Atherogenic Cholesterol Reduction

National Lipid Association published part 1 of guidelines in April 2015. Please find below key recommendations and rationales on significance of atherogenic cholesterol reduction in preventing coronary heart disease. Text has been slightly modified for easier and succinct reading.

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Lipid Guidelines: Root Cause

National Lipid Association published part 1 of guidelines in April 2015. Please find below a key recommendation and rationale regarding ApoB, non-HDL and LDL as root cause of cardiovascular disease.  Text has been slightly modified for easier and succinct reading.

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Bariatric Surgery in patients with type 2 diabetes

A major study published in New England Journal of Medicine in February 2017 shows that bariatric surgery, either RY bypass or sleeve gastrectomy, is superior to medications alone in lowering A1c, body weight, triglycerides, HDL, insulin use and improving quality of life in adults with type 2 diabetes.

A group of 150 patients with baseline A1c 9.2% were randomized to receive surgery plus medications or medications alone. Participants were followed for 5 years. No major surgical adverse events were seen.

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2017 ATA Guidelines: Thyroid & Pregnancy (Part 2)

ATA has “developed evidence-based recommendations to inform clinical decision making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders”

Part 2 of recommendations are listed with slightly modified wording for easier and succinct reading:

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2016 Endocrine Society Guidelines: Central Hypothyroidism

Central Hypothyroidism is a very rare cause of reduced thyroid production, mainly secondary to pituitary anomaly. Infections, tumors, cysts, autoimmunity, surgery and radiation are usually responsible for the abnormal TSH secretion by the pituitary gland.

Endocrine Society released guidelines on diagnosis and management of central hypothyroidism in November 2016. Please find below excerpts with slightly modified wording for easier and succinct reading.

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Bihormonal Bionic Pancreas – using both insulin and glucagon

This study demonstrates a great advancement in the field of type 1 diabetes. A full artificial pancreas, called “bihormonal bionic” shows superior results compared to the traditional CGM-assisted insulin pump.

The bihormonal system utilizes both insulin and glucagon to maintain steady blood glucose levels, resulting in better glycemic control with less hypoglycemia. No carbohydrate counting is needed by the patient. Although of short duration, 11 days, the results are very promising.

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Hyperthyroidism in the womb – a rare case.

This publication reports a rare and counterintuitive case of neonatal hyperthyroidism: mother has underactive thyroid, while the unborn baby has an overactive one. Although the mother has hypothyroidism from hashimoto’s thyroiditis, she produces TSI (thyroid stimulating immunoglobulin) triggering excessive thyroid hormone formation by the fetus.

Paradoxically the mother was treated with both medications; levothyroxine for her hypothyroidism and methimazole for her fetus’ hyperthyroidism.

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Semi-artificial pancreas shows positive outcomes.

Although of short duration, this well designed study shows that semi-artificial pancreas helps in reducing A1c and preventing hypoglycemia more than the usual insulin pump. A group of 29 individuals with type 1 diabetes and A1c < 7.5% were randomized to receive hybrid closed-loop system or the traditional pump therapy. Participants were followed for 4 weeks and then crossed over for another 4 weeks.

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Low-risk thyroid cancer: surgery or no surgery?

This original study suggests thyroidectomy for low-risk cancers measuring >1.5 cm rather >1.0 cm as currently recommended by ATA; to avoid unnecessary surgeries, cost and complications. 

In stead, authors propose “active surveillance” in carcinomas <1.5 cm. About 700 thyroid cancer patients were analyzed over a 10 year period.

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2016 Endocrine Society Guidelines: CENTRAL Adrenal Insufficiency

Adrenal Insufficiency (AI) is defined by low cortisol production.  It could be due to failure, infection, injury, bleeding or inflammation of the adrenal glands, or from limited production of ACTH hormone by the pituitary.  

Adrenal Insufficiency as a result of low ACTH is called “central” or “secondary”. These guidelines were developed by Endocrine Society to address specifically Central AI. They were released in November 2016.

Please find below excerpts with slightly modified wording for easier and succinct reading.

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