Publications by authors named "Roland Gärtner"

32 Publications

[Menopausal hormone therapy: internal-endocrine point of view].

Dtsch Med Wochenschr 2021 01 4;146(1):41-47. Epub 2021 Jan 4.

Frauenärzte fünf Höfe, München.

The history of menopausal hormone therapy (MHT) started in 1942 in the US and became very popular in the 1960s worldwide because of the beneficial effects on vasomotor-vegetative and vulvovaginal symptoms. These symptoms may begin already in the premenopausal period, and can last for more than 10 years with reduced quality of life. Many women with vasomotor-vegetative symptoms do not visit a gynaecologist first but primarily a general physician or cardiologist because of instable blood pressure and palpitations, leading to the focus on the heart. To avoid unnecessary examinations and treatment with ß-blockers or antidepressants, an interdisciplinary look is necessary. In most cases, appropriate and low dose hormone replacement will relieve the symptoms and restore quality of life. In addition, it is worthwhile to know about the long-term effect of hormone deficiency as well as replacement on the different organ systems and the possible influences of hormone replacement therapy including contra indications. This is especially necessary after the uncertainties raised after the first deleterious announcements of the currently corrected results of the WHI (women's health initiative) study.
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http://dx.doi.org/10.1055/a-1180-3127DOI Listing
January 2021

[Update Vitamin D: Supplementation when and why?]

Authors:
Roland Gärtner

MMW Fortschr Med 2020 11;162(Suppl 3):68-75

udwig-Maximilians-Universität, Endokrinologie, Medizinische Klinik IV, Innenstadt, München, Germany.

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http://dx.doi.org/10.1007/s15006-020-4406-8DOI Listing
November 2020

[Elevated TSH: when and how to treat].

Authors:
Roland Gärtner

MMW Fortschr Med 2020 06;162(12):46-48

Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, D-80336, München, Deutschland.

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http://dx.doi.org/10.1007/s15006-020-0616-3DOI Listing
June 2020

Recent data on iodine intake in Germany and Europe.

Authors:
Roland Gärtner

J Trace Elem Med Biol 2016 Sep 1;37:85-89. Epub 2016 Jul 1.

Medizinische Klinik IV der Universität München. Electronic address:

Iodine is essential for the synthesis of thyroid hormones. These regulate metabolism, promote growth, development and maturation of all organs, especially the brain. Most iodine is found in oceans and most continental soil and ground water is deficient in iodine. Therefore, around 2 billion individuals are estimated to have insufficient iodine intake and are at risk of iodine deficiency disorders. The best carrier for save iodine supplementation is salt, as the daily intake of salt is mainly constant. Due to the collaboration between international and national organisations and the salt industry, many developing and developed countries introduced universal salt iodization (USI) or have mandatory or voluntary fortification programs. In Germany as in most European countries the use of iodized salt is voluntary not only in household but also in the food industry. Two recent epidemiological surveys in Germany revealed that 33% of children and 32% of adults are still suffering from mild to moderate iodine deficiency. The best surrogate parameter for iodine deficiency is goitre. The goitre prevalence is around 30% in children as well as in adults which is in accordance with the documented iodine deficiency. From other European countries epidemiological derived data on iodine intake are only available from Denmark and Poland. Further efforts are under way to reveal the iodine status with proper methods in all European countries. On this background it might be possible to establish adequate iodine fortification programs in all European countries.
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http://dx.doi.org/10.1016/j.jtemb.2016.06.012DOI Listing
September 2016

Comparison of color-Doppler and qualitative and quantitative strain-elastography for differentiation of thyroid nodules in daily practice.

Hormones (Athens) 2016 Apr;15(2):197-204

Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munchen, Germany.

Objective: Strain-elastography provides a new ultrasound-based method that can offer information about the stiffness of thyroid nodules as an indicator of malignancy. The aim of our study was to compare the utility of color-Doppler and strain-elastography in differentiating between benign and malignant nodules.

Design And Methods: 77 thyroid nodules (70 benign and 7 malignant) from 70 unselected patients (48 female/22 male, mean age 49.7±14.3 years) were evaluated with color-Doppler and elastography based on a five-scale elastogram score for qualitative elastography and strain ratio for quantitative elastography. As reference tissue we chose normal thyroid tissue [strain ratio a (SR a)] and cervical muscles [strain ratio b (SR b)]. The cytological or histological results were used as a reference standard. Diagnostic performances of qualitative and quantitative elastography were compared using ROC curves.

Results: Vascularization score 3 or 4 was associated with malignancy (p=0.024) as well as elastogram score 4 or 5 (p=0.070, n.s.s.). SR a was indicatively higher and SR b lower in the group of malignant nodules (p=0.065 and p=0.246, n.s.s.). The best cut-off points predicting malignancy were 3.32 for SR a (66.7% sensitivity, 83.3% specificity) and 0.10 for SR b (71.4% sensitivity, 67.1% specificity).

Conclusion: In our study, the accuracy of elastography did not surpass other sonographic parameters in differentiating thyroid nodules. The technique can play a role as a supplementary parameter in assessment of malignancy to improve diagnostic efficacy. The best parameter is SR a, but SR b can serve as an alternative if SR a is not assessable.
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http://dx.doi.org/10.14310/horm.2002.1673DOI Listing
April 2016

Multi-scale simulation of plant stem reinforcement by brachysclereids: A case study in apple fruit peduncles.

J Struct Biol 2015 Oct 13;192(1):116-26. Epub 2015 Aug 13.

Technische Universität Dresden, Institute for Botany, Zellescher Weg 20b, 01217 Dresden, Germany. Electronic address:

Sclereid formation in addition to or in gaps of fragmented fibre rings is common in dicotyledonous plant stems. Whether this sclereid formation is force-triggered remains open so far. In fruit peduncles of several Malus species as modified plant stems, for example, the persistent fibre ring is displaced to the centre by formation of cortex parenchyma during growth. Parenchyma cells subsequently differentiate into an additional layer of brachysclereids, previously interpreted as an adaptation to continuously rising fruit loads. The present study pursues a multi-scale numerical modelling approach, to verify the important effect for different cellular architectures in both sclerenchyma categories on the stiffness of these tissues and the entire peduncle. First, different material properties are simulated analogue to plant tissues on the basis of three cell types. A regular three-dimensional and a random Voronoi microstructure combined with various mechanical cell wall parameters are applied. Using homogenisation simulations based on HILL's principle, numerical calculations predict a lower effective homogenised tissue stiffness of isodiametric brachysclereids compared to those of fibres, confirming experimentally obtained data from Malus fruit peduncles. Furthermore, a curved peduncle model with a complex arrangement of different material layers is generated. Diverse material sets are tested under three representative loadings, using an adaptive diffuse domain approach (AMDiS). The model explains the function of sclereids as considerable contributors to the stiffness against bending and tensile deformations, as well as torsion, especially in consequence of superimposed load conditions in the case of a curved plant stem.
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http://dx.doi.org/10.1016/j.jsb.2015.08.002DOI Listing
October 2015

Nodular goiter: cautious indications for surgery.

Authors:
Roland Gärtner

Dtsch Arztebl Int 2014 Mar;111(10):169-70

Medical Clinic IV, LMU, Munich.

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http://dx.doi.org/10.3238/arztebl.2014.0169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3971566PMC
March 2014

[Thyroid hormone treatment].

Authors:
Roland Gärtner

Dtsch Med Wochenschr 2014 Feb 20;139(9):448. Epub 2014 Feb 20.

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http://dx.doi.org/10.1055/s-0033-1360050DOI Listing
February 2014

Interrelations between thyrotropin levels and iodine status in thyroid-healthy children.

Thyroid 2014 Jul 5;24(7):1071-9. Epub 2014 Jun 5.

1 DONALD Study Centre at the Research Institute of Child Nutrition, University of Bonn , Dortmund, Germany .

Background: Worldwide, iodine prophylaxis measures have improved iodine status in populations. Several studies have reported an increase in thyrotropin (TSH) levels coinciding with this prophylaxis. Whether this implies an increased risk for hypothyroidism or simply reflects a physiologic TSH adaptation mechanism is not clear.

Methods: Data on iodine and thyroid status of 6-17 year old children and adolescents (n=9175), collected between 2003 and 2006 in the German-wide Health Interview and Examination Survey for Children and Adolescents (KiGGS) Study, provided the basis for the analyses of mutual relationships of urinary iodine status (assessed by iodine/creatinine ratio in spot urines), serum TSH levels, and thyroid volume (determined by ultrasound). For data analyses (multivariable linear regression analysis), only those children were included for whom none of the available parameters (including free triiodothyronine [fT3], free thyroxine [fT4], and thyroperoxidase antibody [TPO-Ab] measurements) indicated a potential pathophysiologic thyroid status (n=6101).

Results: In this population-based sample of thyroid-healthy children, higher urinary iodine excretion was associated with higher TSH levels (p<0.05), adjusted for sex, age, body surface area, body mass index, fT3/fT4 ratio, and time of blood sampling. Higher TSH levels were not associated with a higher prevalence of TPO-Ab but with lower thyroid volume (p<0.001, fully adjusted). For the present study sample, one-time spot measurements of urinary iodine excretion were not related to thyroid volume, the long-term marker of iodine status.

Conclusion: Our findings show for the first time in thyroid-healthy children that smaller thyroid volume is associated with higher normal TSH levels. A decreased thyroid cell mass and cell amount, as induced by an improved iodine status, does presumably require a higher TSH signal to maintain a constant thyroid hormone production, suggesting an underlying physiologic adaptation. Correspondingly, an increased TSH level should not be used as the single criterion to evaluate the prevalence of hypothyroidism, and the repeatedly observed parallel increases of iodine supply and TSH levels should not readily be interpreted as evidence for an increased hypothyroidism risk. These insights, contradicting conventional interpretations, may contribute to dispel uncertainties about the safety of iodine prophylaxis measures.
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http://dx.doi.org/10.1089/thy.2013.0480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080866PMC
July 2014

A NOMPC-dependent membrane-microtubule connector is a candidate for the gating spring in fly mechanoreceptors.

Curr Biol 2013 May 11;23(9):755-63. Epub 2013 Apr 11.

Max-Planck Institute of Molecular Cell Biology and Genetics, 01307 Dresden, Germany.

Background: Mechanoreceptors contain compliant elements, termed "gating springs," that transfer macroscopic stimuli impinging on the cells into microscopic stimuli that open the mechanosensitive channels. Evidence for gating springs comes from mechanical experiments; they have not been identified molecularly or ultrastructurally.

Results: We show that the filamentous structures that connect the plasma membrane to the microtubules are compliant structural elements in the mechanoreceptive organelle of fly campaniform receptors. These filaments colocalize with the ankyrin-repeat domain of the transient receptor potential (TRP) channel NOMPC. In addition, they resemble the purified ankyrin-repeat domain in size and shape. Most importantly, these filaments are nearly absent in nompC mutants and can be rescued by the nompC gene. Finally, mechanical modeling suggests that the filaments provide most of the compliance in the distal tip of the cell, thought to be the site of mechanotransduction.

Conclusions: Our results provide strong evidence that the ankyrin-repeat domains of NOMPC structurally contribute to the membrane-microtubule connecting filaments. These filaments, as the most compliant element in the distal tip, are therefore good candidates for the gating springs.
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http://dx.doi.org/10.1016/j.cub.2013.03.065DOI Listing
May 2013

Thyroid (dys-)function in normal and disturbed pregnancy.

Arch Gynecol Obstet 2013 Jan 27;287(1):1-7. Epub 2012 Oct 27.

Department of Obstetrics and Gynecology, Ludwig-Maximilians University, Maistraße 11, 80337 Munich, Germany.

Introduction: During pregnancy, physiologic changes in maternal thyroid function take place especially due to hormonal as well as metabolic processes. Human chorionic gonadotropin activates the maternal thyroid gland leading to increased thyroid hormone production. A sufficient availability of maternal thyroid hormones is essential for fetal development, especially during the first trimester of pregnancy, when the fetal thyroid gland is not yet functional.

Materials And Methods: Current knowledge of thyroid dysfunction including thyroid autoimmunity, hypothyroidism or hyperthyroidism is summarized with special focus on miscarriage and pregnancy disorders. Therefore, a Medline research as well as an analysis of current guidelines on thyroid function and pregnancy was performed.

Results: A study focusing on TSH levels in normal and disturbed pregnancies, the risk of miscarriage in association with thyroid autoantibodies, and (subclinical) hypothyroidism in infertile and fertile women were included.

Conclusion: Maternal thyroid dysfunction negatively affects pregnancy outcome. Besides a routine iodine supplementation in pregnant women and treatment of hypo as well as hyperthyroidism, TSH levels should routinely be measured in women during childbearing years and adjusted to concentrations <2.5 mIU/l in order to optimize maternal health and fetal development.
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http://dx.doi.org/10.1007/s00404-012-2592-zDOI Listing
January 2013

High (but not low) urinary iodine excretion is predicted by iodine excretion levels from five years ago.

Ann Nutr Metab 2011 Oct 7;58(4):335-42. Epub 2011 Oct 7.

Institute of Community Medicine, University of Greifswald, Greifswald, Germany.

Background: It has not been investigated whether there are associations between urinary iodine (UI) excretion measurements some years apart, nor whether such an association remains after adjustment for nutritional habits. The aim of the present study was to investigate the relation between iodine-creatinine ratio (ICR) at two measuring points 5 years apart.

Methods: Data from 2,659 individuals from the Study of Health in Pomerania were analyzed. Analysis of covariance and Poisson regressions were used to associate baseline with follow-up ICR.

Results: Baseline ICR was associated with follow-up ICR. Particularly, baseline ICR >300 μg/g was related to an ICR >300 μg/g at follow-up (relative risk, RR: 2.20; p < 0.001). The association was stronger in males (RR: 2.64; p < 0.001) than in females (RR: 1.64; p = 0.007). In contrast, baseline ICR <100 μg/g was only associated with an ICR <100 μg/g at follow-up in males when considering unadjusted ICR.

Conclusions: We detected only a weak correlation with respect to low ICR. Studies assessing iodine status in a population should take into account that an individual with a low UI excretion in one measurement is not necessarily permanently iodine deficient. On the other hand, current high ICR could have been predicted by high ICR 5 years ago.
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http://dx.doi.org/10.1159/000331991DOI Listing
October 2011

[Hypothyroidism--diagnosis and therapy].

Authors:
Roland Gärtner

MMW Fortschr Med 2010 Nov;152(44):67-9, 71; quiz 72

Medizinische Klinik Innenstadt der Universität, München.

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http://dx.doi.org/10.1007/BF03367328DOI Listing
November 2010

The role of iodine and delta-iodolactone in growth and apoptosis of malignant thyroid epithelial cells and breast cancer cells.

Hormones (Athens) 2010 Jan-Mar;9(1):60-6

Department of Endocrinology, University of Munich, Germany.

Objective: As we previously demonstrated, the inhibitory effect of iodine on thyroid cell growth is mediated by iodolactones, especially 6-iodo-5-hydroxy-eicosatrienoic acid (delta-iodolactone). In this communication we compare the effect of iodide, molecular iodine and delta-iodolactone on growth inhibition and apoptosis on three human thyroid carcinoma cell lines (B-CPAP cells, FTC-133 cells and 8505C cells) as well as on human breast cancer cells (MCF 7).

Methods: Thyroid carcinoma cells were cultured in Dulbecco's modified Eagle's medium (DMEM) and MCF 7 cells in Rowswell Park Memorial Institute (RPMI) culture medium, both containing 10% (v/v) Fetal Calf Serum (FCS), until they were confluent. Around 2000 cells were then distributed in 12-well plates and grown for 48 h in either DMEM (thyroid cancer cells) or in RPMI medium (MCF 7 cells) both containing 5% FCS. Thereafter, different concentrations of iodide, iodine or delta-iodolactone were added for 24 h. Growth rate was estimated by cell counting in a Coulter Counter adapted for epithelial cells. Apoptosis was determined by a mitochondrial potential assay.

Results: The growth rate of B-CPAP cells was unaffected by iodide, but was reduced by high concentreations of molecular iodine (100 and 500 microM). However, delta-iodolactone significantly reduced cell proliferation already with low concentrations (5 microM and 10 microM) and further in a dose-dependent manner up to 82%. FTC-133 and 8505C cells were unaffected by iodide, iodine or delta-iodolactone. In contrast, in MCF 7 cells, molecular iodine (100 microM) inhibited growth from 100% to 83% but delta-iodolactone (1, 5 and 10 microM) dose-dependently decreased growth rate from 100% to 82% and 62%, respectively. The inhibition of growth was through apoptosis, and not necrosis, as the amount of apoptotic cells corresponded to the growth inhibition.

Conclusion: delta-Iotaodolactone seems to be the main iodocompound which can inhibit growth and induce apoptosis in B-CPAP cells as well as in MCF 7 breast cancer cells.
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http://dx.doi.org/10.14310/horm.2002.1254DOI Listing
April 2010

[Epidemiology, pathophysiology, guideline-adjusted diagnostics, and treatment of thyroid nodules].

Med Klin (Munich) 2010 Feb 20;105(2):80-7. Epub 2010 Feb 20.

Medizinische Klinik und Poliklinik III, Universitätsklinikum Leipzig, Leipzig, Germany.

Background: Clinically relevant thyroid carcinomas can be found in 5-6% of nodular goiters which undergo surgery. Moreover, multinodular goiters fre- quently contain hot areas. Therefore, efficient and rational methods for the differential diagnosis and decision are required to identify those nodules with an increased cancer risk or those which are hot among the many thyroid nodules.

Methods: Description of a newly revised and further guidelines and consensus statements as well as selected literature search.

Results: Already history, ultrasound and TSH (thyroid-stimulating hormone) determination do allow a first risk assessment for the further diagnostic work-up. Fine-needle biopsy (FNB) offers the best sensitivity and specificity for the distinction between benign and malignant thyroid nodules. The combination of several clinical and ultrasound criteria and laboratory determinations (calcitonin) can help with the selection of thyroid nodules with scintigraphically normal or decreased uptake > 1 cm for FNB. However, the efficiency of FNB requires sufficient training and experience of both the cytopathologist and the person performing FNB.

Conclusion: Whereas solitary thyroid nodules with a suspicion for malignancy should be referred to the surgeon, euthyroid thyroid nodules without clinical ultrasound or cytological indicators of malignancy may be followed up - possibly under medication -, if surgery is not indicated by local complaints, tracheal or mediastinal involvement.
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http://dx.doi.org/10.1007/s00063-010-1011-9DOI Listing
February 2010

Selenium and thyroid.

Best Pract Res Clin Endocrinol Metab 2009 Dec;23(6):815-27

Institut für Experimentelle Endokrinologie, Charité Universitätsmedizin Berlin, CVK, D-13353 Berlin, Germany.

Inadequate supply of the essential trace element selenium (Se) has been associated with predisposition for, or manifestation of, various human diseases such as Keshan and Kashin-Beck disease, cancer, impaired immune function, neurodegenerative and age-related disorders and disturbances of the thyroid hormone axis. Se deficiency in combination with inadequate iodine contributes to the pathogenesis of myxedematous cretinism. The recent identification of various distinct selenocysteine-containing proteins, encoded by 25 human genes, provides information on the molecular and biochemical basis of beneficial and possible adverse effects of this trace element. The thyroid gland is among the human tissues with the highest Se content per mass unit similar to other endocrine organs and the brain. Selenoproteins involved in cellular antioxidative defence systems and redox control, such as the glutathione peroxidase (GPx) and the thioredoxin reductase (TxnRd) family, are involved in protection of the thyroid gland from excess hydrogen peroxide and reactive oxygen species produced by the follicles for biosynthesis of thyroid hormones. In addition, the three key enzymes involved in activation and inactivation of thyroid hormones, the iodothyronine deiodinases (DIO1,2,3), are selenoproteins with development, cell- and pathology-related expression patterns. While nutritional Se supply is normally sufficient for adequate expression of functional Dio enzymes with exception of long-term parenteral nutrition and certain diseases impairing gastrointestinal absorption of Se compounds, the nutritional Se supply for the protection of the thyroid gland and synthesis of some more abundant selenoproteins of the GPx and the TrxR family might be limiting their proper expression under (patho-)physiological conditions.
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http://dx.doi.org/10.1016/j.beem.2009.08.002DOI Listing
December 2009

[48-year-old woman with pressure pain in the neck].

Authors:
Roland Gärtner

Dtsch Med Wochenschr 2009 Dec 25;134(49):2515-6. Epub 2009 Nov 25.

Medizinische Klinik Innenstadt der LMU, Ziemssenstr. 1, 80336 München.

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http://dx.doi.org/10.1055/s-0029-1243055DOI Listing
December 2009

Thyroid diseases in pregnancy.

Authors:
Roland Gärtner

Curr Opin Obstet Gynecol 2009 Dec;21(6):501-7

Department of Endocrinology, Ludwig-Maximilians-University, München, Germany.

Purpose Of Review: Thyroid disorders are common in pregnancy and affect maternal and fetal outcome.

Recent Findings: The reference values for normal thyroid function during first and second trimester had been re-evaluated recently. Hypothyroxinemia affects the neuropsychological development of the child. Maternal thyroid dysfunction or only the presence of thyroid-specific antibodies is associated with increased risk for early abortion, preterm delivery and neonatal morbidity. Pregnant women under levothyroxine treatment are often undertreated or overtreated. Screening for thyroid dysfunction of pregnant women is recommended and cost-effective.

Summary: Recently, the recommended dose for iodine intake during pregnancy had been increased from 200 to 250 microg/day, because recent studies revealed that even mild-to-moderate iodine intake might affect the neuropsychological development of the child. About 5-18% of all pregnant women exhibit elevated thyroid-specific antibodies, but only 0.3% develop overt hypothyroidism and 0.1-0.4% overt hyperthyroidism. However, those pregnant women with autoimmune thyroiditis and normal thyroid function may have a restricted thyroid reserve, followed by hypothyroxinemia and/or thyroid-stimulating hormone increase during pregnancy. The incidence of miscarriage, preterm delivery and small for date offspring might be increased and probably a delayed neuropsychological development. Routine thyroid function testing at least as early as possible in all pregnant women is emphasized.
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http://dx.doi.org/10.1097/GCO.0b013e328332a836DOI Listing
December 2009

Selenium and thyroid hormone axis in critical ill states: an overview of conflicting view points.

Authors:
Roland Gärtner

J Trace Elem Med Biol 2009 25;23(2):71-4. Epub 2009 Feb 25.

Medizinische Klinik Innenstadt der Universität München, München, Germany.

In critical ill states the plasma selenium levels are low and inversely correlated with the severity and outcome of the disease. The plasma selenium levels indicate the amount of circulating selenoproteins and selenoenzymes. These are important for the maintenance of the redox system, modulating the immune system and also for thyroid hormone metabolism. Not only all three deiodinases (D1-3) are selenoenzymes, but within the thyroid gland there are several other selenoenzymes, which are important for the maintenance of normal thyroid function. In critical ill states also triodothyronine (T3) is low and reverse T3 elevated, and also TSH and thyroxin (T4) are low, correlating like low plasma selenium with the severity of the disease. Subsequently, several intervention trials had been performed to evaluate whether an adjuvant selenium supplementation might attenuate the course of the disease and improve outcome. The selenium supplementation improved outcome and even reduced mortality in some but not all prospective randomized trials. A few prospective randomized intervention trials with selenium supplementation had also been performed to evaluate the hypothesis, whether low selenium is the cause of low-T3-syndrome, however, with conflicting results and no clear evidence that low D1 activity is due to the selenium deficiency in critical illness. Because D1 catalyses the conversion of T4 to T3 and also the clearance of reverse T3, low D1 activity would sufficiently explain low plasma T3 and elevated reverse T3. It had been, however, clearly shown that cytokines are responsible for the inhibition of D1 activity, but D2 and D3 are even higher during acute inflammation in critically ill patients. One of the most important effects of selenium on the immune system seems to be the reduction of cytokine release and therefore an indirect connection between low selenium and low D1 activity has to be postulated and not a lower D1 activity due to lower availability of selenium for the D1 expression.
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http://dx.doi.org/10.1016/j.jtemb.2009.01.001DOI Listing
July 2009

[Hyperthyroidism in the elderly: do not rely only on TSH and typical symptoms].

Authors:
Roland Gärtner

MMW Fortschr Med 2008 Sep;150(36-37):29-31

Medizinische Klinik Innenstadt, Universität München.

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http://dx.doi.org/10.1007/BF03365547DOI Listing
September 2008

[Osteoporosis in the elderly--diagnosis and treatment].

Authors:
Roland Gärtner

MMW Fortschr Med 2005 Feb;147(7):33, 35-6

Medizinische Klinik Innenstadt der Universität München.

In contrast to postmenopausal osteoporosis, the overriding objective in senior citizens older than 75 years is to avoid fractures of the hip, which are associated with a high mortality rate. Bone density measurement obtained at the neck of the femur using DXA provides reliable data on the risk of an individual patient of sustaining a fracture close to the hip joint. A physical examination can help to assess the patient's risk of falling, while diagnostic laboratory studies can help to exclude secondary osteoporosis. As a preventive measure, physical activity can increase bone density also in old age. Calcium and vitamin D improve muscular strength and coordination, and thus also may be helpful in preventing falls. In manifest osteoporosis, risedronate and alendronate reduce the risk of fractures close to the hip and of vertebrae by 50%. In addition, raloxifene can be employed to prevent vertebral fractures.
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February 2005

Selenium in Intensive Care (SIC): results of a prospective randomized, placebo-controlled, multiple-center study in patients with severe systemic inflammatory response syndrome, sepsis, and septic shock.

Crit Care Med 2007 Jan;35(1):118-26

Medizinische Klinik Innenstadt, Ludwig-Maximilians Universität München, Münich, Germany.

Objective: Sepsis is associated with an increase in reactive oxygen species and low endogenous antioxidative capacity. We postulated that high-dose supplementation of sodium-selenite would improve the outcome of patients with severe sepsis and septic shock.

Design: Prospective randomized, placebo-controlled, multiple-center trial.

Setting: Eleven intensive care units in Germany.

Patients: Patients were 249 patients with severe systemic inflammatory response syndrome, sepsis, and septic shock and an Acute Physiology and Chronic Health Evaluation (APACHE) III score >70.

Interventions: Patients received 1000 microg of sodium-selenite as a 30-min bolus injection, followed by 14 daily continuous infusions of 1000 microg intravenously, or placebo.

Measurements And Main Results: The primary end point was 28-day mortality; secondary end points were survival time and clinical course of APACHE III and logistic organ dysfunction system scores. In addition, selenium levels in serum, whole blood, and urine as well as serum glutathione-peroxidase-3 activity were measured. From 249 patients included, 11 patients had to be excluded. The intention-to-treat analysis of the remaining 238 patients revealed a mortality rate of 50.0% in the placebo group and 39.7% in the selenium-treated group (p = .109; odds ratio, 0.66; confidence interval, 0.39-1.1). A further 49 patients had to be excluded before the final analysis because of severe violations of the study protocol. In the remaining 92 patients of the study group, the 28-day mortality rate was significantly reduced to 42.4% compared with 56.7% in 97 patients of the placebo group (p = .049, odds ratio, 0.56; confidence interval, 0.32-1.00). In predefined subgroup analyses, the mortality rate was significantly reduced in patients with septic shock with disseminated intravascular coagulation (n = 82, p = .018) as well as in the most critically ill patients with an APACHE III score > or =102 (>75% quartile, n = 54, p = .040) or in patients with more than three organ dysfunctions (n = 83, p = .039). Whole blood selenium concentrations and glutathione peroxidase-3 activity were within the upper normal range during selenium treatment, whereas they remained significantly low in the placebo group. There were no side effects observed due to high-dose sodium-selenite treatment.

Conclusions: The adjuvant treatment of patients with high-dose sodium-selenite reduces mortality rate in patients with severe sepsis or septic shock.
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http://dx.doi.org/10.1097/01.CCM.0000251124.83436.0EDOI Listing
January 2007

Dose-related influence of sodium selenite on apoptosis in human thyroid follicles in vitro induced by iodine, EGF, TGF-beta, and H2O2.

Biol Trace Elem Res 2006 Aug;112(2):119-30

Medizinische Klinik der Universität München, Campus Innenstadt, 80336 München, Germany.

Apoptosis of thyroid follicular cells is induced by high doses of iodide, epidermal growth factor (EGF), transforming growth factor-beta (TGF-beta), as well as H2O2 and might be attenuated by antioxidants. Therefore, we examined the apoptotic index induced by these substances in selenium-treated vs untreated human thyroid follicular cells. Reconstituted human thyroid follicles were incubated with sodium selenite (10 or 100 nM) for 72 h; controls received none. The follicles were then distributed to 24-well plates and incubated with potassium iodide (5, 10, or 20 nM), EGF (5 ng/mL), TGF-beta (5 ng/mL), or H2O2 (100 muM). Apoptosis was determined by a mitochondrial potential assay and the number of apoptotic cells counted by two independent, experienced technicians and the glutathione peroxidase (GPx) activity was determined. Asignificant increase of apoptic cells was obtained in control thyroid follicles treated with iodine (5, 10, or 20 microM), thyroidstimulating hormone (TSH) 1, or 10 mU/mL in combination with 5 and 10 microM iodine, EGF (5 ng/mL) and TGF-beta (5 ng/mL), or H2O2 (100 microM) (p < 0.001). In contrast, in thyroid follicles preincubated with 10 or 100 nM sodium selenite, the apoptototic index was identical to the basal rate. In H2O2-treated follicles, the apoptotic index was still significantly elevated but 50% lower compared to control cells. The GPx activity increased from 1.4 +/- 0.2 to 2.25 +/- 0.4 mU/microg DNA with 10 nMselenite and 2.6 + 0.4 mU/microg DNA with 100 nM selenite. Sodium selenite might increase the antioxidative potential in human thyroid follicles in vitro and therefore diminish the apoptosis induced by TGF-beta, EGF, iodide, and even H2O2.
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http://dx.doi.org/10.1385/BTER:112:2:119DOI Listing
August 2006

[Modern diagnostic approach to autoimmune thyroiditis].

Authors:
Roland Gärtner

MMW Fortschr Med 2006 Apr;148(16):41, 43-5

Medizinische Klinik Innenstadt der Universität München, Ziemssenstr. 1 D-80336, München.

High-resolution ultrasonography of the thyroid gland is the major primarytechnical diagnostic procedure in suspected autoimmune thyroiditis (AIT). A diffusely echo-poor thyroid is proof of the presence of AIT. Duplex sonography provides further information about the activity of the disease, and is of differential diagnostic importance for distinguishing postpartum thyroiditis from AIT, or for the investigation of an infiltrating carcinoma. Today, antibody determination serves merely to confirm the diagnosis, with TPO antibodies being the most specific for AIT. The TG antibodies may also be nonspecifically elevated in subacute thyroiditis (de Quervain) or irradiation or radioiodine treatment. For an evaluation of thyroid gland function in AIT, determination of basal TSH is needed.
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April 2006

[Every second person over 65 years of age has a problem with the thyroid].

Authors:
Roland Gärtner

MMW Fortschr Med 2004 Sep;146(39):36

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September 2004

High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome.

Eur J Endocrinol 2004 Mar;150(3):363-9

Division of Endocrinology, Department of Medicine, University of Essen, Essen, Germany.

Objective: To investigate the prevalence of autoimmune thyroiditis (AIT) in patients with polycystic ovary syndrome (PCOS).

Design: Over a period of 30 months, 175 patients with PCOS were recruited to a prospective multicenter study to evaluate thyroid function and morphology; 168 age-matched women without PCOS were studied as a control group.

Methods: PCOS was defined as a- or oligomenorrhea, hyperandrogenism and exclusion of other disturbances of estrogen or androgen synthesis. All laboratory parameters were determined with automated immunoassays. Thyroid morphology was assessed by ultrasound.

Results: PCOS patients were characterized by an increased LH/FSH ratio, low progesterone, elevated testosterone and a high prevalence of hirsutism (PCOS 83%, control 3%; mean hirsutism score 12+/-5 and 3+/-2 respectively), but no differences in estrogen levels were found. Thyroid function and thyroid-specific antibody tests revealed elevated thyroperoxidase (TPO) or thyroglobulin (TG) antibodies in 14 of 168 controls (8.3%), and in 47 of 175 patients with PCOS (26.9%; P<0.001). On thyroid ultrasound, 42.3% of PCOS patients, but only 6.5% of the controls (P<0.001) had a hypoechoic tissue typical of AIT; while thyroid hormone levels were normal in all subjects, PCOS patients had a higher mean TSH level (P<0.001) and a higher incidence of TSH levels above the upper limit of normal (PCOS 10.9%, controls 1.8%; P<0.001).

Conclusion: This prospective study demonstrates a threefold higher prevalence of AIT in patients with PCOS, correlated in part with an increased estrogen-to-progesterone ratio and characterized by early manifestation of the disease.
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http://dx.doi.org/10.1530/eje.0.1500363DOI Listing
March 2004

Selenium in the treatment of autoimmune thyroiditis.

Biofactors 2003 ;19(3-4):165-70

Department of Endocrinology, Medizinische Klinik Innenstadt, University of Munich, D-80336 Munich, Germany.

We recently conducted a prospective, placebo-controlled clinical study, where we could demonstrate, that a substitution of 200 microg sodium selenite for three months in patients with autoimmune thyroiditis reduced thyroid peroxidase antibody (TPO-Ab) concentrations significantly. Forty-seven patients from the initially 70 patients agreed to participate in a follow-up cross-over study for further six months. One group (n = 13), which initially received selenium continued to take 200 microg sodium selenite (Se-Se), one group stopped taking selenium (Se-0) ( n = 9), another group which received placebo started to take 200 microg selenium (n = 14) (Plac-Se) and the last group was without selenium substitution (Plac-0) (n = 11). TPO-Ab concentrations were measured at beginning and the end of the study. In the Se-Se group, the TPO-Ab concentrations further significantly p = 0.004) decreased from 625 +/- 470 U/ml to 354 +/- 321 U/ml, in the Se-0 group the TPO-Ab concentrations increased significantly p = 0.017) from 450 +/- 335 to 708 +/- 313 U/ml. In the placebo group, the TPO-Ab concentrations in those patients who were followed without selenium substitution were unchanged (1351 +/- 940 vs. 1724 +/- 1112 U/ml, p = 0.555). In contrast, the patients who received 200 microg sodium selenite after placebo, the TPO-Ab concentrations decreased significantly (p = 0.029) from 1182 +/- 723 to 643 +/- 477 U/ml.
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http://dx.doi.org/10.1002/biof.5520190309DOI Listing
June 2004

Quantification of iodine supply: representative data on intake and urinary excretion of iodine from the German population in 1996.

Ann Nutr Metab 2002 ;46(3-4):128-38

Research Institute of Child Nutrition, Dortmund, Germany.

Background/methods: In Germany, iodine deficiency is common. In a representative group of 2,500 Germans (age >13 years), using a specially designed food questionnaire, the iodine intake was calculated. In addition, iodine and creatinine concentrations in spot urine samples were determined in three groups with a possibly increased risk of iodine deficiency (769 conscripts, 886 pairs of mothers and newborns) or future hyperthyroidism (574 adults, age range 50-70 years) from 26 representative regions. In four groups of controls (young and older male and female adults; n = 91), 24-hour urine iodine and creatinine were measured in six diurnal fractions to calculate group- and period-specific factors for the estimation of the 24-hour iodine excretion from data of iodine/creatinine ratio and time of micturition in spot urine samples.

Results: The mean calculated iodine intake (excretion) was 119 microg/day for the group of Germans above 13 years; it was 119 microg/day (125 microg/day) for adults aged 50-70 years, 137 microg/day (125 microg/day) for conscripts, and 162 microg/day for breast-feeding mothers. The median iodine concentration (iodine/creatinine ratio) was 9.4 microg/dl (83 microg/g) in 566 adults aged 50-70 years, 8.3 microg/dl (57 microg/g) in 772 conscripts. and 5.6 microg/dl (156 microg/g) in 739 breast-fed newborns.

Conclusions: Compared to older data, the iodine intake in Germany has increased. In 1996, the meticulously quantified average deficit was about 30% of the recommended iodine intake.
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http://dx.doi.org/10.1159/000063083DOI Listing
November 2002