A case of thyroxine (T4) toxicosis complicated by thyroid storm with an unusual precipitant.

BACKGROUND: Thyrotoxicosis, though commonly encountered in endocrinology practice in Nigeria, seldom presents solely as thyroxine (T4) toxicosis. Thyroid storm, a known life-threatening complication of thyrotoxicosis, can be precipitated by myriad factors. Fine need aspiration for cytology is not known, and has not been previously reported (to the best of our knowledge) to precipitate thyroid storm. CASE PRESENTATION: The case described is that of a 55 year old woman who presented with a neck swelling and features of hyperthyroidism, with biochemical parameters in keeping with T4 toxicosis. Investigating the patient necessitated a fine needle aspiration of the thyroid swelling. The patient thereafter developed hyper-metabolic features, and subsequently progressed to confusion and loss of consciousness few hours following the procedure. Close monitoring and medical management with anti-thyroid and other supportive therapies, resulted in an improved clinical condition. CONCLUSION: T4 toxicosis is a distinct biochemical entity of clinical significance. Physicians should bear in mind that micro-trauma from an investigation such as fine needle aspiration of the thyroid gland can tilt a thyrotoxic patient into thyroid storm, and this risk should be considered and prepared for by physicians and patients.

Risk factors for dysmenorrhea among Ghanaian undergraduate students.

BACKGROUND: Menstrual pain is one of the common gynaecological presentations of women of reproductive age to health care physicians. In Ghana, there exist a paucity of research on the risk factors of dysmenorrhea among older females. OBJECTIVES: Very few studies in Ghana have addressed the risk factors for severe dysmenorrhea among University students. This study aims to identify the common risk factors and associated symptoms of menstrual pain which have been previously not caught the attention of researchers in Ghana. METHODOLOGY: The study was a descriptive cross-sectional study involving to two hundred female undergraduate students of the University of Cape Coast (UCC), Ghana. Data collected and analysed using standardized and acceptable statistical tools. Verbal multidimensional scoring system for assessment of dysmenorrhoea severity was used in this study to assess the severity of dysmenorrhoea. RESULTS: More than half (57.3%) of the respondents having pain beginning within the first two days of their menses. The common risk factors that predicted severity of dysmenorrhea (p<0.05) were quantity of menstrual flow and family history of menstrual pain. The common symptoms that accompanied dysmenorrhea were tiredness, loss of appetite, backache, dizziness, diarrhoea and mood changes (p<0.05). CONCLUSION: Dysmenorrhea is a serious public health problem which can be incapacitating. We advocate for more attention to reduce the burden of its negative consequences.

Patterns and Impact of Consultations to an Endocrinology Unit in a Tertiary Hospital in Southwestern Nigeria.

BACKGROUND: The dearth of endocrinologists in Nigeria, coupled with a paucity of data on patterns of endocrine consultations pose a challenge in evaluating the impact of consultations on patients' management and eventual outcomes. The objectives of this study were to determine the frequency, sources of referrals, the common cases referred, the reasons for consultation requests, and the outcome of patients who benefitted from endocrine consultations. MATERIALS AND METHODS: This study was carried out in the Endocrinology unit of Babcock University Teaching Hospital, over 9 months. All patients referred to the unit were sampled (total sampling). Their sociodemographic parameters, sources, and reasons for consultations were documented. The patients' case notes were then retrospectively reviewed, to determine the impact of the consultation on their management and outcome. RESULTS: A total of 108 consults were received throughout the study. Most consultations were requested by the general outpatient clinic (37%) followed by cardiology clinic (12%). The most common reason was to take over management of the patients. Diabetes mellitus accounted for 68.7% of the cases seen. Diagnosis made by the referring physician was confirmed in most cases, new diagnoses or change in diagnosis was reached in 9.3% and 3.7%, respectively. About 39.8% of the patients were lost to follow-up, while 53.8% were in good and fair clinical condition. CONCLUSION: Most of the cases referred for specialist care were from the general outpatient clinic, had diabetes mellitus, and benefitted from specialist care by the way of advanced investigations and treatments, though about a third were lost to follow-up. It is imperative that a good referral system is maintained among physicians, to ensure that patients get the best care available. Attention must be paid to common causes of patient attrition such as lack of widespread health insurance coverage, to ensure continuity of care.