Background. Subacute thyroiditis has been reported after administration of influenza vaccine. We describe a case of a patient who developed subacute thyroiditis after administration of. Moderna mRNA COVID-19 vaccine. Case Presentation. A 42-year-old female, with a past medical history of stage IIIB pT3N1aM0 right adenocarcinoma of colon status, after right hemicolectomy on 01/2020, followed by adjuvant chemotherapy, paroxysmal supraventricular tachycardia, iron deficiency anemia, chemotherapy-induced neuropathy, and lumbar radiculopathy, presented to our clinic with anterior neck pain that started 6 days after the second dose of Moderna mRNA COVID-19 vaccine. She was diagnosed with subacute thyroiditis and treated conservatively with pain medications. Conclusion. Subacute thyroiditis could represent one of the side effects of Moderna mRNA COVID-19 vaccine. Further reports are lacking.

Introduction. Glycogenic hepatopathy is a rare complication of uncontrolled diabetes mellitus that presents with hepatomegaly and transient elevation in serum aminotransferase enzymes. The underlying pathophysiology involves excessive accumulation of intrahepatic glycogen. Glycogenic hepatopathy is usually underdiagnosed because it is difficult to differentiate from other entities, such as the nonalcoholic fatty liver. The gold standard for diagnosis is liver biopsy. Glycogenic hepatopathy can be reversed by the achievement of adequate glycemic control. Case description. A 19-year-old female patient with a history of poorly controlled type 1 diabetes mellitus that resulted in several episodes of diabetes ketoacidosis requiring hospital admissions. The patient presented to the emergency room with generalized weakness and fatigue found to have diabetic ketoacidosis. Blood tests revealed abnormal liver function with aspartate aminotransferase 1129 U/L (13–37 U/L), alanine aminotransferase 766 U/L (13–56 U/L), alkaline phosphatase 216 U/L (45–117 U/L), total bilirubin 1.0 mg/dL (0.2–1.3 mg/dL), albumin 3.8 g/dL (3.4–5.0 g/dL), partial thromboplastin time < 20 s (23–31 s), prothrombin time 11.8 s (9.5–11.5 s), and international normalized ratio 1.1. Acute hepatitis serologies were negative. Epstein–Barr virus and cytomegalovirus were ruled out. Extensive autoimmune hepatitis tests were negative. Primary biliary cirrhosis was also ruled out. A liver biopsy was obtained, which was diagnostic of glycogenic hepatopathy. Conclusion. Glycogenic hepatopathy must be suspected in patients with uncontrolled type 1 diabetes mellitus who present with elevated liver enzymes and hepatomegaly. Treating this rare condition requires a timely diagnosis with liver biopsy and strict glycemic control.

Introduction Cushing syndrome (CS) is a systemic disorder characterized by prolonged exposure to high cortisol hormones. Our study analyses the association of Cushing syndrome as a risk factor for atrial fibrillation (A-fib), its effect on associated complications and mortality. Methods We conducted a retrospective analysis of 3 years of the National Inpatient Sample (NIS) data base from 2016 to 2018. Patients with Cushing syndrome, in association with/without A-fib were selected using ICD-10 diagnosis code. Discharge-level weight analysis was used to produce a national estimate. We conducted multivariate regression analysis to calculate odds ratio. RESULTS: During the study period 107,024,275 patient met inclusion criteria. 35,309 patient was diagnosed with CS. Mean age of Cushing patients was 52 and non-Cushing patients was 49. History of hypertension, congestive heart failure (CHF) and obstructive sleep apnea (OSA) were more prevalent in CS population (42. 03% v 29.34%, 20.99% vs 14.18, 17.29% v 5.86). Cushing patients had less prevalence of ischemic heart disease (5.10% v 5.91%). After adjusting with age, hypertension, CHF, ischemic heart disease, race and OSA, CS is related with higher prevalence of A-fib (OR 1.13, 1. 03-1.24, p = 0. 014). However it doesn't increase the complications of A-fib. While 3.70% patients with both CS and A-fib developed ischemic stroke, 3.81% patients without Cushing had the ischemic strokes. No arterial embolic events were detected in CS patients with A-fib, but 0.41% of patients without CS had arterial embolism. Univariate regressions demonstrated no significant association between CS and ischemic stroke associated with A-fib (p = 0.898). Our study also demonstrated that CS is related with high in-hospital mortality. When it was adjusted to age, sex, congestive heart failure, ischemic stroke and chronic kidney disease, CS with concomitant A-fib is associated 1.8 times higher mortality (OR 1.8, 1.27- 2.60, p = 0. 001). Discussion Several studies have demonstrated a possible association between serum cortisol level and the risk of A-fib. To our knowledge, this is the first study to demonstrate CS's clinical significance on A-fib. In our analysis, a statistically significant association was found between A-fib and CS with higher in-hospital mortality reported in patients with CS and concomitant A-fib. Patients with CS tend to have higher CHA2DS2-VASc Score but there is no association with higher risk of complications from A-fib. Our study prompts the need for further research to establish CS as an important risk factor for atrial fibrillation. Presentation: No date and time listed

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Introduction Thyroid hormones play an essential role in maintaining cardiovascular homeostasis. Experimental studies have revealed that subtle changes in thyroid hormone levels, as observed in subclinical hypothyroidism, have adverse effects on the cardiovascular system due to predisposition to endothelial dysfunction, dyslipidemia and direct effects of thyroid hormones on the myocardium. We conducted a retrospective cohort study to elicit the role of subclinical hypothyroidism as an independent risk factor for cardiovascular diseases. Methods We conducted a retrospective analysis of 3 years of the National Inpatient Sample (NIS) database, 2016 to 2018. Study populations were selected using ICD-10 diagnosis code. Discharge-level weight analysis was used to produce a national estimate. We conducted multivariate regression analysis to calculate odds ratio with STATA 17. Results During the study period, 106,970,745 study population met the inclusion criteria and 37,215 of subclinical hypothyroidism (SCH) patients were discharged. SCH patients tended to be more female (63.48% v 56.40%), older (mean age 58.22± 0.25 v 49.48 ± 0. 01), diabetic (24.84% v 21.47%) and obese (18.63% v 13.54%). Prevalence of hyperlipidemia and hypertension were similar in both SCH and non-SCH groups (3.75% v 3.24% and 29. 09% v 29.35% each). Caucasian patients were predominant in both groups with similar ethnicity distribution (62.26% v 64.96%). 3.56% of SCH patient had acute coronary artery syndromes (ACS), whereas 2.78% of non-SCH patients developed the ACS. For the patients without history of heart failure (HF), 2.54% of SCH patients developed new onset of HF, whereas 1.11% of non-SCH patients developed HF. After adjusting for age, sex, race and comorbid burden, SCH is not associated with ACS (p = 0.375) or Afib (p= 0.74) but associated with elevated risk for new onset of HF (OR 1.88, 1.62–2.18, p &lt; 0. 0001). Conclusion Our study shows that subclinical hypothyroidism is not associated with higher rates of ACS or Atrial fibrillation, however it is associated with statistically significant higher risk of new onset HF. Further research needs to be done to determine subclinical hyperthyroidism as a potential risk factor for HF and assess the benefit of lower threshold for treating subclinical hypothyroidism in preventing or delaying the onset of HF in patients with associated cardiac risk factors. Presentation: No date and time listed