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Meling Stokland AE, Austdal M, Nedrebø BG, Carlsen S, Hetland HB, Breivik L, Ueland HO, Watt T, Cramon PK, Løvås K, Husebye ES, Ueland GÅ. Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy. J Clin Endocrinol Metab 2024; 109:827-836. [PMID: 37747433 PMCID: PMC10876387 DOI: 10.1210/clinem/dgad538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Indexed: 09/26/2023]
Abstract
CONTEXT Graves disease (GD) is a leading cause of hyperthyroidism. Detailed investigations and predictors of long-term outcomes are missing. OBJECTIVE This work aimed to investigate the outcomes in GD 25 years after initiating antithyroid drug treatment, including disease course, clinical and biochemical predictors of relapse, and quality of life. METHODS A retrospective follow-up was conducted of GD patients that participated in a randomized trial from 1997 to 2001. Demographic and clinical data were obtained from medical records and questionnaires. Biobank samples were analyzed for inflammatory biomarkers and compared with age- and sex-matched healthy individuals. RESULTS We included 83% (182/218) of the patients from the original study. At the end of follow-up, normal thyroid function was achieved in 34%. The remaining had either active disease (1%), spontaneous hypothyroidism (13%), or had undergone ablative treatment with radioiodine (40%) or thyroidectomy (13%). Age younger than or equal to 40 years, thyroid eye disease (TED), smoking, and elevated levels of interleukin 6 and tumor necrosis factor receptor superfamily member 9 (TNFRS9) increased the risk of relapsing disease (odds ratio 3.22; 2.26; 2.21; 1.99; 2.36). At the end of treatment, CD40 was lower in patients who maintained normal thyroid function (P = .04). At the end of follow-up, 47% had one or more autoimmune diseases, including vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). GD patients who developed hypothyroidism had reduced quality of life. CONCLUSION Careful lifelong monitoring is indicated to detect recurrence, hypothyroidism, and other autoimmune diseases. Long-term ATD treatment emerges as a beneficial first-line treatment option, especially in patients with young age at onset or presence of TED.
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Affiliation(s)
- Ann-Elin Meling Stokland
- Department of Endocrinology, Stavanger University Hospital, 4011 Stavanger, Norway
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Marie Austdal
- Department of Research, Stavanger University Hospital, 4011 Stavanger, Norway
| | | | - Siri Carlsen
- Department of Endocrinology, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Hanne Brit Hetland
- Department of Research, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Lars Breivik
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Hans Olav Ueland
- Department of Ophthalmology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Torquil Watt
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Per Karkov Cramon
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Kristian Løvås
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Eystein Sverre Husebye
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
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Richter MM, Thomsen MN, Skytte MJ, Kjeldsen SAS, Samkani A, Frystyk J, Magkos F, Holst JJ, Madsbad S, Krarup T, Haugaard SB, Wewer Albrechtsen NJ. Effect of a 6-Week Carbohydrate-Reduced High-Protein Diet on Levels of FGF21 and GDF15 in People With Type 2 Diabetes. J Endocr Soc 2024; 8:bvae008. [PMID: 38379856 PMCID: PMC10875725 DOI: 10.1210/jendso/bvae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Indexed: 02/22/2024] Open
Abstract
Context Fibroblast growth factor 21 (FGF21) and growth differentiation factor 15 (GDF15) are increased in type 2 diabetes and are potential regulators of metabolism. The effect of changes in caloric intake and macronutrient composition on their circulating levels in patients with type 2 diabetes are unknown. Objective To explore the effects of a carbohydrate-reduced high-protein diet with and without a clinically significant weight loss on circulating levels of FGF21 and GDF15 in patients with type 2 diabetes. Methods We measured circulating FGF21 and GDF15 in patients with type 2 diabetes who completed 2 previously published diet interventions. Study 1 randomized 28 subjects to an isocaloric diet in a 6 + 6-week crossover trial consisting of, in random order, a carbohydrate-reduced high-protein (CRHP) or a conventional diabetes (CD) diet. Study 2 randomized 72 subjects to a 6-week hypocaloric diet aiming at a ∼6% weight loss induced by either a CRHP or a CD diet. Fasting plasma FGF21 and GDF15 were measured before and after the interventions in a subset of samples (n = 24 in study 1, n = 66 in study 2). Results Plasma levels of FGF21 were reduced by 54% in the isocaloric study (P < .05) and 18% in the hypocaloric study (P < .05) in CRHP-treated individuals only. Circulating GDF15 levels increased by 18% (P < .05) following weight loss in combination with a CRHP diet but only in those treated with metformin. Conclusion The CRHP diet significantly reduced FGF21 in people with type 2 diabetes independent of weight loss, supporting the role of FGF21 as a "nutrient sensor." Combining metformin treatment with carbohydrate restriction and weight loss may provide additional metabolic improvements due to the rise in circulating GDF15.
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Affiliation(s)
- Michael M Richter
- Department of Clinical Biochemistry, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Mads N Thomsen
- Department of Endocrinology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
| | - Mads J Skytte
- Department of Endocrinology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, 2100, Denmark
| | - Sasha A S Kjeldsen
- Department of Clinical Biochemistry, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Amirsalar Samkani
- Department of Endocrinology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
| | - Jan Frystyk
- Department of Endocrinology, Odense University Hospital, Odense, 5000, Denmark
| | - Faidon Magkos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital—Hvidovre, Hvidovre, 2650, Denmark
| | - Thure Krarup
- Department of Endocrinology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Steen B Haugaard
- Department of Endocrinology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Nicolai J Wewer Albrechtsen
- Department of Clinical Biochemistry, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, 2400, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
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Baksh SN, Heath SL, Fukuta Y, Shade D, Meisenberg B, Bloch EM, Tobian AAR, Spivak ES, Patel B, Gerber J, Raval JS, Forthal D, Paxton J, Mosnaim G, Anjan S, Blair J, Cachay E, Currier J, Das P, Huaman M, Sutcliffe C, Yarava A, Casadevall A, Sullivan D, Hanley D, Gebo KA. Symptom Duration and Resolution With Early Outpatient Treatment of Convalescent Plasma for Coronavirus Disease 2019: A Randomized Trial. J Infect Dis 2023; 227:1266-1273. [PMID: 36722044 PMCID: PMC10226658 DOI: 10.1093/infdis/jiad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) reduces hospitalizations among outpatients treated early after symptom onset. It is unknown whether CCP reduces time to symptom resolution among outpatients. METHODS We evaluated symptom resolution at day 14 by trial arm using an adjusted subdistribution hazard model, with hospitalization as a competing risk. We also assessed the prevalence of symptom clusters at day 14 between treatments. Clusters were defined based on biologic clustering, impact on ability to work, and an algorithm. RESULTS Among 1070 outpatients followed up after transfusion, 381 of 538 (70.8%) receiving CCP and 381 of 532 (71.6%) receiving control plasma were still symptomatic (P = .78) at day 14. Associations between CCP and symptom resolution by day 14 did not differ significantly from those in controls after adjustment for baseline characteristics (adjusted subdistribution hazard ratio, 0.99; P = .62). The most common cluster consisted of cough, fatigue, shortness of breath, and headache and was found in 308 (57.2%) and 325 (61.1%) of CCP and control plasma recipients, respectively (P = .16). CONCLUSIONS In this trial of outpatients with early COVID-19, CCP was not associated with faster resolution of symptoms compared with control. Overall, there were no differences by treatment in the prevalence of each symptom or symptom clusters at day 14. CLINICAL TRIALS REGISTRATION NCT04373460.
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Affiliation(s)
- Sheriza N Baksh
- Department of Epidemiology Bloomberg Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - David Shade
- Department of Epidemiology Bloomberg Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Barry Meisenberg
- Department of Medicine and Research Institute of Luminis Health, Annapolis, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Bela Patel
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Jonathan Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, Massachusetts, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Donald Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - James Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Giselle Mosnaim
- Department of Medicine Northshore University Health System, Division of Allergy and Immunology, Evanston, Illinois, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miami, Florida, USA
| | - Janis Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, Phoenix, Arizona, USA
| | - Edward Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, La Jolla, California, USA
| | - Judith Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Piyali Das
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Moises Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Catherine Sutcliffe
- Department of Epidemiology Bloomberg Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Anusha Yarava
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Departments of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Sullivan
- Departments of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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van Engelen TSR, Kanglie MMNP, van den Berk IAH, Altenburg J, Dijkgraaf MGW, Bossuyt PMM, Stoker J, Prins JM. Limited Clinical Impact of Ultralow-Dose Computed Tomography in Suspected Community-Acquired Pneumonia. Open Forum Infect Dis 2023; 10:ofad215. [PMID: 37213423 PMCID: PMC10199111 DOI: 10.1093/ofid/ofad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/19/2023] [Indexed: 05/23/2023] Open
Abstract
Patients clinically suspected of community-acquired pneumonia (CAP) were randomized between ultralow-dose chest computed tomography ([ULDCT] 261 patients) and chest radiograph ([CXR] 231 patients). We did not find evidence that performing ULDCT instead of CXR affects antibiotic treatment policy or patient outcomes. However, in a subgroup of afebrile patients, there were more patients diagnosed with CAP in the ULDCT group (ULDCT, 106 of 608 patients; CXR, 71 of 654 patients; P = .001).
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Affiliation(s)
- Tjitske S R van Engelen
- Correspondence: Tjitske S. R. van Engelen, MD, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Room G2-105, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands (); Jan M. Prins, MD, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Room D3-217, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands ()
| | - Maadrika M N P Kanglie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Inge A H van den Berk
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Josje Altenburg
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jan M Prins
- Correspondence: Tjitske S. R. van Engelen, MD, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Room G2-105, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands (); Jan M. Prins, MD, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Room D3-217, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands ()
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5
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Cooper LN, Radunsky AP, Hanna JJ, Most ZM, Perl TM, Lehmann CU, Medford RJ. Analyzing an Emerging Pandemic on Twitter: Monkeypox. Open Forum Infect Dis 2023; 10:ofad142. [PMID: 37035497 PMCID: PMC10077829 DOI: 10.1093/ofid/ofad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background Social media platforms like Twitter provide important insights into the public's perceptions of global outbreaks like monkeypox. By analyzing tweets, we aimed to identify public knowledge and opinions on the monkeypox virus and related public health issues. Methods We analyzed English-language tweets using the keyword "monkeypox" from 1 May to 23 July 2022. We reported gender, ethnicity, and race of Twitter users and analyzed tweets to identify predominant sentiment and emotions. We performed topic modeling and compared cohorts of users who self-identify as LGBTQ+ (an abreviation for lesbian, gay, bisexual, transgender, queer, and/or questioning) allies versus users who do not, and cohorts identified as "bots" versus humans. Results A total of 48 330 tweets were written by LGBTQ+ self-identified advocates or allies. The mean sentiment score for all tweets was -0.413 on a -4 to +4 scale. Negative tweets comprised 39% of tweets. The most common emotions expressed were fear and sadness. Topic modeling identified unique topics among the 4 cohorts analyzed. Conclusions The spread of mis- and disinformation about monkeypox was common in our tweet library. Various conspiracy theories about the origins of monkeypox, its relationship to global economic concerns, and homophobic and racial comments were common. Conversely, many other tweets helped to provide information about monkeypox vaccines, disease symptoms, and prevention methods. Discussion of rising monkeypox case numbers globally was also a large aspect of the conversation. Conclusions We demonstrated that Twitter is an effective means of tracking sentiment about public healthcare issues. We gained insight into a subset of people, self-identified LGBTQ+ allies, who were more affected by monkeypox.
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Affiliation(s)
- Lauren N Cooper
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander P Radunsky
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John J Hanna
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zachary M Most
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Trish M Perl
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Richard J Medford
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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