Thyroid Function Reference Intervals by Age, Sex, and Race

How Would You Manage This Patient With Iron Deficiency Anemia? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Iron deficiency anemia (IDA) is the most common cause of anemia worldwide and a major cause of disability, manifesting with symptoms including fatigue, weakness, exercise intolerance, worsening heart failure, impaired concentration, irritability, and depression. Women of reproductive age are disproportionately affected due to menstrual blood loss and gynecologic disorders. Iron deficiency anemia is diagnosed in patients who have both iron deficiency (ID), noted by low ferritin level and/or transferrin saturation, and anemia. Notably, iron deficiency (ID) can also occur in the absence of anemia, and overreliance on hemoglobin thresholds may risk missing the diagnosis in menstruating women due to flawed sex-specific reference ranges. Work-up for ID and IDA should focus on identifying the underlying cause of anemia, and may include a gynecologic work-up, bidirectional endoscopy, testing for Helicobacter pylori infection and celiac disease, as well as administering a trial of iron. Iron deficiency can be treated with either oral or intravenous iron. Although several guidelines address the diagnosis or management of ID and IDA, they differ in their recommendations based on the population studied, the clinical context, and the quality of the underlying evidence. Here, 2 hematologists and coauthors of the 2025 Iron Consortium Guideline published in Lancet Haematology discuss areas of guideline uncertainty relating to the diagnosis, evaluation, and treatment of patients with IDA and for Ms. B, a young woman diagnosed with ID.

Hypertension

Updated U.S. and international hypertension guidelines reflect new studies and analyses that support changes in hypertension management. The 2025 U.S. guideline for prevention, detection, evaluation, and management of high blood pressure (BP) recommends lower BP targets, greater use of out-of-office BP for diagnosis and medication titration, and a different approach to severe hypertension presenting without acute or evolving cardiovascular disease symptoms or signs. New treatments for resistant hypertension are recommended. Trial evidence supports benefit from tighter BP control to prevent mild cognitive impairment and dementia, further emphasizing the importance of lower BP goals.

In patients receiving benzodiazepines long-term, a web-based education and tapering tool improved cessation vs. usual care

Clinical Impact Ratings Mental Health: 6 out of 7 GIM/FP/GP: 6 out of 7

Experts discuss developments in dementia

Dementia: Clinical Challenges

In patients with painful diabetic neuropathy, pregabalin does not differ from duloxetine for pain

Clinical Impact Ratings GIM/FP/GP: 5 out of 7 Endocrinology: 5 out of 7

Public Policy Approaches to Addressing Adult Obesity: A Position Paper From the American College of Physicians

Forty percent of U.S. adults have obesity, a complex condition determined by genetics, behavior, environment, and other modifiable and nonmodifiable factors. Obesity is associated with certain comorbid conditions, including type 2 diabetes, high cholesterol, heart disease, and some cancer types, and may increase the severity of communicable illnesses, such as influenza. Treatments of obesity include behavioral modification, pharmacotherapy, and surgical procedures, but high cost and coverage restrictions are a substantial barrier for many patients. In this position paper, the American College of Physicians (ACP) offers recommendations on how policymakers can increase the affordability and accessibility of obesity treatment for adults and address modifiable factors that contribute to obesity, like diet and physical activity. ACP also includes recommendations on reducing stigma associated with obesity, improving understanding of obesity among physicians, increasing access to healthy food, and curbing the proliferation of unhealthy, highly processed fare. Population health strategies for addressing obesity are also discussed.

Correction: Hyponatremia

Surgery Versus Watchful Waiting for First Metatarsophalangeal Joint Osteoarthritis: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 0, No 0

Background: Hallux rigidus, or osteoarthritis of the first metatarsophalangeal joint (MTPJ), causes pain and functional limitation. No randomized trials have compared surgery with the natural course of the disease. Objective: To compare first MTPJ arthrodesis—a widely used surgical intervention—with watchful waiting in reducing walking-related pain in symptomatic hallux rigidus at 12 months after randomization. Design: Single-center, parallel-group, randomized, controlled, superiority trial with 12-month follow-up. (ClinicalTrials.gov: NCT04590313) Setting: Orthopedic department of a tertiary care hospital in Finland. Participants: Adults aged 40 years or older with radiographically confirmed (Coughlin–Shurnas grade I to III) hallux rigidus with symptoms over a year and a walking pain score of 4 or higher on a numerical rating scale (NRS) of 0 to 10 were eligible. Exclusion criteria included type 1 diabetes mellitus, rheumatoid arthritis, and hallux valgus angle greater than 15°. Intervention: Participants were randomly assigned in a 1:1 ratio to surgery with first MTPJ arthrodesis using lag-screw and dorsal plating or to watchful waiting. Measurements: The primary outcome was walking-related pain (NRS of 0 to 10) at 12 months. The prespecified minimal clinically important difference was 1.7 points. Results: Between November 2021 and June 2024, 90 patients were randomly assigned (45 per group). The mean age was 58.1 years, and 89 participants completed the 12-month follow-up. At 12 months, the observed mean walking-related pain was 1.3 in the arthrodesis group and 5.7 in the watchful waiting group (adjusted mean difference, −5.0 points [95% CI, −6.1 to −3.9 points]), exceeding the prespecified minimal clinically important difference and favoring arthrodesis. Limitation: Single-center design. Conclusion: Among adults aged 40 years or older with painful hallux rigidus, first MTPJ arthrodesis provides a superior and clinically significant reduction in walking-related pain at 12 months compared with watchful waiting. Primary Funding Source: Suomen Lääketieteen Säätiö Foundation, Finland.