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Bangkok, Thailand

Sriphrapradang C.,Mahidol University | Thewjitcharoen Y.,Diabetes and Thyroid Center | Chanprasertyothin S.,Mahidol University | Nakasatien S.,Diabetes and Thyroid Center | And 2 more authors.
JCRPE Journal of Clinical Research in Pediatric Endocrinology | Year: 2016

Thyroid dyshormonogenesis is responsible for 10-15% of all cases of congenital hypothyroidism and is usually inherited. We report a 26-year-old German-Thai male with congenital hypothyroidism caused by a compound heterozygous mutation in the thyroid peroxidase (TPO) gene. He was diagnosed with congenital goitrous hypothyroidism at 4 months of age and had been treated with levothyroxine replacement therapy. His goiter size had increased due to poor compliance to treatment. Ultrasonography of the thyroid gland showed a pattern suspicious for malignancy. The patient later underwent near-total thyroidectomy. Pathologic examination results were consistent with a multinodular goiter and no malignancy. Genetic analyses by direct sequencing of the entire exons and flanking regions of the TPO gene were performed in the index case and family members. The analyses revealed a compound heterozygote of novel TPO mutation of c.1727C>T in exon 10 resulting in amino acid substitution (p.Ala576Val) and c.2268_2269insT in exon 13 causing a frameshift mutation which introduced a stop codon after the insertion site. The latter has been reported in Chinese subjects. However, there is no previous report of c.1727C>T mutation in the literature. We found the allele contained a novel exon 10 mutation inherited from the patient’s German mother and an exon 13 mutation from his Thai father. Analysis using two bioinformatic software programs indicated that this variant was likely to cause damage in the resulting protein molecule. The present report emphasizes the importance of regular follow-up and patient compliance to levothyroxine replacement in patients with goitrous congenital hypothyroidism to avoid prolonged stimulation of thyroid tissue by thyroid-stimulating hormone. © Journal of Clinical Research in Pediatric Endocrinology, Published by Galenos Publishing.

Thewjitcharoen Y.,Diabetes and Thyroid Center | Wanothayaroj E.,Diabetes and Thyroid Center | Himathongkam T.,Diabetes and Thyroid Center | Flanagan S.E.,University of Exeter | And 2 more authors.
Diabetes Research and Clinical Practice | Year: 2014

Many patients with monogenic diabetes are missed or misclassified. Herein, we report a 28-year-old Indian female who developed diabetes at the age of 3 months. An audit of our type 1 diabetes database led to her genetic testing. A KCNJ11 mutation was identified and she was successfully switched to sulphonylurea. © 2014 Elsevier Ireland Ltd.

Chotwanvirat P.,Diabetes and Thyroid Center | Thewjitcharoen Y.,Diabetes and Thyroid Center | Parksook W.,Diabetes and Thyroid Center | Krittiyawong S.,Diabetes and Thyroid Center | And 4 more authors.
Journal of the Medical Association of Thailand | Year: 2016

Background: The oral glucose tolerance test (OGTT) is essential procedure in both screening and diagnosis of impaired glucose tolerance (IGT), impaired fasting glucose (IFG) and diabetes mellitus (DM), but it is not easy to perform because of intense sweetness of the 75-g glucose test beverage causing abdominal discomfort post-testing. Therefore, the new formula of non-carbonated lemon-lime flavored beverage was developed to increase its palatability and better compliance. Objective: To develop a new non-carbonated lemon-lime flavored beverage to replace the standard beverage for OGTT. Subsequently, the diagnostic value and acceptability between the new formula and the traditional 75-g OGTT formula were compared in healthy subjects. Material and Method: The new lemon-lime flavored formula was developed to replace the standard beverage for OGTT by adding 1,000 milligram of citric acid and 0.03 gram of lime flavor to 75 gram of anhydrous glucose to a final volume of 300 ml. The study was conducted in 30 healthy subjects who underwent the traditional 75-gram OGTT test and the new formula of OGTT beverage one week later, or vice versa, to access acceptability, indices markers of insulin secretion, and insulin sensitivity. Palatability was determined by rating on a 9-point Hedonic Scale. Results: Thirty healthy subjects (15 females) with the age of 33.2±7.5 years and body mass index of 22.9±3.5 kg/m2 were enrolled. No significant difference was found between plasma glucose in 0, 30, 60, 90, and 120 minutes, insulin level (0 and 120 minutes) and four insulin surrogate markers in both traditional 75-gram OGTT and new formula of lemon-lime flavored OGTT beverage. The overall satisfaction score of the new formula OGTT was better when compared with the scores of the traditional OGTT (7.1±1.8 vs. 4.7±2.0). Only one subject complained about abdominal discomfort in both episode of OGTT. Conclusion: The modified lemon-lime flavored beverage for OGTT demonstrated better acceptance in the subjects without difference in plasma glucose values and OGTT derived parameters responses to OGTT in comparison to the traditional formula. © 2016, Medical Association of Thailand. All rights reserved.

Yotsapon T.,Diabetes and Thyroid Center | Sirinate K.,Diabetes and Thyroid Center | Ekgaluck W.,Diabetes and Thyroid Center | Somboon V.,Diabetes and Thyroid Center | And 4 more authors.
BMC Endocrine Disorders | Year: 2016

Background: Advance in medicine has led to an increase in life expectancy of elderly diabetic patients especially on the growing population called the "oldest old", those in their mid-80s upwards. The aim of this study is to describe clinical characteristics and outcomes of "oldest old" patients in a specialized diabetes center. Methods: A retrospective review was conducted on medical records of type 2 diabetes who were older than 85 years at Theptarin hospital from September 2014 to August 2015. Results: During the study period, there were 143 oldest old diabetic patients who visited our hospital regularly. Of the 133 active follow-up patients (median time of follow-up 15 years, range 1-30 years), 70.7 % was female, the mean age of onset was 68.3 ± 11.5 years and duration of diabetes was 20.1 ± 11.1 years. According to the Charlson co-morbidity index (CCI), 35.3 % of patients were classified as having severe co-morbidities. The mean A1C, blood pressure, LDL were 6.7 ± 1.1 %, 132/65 mmHg and 80 ± 29 mg/dl respectively. 66.9 % of patients had tight glycemic control (A1C <7 %) while 12.0 % had poor control (A1C >8 %). Oral hypoglycemic agent (OHA) dual therapy was the most common treatment (26.3 %) followed by OHA monotherapy (22.6 %), insulin alone (19.5 %), diet therapy alone (12.7 %), and insulin plus OHA (8.3 %). Hypoglycemia was found in 10.5 % of patients in previous 12 months. Diabetic retinopathy, chronic kidney disease, cardiovascular disease, and stroke were presented in 23.4, 54.9, 15.8, 18.0 % of patients, respectively. Among patients whose received diabetic medications and resulted in very low level of A1C (A1C less than 6.0 %), only 20.0 % underwent deintensification. Conclusions: Our results revealed that real-world clinical outcomes of extreme elderly diabetic patients were diverse and being too "aggressive" diabetes treatment with older patients did occur frequently. Decision making in older people with diabetes is complex as chronic co-morbidities are very common. © 2016 The Author(s).

Thewjitcharoen Y.,Diabetes and Thyroid Center | Krittiyawong S.,Diabetes and Thyroid Center | Porramatikul S.,Diabetes and Thyroid Center | Parksook W.,Diabetes and Thyroid Center | And 4 more authors.
Journal of Clinical and Translational Endocrinology | Year: 2014

Aims The aims of this study were to evaluate the outcomes of treatment among hospitalized patients with diabetic foot ulcers, the risk factors for non-healing ulcers, and the rate of major amputation among Thai patients.Methods A retrospective study of hospitalized diabetic foot patients treated at Theptarin Hospital during the period of 2009-2013. The complete healing rate was assessed at 12 months after admission.Results During the study period, 232 patients (123 males and 109 females) with 262 admissions were included (mean age 65.6 ± 11.9 years, mean duration of diabetes 17.2 ± 9.9 years) with a mean follow-up of 17.5 ± 16.7 months. Major amputations were performed in 4.2% of the patients and peripheral vascular disease (PVD) was a predictive factor (OR 5.25; 95% CI [1.43-19.29]; p-value 0.006). Complete healing (including minor amputations) was achieved in 82.1% of the admissions. Only DFU of the heel was a statistically significant (OR 3.34; 95% CI [1.11-10.24]; p-value 0.041) predictor of non-healing ulcers. Three patients (1.1%) died during hospitalization.Conclusions Management of diabetes-related foot ulcers with a multidisciplinary approach resulted in a limb salvage rate that was greater than 90% and a complete healing rate that was greater than 80%. Successful management of diabetic foot ulcers might be possible in Thailand utilizing this approach. © 2014 The Authors.

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