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Medscape
05-05-2025
- Health
- Medscape
Subtyping Thyroid Function Testing Halved Positive Diagnoses
Whether clinicians are accurately diagnosing thyroid disease was at issue for Chinese researchers who demonstrated that adding subgroup differences according to age, sex, or race when testing for thyroid disease reduced by half the number of persons eligible for L-thyroxine, a treatment for hypothyroidism. It is the first study to examine the effect of combined age, sex, and race on the diagnosis of thyroid diseases, the authors wrote. The results were published in the Annals of Internal Medicine . 'Use of current reference intervals may result in the overdiagnosis or underdiagnosis of thyroid diseases, leading to subsequent overtreatment or delayed treatment and creating potential health risks and unnecessary healthcare burdens,' the study authors Qihang Li, MD, and colleagues wrote. Li is an endocrinologist at the Shandong First Medical University in Jinan, China. They challenged what they called a 'one-size-fits-all' approach to defining thyroid function reference intervals. In their cross-sectional analysis, the investigators applied age-, sex-, and race-specific factors to the reference intervals used in two population datasets with available thyroid function testing results. The first was anyone aged 20 years or older in the National Health and Nutrition Examination Survey (N = 8308; women = 4235), supplemented by a Chinese database of routine health checkups from 49 hospitals in 10 provinces for persons aged 18 years or older (N = 314,302). Criteria for thyroid disease used by the investigators was based on two sets of reference intervals of thyroid function indicators. The first were the current reference intervals: Thyroid-stimulating hormone (TSH), 0.45-4.5 mIU/L; total thyroxine (TT4), 57.92-169.90 nmol/L (4.5-13.2 μg/dL). The other reference intervals were specific to age, sex, and race. In the NHANES set, the 97.5th percentile of TSH increased with age. Meanwhile, total triiodothyronine (TT3) levels declined with age as TT4 levels remained stable across different ages. Higher TT4 levels were found in women and White individuals had higher TSH levels. Subclinical hypothyroidism varied from 2.4% for ages 20-29 years to 5.9% for ages 70 years or older, when measured with current reference intervals. Nearly half (48.5%) of those diagnosed as having subclinical hypothyroidism using current reference intervals were found not to have the diagnosis when subtyped by age-, sex-, and race-specific reference intervals. This was especially true for female and White study individuals. When subtyped, 31.2% persons with subclinical hyperthyroidism were found to have normal thyroid function, especially women, Black individuals, and Hispanic individuals. When compared with the findings from US participants, many of the results in Chinese participants were similar, according to the study's authors. Those with thyroid peroxidase antibody positivity were excluded from the database, resulting in a reduction in the occurrence of subclinical hypothyroidism and subclinical hyperthyroidism, especially in patients older than 60 years. 'We expect that our findings will help decision makers establish more accurate reference intervals for thyroid diseases and facilitate development of consensus about how to define and manage those diseases,' concluded Li and colleagues. A previous ' investigation of L-thyroxine prescription appropriateness found 31% aligned with American Thyroid Association guidelines, while 54% of new L-thyroxine prescriptions were considered suboptimal, as thyroid function results were unconfirmed or normal,' James V. Hennessey, MD, wrote in an editorial accompanying Li and colleagues' study. Hennessey is an endocrinologist at Beth Israel Deaconess Medical Center in Boston and an associate professor of medicine at Harvard University in Cambridge, Massachusetts. Describing what appears to be a growing body of literature on misdiagnosis in thyroid disease, Hennessey also cited a previous study that used NHANES data to show the efficacy of stratifying reference thresholds for thyroid function tests. In that study, Martin I. Surks and Joseph G. Hollowell described the effect of thyroid autoimmunity and aging on expected TSH values. 'When stratified by age, they noted the 97.5th percentile of TSH in those considered thyroid disease risk free was 'normal' up to 7.49 mIU/L for those older than 80 years,' wrote Hennessey. Another study Hennessey cited found that the results of thyroid function testing within an age-adjusted laboratory reference range were not associated with fluctuations in quality of life, mood, or cognitive function in community-dwelling older men. Further, there was no change in these outcomes during 5-8 years of follow-up and without intervention. 'These observations indicate that minor 'elevations' of TSH do not document that thyroid dysfunction is the cause of nonspecific symptoms,' Hennessey wrote. Hennessey referred to Li and colleagues' study as an 'enhancement' for improving diagnostic accuracy in thyroid disease, and thus patient outcomes. 'Unnecessary L-thyroxine replacement leaves quality of life diminished and symptoms unabated, and some patients seek alternative thyroid solutions to their nonthyroidal symptoms,' Hennessey wrote. 'Unnecessary therapy for subclinical hypothyroidism also results in the expense for prescriptions, laboratory testing, and follow-up care. It is also associated with iatrogenic thyrotoxicosis, especially in older women.'
Medscape
05-05-2025
- Health
- Medscape
GLP-1 RA Use for Obesity Soars Among Nondiabetic US Adults
Nationally representative survey data reveals that glucagon-like peptide 1 receptor agonists (GLP-1 RAs) use for obesity treatment more than tripled among US adults without diabetes between 2018 and 2022, with annual expenditures reaching $5.8 billion in 2022. METHODOLOGY: Although approximately 93 million US adults are potentially eligible for obesity treatment with GLP-1 RAs, estimates of current use and spending are limited to individuals with diabetes or are based on unrepresentative samples. Researchers analyzed data from the Medical Expenditure Panel Survey Household Component (2018 to 2022) to estimate annual prescription fills and national expenditures on GLP-1 RAs among US adults without a prior diagnosis of diabetes (excluding those with gestational diabetes). Surveyed households provided data on demographics, medical conditions, healthcare use, and spending, with follow-back surveys of pharmacies primarily used to establish drug pricing. TAKEAWAY: The unweighted sample included 89,854 adults (51.8% women; 30.7% with a body mass index ≥ 30). Annual prevalence of GLP-1 RA use among US adults without diabetes increased from 0.1% in 2018-2021 to 0.4% in 2022, with an estimated 854,728 adults without diabetes taking these medications. Annual GLP-1 RA spending increased from $1.6 billion in 2018-2021 to $5.8 billion in 2022. Between 2018 and 2022, the mean number of prescriptions per user was 4.1, with a mean expenditure of $1540 and an average out-of-pocket cost of $34.68 per prescription. IN PRACTICE: 'Despite [increased use], adoption remained limited as only 1 in 250 US adults without diabetes used a GLP-1 RA in 2022,' the authors wrote. 'Average prices for these medications consistently exceeded $1500 per prescription, although average out-of-pocket costs were well contained, potentially due to people without private insurance being disproportionately less likely to access these medications,' the authors concluded. SOURCE: The study was led by Cade Shadbolt, MA, and Jasmin Elkin, The University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Australia. It was published online in Annals of Internal Medicine . LIMITATIONS: Multiple prescriptions filled by the same individuals may have influenced mean cost estimates. COVID-19 restrictions also posed challenges for survey collection, though data quality assessments during the pandemic yielded encouraging results. Disclosure restrictions limited detailed reporting on spending for less commonly prescribed GLP-1 RAs. DISCLOSURES: One author received support from the Australian Government Research Training Program Scholarship. Other authors reported serving as consultants for or having grants, contracts, or other ties with various organizations and pharmaceutical companies.
Yahoo
02-05-2025
- Health
- Yahoo
Weight-Loss Drugs Have Sent a Shocking Number of People to the Emergency Room, New Study Claims
A new study analyzed how often people develop severe side effects after taking semaglutide The report claims the trendy drug contributed to nearly 25,000 emergency room visits between 2022 and 2023 Most reported hospital visits were due to gastrointestinal complications Trendy weight-loss drugs like Ozempic and Wegovy have sent a shocking number of people to the hospital, according to claims made in a new study. The study — published April 8 in Annals of Internal Medicine — analyzed how often people develop severe side effects that send them to the emergency department or hospital after taking semaglutide, an FDA-approved prescription medication for people with type 2 diabetes and chronic obesity. A spokesperson for Ozempic's manufacturer, Novo Nordisk, told PEOPLE in a statement, "The safety and efficacy profile of Ozempic has been evaluated in clinical studies involving more than patients. The most commonly reported side effects were gastrointestinal, including nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation. The known risks associated with use of Ozempic are reflected in the FDA-approved product labeling." Semaglutide — known by brand names Ozempic and Wegovy — works in the brain to impact satiety. Over the past two years, the popularity of weekly injections for weight loss has soared. As of 2024, one in eight adults in the United States has taken a GLP-1 medication (glucagon-like peptide-1 receptor agonists) like Ozempic. Scientists from the Centers for Disease Control and Prevention studied national surveillance data collected at dozens of hospitals. They found that semaglutide contributed to nearly 25,000 emergency room visits between 2022 and 2023, with more than 82% occurring in 2023. The visits were typically due to gastrointestinal complications. Patients experienced nausea, vomiting, abdominal pain and diarrhea. Related: Ozempic FAQ: All About the Drug Being Used for Weight Loss — Yes, You Will Likely Gain Weight When You Stop Taking It Never miss a story — sign up for to stay up-to-date on the best of what PEOPLE has to offer, from celebrity news to compelling human interest stories. Additionally, some hospital visits were also reported for low blood sugar, allergic reactions, pancreatitis, and bile duct disease — all less common incidences. 'We found that it's very infrequent that semaglutide leads to very serious adverse events that would land a patient in the hospital, but that they do occur,' Dr. Pieter Cohen, study author and associate professor of medicine at Harvard Medical School, told Health. 'The adverse events presented [in this study] are not new,' added Dr. Mahyar Etminan, associate professor of medicine at the University of British Columbia. Although researchers noted that most drugs have some side effects, and most reported in the study were already known, they stress that these findings should not be minimized, and that doctors should do more to mitigate those that require hospitalization. 'Clinicians could counsel patients when initiating semaglutide about the potential for severe gastrointestinal adverse effects and adjust co-prescribed antidiabetic medications to decrease hypoglycemia risk,' the authors wrote. Related: Ozempic Face — and Now Ozempic Breast and Butt? What's Really Going on with These Side Effects? ! The impacts of semaglutide and similar medications on the digestive system have been investigated; In June 2024, the drugs were linked to severe gastroparesis, also known as stomach paralysis, which the Mayo Clinic says '[prevents] your stomach from emptying properly.' In September 2024, the FDA issued a warning that Ozempic can lead to a life-threatening condition known as ileus — a type of bowel obstruction where either sections or the entirety of the intestines become obstructed. This blockage can restrict blood flow to organs, resulting in tissue necrosis. "We stand behind the safety and efficacy of Ozempic® when used as indicated," the company said in its statement. Read the original article on People
New York Post
01-05-2025
- Health
- New York Post
Top reasons Ozempic users visit the ER — and when you should go
Though popular weight loss jabs like Ozempic and Wegovy have been deemed safe and effective by the FDA, concerning side effects are sending some users to the ER. A staggering one in eight adults in the US have used a GLP-1, and a study published last month in the Annals of Internal Medicine revealed how often these users develop complications that require a trip to the hospital. The study outlined the top reasons people are seeking medical attention — and one doctor is warning about a 'Wild West' factor that could be at the root of an unexpected issue. 3 A staggering one in eight adults in the US has tried GLP-1 mbruxelle – Using a national surveillance network, a team of researchers at Cambridge Health Alliance tracked emergency room visits linked to semaglutide in 82 different hospitals over a two-year period. In total, semaglutide side effects resulted in 551 emergency room visits, though less than 18% led to hospitalization. Statistically speaking, this amounts to four ER visits and less than one hospitalization for every 1,000 semaglutide patients. Of these ER visits, 70% cited gastrointestinal distress, with common complaints of nausea, vomiting, abdominal pain and diarrhea. GLP-1 medications are notorious for triggering digestive discomfort. Shrinking tummy, uncomfortable tummy A recent report found that more than 30% of GLP-1 patients drop the meds after just four weeks because they suffer early side effects like nausea or other digestive problems. These medications slow down the passage of food through the stomach, allowing people to feel fuller, longer. However, issues arise if the drugs slow down the stomach too much and, in some cases, can lead to severe gastroparesis, or stomach paralysis. The Post previously reported that about 30% of Wegovy users have experienced diarrhea, including some who claim they've woken up in the middle of the night to discover that they've defecated in their sleep. Of the 70% of ER visits related to GI issues, 15% required hospitalization. 'We found that it's very infrequent that semaglutide leads to very serious adverse events that would land a patient in the hospital, but that they do occur,' study author Pieter Cohen, MD, internist at Cambridge Health Alliance and associate professor of medicine at Harvard Medical School, told Health. A surprising twist Low blood sugar resulted in a further 16.5% of ER visits, with nearly 38% of those cases requiring hospitalization. That one comes as a bit of surprise, since GLP-1s play a role in regulating blood sugar. At least one doctor thinks off-brand, compounded drugs — which are typically prepared by a pharmacist and dispensed in vials, allowing patients to administer their own dosages — could be to blame. Compounded drugs aren't regulated by the FDA and don't undergo the same level of scrutiny as FDA-approved drugs. 'It's kind of like the Wild West when it comes to medications [that] are compounded because there is no standardization,' Dr. Peminda Cabandugama, endocrinologist at Cleveland Clinic and spokesperson for The Obesity Society, told Health. 3 Of the documented ER visits, 70% cited gastrointestinal distress, with common complaints of nausea, vomiting, abdominal pain, and diarrhea. zigres – Other GLP-1 issues Less common complications that resulted in hospital visits included allergic reactions, pancreatitis, and bile duct disease. GLP-1 users have also reported experiencing vision changes, erectile dysfunction, personality changes, increased reckless behavior, and the infamous 'Ozempic butt' and 'Ozempic boobs' (sagging in all the wrong places). Doctors have also seen other unusual complications, such as allodynia, a type of nerve pain where things that shouldn't hurt — like brushing your hair or wearing a shirt — suddenly do. Researchers contributing to this recent study predicted that the vast majority of ER visits would be driven by GI distress; however, they were surprised at the number of cases connected to low blood sugar, as Ozempic and Wegovy have not been previously linked to hypoglycemia. 3 A number of Ozempic users have also reported to the emergency room with gallbladder inflammation — a side effect that stems from the body failing to adapt quickly enough to rapid weight loss. nilsversemann – Experts note that this latest study has limitations, specifically that the data is based on documentation from ER physicians who did not differentiate between patients taking Ozempic, Wegovy, or compounded semaglutide. Despite the FDA's warning against using off-brand semaglutide compounds due to their potential 'adverse effects,' a shortage of brand-name drugs and their hefty $1,300-a-month price tag is motivating people to seek cheaper, more accessible options. When should you go to the doctor? While severe side effects related to GLP-1 are rare, experts suggest seeking emergency medical attention if you experience one or more of the following symptoms: fever, vomiting, and diarrhea that lasts longer than a few hours, or constipation that lasts several days and is accompanied by vomiting. In addition, severe pain that radiates from the abdomen through the back could be a symptom of pancreatitis, which can require hospitalization. According to Cabandugama, clinicians should ensure that patients do not have a history of pancreatitis before prescribing Ozempic or Wegovy. 'It's very important to mention that patients go to the right trained providers for weight loss, especially with all the rise of the Instagram clinics and online clinics,' explained Cabandugama. A number of Ozempic users have also reported to the emergency room with gallbladder inflammation — a side effect that stems from the body failing to adapt quickly enough to rapid weight loss. 'Rapid weight loss causes the liver to pump out more bile and more cholesterol, both of which can lead to the formation of gallstones within the gallbladder,' pharmacist Dr. Dan explained in a viral TikTok video. Gallbladder inflammation is characterized by enduring pain that originates in the right upper abdomen and radiates around the sides. This inflammation can be life-threatening and patients who experience these symptoms are urged to seek medical care. For those who find themselves in the ER, it is imperative to tell providers that they are taking GLP-1 drugs. Experts also note that side effects tend to flare up in GLP-1 patients after eating. Consuming smaller, lighter, fiber-rich meals and avoiding fatty, fried of processed foods can help mitigate these effects.
Daily Mail
28-04-2025
- Health
- Daily Mail
Scientists discover disturbing 'unexpected' side effect of new mRNA jab
Patients given experimental mRNA jabs for HIV have developed an 'unexpected' side-effect needing further investigation, experts say. About 7 per cent of volunteers given the jabs in the trial broke out in an itchy bumpy rash called hives. While this rash disappeared for some sufferers, over half were still experiencing bouts a year after injection. Some were still breaking out in hives almost three years after receiving the jab. Experts analysing the data noted volunteers who suffered the hive reaction were more likely to have received the Moderna mRNA Covid vaccine in the past. However, they added this finding didn't necessarily mean the two are linked and how and why the new jabs were provoking this reaction remained unclear. The reaction was seen across a trio of potential HIV jabs manufactured by Moderna with the same mRNA technology famously used in Covid vaccines. These jabs were tested on a group of 108 HIV-negative volunteers to measure their overall safety. Volunteers were split into three groups, each receiving one of the three different vaccine formulas. These groups were then split further into a high-dose or low-dose cohort for a total of six different cohorts. After the initial injection repeat doses were administered at 12 weeks and then again at 24 weeks. In their report experts from the University of Pittsburgh found the jabs to be 'generally safe and tolerable'. However, they noted the hive reaction in seven participants — seen across all three vaccine formulas— was an 'unexpected' result. Writing in the Annals of Internal Medicine, they said what was causing the hives in some people was unclear. But they theorised it could be due to a combination of vaccine components, the dosage, and an unknown environmental factor. The scientists said while mRNA vaccine technology continued to hold great promise, further research was needed into what was causing this hive reaction. Independent experts, writing in a linked editorial, agreed. They said that while hives is, overall, a minor ailment it can still contribute to vaccine hesitancy and hinder vaccine uptake. The experts said more work was needed to understand the mechanisms behind the reaction 'to ultimately promote the safety and uptake of vaccines'. There is currently no cure for HIV, which affects approximately 100,000 Britons and 1.2million Americans. Although there are prevention drugs, they need to be taken daily. WHAT IS HIV? HIV (human immunodeficiency virus) is a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and disease. AIDS (acquired immune deficiency syndrome) is the name used to describe a number of potentially life-threatening infections and illnesses that happen when your immune system has been severely damaged by the HIV virus. While AIDS cannot be transmitted from 1 person to another, the HIV virus can. There's currently no cure for HIV, but there are very effective drug treatments that enable most people with the virus to live a long and healthy life. With an early diagnosis and effective treatments, most people with HIV will not develop any AIDS-related illnesses and will live a near-normal lifespan. Source: NHS A vaccine that offers lifetime protection from the virus would be a breakthrough for the disease that has claimed millions of lives. But despite 40 years of research since HIV was first identified, a vaccine has been elusive, with half-a-dozen real-world trials repeatedly failing to deliver on initial results. HIV is a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and disease. AIDS is the name used to describe the potentially life-threatening infections and illnesses that happen when your immune system has been severely damaged by HIV. While AIDS cannot be transmitted from one person to another, the HIV virus can. There's currently no cure for HIV, but there are extremely effective treatments. With an early diagnosis most people with HIV will not develop any AIDS-related illnesses and will live a near-normal lifespan. Currently health officials focus on measures like encouraging safe sex and providing patients medications that stop HIV from spreading. HIV is estimated to have claimed over 40million lives since it first emerged. While new HIV diagnoses in the UK had been trending down for years, there has been a recent surge of new cases. In 2023, there were just over 6,400 HIV diagnoses in the UK, a 46 per cent increase compared to the year before. Health officials have said the wave of new cases could be a sign of ongoing transmission or a reflection of migration bringing more people with HIV into the country.
