Publications by authors named "Andrzej Lewiński"

331 Publications

New aspects in the pathogenesis and management of subacute thyroiditis.

Rev Endocr Metab Disord 2021 May 5. Epub 2021 May 5.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital, Research Institute, 281/289 Rzgowska St, 93-338, Lodz, Poland.

Subacute thyroiditis (SAT) is a thyroid inflammatory disease, whose pathogenesis and determinants of the clinical course were unclear for many decades. The last few years have brought many clinically significant new data on the epidemiology, pathogenesis and management of SAT. Several human leukocyte antigen (HLA) alleles were demonstrated not only to increase the risk of SAT, but also to correlate with SAT clinical course and determine the risk of recurrence. The world-wide epidemic of the coronavirus disease 19 (COVID-19) has provided new observations that the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can be a potent SAT-triggering factor, and that the clinical course of SAT in patients affected by COVID-19 is different from a typical one. Additionally, many new trends in the clinical course are emerging. In the last years, painless course of SAT is more and more often described, constituting a special challenge in patients hospitalized due to COVID-19. Despite an excellent availability of diagnostic methods, several difficulties in SAT differential diagnosis can be currently encountered and the proper diagnosis and treatment is frequently delayed. False positive diagnoses of SAT in patients with malignancies of poor prognosis constitute a life-threatening problem. Taking into account all the new aspects of SAT pathogenesis and of its clinical course, the new - modified - SAT diagnosis criteria have been proposed.
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http://dx.doi.org/10.1007/s11154-021-09648-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096888PMC
May 2021

Hormonal replacement therapy in women with a history of internal genital organ malignancy.

Prz Menopauzalny 2021 Apr 18;20(1):34-39. Epub 2021 Mar 18.

Department of Endocrinology and Metabolic Diseases, Medical University, Lodz, Poland Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.

Sudden cessation of ovary activity as a result of bilateral oophorectomy or chemo- or radiotherapy in premenopausal women is linked with more serious consequences that bear no comparison to natural menopause - to name just a few: higher rate of mortality, higher rate of colorectal and lung cancer, circulatory system diseases, cognitive disorders, Parkinson's disease, psychological disorders, osteoporosis, and sexual disorders. The prolonged period of estrogens deficit in premenopausal age is connected with worsened quality of life. The progress in oncological care means that in many malignant diseases, also in the case of gynaecological malignancies, the percentage of survivors increases. This makes improving the quality of life more and more important. The purpose of this review is to establish, based on EBM data, the answer to whether replacement hormonal therapy, being the most effective treatment of menopause symptoms, can be recommended for women who have undergone bilateral oophorectomy because of gynaecological cancer. On the basis of collected data, derived from meta-analysis, and studies which have been published within the last 20 years, it seems that the use of the appropriate type of hormonal replacement therapy (HRT) in properly selected gynaecological cancer survivors (epithelial ovarian cancer - EOC, endometrial cancer, squamous cell carcinoma of the cervix) is safe and effective. It seems that benefits connected with better quality of life that stem from the use of appropriate HRT in gynaecological cancer survivors predominate the unfounded fear of disease recurrence in selected patients' groups.
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http://dx.doi.org/10.5114/pm.2021.104572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077805PMC
April 2021

Transient Hyperthyrotropinemia in Outpatient Children with Acute Infections of the Respiratory System.

Int J Environ Res Public Health 2021 Apr 13;18(8). Epub 2021 Apr 13.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, 93-338 Lodz, Poland.

Background: Diagnostics of thyroid disorders (TD) are frequently based on the measurements of thyroid stimulating hormone (TSH) concentration only. If TSH is outside the reference range, the diagnostic procedure used in patients with TD isintroduced. Observations indicate that in a considerable number of these patients, TD is not confirmed. The aim of the study was to assess the incidence of transient hyperthyrotropinemia in healthy children during acute infections of the respiratory system.

Patients And Methods: The study included consecutive children (49 boys and 45 girls), aged 2.2-17.3 years, who visited one General Practitioner (GP) due to respiratory tract infections. The tests: complete blood count (CBC), C-reactive protein (CRP), TSH and FT4 were run on the next day after the visit at the physician's (initial visit) and ≥2 weeks after recovery.

Results: Among these children, elevated TSH values were found in about 10% of patients, and they went back to normal values after recovery. A prospective analysis showed a reduction of TSH values in approx. 65% of all groups and TSH at the follow-up visit was significantly lower.

Conclusions: Transient hyperthyrotropinemia was observed in about 10% of children with acute respiratory tract infection. This preliminary finding remains unexplained.
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http://dx.doi.org/10.3390/ijerph18084115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070413PMC
April 2021

Percentage of Myeloid Dendritic Cells in Peripheral Venous Blood Is Negatively Related to Incidence of Graves' Orbitopathy.

Mediators Inflamm 2021 26;2021:8896055. Epub 2021 Jan 26.

Department of Endocrinology and Metabolic Disease, Medical University of Lodz, 93-338 Lodz, Poland.

The aim of the study was to evaluate the distribution of blood dendritic cells (DCs) in patients with Graves' orbitopathy (GO) and to assess the influence of methylprednisolone therapy on subsets of peripheral blood mononuclear cells (PBMCs). Peripheral blood DC subsets were analyzed by flow cytometry in patients with active GO ( = 17), inactive GO ( = 8), and Graves' disease (GD) without GO ( = 8) and controls ( = 15); additionally, in patients with active GO ( = 17), analyses were done at three time points, i.e., before methylprednisolone treatment and after 6 weeks and after 12 weeks of the treatment. Percentage of myeloid DCs (mDCs) in PBMC fraction was significantly lower in patients with both active and inactive GO, compared to patients with GD without GO and controls ( < 0.05). In addition, mDCs were also documented to be an independent factor negatively associated with GO, however without essential differences between active and inactive phases. On the other hand, we did not observe any changes in the percentage of DCs after methylprednisolone therapy ( > 0.05). In the present study, we have succeeded to firstly demonstrate-according to our knowledge-that blood mDCs are negatively related to GO incidence.
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http://dx.doi.org/10.1155/2021/8896055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857924PMC
January 2021

Innovative biodegradable dibutyrylchitin dressing for the treatment of ulcers occurring during chronic venous insufficiency in patients with type 2 diabetes.

Int J Occup Med Environ Health 2021 Jan 8. Epub 2021 Jan 8.

Polish Mother's Memorial Hospital - Research Institute, Łódź, Poland (Department of Endocrinology and Metabolic Diseases).

The aim of this study was to assess the course of the healing process following the use of dibutyrylchitin (DBC) dressing, a fully degradable material used in the treatment of ulcers which occur during chronic venous insufficiency common in patients suffering from type 2 diabetes. These diseases have a significant impact on the patients' standard of living, including the potential employment, and on the declining attendance at the current workplace. The implementation of this innovative therapeutic solution may positively affect the above-mentioned difficulties. An analysis of the healing process, following the application of the DBC dressing, was performed. Once the dressing was positioned on the wound, the analysis indicated that it underwent a process of degradation facilitated by the enzymes occurring naturally in the wound. When fully degraded, a further layer was applied. This process was repeated until the wound was fully healed. The study group consisted of 4 patients previously diagnosed with type 2 diabetes. During the observation period, the ulcers in all 4 cases had healed. The examined wound dressings adhered well to the wound surface and degraded within it. No side effects or adverse effects of the applied innovative therapy were observed. An addition of the biodegradable DBC dressing to the standard therapy procedure of ulcers occurring during chronic venous insufficiency among patients with type 2 diabetes indicate safe and effective treatment, which may have a direct reflection in the patient's professional capacity enhancement. It resulted in the complete healing of all ulcers in each of the observed cases.
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http://dx.doi.org/10.13075/ijomeh.1896.01670DOI Listing
January 2021

Changes of androgens levels in menopausal women.

Prz Menopauzalny 2020 Dec 7;19(4):151-154. Epub 2021 Jan 7.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.

Androgens play an important role in women's health. They are responsible for the sexual well-being and for maintaining proper structure and function of genitourinary woman's tract. In menopausal period a relative increase in androgens level is observed as a result of dramatic demise of estrogens and increase of sex hormone-binding globulin (SHBG). However, the response of target tissue depends on its ability to control androgens availability. In menopausal women the symptoms of both hyperandrogenemia and of androgens deficiency may be observed. Hyperandrogenemia may result in discrete symptoms, such as slight terminal facial hair grow, or worsening of scalp hair loss. Those symptoms should not be belittled in any of the cases, especially when their severity increases one should seek possible causes of postmenopausal hyperandrogenemia. Ovarian and adrenal aging, leading to a progressive decline in androgen levels, may exert detrimental effects on the quality of life. During menopause, changes in activation of particular brain spheres are connected with low sex hormone concentration and correlate with loss of sexual arousability. Hypoactive sexual desire dysfunction (HSDD) may be the direct result of androgens deficiency in menopausal women. It is the only evidence-based indication for the use of testosterone in women. However, before treatment, other diseases must be excluded that might alternatively be the cause of HSDD.
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http://dx.doi.org/10.5114/pm.2020.101941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812536PMC
December 2020

Interobserver Agreement and Plane-Dependent Intraobserver Variability of Shear Wave Sonoelastography in the Differential Diagnosis of Ectopic Thymus Tissue.

J Clin Med 2021 Jan 9;10(2). Epub 2021 Jan 9.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital Research Institute, 93-338 Lodz, Poland.

Shear wave elastography (SWE) has been demonstrated to be a useful tool in the differential diagnosis of ectopic thymus tissues (ETs), providing quantitative values of the shear wave stiffness (SWS) of both ETs and adjacent thyroid tissue. However, no data are available on the potential influence of the imaging plane (transverse vs. longitudinal) on the obtained SWS and shear wave ratio (SWR) values in SWE of these tissues. Moreover, no reports on the interobserver repeatability of SWE were published in regard to ETs. The aim of this study has been to evaluate the potential influence of the examination plane-transverse vs. longitudinal-on the SWS and SWR results, as well as to determine whether SWE of ETs is subjected to interobserver variability. SWE was demonstrated to have high inter- and intraobserver agreement in the evaluation of ETs and adjacent thyroid tissue. Significant differences between SWS values, but not SWR values, obtained in the transverse and longitudinal planes were observed. This phenomenon is probably a result of anisotropy-related artifacts and does not reduce the reliability of the method. SWE operators should be aware of the presence of plane-dependent artifacts to properly interpret the obtained results.
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http://dx.doi.org/10.3390/jcm10020214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827397PMC
January 2021

Specialist thyroid package 1 (PS1) in outpatient endocrine care [Pakiet specjalistyczny dotyczący tarczycy (PS1) w ambulatoryjnej opiece endokrynologicznej].

Endokrynol Pol 2020 ;71(6):485-496

Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland.

The article presents the assumptions of a new specialist thyroid package (PS1) in outpatient specialist care in the field of endocrinology, which was introduced by the National Health Fund (NFZ - Narodowy Fundusz Zdrowia) from January 2020. It became an impulse to characterize the current problems affecting specialist care in the field of endocrinology, search for their potential causes and propose strategies that are intended to contribute to increasing the efficiency of the system.
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http://dx.doi.org/10.5603/EP.a2020.0078DOI Listing
January 2020

Recombinant Human Thyroid-Stimulating Hormone Increases the Percentages of Natural Killer T Cells and B Lymphocytes in Human Peripheral Blood .

Front Endocrinol (Lausanne) 2020 20;11:543845. Epub 2020 Nov 20.

Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland.

Multiple cellular and humoral components of the immune system play a significant role in the physiology and pathophysiology of various organs including the thyroid. On the other hand, both thyroid hormones and thyroid-stimulating hormone (TSH) have been shown to exert immunoregulatory activities, which are difficult to assess independently . In our study we employed a unique clinical model for the assessment of TSH biological function in humans. The structure of peripheral blood mononuclear cell populations was investigated, using flow cytometry, in athyroid patients (n = 109) after treatment because of the differentiated thyroid carcinoma (DTC) at two time-points: directly before and five days after recombinant human TSH (rhTSH) administration. The analysis revealed significant increase in the percentage of natural killer T cells and B lymphocytes in the peripheral blood of rhTSH treated patients, whereas, we did not observe any effects on investigated subpopulations of dendritic cells and monocytes, T cells and natural killer cells. The findings of the study indicate the immune regulatory role of TSH, directed specifically on selected cell subtypes.
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http://dx.doi.org/10.3389/fendo.2020.543845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7715015PMC
November 2020

Application of Shear Wave Sonoelastography in the Differential Diagnosis of Extra- and Intra-Thyroidal Ectopic Thymic Tissue.

J Clin Med 2020 Nov 25;9(12). Epub 2020 Nov 25.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, 281/289 Rzgowska St., 93-338 Lodz, Poland.

The ultrasound (US) pattern of intrathyroidal ectopic thymus (IET) can resemble papillary thyroid carcinoma (PTC) while the extrathyroidal ectopic thymus (EET) can mimic pathological lymph nodes. Recently, the usefulness of strain elastography (SE) was demonstrated in the differential diagnosis, however this method has several limitations. The aim of the current study was to assess the usefulness of shear wave elastography (SWE) in this field. The US, SE, and SWE were performed in 31 children with 53 ectopic thymuses (ETs) and quantitative values of SWE parameters were calculated, so as to generate potential normative values of ET elasticity and of the shear wave ratio (SWR). The mean SWR was 0.89 ± 0.21 and the mean shear wave stiffness (SWS) was 7.47 ± 1.93 kPa. The mean SWR was 0.84 ± 0.15 and the mean SWS was 11.28 ± 2.58 kPa. The results have proven that the stiffness of ETs is lower or equal to the thyroid's. SWE was demonstrated to be a useful diagnostic method for ET evaluation. Therefore, the application of SWE in ET diagnosis allows more accurate evaluation of ET-like lesions and, in many cases, allows one to avoid invasive procedures, simultaneously providing a precise monitoring method based on combined US and SWE evaluation.
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http://dx.doi.org/10.3390/jcm9123816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761517PMC
November 2020

Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation - Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy].

Endokrynol Pol 2020 ;71(5):441-465

Department of Endocrinology, Medical Centre of Postgraduate Education, Warsaw, Poland.

Hypothyroidism is a common endocrine disorder affecting 3-15% of the adult population in subclinical form and 0.3-0.8% as overt disease. The mainstay of treatment is replacement monotherapy with levothyroxine (LT4). Currently several oral LT4 formulations including tablets, softgel capsules, and liquid formulations are available. Liquid LT4 is manufactured as LT4 solution in 85% glycerol and 96% ethanol and as LT4 solution in purified water and glycerol. The latest formulation, Tirosint SOL, gained FDA approval in 2017. To evaluate the clinical utility of liquid LT4 we reviewed the literature using three databases: PubMed/MEDLINE, Scopus, and Embase and found 405 articles among which 23 prospective and two retrospective studies were further evaluated. Finally, several case reports on rare clinical conditions were discussed. Our review demonstrated that liquid LT4 was more effective than tablet formulation in patients with malabsorption caused by interfering diseases, drugs, and bariatric surgery. The better pharmacokinetics of liquid LT4 was also confirmed in subjects without malabsorption: patients on replacement or suppressive therapy, who switched from tablet to liquid formulation in equivalent dose, gained better hormonal control, and required less frequent TSH measurements. The drug also appeared effective and easy to handle in patients fed by enteric tube. Liquid LT4 appeared equally effective whenever taken before or during breakfast. The analysis of the drug utility in particular populations including newborns, pregnant women, and the elderly confirmed the high value and safety of liquid LT4. However, in neonates the higher incidence of TSH suppression on liquid in comparison to tablet LT4 therapy was noted, and particular attention to avoid over-treatment must be paid. Concluding: the literature review revealed that liquid LT4 is especially advantageous in patients with malabsorption and the critically ill, but it seems also very promising in common therapy. The lack of alcohol content in the new formulation makes Tirosint SOL especially attractive.
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http://dx.doi.org/10.5603/EP.a2020.0065DOI Listing
January 2020

Strong Correlation between HLA and Clinical Course of Subacute Thyroiditis-A Report of the Three Siblings.

Genes (Basel) 2020 Oct 29;11(11). Epub 2020 Oct 29.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, 93-338 Lodz, Poland.

Subacute thyroiditis (SAT) is a thyroid inflammatory disease with susceptibility associated with the presence of human leukocyte antigen (, , and . Previous viral infection is considered as a triggering factor in genetically predisposed individuals. The influence of HLA on the SAT course was previously suggested. We aim to present the three siblings-female twins and their brother-with very close onset but different clinical courses of SAT, which appeared to be HLA-dependent. The HLA profile in the reported three siblings is strongly correlated with both SAT and Graves' disease (GD), however the coexistence of particular sets of high risk and protective alleles seems to be crucial for the GD development and the SAT course. The co-occurrence of and/or , possibly together with the lack of and seems to be key factors protecting against the development of GD with high TRAb levels, as well as against the recurrent SAT course and steroid dependence.
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http://dx.doi.org/10.3390/genes11111282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693567PMC
October 2020

Strong Positive Correlation between TSH and Ghrelin in Euthyroid Non-Growth Hormone-Deficient Children with Short Stature.

Molecules 2020 Aug 27;25(17). Epub 2020 Aug 27.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, 93-338 Lodz, Poland.

The growth processes in children depend on the proper functioning of some hormones and growth factors. Recently, a positive correlation between ghrelin and TSH (thyroid stimulating hormone) in patients with hyper- and hypothyroidism was proved. Moreover, in hypothyroid rats with high ghrelin concentration, growth hormone (GH) and insulin-like growth factor I (IGF-I) secretion was suppressed. We analyzed these relationships in euthyroid prepubertal children with idiopathic short stature (ISS). The analysis comprised concentration of ghrelin, GH in stimulating tests and during the night, as well as IGF-I, TSH, free thyroxine (FT4) and free triiodothyronine (FT3) in 85 children with ISS (36 girls, 49 boys) aged 9.65 ± 3.02 years (mean ± SD). A strong positive correlation between ghrelin and TSH was confirmed (r = +0.44, < 0.05). A higher ghrelin but lower nocturnal GH and lower IGF-I were observed in children with higher normal TSH concentration than those in children with lower normal TSH. Interestingly, alterations of TSH level were without any impact on FT4 and FT3 concentrations. Summing up, in ISS prepubertal euthyroid children, ghrelin and TSH secretion are closely related. On the other hand, the higher the TSH, the lower the nocturnal GH and IGF-I levels. The contribution of the above findings in deterioration of growth processes requires further studies.
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http://dx.doi.org/10.3390/molecules25173912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503826PMC
August 2020

Novel Germline c.105_107dupGCT Mutation in a Family with Newly Diagnosed Multiple Endocrine Neoplasia Type 1.

Genes (Basel) 2020 08 24;11(9). Epub 2020 Aug 24.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, 93-338 Lodz, Poland.

In multiple endocrine neoplasia type 1 (MEN1), the causative gene mutations lead to the reduced expression of menin, which is a tumor suppressor protein. In this study, we present a case of a 16-year-old woman with severe primary hyperparathyroidism and a non-functioning pituitary microadenoma. Genetic testing demonstrated a novel germline heterozygote variant c.105_107dupGCT of , leading to Leu duplication in position 37 of the menin polypeptide chain. As such a mutation was not reported before as a causative one, confirmation of its pathogenicity required showing the same mutation in a symptomatic first-degree relative. An identical mutation was found in the patient's father, who was further diagnosed with hyperparathyroidism and a pituitary microadenoma. We observed the presence of the same MEN1-related tumors but an entirely different symptom severity. To the best of our knowledge, this is the first report of MEN1 syndrome caused by the c.105_107dupGCT mutation. This case report demonstrates the importance of genetic evaluation towards MEN1. Genetic testing for MEN1 mutations should be performed in all patients with MEN1-related tumors, and in the young patients even with only one such tumor, despite the supposedly negative family history.
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http://dx.doi.org/10.3390/genes11090986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565931PMC
August 2020

Overexpression Correlates with Metastatic Phenotype in BRAF Positive Papillary Thyroid Carcinoma.

J Clin Med 2020 Aug 21;9(9). Epub 2020 Aug 21.

Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland.

The ability of cancer to metastasize is regulated by various signaling pathways, including transforming growth factor β (TGFβ), also implicated in the upregulation of Snail-1 transcription factor in malignant neoplasms. B-type Raf kinase gene (BRAF), the most common driving mutation in papillary thyroid carcinoma (PTC), induces epithelial to mesenchymal transition (EMT) in thyroid cancer cells through changes in the Snail-1 level, increasing cell migration and invasion. However, little is known about the mechanism of Snail-1 and BRAF relations in humans. Our study included 61 PTC patients with evaluated BRAF mutation status. A total of 18 of those patients had lymph node metastases-of whom 10 were BRAF positive, and 8 negative. Our findings indicate that the expression of Snail-1, but not TGFβ1, correlates with the metastatic phenotype in PTC. This is the first piece of evidence that the upregulation of Snail-1 corresponds with the presence of BRAF mutation and increased expression of Snail-1 in metastatic PTC samples is dependent on BRAF mutation status.
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http://dx.doi.org/10.3390/jcm9092701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565998PMC
August 2020

Comparison of nocturnal and morning ghrelin concentration in children with growth hormone deficiency and with idiopathic short stature.

Chronobiol Int 2020 11 11;37(11):1629-1635. Epub 2020 Aug 11.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute , Lodz, Poland.

Ghrelin - a growth hormone (GH) secretagogue - presents a circadian rhythm with higher nocturnal than diurnal concentration (similar to GH). However, daily ghrelin production depends on food intake and nutritional state; it is increased in the fasting state and decreased after a meal. Since most past research concerning short stature children has relied on the morning ghrelin concentration for analyses, we decided to assess ghrelin concentration at the 60 and 90 minute after falling asleep and in the morning at 06:00 h, shortly after waking up from nighttime sleep (after 12 h of fasting). We compared these ghrelin concentrations to determine differences between nocturnal and morning ghrelin release in short children, both with idiopathic short stature (ISS) and growth hormone deficiency (GHD). We also analyzed the correlation between the nocturnal and morning ghrelin concentrations with nocturnal GH concentrations, measured at the same time points, as well as with maximal GH concentration, achieved by stimulation tests, and with the insulin-like growth factor I (IGF-I). The ghrelin and GH concentration 60 and 90 minute after falling asleep, as well as fasting morning ghrelin and IGF-I concentrations, were measured in 19 (n = 10 ISS and n = 9 GHD) prepubertal short children (7 girls and 12 boys), aged 10.36 ± 3.06 y. Differences between the nocturnal and morning ghrelin concentrations were analyzed by the Wilcoxon matched-pairs signed-rank test. Typical regression and correlation analyses were used to assess relationships among parametric data for other analyses. The Wilcoxon test showed ghrelin concentration is significantly higher in the morning than both at the 60 and 90 minute after falling asleep time points (in ISS and GHD). A significant correlation was observed: a) positive - between nocturnal ghrelin (both at the 60 and 90 minute) and morning ghrelin concentrations; b) positive - between ghrelin at the 60 minute and nocturnal GH concentrations (both at the 60 and 90 minute); c) negative - between ghrelin at the 60 minute and IGF-I concentrations; and d) negative - between body mass index and ghrelin concentrations at the 60 and 90 minute. We conclude: 1) in short children, both with GHD and with ISS, morning ghrelin level reflects its nocturnal concentration; however, it is significantly higher than the nocturnal ones. There is no significant difference between the measurement of ghrelin concentration at night at the 60 or 90 minute after falling asleep; 2) morning ghrelin concentration is affected by the hunger and satiety; therefore, it appears that nocturnal measurements better reflect the pool of hormone responsible for stimulation of GH and IGF-I secretion, especially since positive correlation between nocturnal ghrelin and nocturnal GH secretion was noted; 3) it seems that a higher body mass index is an additional independent factor, associated mainly with lower nocturnal (but not morning) ghrelin secretion.
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http://dx.doi.org/10.1080/07420528.2020.1797765DOI Listing
November 2020

S-Detect Software vs. EU-TIRADS Classification: A Dual-Center Validation of Diagnostic Performance in Differentiation of Thyroid Nodules.

J Clin Med 2020 Aug 3;9(8). Epub 2020 Aug 3.

Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland.

Computer-aided diagnosis (CAD) and other risk stratification systems may improve ultrasound image interpretation. This prospective study aimed to compare the diagnostic performance of CAD and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classification applied by physicians with S-Detect 2 software CAD based on Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and combinations of both methods (MODELs 1 to 5). In all, 133 nodules from 88 patients referred to thyroidectomy with available histopathology or with unambiguous results of cytology were included. The S-Detect system, EU-TIRADS, and mixed MODELs 1-5 for the diagnosis of thyroid cancer showed a sensitivity of 89.4%, 90.9%, 84.9%, 95.5%, 93.9%, 78.9% and 93.9%; a specificity of 80.6%, 61.2%, 88.1%, 53.7%, 73.1%, 89.6% and 80.6%; a positive predictive value of 81.9%, 69.8%, 87.5%, 67%, 77.5%, 88.1% and 82.7%; a negative predictive value of 88.5%, 87.2%, 85.5%, 92.3%, 92.5%, 81.1% and 93.1%; and an accuracy of 85%, 75.9%, 86.5%, 74.4%, 83.5%, 84.2%, and 87.2%, respectively. Comparison showed superiority of the similar MODELs 1 and 5 over other mixed models as well as EU-TIRADS and S-Detect used alone (-value < 0.05). S-Detect software is characterized with high sensitivity and good specificity, whereas EU-TIRADS has high sensitivity, but rather low specificity. The best diagnostic performance in malignant thyroid nodule (TN) risk stratification was obtained for the combined model of S-Detect ("possibly malignant" nodule) and simultaneously obtaining 4 or 5 points (MODEL 1) or exactly 5 points (MODEL 5) on the EU-TIRADS scale.
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http://dx.doi.org/10.3390/jcm9082495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464710PMC
August 2020

Bone Metabolism in Patients Treated for Depression.

Int J Environ Res Public Health 2020 07 2;17(13). Epub 2020 Jul 2.

Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland.

Background: Depression and osteoporosis are severe public health problems. There are conflicting findings regarding the influence of depression on bone metabolism. The aim of the presented study was to compare bone turnover markers and vitamin D levels between patients treated for depression and healthy controls.

Patients And Methods: We determined a concentration of osteocalcin, carboxy-terminal telopeptide of type I collagen (β-CTX), 25-hydroxyvitamin D (25OHD) and 1,25(OH)D in 99 patients, aged 46.9 ± 11 years, treated for depression, as well as in 45 healthy subjects. Depressive status was determined with the Hamilton Depression Scale (HDRS).

Results: In patients treated for depression, we demonstrated significantly lower osteocalcin concentrations ( < 0.03) and higher concentration of β-CTX (result on the border of significance; = 0.08). Those relationship were stronger in women. The level of 25OHD and 1,25(OH)D did not differ significantly between the examined groups. We observed a negative correlation between the 25OHD and HDRS score after treatment in all patients treated for depression and in subgroups of women and subjects with recurrent depression.

Conclusions: Our results indicate that depression is related to disturbances in bone metabolism, especially in women and patients with recurrent depression, suggesting its role in context of osteoporosis development.
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http://dx.doi.org/10.3390/ijerph17134756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369860PMC
July 2020

Correction to: High normal TSH is associated with lower mannan-binding lectin in women of childbearing age.

BMC Endocr Disord 2020 06 9;20(1):82. Epub 2020 Jun 9.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12902-020-00564-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282126PMC
June 2020

Adequate timing and constant supervision are the keys for successful implementation of levothyroxine or levothyroxine/paracetamol absorption test.

Thyroid Res 2020 18;13. Epub 2020 May 18.

1Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Rzgowska 281/289, 93-338 Lodz, Poland.

Background: Levothyroxine (LT) pseudomalabsorption due to medication non-adherence results in significant costs for Health Service. High dose LT or LT/paracetamol absorption test is used in such cases. Hence, establishment of an optimal test protocol and timing of sample collection is of utmost importance.

Case Presentation: A 34-year old woman was admitted to our Department because of severe hypothyroidism [on admission thyrotropin (TSH) > 100 μIU/ml, free thyroxine (FT) 0.13 ng/dl (ref. range 0.93-1.7)] despite apparently taking 1000 μg of LT a day. Autoimmune hypothyroidism had been diagnosed 4 years before during post-partum thyroiditis. Subsequently, it was not possible to control her hypothyroidism despite several admissions to two University Hospitals and despite vehement denial of compliance problems. There was no evidence of coeliac disease or other malabsorption problems, though gluten-free and lactose-free diet was empirically instigated without success. A combined paracetamol (1000 mg)/LT (1000 μg) absorption test was performed in one of these Hospitals. This showed good paracetamol absorption (from < 2 μg/ml to 14.11 μg/ml at 120 min), with inadequate LT absorption (FT increase from 5.95 pmol/l to 9.92 pmol/l at 0 and 120 min respectively). About 2 years prior to admission to our Department the patient was treated with escalating doses of levothyroxine [up to 3000 μg of T and 40 μg of triiodothyronine (T) daily] without significant impact on TSH (still > 75 μIU/ml, and FT still below reference range).After admission to our Department we performed a 2500 μg LT absorption test with controlled ingestion of crushed tablets, strict patient monitoring and sampling at 30 min intervals. We observed a quick and striking increase in FT from 0.13 to 0.46, 1.78, 3.05 and 3.81 ng/dl, at 0, 30, 60, 90 and 120 min, respectively. Her TSH concentration decreased to 13.77 μIU/ml within 4 days. When informed, that we had managed to "overcome" her absorption problems, she discharged herself against medical advice and declined psychiatric consultation.

Conclusions: Adequate patient supervision and frequent sampling (e.g. every 30 min for 210 min) is the key for successful implementation of LT absorption test. Paracetamol coadministration appears superfluous in such cases.
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http://dx.doi.org/10.1186/s13044-020-00079-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236172PMC
May 2020

Night shift work and osteoporosis among female blue-collar workers in Poland - a pilot study.

Chronobiol Int 2020 06 26;37(6):910-920. Epub 2020 May 26.

Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine , Lodz, Poland.

Osteoporosis is an important public health problem worldwide. Although a number of factors that affect bone structure have been described; thus far, the current knowledge of occupational factors that may have an influence on bone tissue metabolism is strongly limited. Published studies indicate night shift work and the related circadian rhythm disruption may be considered as plausible underlying factors. The aim of the present study was to assess the potential association between night shift work and bone mineral density (BMD) among female blue-collar workers in Poland. A cross-sectional study was carried out among 194 female blue-collar workers >40 years of age employed in industrial plants. The operating system of work consisted of three work shifts clockwise rotation: morning (06:00-14:00 h), afternoon (14:00-22:00 h), and night (22:00-06:00 h), with five consecutive shifts per week followed by a free weekend. A questionnaire survey, based on a Polish version of The European vertebral osteoporosis study (EVOS) questionnaire, a validated instrument, was administered. Data on current job characteristics, job seniority, and lifetime duration of night shift work were also collected. BMD of the lumbar spine and hip (both total femur and femoral neck) was measured using dual-energy X-ray absorptiometry. Multivariate linear regression models were run, with bone mineralization parameters as dependent variables, as well as night work characteristics and important confounders. Statistical analysis was performed separately for premenopausal and postmenopausal women. The analyses adjusted for confounders did not reveal any significant differences between current or lifetime experience of night shift work and BMD among both premenopausal and postmenopausal women. However, the outcomes supported the well-established correlation with factors, such as age, BMI, and menopausal status. BMD at the three sites measured was significantly associated with BMI ( < .001) and inversely associated with age ( < .001) in the total study population. Postmenopausal women had significantly lower BMD than did premenopausal women ( < .001). The study findings indicate that in the population of Polish female blue-collar workers, the system of work does not seem to be associated with the development of osteoporosis.
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http://dx.doi.org/10.1080/07420528.2020.1763381DOI Listing
June 2020

Subclinical thyroid dysfunction in the first trimester of pregnancy: 'Disease' versus physiological (pulsatile) variation in TSH concentrations.

Clin Endocrinol (Oxf) 2020 12 16;93(6):739-745. Epub 2020 Jun 16.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland.

Background: There is no universal consensus regarding cut-off points for TSH in pregnancy, so concentrations of 2.5 or 4.0 mIU/L were suggested for first trimester (Endocrine Society [2012] and ATA [2017] guidelines, respectively). Yet, the impact of physiological variation in TSH secretion has not been assessed.

Subjects And Methods: We assessed baseline concentrations of free T4, free T3 and TSH at 30-minute intervals (between 7.00 and 9.00 hours) in 110 healthy pregnant women, age 30.2 ± 6.0 years, 9.9 ± 2.4 weeks of gestation, and in 19 female controls, age 28.9 ± 10.7.

Results: Mean TSH concentrations in pregnant women were 1.62 ± 1.26 mIU/L and on average varied by 39.5% (dispersion between the highest and the lowest TSH), with no difference in TSH variation between pregnant women and controls. Taking into account the highest TSH out of five consecutive measurements, TSH >2.5 mIU/L and TSH above 4.0 mIU/L were found in 23 (20.9%) and 10 (9.1%) pregnant women, respectively. In contrast, when the lowest TSH value was considered, then concentrations of TSH >2.5 mIU/L and >4.0 mIU/L were found in 14 (12.7%) and 4 (3.6%) women, respectively. This discrepancy was even more pronounced in aTPO-negative subjects (21 [21.2%] vs 8 [8.1%] women, for TSH >2.5 mIU/L, and six [6.06%] vs one [1.01%], for TSH >4.0 mIU/L). Furthermore, either six (5.4%) or 10 (9.1%) women had TSH concentrations below 0.1 mIU/L.

Conclusions: In a significant number of patients, diagnosis of subclinical thyroid dysfunction could be erroneously made not as a result of 'disease', but as a result of physiological variation in TSH concentrations.
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http://dx.doi.org/10.1111/cen.14256DOI Listing
December 2020

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH-Retrospective Study.

Int J Environ Res Public Health 2020 03 23;17(6). Epub 2020 Mar 23.

Polish Mother's Memorial Hospital-Research Institute, 93-338 Lodz, Poland.

High-normal TSH can be associated with metabolic abnormalities and infertility. Aims of this study are to analyze retrospectively if routinely measured blood laboratory and anthropometric parameters differ between women of reproductive age with TSH < 2.5 mIU/L and with TSH ≥ 2.5 mIU/L. Retrospective analysis was performed in 466 female inpatients, aged 13-51, hospitalized in an endocrine department. The group of 280 patients with normal thyroid tests (TSH 0.27-4.2 mIU/L; normal FT3 and FT4) was selected and it was divided into two subgroups, i.e., with TSH < 2.5 mIU/L and TSH ≥ 2.5 mIU/L (n = 66; 23.6%). After excluding patients on L-thyroxine treatment (n = 240), those with TSH ≥ 2.5 mIU/L constituted 22.92% (n = 55). In the group of 280 patients with normal thyroid tests, an abnormally high concentration of triglycerides and an abnormally low HDLC/cholesterol ratio occurred more frequently in women with TSH ≥ 2.5 mIU/L than those with TSH < 2.5 mIU/L (17% vs. 7%, = 0.017; 14% vs. 5%, = 0.015, respectively). Increased concentration of thyroid antibodies, i.e., TPOAb, occurred more frequently in patients with TSH ≥ 2.5 mIU/L than those with TSH < 2.5 mIU/L (27% vs. 9%, = 0.001). The same differences were found in the group of 240 patients after excluding those on L-thyroxine treatment. Blood lymphocyte concentration was the only independent linear parameter associated with TSH ≥ 2.5 mIU/L (OR = 1.551, = 0.024) but only in the group of 280 patients with normal thyroid tests. TSH concentration correlated positively with blood lymphocyte (r = 0.129, = 0.031) and TPOAb (r = 0.177, = 0.005) concentrations but only in the group of 280 patients with normal thyroid tests. Less favorable lipid profiles and a higher prevalence of thyroid antibodies in women of reproductive age with high-normal TSH suggests that L-thyroxine treatment should be considered in such patients. The significance of a positive association between high-normal TSH and blood lymphocytes requires further evaluation.
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http://dx.doi.org/10.3390/ijerph17062122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7143605PMC
March 2020

Subacute Thyroiditis is Associated with , - and --The Significance of the New Molecular Background.

J Clin Med 2020 Feb 16;9(2). Epub 2020 Feb 16.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital Research Institute, 281/289 Rzgowska St., 93-338 Lodz, Poland.

Subacute thyroiditis (SAT) is a thyroid inflammatory disease whose pathogenesis is still not completely defined. Previous viral infection is considered to be a triggering factor in genetically predisposed individuals. In about 70% of patients, susceptibility to SAT is associated with the allele. The correlation between SAT and other human leukocyte antigens (HLA) has not yet been unequivocally demonstrated and the genetic background is still unknown in about 30% of patients. The purpose of our study was to perform HLA genotyping using a next-generation sequencing method, to find out whether alleles other than HLA-B*35 are correlated with SAT morbidity. were genotyped using a next-generation sequencing method in 1083 subjects, including 60 SAT patients and 1023 healthy controls. Among 60 patients diagnosed with SAT, 81.7% of subjects were identified as having allele , 23.3% had , 28.3% had and 75.5% had . These alleles occurred in the control group at frequencies of 10.2%, 7.2%, 12.9% and 12.5%, respectively. The differences were statistically significant, with < 0.05. In addition to its previously described relationship with , genetic susceptibility to SAT was associated with the presence of and . The alleles and were independent SAT risk factors. The assessment of these four alleles allows the confirmation of genetic predisposition in almost all patients with SAT.
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http://dx.doi.org/10.3390/jcm9020534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074389PMC
February 2020

Significance of Direct Confirmation of Growth Hormone Insensitivity for the Diagnosis of Primary IGF-I Deficiency.

J Clin Med 2020 Jan 16;9(1). Epub 2020 Jan 16.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital-Research Institute, 93-338 Lodz, Poland.

Primary insulin-like growth factor-I (IGF-I) deficiency is a synonym of growth hormone (GH) insensitivity (GHI), however the necessity of direct confirmation of GH resistance by IGF-I generation test (IGF-GT) is discussed. GHI may disturb intrauterine growth, nevertheless short children born small for gestational age (SGA) are treated with GH. We tested the hypothesis that children with appropriate birth size (AGA), height standard deviation score (SDS) <-3.0, GH peak in stimulation tests (stimGH) ≥10.0 µg/L, IGF-I <2.5 centile, and excluded GHI may benefit during GH therapy. The analysis comprised 21 AGA children compared with 6 SGA and 20 GH-deficient ones, with height SDS and IGF-I as in the studied group. All patients were treated with GH up to final height (FH). Height velocity, IGF-I, and IGF binding protein-3 (IGFBP-3) concentrations before and during first year of treatment were assessed. Effectiveness of therapy was better in GHD than in IGF-I deficiency (IGFD), with no significant difference between SGA and AGA groups. All but two AGA children responded well to GH. Pretreatment IGF-I and increase of height velocity (HV) during therapy but not the result of IGFGT correlated with FH. As most AGA children with apparent severe IGFD benefit during GH therapy, direct confirmation of GHI seems necessary to diagnose true primary IGFD in them.
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http://dx.doi.org/10.3390/jcm9010240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019910PMC
January 2020

High normal TSH is associated with lower mannan-binding lectin in women of childbearing age.

BMC Endocr Disord 2020 Jan 3;20(1). Epub 2020 Jan 3.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, 7/9 Zeligowski St., 90-752, Lodz, Poland.

Background: Mannan-binding lectin (MBL) is a main component of the lectin pathway of the complement system. Lower MBL levels are associated with, among other conditions, hypothyroidism and adverse pregnancy outcomes. In turn, adverse pregnancy outcomes and infertility may result from hypothyroidism, even in patients with high normal Thyroid-stimulating hormone (TSH). The aim of this study was to determine if MBL level differs between women of reproductive age with low normal (< 2.5 mIU/l) and high normal (≥2.5 mIU/l) TSH. Associations with other parameters potentially affected by hypothyroidism were also evaluated.

Methods: Ninety five (95) patients with normal thyroid tests (TSH 0.27-4.2 mIU/l), aged 18-48 years, were prospectively enrolled. Several laboratory parameters were measured, including MBL level, thyroid tests and lipid profile.

Results: Serum MBL level was lower in women with TSH ≥ 2.5 mIU/l than with TSH < 2.5 mIU/l. This association was confirmed by univariate regression analysis. MBL level was significantly lower in patients with abnormally low HDLC/cholesterol ratio and a positive correlation was found between MBL level and HDL/cholesterol ratio.

Conclusion: In women of reproductive age with normal thyroid tests, lower MBL is associated with high normal TSH and with less favourable lipid profile. Therefore treatment with L-thyroxine should be considered in women of reproductive age with TSH ≥ 2.5 mIU/l.
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http://dx.doi.org/10.1186/s12902-019-0484-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942275PMC
January 2020

Prospective analysis of inter-observer and intra-observer variability in multi ultrasound descriptor assessment of thyroid nodules.

J Ultrason 2019 Nov 30;19(78):198-206. Epub 2019 Sep 30.

Department of Nuclear Medicine and Endocrine Oncology, The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.

The aim of this study was to evaluate the inter- and intra-observer variability and accuracy of ultrasound assessment of thyroid nodules using a descriptive lexicon. A prospective study was performed on complete ultrasound examinations, including sonoelastography and color Doppler ultrasound of 18 patients with 20 thyroid nodules. A total of 20 records of thyroid nodules from these techniques were duplicated, numbered, and randomly arranged. Five radiologists assessed the recordings independently. Cohen Kappa and Fleiss Kappa statistics were used to determine the degree of intra- and inter-observer agreement. Mean accuracy rates for all radiologists, for all ultrasound features, ranged from 82.7 to 87.8%. For B-mode and strain elastography, accuracies ranged from 65.0 to 100% and 47.4 to 86.8%, respectively. Concerning intra-observer variability, three radiologists demonstrated almost perfect agreement (the κ-value ranged from 0.81 to 0.86), and a substantial agreement was noted for the two remaining radiologists. The κ-values for inter-observer agreement ranged from 0.61 for macrocalcifications (substantial agreement) to 0.33 for Asteria four-point elastography scale criteria (fair agreement). The results suggest relatively good inter-observer and excellent intra-observer agreement in the assessment of thyroid nodules using ultrasound, and fair agreement in the case of strain elastography.
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http://dx.doi.org/10.15557/JoU.2019.0030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856778PMC
November 2019

Positive TgAbs in patients with Graves' orbitopathy are associated with lower risk of its active form - preliminary study.

Neuro Endocrinol Lett 2019 Oct;40(2):105-110

Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland.

Introduction: In this retrospective, single-centre cohort study, we report our 10-year experience concerning clinical manifestation, diagnosis and treatment of Graves' orbitopathy (GO), with particular regard to antithyroid antibodies in iodine sufficient Polish population.

Materials And Methods: Data on thyrometabolic and immunological status of 71 patients diagnosed with GO, were collected. Also, we gathered information on the selection of the applied treatment in these cases of Graves' disease (GD): pharmacological, radioiodine or surgery. The chi-square test, correlation coefficient and univariate logistic regression analysis were used to determine the influence of clinical parameters on activity of GO.

Results: Significantly lower frequency of active GO in positive anti-thyroglobulin antibodies (TgAbs) patients was documented (p<0.05, chi-square analysis). Expectedly, concentration of antibodies against thyrotropin receptor (TRAbs) did constitute linear factor positively associated with clinical activity score (CAS) (p<0.05). Moreover, the pretreatment with radioiodine and smoking were significantly associated with the increased GO activity (p<0.05 and p<0.05, respectively).

Conclusion: Our data suggest some kind of "protective" effect of TgAbs presence against the active form of GO.
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October 2019

Time-Lag Between Symptom Onset and Diagnosis of Subacute Thyroiditis - How to Avoid the Delay of Diagnosis and Unnecessary Overuse of Antibiotics.

Horm Metab Res 2020 Jan 26;52(1):32-38. Epub 2019 Nov 26.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.

Clinical symptoms of subacute thyroiditis (SAT) may be misleading and the proper diagnosis is significantly delayed, and many unnecessary therapeutic methods are used, including application of antibiotics. The purpose of the study is to analyze the reasons and frequency of delayed SAT diagnosis and unnecessary antibiotic treatment and to propose a simple algorithm to facilitate the diagnosis and prevent antibiotic abuse. Sixty-four SAT patients were divided into groups depending on the period of time from the first symptoms of SAT to diagnosis and on the unnecessary use of antibiotics. Data from medical history and laboratory test results were analyzed for individual groups to determine the reasons for delayed diagnosis and incorrect treatment. In 73% of patients, the diagnosis was delayed from over two weeks up to six months. Among 62 patients who provided data on antibiotic use, 29 (46.77%) were treated with one or more antibiotics due to SAT symptoms. Fever, preceding infection, increased C-reactive protein (CRP), and WBC were characteristic for the antibiotic treated group. Fever, preceding infection, increased CRP and WBC are typical for both SAT and infection and are the main symptoms leading to misdiagnosis and unnecessary antibiotic treatment in SAT. Thus, in all patients with neck pain or other SAT-like symptoms, thorough clinical examination of the neck is mandatory. When firm and/or tender thyroid nodule/goitre is present and erythrocyte sedimentation rate /CRP is increased, patient should be promptly referred to an endocrinologist, and antibiotics are not recommended.
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http://dx.doi.org/10.1055/a-1033-7524DOI Listing
January 2020

Evaluation of the effectiveness of iodine prophylaxis in Poland based on over 20 years of observations of iodine supply in school-aged children in the central region of the country.

Arch Med Sci 2019 Oct 1;15(6):1468-1474. Epub 2018 Jun 1.

Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.

Introduction: Due to the mild-to-moderate iodine deficiency in Poland, in 1997 iodine prophylaxis based on obligatory salt iodization was introduced. We attempted to evaluate the effectiveness of such prophylaxis, based on over 20 years of observations of iodine supply in school-aged children in Opoczno district (Central Poland).

Material And Methods: A group of 603 children (316 girls and 287 boys), aged 6-14, was examined at 4 time points: in the years 1994, 1999, 2010 and 2016. The children were tested for urine iodine concentration (UIC) and in each child the thyroid volume was measured ultrasonographically.

Results: The median UIC in 1994 (45.5 μg/l) indicated moderate iodine deficiency, while after introducing prophylaxis it corresponded to adequate values (1999 - 101.1 μg/l, 2010 - 100.6 μg/l, 2016 - 288.3 μg/l); however, the last value was higher than the previous two. The thyroid size, assessed by ultrasonography and presented as volume/body surface area (V/BSA), in 1994 was 6.55 × 10 m; this value was higher than at other time points (2.73 × 10 m in 1999, 2.73 × 10 m in 2010, and 2.70 × 10 m in 2016).

Conclusions: Iodine prophylaxis has proved effective in eliminating iodine deficiency. In recent years, the diversification of iodine sources, despite the reduction of salt consumption, has led to an increase in median UIC to values close to the upper limit of UIC, accepted as normal. Further increase in iodine supply may be unfavourable for health; therefore constant monitoring of iodine prophylaxis is required.
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http://dx.doi.org/10.5114/aoms.2018.76150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855168PMC
October 2019