Background: Subclinical hypothyroidism (SCH) is a biochemical diagnosis wherein free T4 is within normal range while serum TSH value >5mIU/L. We aimed to study effects of alternate day fixed dose thyroxine therapy on this subset of patients with a 3month follow up of various clinical and biochemical parameters.Methods: It was an interventional trial. Fifty consecutive consenting participants with SCH aged 18-45 years were started on alternate day 50µg thyroxine and were observed for 3 months for changes in body mass index, blood pressure, serum cholesterol, serum triglyceride, serum TSH, T3 and T4 levels.Results: Forty four out of fifty participants had initial TSH levels between 5-10 µU/mL and at the end of 3 months, 58% of these (n=29/44) shown improved thyroid profile as their TSH fell to the target 2-4 µU/mL. Seven participants’ (n=7,14%) turned into iatrogenic hyperthyroidism as their T3 and T4 levels rose above normal and TSH levels fell to below 1 µU/mL. Another 7 participants (n=7,14%) showed increased T3 and T4 levels (n=3, n=4 respectively) above normal range with TSH still within normal range. One patient (n=1,2%) had persistently raised TSH levels. Out of 6 participants (n=6,12%) who had initial TSH>10 µU/mL, 3 participants achieved normal TSH with alternate day therapy (n=3,6%) while 3 participants did not achieve euthyroid status (n=3,6%). Authors observed decrease in cholesterol levels (initial=183.18±52.96 mg/dL, final=170.04±42.13 mg/dL, p<0.05). It lead to reduction in weight (initial BMI=24.11±5.69, final=23.33±5.30, p<0.05).Conclusions: Authors found that treatment of SCH with alternative day thyroxine therapy is effective in normalizing TSH values. Its dose needs to be titrated according to TSH levels to avoid side effects. It decreased cost of therapy resulting in good compliance in noncompliant patients and reduced pill burden helped the patients in adhering to the therapy.

Background: There is plenty of evidence to support the fact that inflammation is a risk factor for atherosclerotic diseases and other lifestyle related diseases like diabetes and obesity. Elevated leukocyte count is associated with insulin resistance and is also associated with macro and micro vascular complications in diabetes. This study aimed to investigate the relation between peripheral total and differential WBC count in diabetes and its complications.Methods: This was a cross sectional observational study. It was carried out in the outpatient wing of Department of Medicine, M. G. M. Medical College and M.Y. Hospital. A total of 130 consecutive consenting diabetic patients (type 2) were selected. Those with any obvious stressful condition like acute illness were excluded. All the participants were screened for retinopathy, neuropathy, cerebrovascular disease and cardiovascular disease by history and clinical examination and had their height, weight, waist circumference, hip circumference and white blood cell counts notedResults: In the present study, most of the patients were middle aged patients (46 out of 130 were in age group 51-60 years) and were obese (60/130 had BMI of 26 to 30) with most of them having abdominal obesity (87% males i.e. 48/55 had waist hip ratio >0.90, 56% females i.e. 42/75 had waist hip ratio >0.85). It was found that, amongst 130 patients with type 2 diabetes 56% have WBC counts on the higher side of the normal range i.e. 7000-11000/cu mm. Polymorphs were also on higher side of the normal range in 47% of patients i.e. PMN= 61-70% and 26% had polymorphs above 70%. About 61% patients had monocyte count >6%. Out of the 130 patients, 35 had retinopathy, 57 had neuropathy and 9 had nephropathy as micro vascular complications while as macro vascular complications, 9 had a history of CVA, 14 had CAD and 4 had PVD. Also, maximum patients having micro and macro vascular complications had WBC counts in the range of 7000-11000.Conclusions: An elevated leukocyte count even within the normal range was associated with chronic complications in type 2 diabetes and can be used to predict development of micro and macro vascular complications in patients diagnosed with type 2 diabetes.

Palpitations due to supra-ventricular tachycardia are a common mode of presentation to the emergency department. A 12 lead electrocardiography usually leads to immediate diagnosis and prompt management of this condition. Adenosine injection is the treatment of choice for rapid termination of supra-ventricular tachycardia which is widely used. It is generally considered safe and serious side effects are rare. We presented a rare case of a post-menopausal female admitted with supra-ventricular tachycardia and after injection of Adenosine, chest pain with a transient elevation of ST segment occurred. The ST segment changes reverted back to normal after a few minutes spontaneously without any therapy. This phenomenon could be explained due to coronary vasospasm produced by Adenosine. A review of literature revealed anecdotal cases of adenosine induced possible coronary vasospasm.