GiT Updates and More

Schematic representation of different patterns of thyroid function tests and their causes.

Primary and secondary headache

Albumin use in critically ill patients

💊Management summary of Hyperthyroidism 📌Prescribe beta-blockers for symptom relief from tachycardia, tremors, and anxiety (Strong recommendation). 📌Treatment of hyperthyroidism usually depends on the underlying cause: 🔸Treat Graves disease with antithyroid medications, radioactive iodine, or thyroidectomy (Strong recommendation). 🔸Consider treating toxic multinodular goiter with radioactive iodine or thyroidectomy over antithyroid medications (Conditional recommendation). 🔸Consider treating toxic thyroid adenoma with radioactive iodine or thyroidectomy over antithyroid medications (Conditional recommendation). 🔸Treat acute (suppurative) thyroiditis with antibiotics (Strong recommendation). 🔸Treat subacute painful thyroiditis with supportive care such as nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy or corticosteroids if patient fails to respond to NSAIDs or initially presents with moderate to severe pain or symptoms of thyrotoxicosis (Strong recommendation). 🔸Treat painless (silent) thyroiditis with beta-blockers in patients with symptomatic thyrotoxicosis (Strong recommendation). 🔸Treat amiodarone-induced type 1 thyrotoxicosis with methimazole (Strong recommendation) and treat amiodarone-induced type 2 thyrotoxicosis with corticosteroids. Occasionally both methimazole and corticosteroids are required if the type is uncertain. (Strong recommendation). 📌 Manage patients with thyroid storm in an intensive care unit with beta-blockers, antithyroid drugs (ATDs), iodine, corticosteroids, aggressive cooling measures, and fluid replacement (Strong recommendation). 📌 Consider treating subclinical hyperthyroidism in patients > 65 years old, patients with hyperthyroid symptoms, and in patients with cardiac risk factors, heart disease, or osteoporosis according to same principles used in treating overt hyperthyroidism. 📌 During pregnancy, treat gestational hyperthyroidism and hyperemesis gravidarum-associated thyrotoxicosis with supportive therapy, without ATDs (Strong recommendation). 📌 Perioperative management in patients with hyperthyroidism depends on the clinical status and the urgency of the procedure. 🔸Surgery (thyroid or nonthyroid) in those with unrecognized or inadequately treated hyperthyroidism can precipitate thyroid storm. 🔸Prior to any surgery, the goal is to achieve a euthyroid state. 🔸Patients with moderate to severe hyperthyroidism should wait until hyperthyroidism is under control prior to proceeding to elective surgeries. 🔸If the patient does not become euthyroid prior to thyroidectomy, if the need for surgery is urgent, or if the patient is allergic to antithyroid medication, premedication should include beta-blockers, potassium iodide, glucocorticoids, and possibly cholestyramine.

💊Management summary of Hyperthyroidism 📌Prescribe beta-blockers for symptom relief from tachycardia, tremors, and anxiety (Strong recommendation). Treatment of hyperthyroidism usually depends on the underlying cause. Treat Graves disease with antithyroid medications, radioactive iodine, or thyroidectomy (Strong recommendation). Consider treating toxic multinodular goiter with radioactive iodine or thyroidectomy over antithyroid medications (Conditional recommendation). Consider treating toxic thyroid adenoma with radioactive iodine or thyroidectomy over antithyroid medications (Conditional recommendation). Treat acute (suppurative) thyroiditis with antibiotics (Strong recommendation). Treat subacute painful thyroiditis with supportive care such as nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy or corticosteroids if patient fails to respond to NSAIDs or initially presents with moderate to severe pain or symptoms of thyrotoxicosis (Strong recommendation). Treat painless (silent) thyroiditis with beta-blockers in patients with symptomatic thyrotoxicosis (Strong recommendation). Treat amiodarone-induced type 1 thyrotoxicosis with methimazole (Strong recommendation) and treat amiodarone-induced type 2 thyrotoxicosis with corticosteroids. Occasionally both methimazole and corticosteroids are required if the type is uncertain. (Strong recommendation). Manage patients with thyroid storm in an intensive care unit with beta-blockers, antithyroid drugs (ATDs), iodine, corticosteroids, aggressive cooling measures, and fluid replacement (Strong recommendation). Consider treating subclinical hyperthyroidism in patients > 65 years old, patients with hyperthyroid symptoms, and in patients with cardiac risk factors, heart disease, or osteoporosis according to same principles used in treating overt hyperthyroidism. During pregnancy, treat gestational hyperthyroidism and hyperemesis gravidarum-associated thyrotoxicosis with supportive therapy, without ATDs (Strong recommendation). Perioperative management in patients with hyperthyroidism depends on the clinical status and the urgency of the procedure. Surgery (thyroid or nonthyroid) in those with unrecognized or inadequately treated hyperthyroidism can precipitate thyroid storm. Prior to any surgery, the goal is to achieve a euthyroid state. Patients with moderate to severe hyperthyroidism should wait until hyperthyroidism is under control prior to proceeding to elective surgeries. If the patient does not become euthyroid prior to thyroidectomy, if the need for surgery is urgent, or if the patient is allergic to antithyroid medication, premedication should include beta-blockers, potassium iodide, glucocorticoids, and possibly cholestyramine.

💊Management summary of Hyperthyroidism 📌Prescribe beta-blockers for symptom relief from tachycardia, tremors, and anxiety (Strong recommendation). Treatment of hyperthyroidism usually depends on the underlying cause. Treat Graves disease with antithyroid medications, radioactive iodine, or thyroidectomy (Strong recommendation). Consider treating toxic multinodular goiter with radioactive iodine or thyroidectomy over antithyroid medications (Conditional recommendation). Consider treating toxic thyroid adenoma with radioactive iodine or thyroidectomy over antithyroid medications (Conditional recommendation). Treat acute (suppurative) thyroiditis with antibiotics (Strong recommendation). Treat subacute painful thyroiditis with supportive care such as nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy or corticosteroids if patient fails to respond to NSAIDs or initially presents with moderate to severe pain or symptoms of thyrotoxicosis (Strong recommendation). Treat painless (silent) thyroiditis with beta-blockers in patients with symptomatic thyrotoxicosis (Strong recommendation). Treat amiodarone-induced type 1 thyrotoxicosis with methimazole (Strong recommendation) and treat amiodarone-induced type 2 thyrotoxicosis with corticosteroids. Occasionally both methimazole and corticosteroids are required if the type is uncertain. (Strong recommendation). Manage patients with thyroid storm in an intensive care unit with beta-blockers, antithyroid drugs (ATDs), iodine, corticosteroids, aggressive cooling measures, and fluid replacement (Strong recommendation). Consider treating subclinical hyperthyroidism in patients > 65 years old, patients with hyperthyroid symptoms, and in patients with cardiac risk factors, heart disease, or osteoporosis according to same principles used in treating overt hyperthyroidism. During pregnancy, treat gestational hyperthyroidism and hyperemesis gravidarum-associated thyrotoxicosis with supportive therapy, without ATDs (Strong recommendation). Perioperative management in patients with hyperthyroidism depends on the clinical status and the urgency of the procedure. Surgery (thyroid or nonthyroid) in those with unrecognized or inadequately treated hyperthyroidism can precipitate thyroid storm. Prior to any surgery, the goal is to achieve a euthyroid state. Patients with moderate to severe hyperthyroidism should wait until hyperthyroidism is under control prior to proceeding to elective surgeries. If the patient does not become euthyroid prior to thyroidectomy, if the need for surgery is urgent, or if the patient is allergic to antithyroid medication, premedication should include beta-blockers, potassium iodide, glucocorticoids, and possibly cholestyramine.

Thyrotoxicosis differential diagnosis algorithm

💠 Summary Resmetirom, the first FDA-approved liver-specific drug for treating metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced fibrosis (stages F2-F3). Here are the key points: Background: - The FDA conditionally approved resmetirom on March 14, 2024 - It's indicated for adults with noncirrhotic MASH and moderate to advanced liver fibrosis (stages F2-F3) - MASH affects 1 in 4 people in the US and Western Europe Patient Selection: - Target population: Patients with MASH and F2-F3 fibrosis - Exclusions: Patients with cirrhosis (F4) or early fibrosis (F0-F1) - Diagnosis can be made through: - Liver biopsy (if available) - Non-invasive tests (NITs) like: - Vibration controlled transient elastography (VCTE) - MRI elastography (MRE) - Enhanced liver fibrosis (ELF) score - Other blood-based markers Dosing: - Weight-based dosing: - 80mg for patients <100kg - 100mg for patients >100kg Monitoring: 1. Initial assessment (12 weeks): Safety and tolerability 2. 6-month assessment: Disease monitoring 3. 12-month and annual assessment: Efficacy monitoring Safety Considerations: - Most common side effects: mild to moderate gastrointestinal issues (nausea, diarrhea) - Potential early liver enzyme elevations, especially in patients on statins - Drug interactions with certain statins require dose adjustments - Can be used with GLP-1 receptor agonists, though concurrent initiation is not recommended Treatment Response: - Positive response indicators include: - Improvement in liver enzymes - 30% reduction in MRI-PDFF - Improvement in liver stiffness measurements - Treatment should be discontinued if: - No response in imaging - >30% increase in liver stiffness - Drug intolerance - Worsening in multiple NITs

Illustration of metabolic pathways affected in liver disorders.