Subclinical hypothyroidism: Should we treat?

Subclinical hypothyroidism (also known as compensated hypothyroidism or mild hypothyroidism) is a condition associated with a raised serum concentration of thyroid stimulating hormone (TSH) but a normal serum free thyroxine (FT4). It is common, affecting about 10% of women above the age of 55 years. Autoimmunity is the commonest cause of subclinical hypothyroidism. About 2.5% of patients with subclinical hypothyroidism progress to clinically overt hypothyroidism each year; the rate of progression is higher in patients with thyroid autoantibodies and higher thyroid stimulating hormone levels. However, thyroid function normalises spontaneously in up to 40% cases. Only a small minority of patients with subclinical hypothyroidism have symptoms, and the evidence to support that levothyroxine ameliorate the symptoms in these patients is weak. Subclinical hypothyroidism in younger patients (<65 years) is associated with an increased risk of coronary heart disease, heart failure and cerebrovascular disease. The risk increases with increasing levels of thyroid stimulating hormone, and is particularly high in patients with TSH levels ≥10.0 mu/L. There is lack of evidence from randomised controlled trials as to whether levothyroxine treatment can prevent these risks, although a large observational study of the UK general practice research database has shown that levothyroxine may reduce the risk of coronary heart disease in younger patients (<70 years). Therefore, the decision whether to treat or not to treat subclinical hypothyroidism should be made after careful consideration of the patient's age, the presence of symptoms, the presence of thyroid antibodies and other risk factors such as cardiovascular disease.

trans-Chloridobis(4-methyl-pyridine-κN)(4,4',4''-tri-tert-butyl-2,2':6',2''-terpyridine-κN,N',N'')ruthenium(II) hexa-fluoridophosphate acetone monosolvate

The title compound, [RuCl(C(6)H(7)N)(2)(C(27)H(35)N(3))]PF(6)·C(3)H(6)O, was obtained unintentionally as the product of the reaction of 1,1'-methyl-enebis(4-methyl-pyridinium) hexa-fluoriso-phos-phate and RuCl(3)(tpy*) (tpy* is 4,4',4''-tri-tert-butyl-2,2':6',2''-terpyridine) in the presence of triethyl-amine and LiCl. The mol-ecular structure of the complex displays an octa-hedral geometry around the Ru(II) ion and the unit cell contains an acetone solvent mol-ecule and one orientationally disordered PF(6) (-) anion (occupancy ratio 0.75:0.25) which is hydrogen bonded to two H atoms of the tpy* ligand of the nearest [RuCl(pic)(2)(tpy*)](+) cation (pic is 4-methyl-pyridine). One of the tert-butyl groups of the tpy* ligand is also disordered over two sets of sites in a 0.75:0.25 ratio.

Predictors of homeless veterans' irregular discharge status from a domiciliary care program

This study addresses the relationship of homeless veterans' discharge status from a domiciliary care program to biopsychosocial characteristics presented at admission into the program. Hypotheses were that younger age, less education, and substance abuse or psychiatric disorder would predict an irregular discharge. Research participants were 367 homeless male veterans who had been admitted to a domiciliary care program at the West Los Angeles Veterans Affairs Medical Center for treatment of medical, psychiatric, or substance disorders. Status of veterans' program discharge (regular or irregular) served as the outcome measure. Logistic regression analysis revealed that irregular discharge from the program was more likely among veterans who were black, who had poor employment histories, or who had problems with alcohol. Results are discussed in light of the need to maintain homeless veterans in treatment programs so that they can achieve maximum benefit from available programs.

Homeless veterans' utilization of medical, psychiatric, and substance abuse services

This study focuses on the association between homeless veterans' prior utilization of medical, psychiatric, and substance abuse services and biopsychosocial characteristics reported at admission into a domiciliary care program. Given the large number of veterans in the US homeless population and their health care needs, understanding factors associated with health service use among homeless veterans is significant. Research participants were 429 homeless male veterans who had been admitted to the Domiciliary Care for Homeless Veterans Program site at the West Los Angeles Veterans Affairs Medical Center between February 1988 and July 1992 for treatment of medical, psychiatric, or substance disorders. Results of logistic regression analyses indicated that self-reported need (chronic medical problems, serious psychiatric symptoms, combat stress, alcohol use) and evaluated need for care (evidence of liver dysfunction) were important to veterans' use of health services in the 6 months before program admission. Predisposing social structure factors (education, residential stability, and usual sleeping place) were also significant predictors of service utilization. Overall, need factors were more strongly related to service use. Supplementary logistic regression analyses indicated that comorbidity of need factors deserves attention in understanding homeless veterans' use of services. In conclusion, it is important to attend to predisposing social structure factors as potential barriers to care for homeless veterans.

Indicators of chronic homelessness among veterans

OBJECTIVE

This study sought to develop a set of indicators of chronic homelessness as a basis for better understanding and treatment of the homeless veteran population.

METHODS

Chi square analysis and the t test or Mann-Whitney U test were used to compare characteristics of veterans who reported long-term homelessness (more than 12 months total since age 18) with those of veterans who reported short-term homelessness (12 months or less). Subjects were 343 homeless male veterans receiving treatment for physical, mental, or substance abuse disorders at the West Los Angeles site of the Domiciliary Care for Homeless Veterans Program. Variables included history of homelessness, employment history, physical and mental health, substance abuse history, social and financial support, criminal history, age, ethnic group, education, military service, and program discharge status.

RESULTS

Veterans experiencing long-term homelessness were more likely to be white, to have had a longer period of recent homelessness and a greater number of homeless episodes, to have a poor employment history, to have symptoms of mental and substance abuse disorders, and to have weaker social support.

CONCLUSIONS

Results show that variables besides duration of lifetime homelessness are important indicators of chronic homelessness.