Confounding medications common in thyroid disease

Nearly one-third of adults age 65 and older who take thyroid hormone concurrently take medications that are known to interfere with thyroid function tests.

They include prednisone, prednisolone, carbamazepine, phenytoin, phenobarbital, amiodarone, lithium, interferon-alpha and tamoxifen.

The US data from 538,137 older adults found 31.6% of the cohort were taking thyroid hormone and at least one TFT confounding medication.

Women, people of non-white and Hispanic ethnicity, and people who had other chronic medical conditions were more likely to concurrently use thyroid hormone and medications that interfere with thyroid tests.

“Our findings highlight the complexity of managing thyroid hormone replacement in older adults, many of whom take medications for other medical conditions,” said first author Dr Rachel Beeson, from the University of Michigan in Ann Arbor.

“Until now, the prevalence of concurrent use of thyroid hormone and interfering medications in older adults, and patient characteristics associated with this practice, has been unknown.”

The study will be presented virtually at ENDO 2021.

Guidance on COVID-19 for osteoporosis patients

Patients with osteoporosis do not appear to be at any increased risk for SARS-CoV-2 infection or for complications from COVID-19 disease and therefore do not need to be prioritised for COVID-19 vaccination.

Similarly, osteoporosis therapy does not appear to increase the risk or severity of COVID-19 infection.

However Joint Guidance on COVID-19 Vaccination and Osteoporosis Management from the Endocrine Society, ASBMR, IOF and other organisations outlines some medication-specific considerations.

They include:

• Oral bisphosphonates should be continued without interruption or delay in patients receiving COVID-19 vaccination.
• A one week interval between IV bisphosphonate infusion and COVID-19 vaccination will allow for distinguishing between putative acute phase reactions resulting from either IV bisphosphonate administration or COVID-19 vaccination.
• An interval of 4-7 days between treatment with denosumab and COVID-19 vaccination allows for the potential occurrence of injection site reactions with either treatment. Alternatively, denosumab treatment could be administered in the contralateral arm or alternative site (abdomen or upper thigh) if it is necessary to administer concomitantly with COVID-19 vaccine.
• While denosumab timing may be slightly adjusted to account for vaccine timing, denosumab injections should not be delayed more than 7 months after the previous denosumab dose.
• Both teriparatide and abaloparatide should be continued in patients receiving COVID-19 vaccination.
• An interval of 4-7 days between romosozumab and COVID-19 vaccination, or consideration for injection in the abdomen (except for a two-inch area around the navel) or thigh if administered concomitantly.
• Raloxifene should be continued in patients receiving COVID-19 vaccination.

EVOLVE advises against intensive glucose control in kidney disease

New advice from the RACP and the EVOLVE program advises against intensive blood glucose control in people with renal disease

In its latest Top-5 recommendations on low value practice the RACP in conjunction with the Australian and New Zealand Society of Nephrology recommends:

“Do not intensively lower HbA1C<6.5% to <8.0% in patients with early (stage 1-3) chronic kidney disease as intense lowering increased the risk of hypoglycaemia and mortality, noting that the individual target depends on factors such as severity of CKD, macrovascular complications, comorbidities, life expectancy and others.”

The other recommendations are:

• Do not give multiple daily doses of aminoglycoside antibiotics to patients with normal and stable kidney function as the risk of toxicity is less with a single dose.
• Do not use oral acetylcysteine before giving radiocontrast to patients at increased risk for contrast-induced acute kidney injury
• Do not give routine prophylactic antibiotics to a child after the first urinary tract infection if at low risk of recurrent urinary tract infections
• Do not prescribe aspirin therapy for primary prevention of cardiovascular disease in patients with stage 1-3 chronic kidney disease as there is no proven benefit and it is associated with increased risk of impaired haemostasis.