has symptoms such as ventricular tachycardia or arrhythmias then you may continue amiodarone, just add thyroxine and monitor thyroid function every 6 weeks first then maybe after 3 months or 6 months, depending on the clinical scenario. 2. Amiodarone-induced thyrotoxicosis (Hyperthyroidism).  If the patient has developed hyperthyroidism, then it is advised to stop amiodarone and start an anti-thyroid drug such as carbimazole, if it is type 1 amiodarone-indu...

Chronic kidney disease, in its later stages, may cause hyperphosphatemia. Hyperphosphatemia promotes the bone resorption and tend to increase the amount of calcium in vessels and increases the risk of vascular calcification. Parathyroid hormone also increases in chronic kidney disease which also promotes bone resorption, hypercalcemia, and vascular calcification. Vitamin D 3, if given in a patient who has hyperphosphatemia, may actually promote bone resorption and vascular calcification if PTH is more than 100. So if there is hyperphosphatemia, vitamin D should be given along with a phosphate binder such as sevelamer if the calcium-phosphate product is more than 55. If Calcium phosphate product is more than 55, it means you shouldn't give calcium-based phosphate binders such as calcium acetate, instead start the patient on Sevelamer. But if Calcium phosphate product is less than 55 then give patient calcium acetate as a phosphate binder. Decide the dose of vitamin D based on PT...

Acromegaly is a condition which results due to excess of growth hormone. Growth hormone is secreted by the anterior lobe of the pituitary gland under the influence of growth hormone releasing hormone which is secreted by the hypothalamus. Causes of acromegaly.  In 90% of cases, the cause of growth hormone excess or acromegaly is Pituitary adenoma while other 10% causes include; Ectopic secretion of growth hormone or growth hormone releasing hormone by some tumour. Diagnosis of Acromegaly It is diagnosed by the clinical features, which include; large spade-like hands, frontal bossing, large jaw and gigantism. IGF 1 and growth hormone level are raised and MRI of the brain usually show pituitary adenoma.  Treatment of Acromegaly.  Any of the following regimens can be tried.  Surgery is the first line: Transsphenoidal resection of pituitary adenoma is the first line treatment, and usually cure the disease.  Dopamine agonists, for example, bromocr...

Carbimazole (Neo-Mercazole), an antithyroid drug, which is used as a first line agent to treat hyperthyroidism, has a half-life of 5.3 hours. It can be given as a single daily dose or in divided doses. Some physicians, recommend divided dose to minimize the gastrointestinal side effects, while the other physicians, recommend a single daily dose for better compliance. Research studies showed that the efficacy of carbimazole (Neomercazole) when taken as a single dose per day or in divided doses, is similar or comparable. The single daily dose of Neomercazole is found to be superior to "Divided-dose" method as it is associated with better compliance. It may be difficult for patients to remember taking the divided doses. Sometimes, the patient may forget to take the evening dose. So a single daily dose is especially effective for those patients who find it difficult to remember the timings of divided dose. Conclusion : A single daily dose of Carbimazole is superior to a di...

MBBS ( University of Peshawar ) Gold Medalist,  MRCS I ( RCSI ) , MRCS Ed ( RCSEd ), MRCS Glasg ( RCPSG ), MRCS Eng (RCSEng), FRCS Section 1 (RCSEng), ACLS ( AHA ),  EBCC ( RCSEd ), ATLS ( USA ), CCrISP (RCSEng) Senior Registrar Breast & General Surgery HSE Ireland ·          FRCS (Eng)                                                                  Colorectal Surgery                            Royal College of  Surgeons of England ,              ...