Osmania General Hospital

Abstract Disclosure: N. Kudugunti: None. L. Sudhakaran: None. D.P. Thuli: None. S. Edigakornapalli: None. R.K. Sahay: None. Background: Thyroid hormone plays a crucial role in pregnancy, and mild TSH elevation (2.5-4 mIU/L) is commonly encountered, but its impact on pregnancy and neonatal outcomes remains unclear. The treatment practices in managing pregnant women with mild TSH elevation (2.5 - 4 mIU/L) is highly variable, especially where anti-TPO testing is not routinely available. This study aimed to evaluate whether levothyroxine treatment in pregnant women with TSH levels between 2.5 and 4 mIU/L influences pregnancy and neonatal outcomes. Methodology: This retrospective study reviewed data from women with singleton pregnancies who delivered at a tertiary care center in South India between January 2022 and December 2023. A waiver of consent was obtained due to the use of de-identified data, with the goal of evaluating pregnancy and neonatal outcomes in women with mild TSH elevation (2.5-4 mIU/L). Inclusion criteria included delivered women in the postnatal ward, and exclusion criteria included those with multiple pregnancies, missing TSH values, or pre-existing thyroid disorders. A structured proforma was used to collect data on detailed history, clinical examination, and antenatal investigations across all trimesters. Delivery and neonatal outcomes, including gestational age, mode of delivery, neonatal complications, and birth weight, were also documented. The subjects were divided into treated and untreated group and was compared to women with TSH between 0.5 and 2.5 mIU/L. Statistical analysis was done to investigate the effect of treatment on pregnancy and neonatal outcomes. Results: Among 854 pregnant women with TSH levels between 2.5 and 4 mIU/L, 408 (47.7%) received levothyroxine treatment, while 446 remained untreated. These two groups were compared to 416 women with TSH levels between 0.5 and 2.5 mIU/L. Pregnant women with TSH between 2.5 and 4 mIU/L were older and overweight/obese compared to pregnant women with TSH below 2.5 mIU/L. The incidence of anaemia was significantly higher in the group with TSH between 2.5 and 4 mIU/L. Rates of gestational diabetes and preeclampsia were not significantly different across the groups. The cesarean section rate was also comparable among the groups. Preterm birth rates (<37 weeks) did not differ significantly between the treated and untreated groups. Neonatal outcomes, including NICU admissions, were also not different across the groups. Conclusion: Treatment of pregnant women with mildly raised TSH levels did not show any significant difference in pregnancy and neonatal outcomes in this study. Presentation: Saturday, July 12, 2025

This journal scan presents recent advances in pharmacotherapy, including obicetrapib, tirzepatide, plozasiran, and solbinsiran. It also discusses polymeric heart valves and demographic thresholds for hypertrophy in the diagnosis of obstructive hypertrophic cardiomyopathy. Additionally, we highlight important trials presented at the EURO PCR 2025, held in Paris, France.

Digitalis glycosides are among the oldest drugs used in cardiology. Despite the reduction in digoxin use and improved therapeutic monitoring, digoxin toxicity remains a significant cause of morbidity and mortality due to its use in specific cardiac diseases. Suspicion of digoxin toxicity should involve supportive care, discontinuation of the drug and administration of digoxin-specific antibody fragments. We present a case of a 62-year-old female with heart failure, who was administered intravenous digoxin for her presentation with atrial fibrillation having a fast ventricular rate. Subsequently, the patient had a junctional rhythm which was mistaken for controlled ventricular rate. This led to bidirectional tachycardia, the sine qua non of digitoxicity. The renal parameters were deranged. The patient was managed with antiarrhythmics and dialysis.

In India, the increasing prevalence of diabetes and obesity poses a significant threat towards a surge in the incidence of metabolic dysfunction‐associated steatotic liver disease (MASLD), formerly known as non‐alcoholic fatty liver disease (NAFLD). Concomitant with the evolving guidelines, there is a need to direct and spread awareness among practicing diabetologists to identify and screen high‐risk individuals for MASLD for timely management. Its asymptomatic nature and the evolving guidelines on diagnosis have hindered the precise estimates of MASLD in the high‐risk group of individuals in a clinical setting. Therefore, an expert panel of diabetologists from India convened to review, discuss and document the approach towards screening, diagnosis and management of MASLD. Serum biomarkers, simple non‐invasive tools and imaging techniques could direct the risk stratification of the patients. Early lifestyle interventions including weight loss and exercise are beneficial. The pharmacological landscape of drugs directed to insulin resistance, lipid metabolism, oxidative stress, inflammation, apoptosis and fibrogenesis pathways for the management of MASLD is expanding. In summary, the consensus statements are expected to serve as a useful guide in the screening and management of MASLD in the region and to direct a well‐planned study design that could enhance the scientific value of these statements.

ABSTRACT Hyalinizing trabecular tumor (HTT) is a rare neoplasm of follicular origin. It is often mistaken for classic papillary thyroid carcinoma (PTC) or medullary thyroid carcinoma (MTC) due to overlapping cytological and architectural features. We report a 49-year-old woman presenting with a left-sided thyroid nodule of 6 months’ duration. Ultrasound had shown a solid hypoechoic TIRADS 3 lesion (29 mm × 14 mm), and FNAC was suggestive of Bethesda category V. Her thyroid-stimulating hormone was 4.04 μIU/ml. She underwent total thyroidectomy with bilateral lymph node dissection. After histopathology, it showed a classic trabecular growth pattern and prominent hyalinization. Immunohistochemistry revealed a low proliferation index (Ki-67-peripheral staining), absent BRAF mutation, and PAS-positive, Congo red-negative stroma-differentiating it from PTC and MTC. A diagnosis of a hyalinizing trabecular tumor of the thyroid was made.