Polycystic ovary syndrome (PCOS) is a common disorder in women of reproductive age. Besides hyperandrogenism, oligomenorrhea and fertility issues, it is associated with a high prevalence of metabolic ...disorders and cardiovascular risk factors. Several genetic polymorphisms have been identified for possible associations with cardiometabolic derangements in PCOS. Different PCOS phenotypes differ significantly in their cardiometabolic risk, which worsens with severity of androgen excess. Due to methodological difficulties, longer time-scale data about cardiovascular morbidity and mortality in PCOS and about possible beneficial effects of different treatment interventions is missing leaving many issues regarding cardiovascular risk unresolved.
Thyroid nodule diagnosis has become increasingly frequent. Defining optimum surveillance intervals for patients with unsuspicious thyroid nodules remains a challenge. This was a single centre cohort ...study in which patients diagnosed with unsuspicious thyroid nodules in whom no treatment was indicated were invited for re-evaluation 5 years after the diagnosis. The primary end point of the study was to estimate the change in nodule size with thyroid ultrasound (US) and the secondary end point was to assess the need for clinical management 5 years after the diagnosis.
Baseline patient parameters and ultrasound characteristics of the nodules were retrospectively collected. At follow-up, thyroid ultrasound was performed.
A hundred and eighteen (107 women / 11 men, aged 56.8 ± 13.4 years) patients were included in the study having 203 nodules at baseline, with mean largest nodule diameter 10.5 ± 7.4 mm. After 5 years, 58 (28.6%) nodules significantly increased in size, 27 (13.3%) decreased, and for 104 (51.2%) of nodules, no change in size was noted. Fourteen (6.9%) nodules disappeared. Additional 26 new nodules (mean largest diameter 7.7 ± 5.0 mm) in 16 patients were identified at follow-up. Regarding the clinical outcome, no new thyroid cancers were found. For 107 (90.7%) patients no further management was indicated. Five (4.2%) patients were referred to thyroidectomy because of the growth of the nodules. Two (1.7%) patients were treated for hyperthyroidism. Four (3.4%) patients did not complete the study.
We report a single centre experience of the natural history of unsuspicious thyroid nodules. Our results showed that 71.4% of such nodules remained stable in size, decreased or even disappeared and that the vast majority of the patients remained clinically stable with no need for treatment 5 years after the diagnosis.
Objective: The optimal corticosteroid treatment regimen for subacute thyroiditis has not yet been established. To avoid side-effects, tapering of the initial dose of corticosteroid is recommended. ...With reducing dose, the symptoms can recur. Design: In a prospective clinical study, a 30-day methylprednisolone (MPSL) treatment protocol with a starting dose of 24 mg/day and tapered by 4 mg every 5 days was assessed for effectiveness and safety regarding possible adrenal insufficiency. Methods: Fifty-nine patients with subacute thyroiditis were included. At visit 1, after establishing the diagnosis, a short stimulation ACTH test was performed and methylprednisolone treatment prescribed. At visit 2 (40±5 days after visit 1), clinical, laboratory (including short stimulation ACTH test), and ultrasound evaluation were repeated. Results: Forty-eight patients (81.4%) were cured by the prescribed protocol, having significantly lower cortisol levels after stimulation at visit 1 than patients who were not cured (mean, 674.9 nmol/L and 764.0 nmol/L, respectively, p=0.012). Seven patients (12.3%) developed adrenal insufficiency; this group had significantly lower cortisol level after stimulation at visit 1 than patients who did not (mean, 561.5 nmol/L and 704.7 nmol/L, respectively, p=0.005). Using stimulated cortisol level at visit 1 as the explanatory variable, logistic models were optimized to determine treatment efficacy (AUC=0.745, optimal threshold 729 nmol/L, specificity 71%, sensitivity 73%), and adrenal function (AUC=0.861, optimal threshold 629 nmol/L, specificity 73%, sensitivity 100%). Conclusions: The described protocol was efficient for more than 80% of patients. Using this protocol, the corticosteroid treatment interval is shorter than proposed in current guidelines.
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder in women of reproductive age. It presents with gynaecologic, metabolic, and psychologic manifestations. The dominant drivers ...of pathophysiology are hyperandrogenism and insulin resistance. Both conditions are related to cardiometabolic risk factors, such as obesity, hypertension, dyslipidaemia, hyperglycaemia, type 2 and gestational diabetes, nonalcoholic fatty liver disease and obstructive sleep apnoea. Women with PCOS of reproductive age consistently demonstrated an elevated risk of subclinical atherosclerosis, as indicated by different measurement methods, while findings for menopausal age groups exhibited mixed results. Translation of subclinical atherosclerosis into the increased incidence of peripheral arterial disease and major cardiovascular (CV) events is less clear. Although several expert groups have advised screening, the CV risk assessment and prevention of CV events are frequently underdiagnosed and overlooked aspects of the management of PCOS. A combination of lifestyle management and pharmacotherapy, including the promising new era of anti-obesity medicine, can lead to improvements in cardiometabolic health.
ObjectiveAccumulating evidence connects polycystic ovary syndrome (PCOS) with increased risk of cardiovascular disease. Endothelial dysfunction is present in PCOS and represents an early, reversible ...marker of cardiovascular damage. As androgens and renin–angiotensin–aldosterone system are implicated in the atherogenesis process of PCOS, we tested the hypothesis that treatment with spironolactone, an androgen and mineralocorticoid receptor blocking drug, might reverse endothelial dysfunction in PCOS.PatientsA total of 30 non-obese PCOS patients, compared with 20 body mass index matched control subjects, were evaluated. PCOS patients were given spironolactone 100 mg daily in 21-day long intervals followed by a 7-day pause, for 6 months.MeasurementsFlow-mediated dilatation (FMD), glyceryl trinitrate-induced dilatation, free testosterone, androstenedione, DHEA-sulfate, total, low-density lipoprotein (LDL)-, high-density lipoprotein-cholesterol, and triglycerides were determined at baseline and after 6 months.ResultsResults are expressed as median (25–75th percentile). At baseline, FMD was significantly lower in PCOS patients than in controls: 6.0 (0.0–11.7) vs 10.2 (6.8–15.9) %, P=0.018. This difference disappeared after 6 months of spironolactone treatment, as FMD in PCOS patients significantly increased to 8.3 (5.7–10.3) %, P=0.034, and was no longer different from controls. In PCOS patients, serum androgen levels did not change during treatment, while total and LDL-cholesterol decreased significantly from 4.8 (4.1–5.1) mmol/l to 4.4 (3.9–4.8) mmol/l and from 2.5 (2.1–3.1) to 2.2. (2.1–2.5) mmol/l, P<0.05 and P<0.05 respectively.ConclusionTreatment with spironolactone normalized endothelial function and improved cholesterol levels in non-obese PCOS patients.
Purpose
Among genetic causes of combined pituitary hormone deficiency (CPHD), mutations of genes coding for transcription factors involved in pituitary development have been implicated. Congenital ...CPHD is a rare disease; therefore, it is important to expand the knowledge about incidence and regional distribution of specific mutations. The aim of this paper is to report results of genetic analyses of adult Slovenian patients with CPHD.
Methods
Twenty-three adult Slovenian patients with early childhood onset CPHD were included in the study. Blood samples were collected through the GENHYPOPIT network to assess possible mutations of six genes (
PROP1/HESX1/LHX4/LHX3/POU1F1
) involved in the pituitary development following an established algorithm.
Results
In seven out of 23 patients (30%) a specific mutation in genes encoding pituitary transcription factors was discovered. In five patients, two different mutations of the
PROP1
gene (c.150delA and c.301-302delAG) were identified. One patient was heterozygous for a missense variant in the
LHX4
gene. Additionally, one patient was positive for a mutation in the gene coding for prokineticin receptor-2.
Conclusions
Our study confirms that the two most common mutations of the
PROP1
gene globally are also the most frequent mutations in the cohort of adult Slovenian patients with CHPD. Other mutations of pituitary transcription factor genes are extremely rare.
Hypothyroidism and hyperthyroidism, both overt and subclinical, are associated with increased risk of cardiovascular morbidity and mortality. The association between thyroid-stimulating hormone ...levels and cardiovascular risk has been demonstrated in large epidemiological studies and meta-analyses and is now considered a U-shaped curve. Several pathophysiological mechanisms linking thyroid and cardiovascular disease are known; however, specific clinical complications of peripheral arterial disease as endpoints of clinical trials have not been adequately investigated. The potential mechanisms linking hypothyroidism and peripheral arterial disease are endothelial dysfunction, blood pressure changes, dyslipidemia, and low-grade systemic inflammation. The potential mechanisms linking hyperthyroidism and peripheral arterial disease are hyperdynamic circulation, elevated systolic blood pressure, hypercoagulability, and possibly increased arterial inflammation.
INTRODUCTION: There are few data about possible interaction of sex hormones and thyroid autoimmunity and function in women with Hashimoto’s thyroiditis (HT) after menopause. Therefore, our aim was to ...investigate sex hormone levels in euthyroid (EuHT) and hypothyroid (HypoHT) postmenopausal women with HT. MATERIAL AND METHODS: We performed a prospective observational clinical study that included 55 women with HT (AllHT) and 18 healthy subjects (HS) after menopause matched by age, body mass index, follicle-stimulating hormone, and menopause duration. According to their thyrotropin (TSH) level, the AllHT patients were divided into two subgroups: EuHT with TSH in the range 0.35–5.5 mU/L and HypoHT with TSH above 5.5 mU/L. Total and free testosterone (T), sex hormone-binding globulin (SHBG), oestradiol (E2), and progesterone (P) were measured in all subjects. Values are presented as mean ± SD. The Mann-Whitney U test was used for comparison of values between the groups. Correlations were tested using Kendall’s tau test. RESULTS: In the HypoHT group, significantly higher free T levels were found in comparison to the HS group (7.89 ± 3.55 pmol/L and 7.13 ± 3.03 pmol/L, p < 0.05). Furthermore, in HypoHT, free T was significantly higher than in EuHT (7.19 ± 5.65 pmol/L, p < 0.05). SHBG was significantly lower in HypoHT compared with HS (45.4 ± 17.4 nmol/L and 60.09 ± 19.51 nmol/L, p < 0.05). No significant correlation was found between sex hormone levels and thyroglobulin and thyroid peroxidase antibodies. CONCLUSION: We report significantly higher free and total T levels in hypothyroid postmenopausal women with HT. To our knowledge, this is the first study of sex hormone levels in postmenopausal women with HT.
Namen prispevka je razjasnitev dilem pri napotitvi bolnika s sumom na bolezen ščitnice k tirologu. Zaradi omejitev zdravstvenega sistema pomoč pri specialistu ni vedno dosegljiva takoj. Stopnje ...nujnosti, opredeljene v »Pravilniku o naročanju in upravljanju čakalnih seznamov ter najdaljših dopustnih čakalnih dobah«, naj bi omogočale bolnikom, da dobijo pomoč takrat, ko jo potrebujejo. Sistem eNaročanja z eNapotnico zahteva razvrščanje napotnic glede na stopnjo nujnosti. Menimo, da mora to zahtevno strokovno opravilo izvajati zdravnik specialist, ne pa drugo medicinsko osebje ali administrativni kader. Ustrezno razvrščanje napotnic je možno samo, če je informacij na napotnici dovolj, sicer jo je treba dopolniti. Stopnje nujnosti pri bolnikih z motnjo v delovanju ščitnice ne opredelimo samo na podlagi laboratorijskih izvidov, čeprav so ti zelo pomembni in morajo biti navedeni na napotnici. Pomagamo si tudi z drugimi informacijami o bolniku, kot so na primer starost, pridružene bolezni, zdravila, ki jih bolnik prejema, morebitna nosečnost ali postopek oploditve z biomedicinsko pomočjo. Pri bolniku s sumom na golšo oziroma nodus v ščitnici so zelo pomembne informacije o klinični oceni velikosti ščitnice, prisotnost morebitnih sumljivih bezgavk na vratu in izvidi opravljenih slikovnih preiskav. Čeprav so ščitnične bolezni zelo pogoste in ne morejo vsi bolniki dobiti pomoči specialista takoj, pa lahko pravilno izpolnjena ter natančno razvrščena eNapotnica zagotovi ustrezen rok obravnave večini bolnikov.
Izhodišča: SARS-CoV-2, ki povzroča bolezen covid-19, vstopa v celice preko receptorja za angiotenzin konvertazo 2, ki je izražen tudi v ščitnici. Pri okužbi s SARS-CoV-2 se močno odzove imunski ...sistem, kar bi lahko vplivalo na pojavnost in izraženost avtoimunskih bolezni pri genetsko dovzetnih posameznikih. Zato smo želeli raziskati vpliv epidemije covida-19 na pojavnost in izraženost Hashimotovega tiroiditisa (HT), ki je najpogostejša avtoimunska bolezen ščitnice. Metode: V retrospektivno klinično raziskavo smo zajeli podatke iz zdravstvene dokumentacije 4.844 bolnikov, ki so bili prvič pregledani v Ambulanti za bolezni ščitnice na Kliniki za nuklearno medicino UKC Ljubljana v obdobju 11 mesecev pred epidemijo covida-19, in 4.084 bolnikov, ki so bili pregledani v 11 mesecih med epidemijo covida-19. Po opravljenem kliničnem pregledu, ultrazvočnem pregledu ščitnice in laboratorijskih meritvah so specialisti za bolezni ščitnice postavili diagnozo ščitnične bolezni. Podatke smo statistično analizirali z Mann-Whitneyevim testom U in s testom χ2. Rezultati: Med epidemijo covida-19 smo ugotovili statistično značilno večjo pojavnost hipotirotičnega HT (p=0,037) in HT brez protiteles (p=0,022), ne pa tudi hipertirotičnega HT (p=0,673) in evtirotičnega HT (p=0,653). Med epidemijo so imeli hipotirotični bolniki višjo koncentracijo tirotropina (p=0,001), hipertirotični bolniki pa višjo koncentracijo prostega tiroksina (p=0,002) kot pred njo. Zaključek: Med epidemijo covida-19 se je povečala pojavnost hipotirotičnega HT in HT brez protiteles. Hipotiroza in hipertiroza zaradi HT sta bili med epidemijo bolj izraženi kot pred njo.
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