Der Internist
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Low back pain is common. In the acute (duration <6 weeks) and subacute pain phases (6-12 weeks) the main goal of pharmacological pain treatment is to enable patients to move and to stay as active as possible. In the chronic phase, pain medications can support non-pharmacological measures and improve physical function. ⋯ Conclusion: in low back pain, the choice of a specific pain medications is based on the individual patient preferences, contraindications, and potential adverse effects. The main goal of pain medications is to enable patients to stay active. In persisting pain, non-pharmacological measures are important and should complement pharmacological pain treatment.
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Substitution with thyroid hormones is indicated in elderly patients with overt hypothyroidism, especially, when they present with typical symptoms of hypothyroidism. In light of the current study situation, the use of levothyroxine to treat clinical hypothyroidism in elderly patients is still controversial. In a recent double-blind, randomized, placebo-controlled study, levothyroxine provided no apparent benefits in older persons with subclinical hypothyroidism. ⋯ The recommendations of the European Thyroid Association is to treat elderly patients only when the TSH value is greater than 10 mU/l and the patient is symptomatic or the patient has a high cardiovascular risk. The therapeutic TSH range in elderly patients in the case of levothyroxine treatment should be 1.0-5.0 mU/l. Follow-up of the TSH level is mandatory in order to not oversee a developing overt hypothyroidism and to avoid overtreatment in case of levothyroxine treatment.
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Eosinophilic granulocytes form peripheral effector cells controlled by Th2 lymphocytes, which cause local cell, tissue, and functional disorders of infiltrated organs via the release of cytotoxic basic proteins and oxygen radicals. Diseases associated with eosinophilia include systemic and organ-related forms. The lungs are involved in eosinophilic granulomatosis with polyangiitis (EGPA, formerly known as Churg-Strauss syndrome), acute and chronic eosinophilic pneumonia, as well as in an organ manifestation in hypereosinophilic syndrome and certain parasitic diseases. ⋯ In addition, there are various overlap syndromes in which characteristic features of EGPA can be detected in the context of other anti-neutrophil cytoplasmic antibody (ANCA-)associated vasculitides. Occasionally, non-ANCA-associated pulmonary vasculitides occur with eosinophilia (e.g., Schönlein-Henoch purpura, Kawasaki disease, drug-induced hypersensitivity, and paraneoplastic syndrome). Herein, the pulmonary vasculitides accompanying eosinophilia are presented with respect to both the lung manifestations and pulmonary eosinophilia.
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The diagnosis of hypothyroidism is primarily based on clinical signs and symptoms as well as measurement of thyroid-stimulating hormone (TSH) concentration. Subclinical hypothyroidism is characterized by elevated TSH with normal serum free thyroxine (fT4) and triiodothyronine (fT3) levels, while in manifest hypothyroidism serum fT4 and fT3 levels are reduced. Common causes of primary hypothyroidism are autoimmune thyroiditis as well as therapeutic interventions, such as thyroid surgery or radioiodine therapy. ⋯ In contrast, in secondary hypothyroidism, serum fT4 levels are the basis for adjusting thyroid hormone dosage. Inadequate replacement of T4 resulting in subclinical or even manifest hyperthyroidism should urgently be avoided. T4/liothyronine (T3) combination therapy is still a matter of debate and not recommended as standard therapy, but may be considered in patients with persistence of symptoms, despite optimal T4 treatment, based on expert opinion.