Browsing by Author "Yotsapon Thewjitcharoen"

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    Effectiveness and safety of sodium–glucose co-transporter-2 inhibitors in Thai adults with type 2 diabetes mellitus: a real-world study
    (2020-01-01) Chutintorn Sriphrapradang; Yotsapon Thewjitcharoen; Supawan Buranapin; Kittisak Sawanyawisuth; Nalin Yenseung; Wisawa Ubonchareon; Laddawan Limpijankit; Thep Himathongkam; Khon Kaen University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Chiang Mai University; Theptarin Hospital
    © 2020 Informa UK Limited, trading as Taylor & Francis Group. Background: Sodium–glucose co-transporter-2 inhibitors (SGLT2is) are widely used to improve both glycemic control and cardio-renal outcomes. We aim to evaluate the real-life clinical effectiveness, safety and outcomes of SGLT2is in Thai adults with type 2 diabetes mellitus (T2DM). Methods: This was a retrospective study involving adults with T2DM who were treated with SGLT2is for ≥3 months. Results: Among 1159 participants (women 52.6%; age: 61.1 ± 10.9 years; body mass index: 28.7 ± 5.2 kg/m2), 65.1%, 34.3% and 0.6% received dapagliflozin, empagliflozin and canagliflozin, respectively. Median SGLT2i treatment duration was 15 (IQR, 8–23) months. Of the patients, 16.5%, 6.4%, 4.9% and 1.6% had pre-existing coronary artery disease, stroke, heart failure and peripheral arterial disease, respectively. Mean HbA1c decreased by 0.7% (95% CI, −1.0 to −0.4) from a baseline of 8.3 ± 1.5%. At 24 months, body weight, and systolic and diastolic blood pressure decreased significantly from the baseline average of 2.5 kg, 3.5 mmHg and 2.4 mmHg, respectively. The median decline in eGFR was −1.3 ml/min/1.73 m2/year. The incidences of pollakiuria, genital tract infection, urinary tract infection and hypoglycemia were 7.2%, 2.8%, 2.2% and 0.9%, respectively. No participants developed diabetic ketoacidosis during the observation period. Conclusions: SGLT2is improved cardiometabolic parameters in Thai adults, clinically confirming findings in controlled trials.
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    A novel mutation in thyroid peroxidase gene causing congenital goitrous hypothyroidism in a German-Thai patient
    (2016-06-01) Chutintorn Sriphrapradang; Yotsapon Thewjitcharoen; Suwannee Chanprasertyothin; Soontaree Nakasatien; Thep Himathongkam; Objoon Trachoo; Mahidol University; Theptarin Hospital
    © Journal of Clinical Research in Pediatric Endocrinology, Published by Galenos Publishing. 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.
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    Unilateral gynecomastia as an initial presentation of hyperthyroid graves’ disease
    (2021-01-01) Titipatima Sakulterdkiat; Kessanee Romphothong; Waralee Chatchomchuan; Soontaree Nakasatien; Sirinate Krittiyawong; Yotsapon Thewjitcharoen; Thep Himathongkam; Mahidol University; Theptarin Hospital
    Graves’ disease is an autoimmune condition leading to the activation of and an increase in thyroid hormone secretion. Manifestations of hyperthyroidism in Graves’ disease can vary among people. In this case, we report a 24-year-old Thai man with a rare presentation of unilateral gynecomastia along with symptoms of thyrotoxicosis. Physical examination revealed a 3 cm non-tender palpable glandular tissue beneath and around the left areola without nipple discharge and moderately diffuse thyroid enlargement with thyroid bruit. Thyroid function test showed a typical thyrotoxicosis state with elevated serum-free T4 and decreased serum TSH. His diagnosis of Graves’ disease was confirmed biochemically with a highly elevated anti-TSH receptor antibody. Early treatment with anti-thyroid medication was given first, followed by Radioiodine treatment (RAI) for definitive treatment due to high level of anti-TSH receptor antibody, enlarged thyroid and severe thyrotoxicosis presentation at a young age, which might not resolve by anti-thyroid medication alone. The patient responded well to treatment and achieved complete resolution of unilateral gynecomastia with clinically and biochemically euthyroid within 3 months after treatment. No recurrent gynecomastia was found during the 2-year follow-up. Learning points: •• Characteristic of gynecomastia in hyperthyroidism is usually presented with bilateral progressive gynecomastia; however, unilateral gynecomastia is occasionally found as a presentation of hyperthyroidism. •• Complete resolution of gynecomastia without recurrence can be achieved within a few months of treatment after thyrotoxicosis is resolved in patients with hyperthyroidism with the recent development of gynecomastia. •• RAI for definitive treatment is recommended in young adult patients expressing very high anti-TSH antibody level with severe thyrotoxicosis.