Thyroid dysfunction is relatively common in pregnancy. The American Thyroid Association (ATA) published its most recent guidelines regarding the management of thyroid disorders in pregnancy in 2017. The American College of Obstetricians and Gynecologists (ACOG) has recently published an updated practice bulletin for thyroid disease in pregnancy that supersedes its previous guidance published in 2015. A comparison of the similarities and differences between the clinical guidelines from the ATA and ACOG can serve to highlight areas of uncertainty where additional studies are needed and may also demonstrate areas where endocrinologists and obstetricians may elect differing approaches to clinical care. The ACOG and ATA guidelines recommend similar approaches to the interpretation of thyroid function testing during gestation and to the management of thyroid cancer, thyroid nodules, gestational thyrotoxicosis, and postpartum thyroiditis Both strongly recommend levothyroxine (L-T4) treatment for overtly hypothyroid pregnant women, and both recommend against the use of T3-containing thyroid hormone preparations when treating hypothyroidism in pregnancy.

Clinical ThyroidologyVol. 32, No. 5 HypothyroidismThyroid Hormone Use Doubled in the United States from 1997 to 2016Elizabeth N. PearceElizabeth N. PearceSection of Endocrinology, Diabetes, Nutrition, and Weight Management; Boston University School of Medicine, Boston, MA, U.S.A.Search for more papers by this authorPublished Online:6 May 2020https://doi.org/10.1089/ct.2020;32.208-210AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 32Issue 5May 2020 InformationCopyright 2020 American Thyroid Association, Inc.To cite this article:Elizabeth N. Pearce.Thyroid Hormone Use Doubled in the United States from 1997 to 2016.Clinical Thyroidology.May 2020.208-210.http://doi.org/10.1089/ct.2020;32.208-210Published in Volume: 32 Issue 5: May 6, 2020PDF download

Purpose To evaluate the morphological and functional changes following intravitreal Ozurdex (dexamethasone implant) injections in patients with macular oedema (MO) secondary to retinal vascular diseases. Design This is a single centre, exploratory phase III, prospective, open-label clinical study. Methods Thirty patients with MO secondary to retinal vascular disorders underwent assessments for best corrected visual acuity, contrast sensitivity, microperimetry, chromatic sensitivity, macular thickness, and morphology using spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography at baseline. They were treated with intravitreal Ozurdex at baseline and monitored monthly with visual acuity and SD-OCT assessments up to 36 weeks. Re-treatment was permitted from 16 to 24 weeks according to pre-defined criteria. All visual function tests were repeated at 24 weeks. Results The mean change in central sub-field thickness (CST) from baseline was significant at all visits up to 32 weeks. The lowest mean CST was recorded at 8 weeks and the highest mean ETDRS score was achieved at 12 weeks. All visual functions except contrast sensitivity improved significantly by 24 weeks. The study showed that the ideal re-treatment time point based on functional and structural outcomes and known side-effects of Ozurdex treatment is at 20 weeks. Conclusion Ozurdex therapy has a rapid and dramatic effect on the macula for about 8 weeks followed by a sustained modest effect up to week 32. The optimal re-treatment time point is at 20 weeks.

Purpose The purpose of this study is to optimise the settings of the Retinal Image Analysis Laboratory (RIALAB), a semi-automatic drusen quantification software, in planning for high-throughput quantification of drusen in clinical studies of age-related macular degeneration (AMD). Patients and methods A comparison of five different settings in RIALAB was made on 67 images from the Rotterdam eye study (population-based study) and 56 images from the fellow eye of patients with active neovascular AMD in King’s College Hospital, London (hospital-based study). Results The ‘Few Outer’ setting was the best setting, with it being most appropriate for 52 (77.6%) of the Rotterdam cohort and 47 (83.9%) for the London cohort. Pearson’s χ 2 -test revealed both results to be statistically significant ( P <0.0001). Conclusions RIALAB is a viable algorithm and software package that can detect, quantify, and analyse drusen efficiently in both population-based and hospital-based studies. We have shown that the ‘Few Outer’ drusen setting can be employed as the default setting, with fine-tuning only needed in a minority of cases, thus helping to speed up workflow.

To define factors that determine the location and stability of fixation in patients with neovascular age-related macular degeneration (NV-AMD) treated with intravitreal ranibizumab injections. The location and stability of fixation using microperimetry were determined in 77 eyes treated with ranibizumab for NV-AMD for at least 12 months. All patients were treated with three injections of ranibizumab 0.5 mg, 1 month apart and retreated according to predefined criteria. The fixation parameters were correlated to the visual acuity, and quantitative measures on OCT. The location of fixation was predominantly central in 52.6%, poor central fixation in 9.2%, and predominantly eccentric fixation in 38.2%. The fixation was stable in 65%, relatively unstable in 25%, and unstable in 10%. Visual acuity was the only factor that determined the stability and location of fixation. The characteristics of fixation were not related to the macular thickness or volume as measured by OCT. Better visual outcome ensures central and stable fixation. Quantitative measures of OCT parameters do not determine fixation. Further studies on morphological features of the macula may provide some insight into the determinants of fixation.

Aim: To assess the safety and efficacy of the combined treatment of reduced-fluence verteporfin photodynamic therapy (PDT), intravitreal ranibizumab, intravitreal dexamethasone and oral minocycline for choroidal neovascularisa- tion (CNV) secondary to age-related macular degeneration (AMD). Methods: Nineteen patients with subfoveal CNV secondary to AMD were recruited into the trial. All study eyes (n = 19) received a single cycle of reduced-fluence (25 mJ/cm2) PDT with verteporfin followed by an intravitreal injection of ranibizumab 0.3 mg/0.05 ml and dexamethasone 200 µg at baseline. Oral minocycline 100 mg daily was started the following day and continued for 3 months. Patients were followed up monthly for 12 months. Repeat intravitreal ranibizumab was given if best-corrected visual acuity (BCVA) deteriorated by >5 letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart or central retinal thickness (CRT) on ocular coherence tomography increased >100 µm. Results: Eighteen patients completed the 12-month study. Stable vision (loss of ≤15 ETDRS letters) was maintained in 89% eyes (16/18). The mean change in BCVA was –5.0 ± 10.5 ETDRS letters. The mean number of ranibizumab injections was 3.4 (range 2–6). The mean reduction in the CRT was 66.3 µm (±75). Conclusion: This open-label clinical trial has demonstrated the safety in terms of adverse effects and maintenance of stable vision of combination treatment with verteporfin, ranibizumab, dexamethasone and minocycline in exudative AMD. However, the outcomes with reduced-fluence PDT combination therapy does not differ significantly with outcomes of clinical trials on combination treatment with standard dose PDT and intravitreal ranibizumab in neovascular AMD.

Purpose To compare fixation location and stability in patients with neovascular age-related macular degeneration (AMD) treated with or without ranibizumab. Methods Patients were recruited from the Macular Clinic of the King's College Hospital in London. Two groups of patients with neovascular AMD with at least 12 months of follow-up were included in the study. The treated group was treated with ranibizumab while the untreated group did not have any treatment. Best corrected visual acuity (BCVA) with modified ETDRS chart, fixation location and stability as measured with Nidek MP1, central retinal thickness as measured by Zeiss Cirrus SD-optical coherent tomography (OCT), and lesion size as measured by Topcon TRC-50IX camera were analysed and correlated. Results In total, 102 eyes were included in the study with 76 in the ranibizumab-treated group and 26 in the untreated group. There were no significantly demographic differences between the two groups. However, as expected, the treated group has significantly better vision (48.5 vs 15.5 letters, P <0.0001) and smaller lesions (10.8 vs 18.3 mm 2 , P =0.004), the central macular thickness as measured by OCT also showed a trend of normalised macular thickness (252 vs 282 microns, P =0.07). The location of fixation was significantly more central in the ranibizumab-treated group (χ 2 17.9, P <0.0001) with over 50% of eyes with predominantly central fixation. Majority (84.6%) of the patients in the untreated group had predominantly eccentric fixation. Fixation stability was significantly better in the ranibizumab-treated group as compared with the untreated group, using both the software provided by the MP1 machine (χ 2 21.8, P <0.0001) and the mean log bivariate contour ellipse area calculated from the raw data obtained from the machine (3.64 vs 4.39 in treated and untreated group respectively, P <0.0001). Conclusion Low vision rehabilitation strategy for this group of patients in the ranibizumab era will be very different from those used in untreated patients with dense central scotoma. Further studies on the visual rehabilitation in the ranibizumab-treated patients should consider fixation characteristics of the patients.