Escitalopram-induced subclinical hypothyroidism. A case report.

Several conditions and drugs induce subclinical hypothyroidism. We report a case of asymptomatic and reversible subclinical hypothyroidism in a 48-year old woman with minor depressive disorder receiving therapy with escitalopram 20 mg daily for six months.

Coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma. A retrospective study.

OBJECTIVE: The association between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) remains controversial in medical bibliography. The main objective of our study was to determine the prevalence of PTC and HT coexistence in histopathologic material of thyroidectomized patients. DESIGN: In a retrospective study, the clinicohistopathologic data of 140 patients (19 males/121 females), who underwent a total or near total thyroidectomy for any thyroid pathology from January 2005 to December 2009 at the Naval Hospital of Crete, were analysed. The mean age of the patients was 52 years (range 16-74). RESULTS: HT was detected in 42 (30%) and PTC in 32 (22.9%) specimens. Coexistence of HT with PTC was present in 12 (8.6%) specimens. Among 32 specimens with PTC, the prevalence of HT was 37.5%. Among 42 specimens with HT, the prevalence of PTC was 28.6%. There was no statistically significant difference between the presence of PTC and HT in histopathologic material. CONCLUSIONS: The prevalence of PTC and HT coexistence in histopathologic material of 140 thyroidectomized patients was 8.6%, whereas the difference between PTC and HT was not statistically significant.

Q fever endocarditis.

Coxiella burnetii, the agent of Q fever, produces a variety of clinical syndromes. The most frequent and serious chronic presentation is endocarditis, which presents unspecifically as a blood-culture negative endocarditis. It occurs almost exclusively in patients who have pre-existing valvular disease or who are immunocompromised. Without prompt recognition and appropriate antimicrobial therapy, the course of Q fever endocarditis is severe and potentially fatal. The epidemiology, signs and symptoms, laboratory findings, diagnosis and treatment of Q fever endocarditis are presented in our review.

Prevention of bacterial endocarditis.

Infective endocarditis (IE) is a rare but severe disease with high mortality, and results most often from the combination of bacteraemia and a predisposing cardiac condition. American Heart Association (AHA) and other national and international organizations have made recommendations for the prevention of IE, although no randomised clinical trial has confirmed its efficacy. The current tendencies of IE prophylaxis, based on 2007 AHA guidelines and recent medical bibliography are presented in our review.

[Is Schilling test necessary for the etiological diagnosis of B12 insufficiency?].

In the following article a comparative evaluation of the tests used for the causative investigation of vitamin B(12) deficiency is presented. Although Schilling test since 2003 is not available in the market, it is considered the gold standard as a functional test of vitamin B(12) absorption, as it not only has a high specificity for the diagnosis of pernicious anaemia but also examines both gastric and intestinal stage of vitamin B(12) absorption. Consequently restoration of Schilling test in the clinical setting is necessary for the etiological diagnosis of B(12) insufficiency at least until a new and better vitamin B(12) absorption test is approved.

Exemestane-induced subclinical hypothyroidism : a case report.

Several conditions and drugs induce subclinical hypothyroidism. We report the first case of subclinical hypothyroidism in a 65-year-old woman with breast cancer receiving therapy with the third-generation aromatase inhibitor exemestane 25 mg/day for 2 months. The patient presented with complaints of increasing fatigue and weakness since being commenced on exemestane and was taking no other drugs. There was no past history or family history of thyroid disease. Thyroid function tests prior to breast cancer surgery were normal. Detailed clinical examination and laboratory tests to determine the cause of the patient's increasing fatigue and weakness revealed only subclinical hypothyroidism, that is, an elevated level of thyroid-stimulating hormone (thyrotropin, TSH) only. Ultrasonography revealed a normal thyroid gland. Based on a diagnosis of symptomatic subclinical hypothyroidism, the patient was commenced on levothyroxine sodium 50 microg/day and exemestane was withdrawn. Thyroid dysfunction was restored 4 months after her admission with a significant improvement in symptoms. Levothyroxine sodium was withdrawn 6 months later and no recurrence of thyroid dysfunction occurred during a 1-year follow-up. We believe that the increasing fatigue and weakness in our patient might have been associated either with subclinical hypothyroidism or with administration of exemestane (a known adverse effect of the drug) or both. Further studies are required to investigate how exemestane influences thyroid function.

Acute rhabdomyolysis caused by Spirulina (Arthrospira platensis).

Rhabdomyolysis is a potentially life-threatening disorder that occurs as a primary disease or as a complication of a broad spectrum of other diseases. We report the first case of acute rhabdomyolysis after ingestion of Spirulina (Arthrospira platensis), a plantonic blue-green alga, as a dietary supplement.