How to diagnose and treat primary hypothyroidism

The diagnosis and management of primary hypothyroidism. Royal College of Physicians, London (2008)

Diagnosis and treatment of primary hypothyroidism. Allahabadia A, Razvi S, Abraham P, Franklyn J. BMJ 2009;338:b725

The position statement/guidance document on the diagnosis and management of primary hypothyroidism produced by the RCP in collaboration with several specialist professional associations and patient groups with interests in the safe management of thyroid diseases, and the editorial in the BMJ from the British Thyroid Association are must-reads for trainees in endocrinology.

You are what you don’t eat

Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. Sacks et al. N Engl J Med 2009;360:859-873

What is your favourite weight-loss diet? Low fat or high fat? Average protein or high protein? Low carb or high carb? Sacks and colleagues set out to answer these much debated questions in this large, long term, population-based trial and report that macronutrient composition made little difference. Although there were few drop-outs and treatment was intensive, the study was marred by a blurring of participants’ diets over time so in the end macronutrient differences between groups were less clear than originally envisaged. Nevertheless, they conclude that reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize. At the risk of stating the obvious, I think the chief take-home message is that a calorie is a calorie, regardless of whether it came from a KitKat or a celery stick: reduce your total calorie-intake and you lose weight. So, yes, you are what you don’t eat… in calories!

Intensive versus conventional glucose control in critically ill patients

Intensive versus Conventional Glucose Control in Critically Ill Patients. The NICE-SUGAR Study Investigators. N Engl J Med 2009; 360:1283-1297

ABSTRACT

Background: The optimal target range for blood glucose in critically ill patients remains unclear.

Methods: Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter (10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization.

Results: Of the 6104 patients who underwent randomization, 3054 were assigned to undergo intensive control and 3050 to undergo conventional control; data with regard to the primary outcome at day 90 were available for 3010 and 3012 patients, respectively. The two groups had similar characteristics at baseline. A total of 829 patients (27.5%) in the intensive-control group and 751 (24.9%) in the conventional-control group died (odds ratio for intensive control, 1.14; 95% confidence interval, 1.02 to 1.28; P=0.02). The treatment effect did not differ significantly between operative (surgical) patients and nonoperative (medical) patients (odds ratio for death in the intensive-control group, 1.31 and 1.07, respectively; P=0.10). Severe hypoglycemia (blood glucose level <40 mg per deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients (6.8%) in the intensive-control group and 15 of 3014 (0.5%) in the conventional-control group (P<0.001). There was no significant difference between the two treatment groups in the median number of days in the ICU (P=0.84) or hospital (P=0.86) or the median number of days of mechanical ventilation (P=0.56) or renal-replacement therapy (P=0.39).

Conclusions: In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter.

Northwest endocrine society meeting: 15 May 2009

Dear colleagues

Just to remind you that the North West Endocrine Society meeting is taking place on 15th May 2009. We would encourage you to attend and also to submit abstracts. A flyer is enclosed giving details of the meeting. Please email abstracts to Mr Kanna Gnanalingham and confirmation of attendance to Dr Kalpana Kaushal (see flyer).

Also attached are a registration form for the meeting and a membership form for those who wish to become members of the NWES. Please complete these and hand them in at the meeting.

Sent on behalf of the NWES

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THE NORTHWEST ENDOCRINE SOCIETY

Announces its next meeting on

FRIDAY 15TH MAY 2009

VENUE: Aspen and Anton Suites, Chill Factore, 7 Trafford Way, Urmston, Manchester, M41 7JA

FINAL PROGRAM

TIME

TOPIC SPEAKER
12:30 – 13:15

BUFFET LUNCH
13:15 – 15:00

OBESITY SYMPOSIUM Chair:  John Wilding
13:15

Adipose tissue and insulin resistance: Basic science for the clinician Paul Trayhurn
13:40

Medical management of obesity John Wilding
14:05

Surgical management of obesity Basil Ammori
14:30

Medical management of patients following bariatric surgery Sumer Aditya
15:00 – 15:30

COFFEE BREAK
15:30 – 16:30

INTERACTIVE CASE/RESEARCH PRESENTATIONS Chair: Stephen Shalet
Three cases will be selected for presentation
Panel Members:Julian Davis, Helen Doran, Ian MacFarlane, Kanna Gnanalingham
16:30 – 16.45 A whimsical history of endocrinology Stephen Shalet
16:45 – 17:00 Prizes and close of meeting

  • Submission of abstracts:
  • Delegates are asked to submit abstracts electronically (maximum 300 words,excluding title, authors and institutions) to Mr Kanna Gnanalingham. Abstracts may describe clinical endocrinology cases, particularly where there were diagnostic or management issues lending themselves to discussion during the meeting, or basic science or clinical research. We are happy to receive abstracts that have been submitted to other meetings. Delegates should indicate at the bottom of the abstract whether they wish their submission to be considered for poster only, oral presentation only, or both. Prizes will be awarded for the best oral presentation and the 2 best posters. The deadline for abstract submission is 5pm on Tuesday 14th April 2009.

    CONFIRMATION OF ATTENDANCE: If you would like to attend the meeting please email confirmation of attendance to Dr Kalpana Kaushal. Please indicate in the email whether or not you require lunch, and if so, whether you have any specific dietary requirements. The deadline for confirming attendance is 5pm on Friday May 1st 2009.

    We look forward to seeing you at the meeting

    NWES Committee

    ***********************

    Northwest Endocrine Society

    Registration form for meeting on 15th May 2009

    All delegates must complete this form and hand it in on the day of the meeting along with payment as appropriate

    Full name
    Job title
    Place of work
    Contact telephone number
    Preferred email address
    Lunch required Yes/No (delete as appropriate)

    Registration fee

    Attendance at this meeting is free for delegates who are NWES members (including those who have handed in a completed membership form and annual membership fee of £20) and also for those on an annual salary < £40 000

    All other delegates must pay a registration fee of £10 for attendance (Payable by cheque to the North West Endocrine Society on the day of the meeting)

    ***********************

    Northwest Endocrine Society

    Membership application form

    Full name including title
    Job title
    Contact address
    Contact telephone number
    Preferred email address
    Annual income > £40 000 YES/NO (delete as appropriate)

    NWES Membership fees
    Membership fees have been based on annual income:
    Annual income < £40 000 – membership of NWES is free
    Annual income > £40 000 – annual membership fee £20

    Those who wish to attend the meeting but do not wish to become members of the NWES must pay a registration fee of £10 for attendance. This only applies to delegates with an annual income > £40 000. This fee is payable by cheque on the day of the meeting.
    Membership forms can be handed in at the NWES meeting on 15th May. Payments can be made by cheque (made payable to the North West Endocrine Society) or by standing order (attached). The completed standing order authority should be returned to your bank/building society.
    If you have already completed a membership form and standing order authority in 2008 you do not need to do this again.

    NWES Committee
    Dr Tara Kearney (Chair) Miss Helen Doran
    Dr Adam Robinson (Secretary) Mr Kanna Gnanalingham
    Dr Annice Mukherjee (Treasurer) Dr Kalpana Kaushal
    Mr Iain Anderson Sister Shashana Shalet
    Dr Dan Cuthbertson Dr Andrew Whatmore


    TOPDOC Diabetes National Study

    The TOPDOC Diabetes national study is a UK-wide survey of foundation doctors and specialist trainees from all specialties looking at their confidence levels in the management of diabetes. The study is funded by the Association of British Clinical Diabetologists and follows from a national pilot that showed  a lack of confidence in managing aspects of diabetes care, including the management of diabetes emergencies.

    All details are available at www.topdocdiabetes.org and the survey takes only 5 minutes to complete.

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    What is TOPDOC Diabetes?

    TOPDOC Diabetes Study (Trainees Own Perception of Delivery Of Care in Diabetes) is a national study of confidence levels amongst trainee doctors in the management of diabetes.

    Who is it for?

    The study is aimed at foundation and specialty trainees in all specialties.

    How can I take part in the study?

    It only takes 5 minutes to answer the online survey at www.topdocdiabetes.org

    What do you get in return?

    Your details will be entered into a draw with a number of prizes (iTunes vouchers, travel grants and more!). TOPDOC results will also help us design training modules for you.

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    Contact: