Abstract Purpose Levothyroxine (LT4) is a drug with a narrow therapeutic index, applied in small amounts (micrograms), which makes interactions in the absorption phase clinically significant. The ...main aim of this article was to review and present the latest information on factors that affect the gastrointestinal absorption of this drug. Methods Relevant data were collected by using the MEDLINE, PubMed, EMBASE, Web of Science, Science Direct, and Scopus databases with the key words levothyroxine and absorption . Searches were not limited to specific publication types, study designs, dates, or languages. The reports were highly variable in the amount of information provided regarding study design and methods. Because of the heterogeneity of studies, no statistical analysis was performed. Findings Many gastrointestinal disorders, such as celiac disease, atrophic gastritis, lactose intolerance, and Helicobacter pylori infection, may impede the absorption of levothyroxine. During treatment of these disorders, it is necessary to monitor serum thyroid-stimulating hormone and free T4 values to reduce the risk of developing iatrogenic hyperthyroidism. Soybeans and coffee have the greatest impact on the reduction of absorption, whereas vitamin C has the ability to increase it. Conversely, the effect of dietary fiber on the absorption of LT4 is not yet fully understood; further research is needed on this topic. A decrease in the absorption of LT4 is established and clinically significant when administered concomitantly with cholestyramine, colesevelam, lanthanum, calcium carbonate, calcium citrate, calcium acetate, iron sulfate, ciprofloxacin, aluminum hydroxide, sevelamer, or proton pump inhibitors. This effect should be taken into consideration when prescribing these drugs concomitantly with LT4. The effects of Giardia lamblia infection and the influence of orlistat, polystyrene sulfonate, raloxifene, and simethicone on absorption of LT4 have been poorly documented. For bariatric surgery, sucralfate and H2 -antagonist interactions are not well founded or contradictory evidence is available regarding their existence; additional research should be conducted. Implications The majority of the interactions are clinically significant. They are based on the LT4 adsorption on interfering substances in the digestive tract, as well as a consequently reduced amount of the drug available for absorption. These interactions can be avoided by separating the administration of LT4 and the interfering substance.
Metabolic syndrome, characterized by obesity, low-grade inflammation, insulin resistance, hyperglycemia, dyslipidemia and hypertension, is a major risk factor for cardiovascular mortality. ...Preclinical studies on recently discovered classes of lipids – fatty acid esters of hydroxy fatty acids (FAHFA) have revealed their anti-inflammatory and insulin-sensitizing potential. The FAHFA levels are significantly decreased in insulin-resistant individuals, their application exhibited anti-inflammatory effects and restoring the glucose-insulin homeostasis. The aim of our research was to analyze the overall FAHFA composition in a common diet, as only a partial FAHFA composition has been revealed so far (only the PAHSA subclass was analyzed in a few foods). A new approach to the FAHFAs analysis includes nano-LC and post-column modifier followed by negative ion mass spectrometry, in order to obtain maximum sensitivity. Analysis of different foods – oat (whole grain, coarse flakes and fine flakes), apple, clementine, lemon, strawberry, blueberry, mango, kiwi, avocado, pineapple, banana, onion, garlic, cherry tomato, carrot, parsley root, pepper and radish – exhibited wide inter-food variation in the FAHFA profiles. Sixteen analyzed FAHFAs (palmitic, oleic, palmitoleic and stearic hydroxy-esters) showed microgram to low nanogram levels (0.165 ng/g – 32 μg/g FW), with the highest abundancy in oat, clementine, garlic and pineapple. Stearic acid hydroxy stearic acid (SAHSA) was the most abundant FAHFA, especially in the food with antioxidative, anti-inflammatory and beneficial metabolic effects. In contrary, the PAHSA - previously proven to have the strongest antihyperglycemic and insulin-sensitizing effects, was not present in some foods (radish, avocado, mango, lemon, cherry tomato, kiwi). Our study proves the importance of overall FAHFA analysis in food (especially in a functional food), because of their potential metabolic benefits and possible future incorporation in special diets.
Pravilna prehrana iznimno je važna u prevenciji šećerne bolesti i regulaciji glikemije. Šećerna bolest ubraja se u kategoriju bolesti koje se uspješno mogu prevenirati, dobro liječiti te im se može ...spriječiti ili odgoditi razvoj kroničnih komplikacija. Edukacija o pravilnoj prehrani treba biti individualno prilagođena, pri čemu treba obratiti pozornost na dob bolesnika, način života, socioekonomski status, tjelesnu aktivnost i komplikacije vezane uz šećernu bolest. Kod šećerne bolesti promjena životnih navika, što uključuje pravilnu prehranu, redovitu tjelesnu aktivnost i regulaciju tjelesne mase, može uvelike pridonijeti regulaciji glikemije, a u tipu 2 u nekim slučajevima može dovesti i do njene remisije. Smjernice su rezultat suradnje zdravstvenih stručnjaka koji sudjeluju u liječenju i edukaciji osoba koje boluju od šećerne bolesti. Utemeljene su na dokazima, prema metodologiji GRADE (engl. grading of recommendations, assessment, development and evaluation) koja uz snagu dokaza opisuje i razinu preporuke. Temeljni zaključci ovih smjernica odnose se na procjenu nutritivnih potreba te primjenu medicinske nutritivne terapije, individualno prilagođene osobama sa šećernom bolešću kao i onima koji imaju i neke od
vezanih komorbiditeta.
Thyroid gland has a key role in maintaining the body homeostasis. Thyroxine is the main hormone secreted from the thyroid gland, its effect being predominantly achieved after the intracellular ...conversion of thyroxine to triiodothyronine, which exhibits a higher affinity for the receptor complex, thus modifying gene expression of the target cells. Amiodarone is one of the most commonly used antiarrhythmics in the treatment of a broad spectrum of arrhythmias, usually tachyarrhythmias. Amiodarone contains a large proportion of iodine, which is, in addition to the intrinsic effect of the medication, the basis of the impact on thyroid function. It is believed that 15%-20% of patients treated with amiodarone develop some form of thyroid dysfunction. Amiodarone may cause amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyrotoxicosis (AIT). AIT is usually developed in the areas with too low uptake of iodine, while AIH is developed in the areas where there is a sufficient iodine uptake. Type 1 AIT is more common among patients with an underlying thyroid pathology, such as nodular goiter or Graves' (Basedow's) disease, while type 2 mostly develops in a previously healthy thyroid. AIH is more common in patients with previously diagnosed Hashimoto's thyroiditis. Combined types of the diseases have also been described. Patients treated with amiodarone should be monitored regularly, including laboratory testing and clinical examinations, to early detect any deviations in the functioning of the thyroid gland. Supplementary levothyroxine therapy is the basis of AIH treatment. In such cases, amiodarone therapy quite often need not be discontinued. Type 1 AIT is treated with thyrostatic agents, like any other type of thyrotoxicosis. If possible, the underlying amiodarone therapy should be discontinued. In contrast to type 1 AIT, the basic pathophysiological substrate of which is the increased synthesis and release of thyroid hormones, the basis of type 2 AIT is destructive thyroiditis caused by amiodarone, desethylamiodarone as its main metabolite, and an increased iodine uptake. Glucocorticoid therapy is the basis of treatment for this type of disease.
Objective
There are no definitive treatment guidelines for hypertriglyceridemia (HTG)‐induced acute pancreatitis (AP). The aim of this retrospective study was to evaluate the efficacy of insulin in ...decreasing triglyceride (TG) levels in patients with HTG‐induced AP.
Design
We included 17 cases of HTG‐induced AP treated with continuous insulin aspart for 4 days.
Patients
Fifteen patients were male, two were female. The mean TG level at admission was 56.53 ± 25.29 mmol/L. The mean APACHE II score was 10.2 ± 5.7, Ranson 4.2 ± 1.7 and Balthazar 6.5 ± 2.6, implying a severe form of the disease.
Methods
In an 8‐year period, 17 patients with a diagnosis of HTG‐induced AP were treated with a continuous infusion of 5% dextrose and insulin aspart in an attempt to lower TG levels. TG levels were assessed on admission, the second and fourth day of therapy. The patient outcome, complications and recurrence of AP were monitored.
Results
A significant reduction of TG levels was observed in all patients on Day 4. All patients survived, with one forming a giant pseudocyst as a disease complication, one needing haemodialyses treatment due to an acute kidney injury, and one developing acute respiratory distress syndrome that required mechanical ventilation for 4 days. All patients recovered completely.
Conclusion
Our study showed that continuous insulin aspart infusion decreases TG levels in HTG‐induced AP from a mean TG level of 56.53 mmol/L on Day 1 to 21.75 mmol/L on Day 2 and finally to 6.86 mmol/L on Day 4. We consider this therapy very efficient, safe, simple to administer and monitor.
Štitna žlijezda zauzima ključno mjesto u održavanju homeostaze cijeloga organizma. Temeljni hormon koji luči je tiroksin,
a učinak se dominantno ostvaruje nakon unutarnje konverzije tiroksina u ...aktivniji oblik, trijodotironin, koji pokazuje
veći afinitet za receptorski kompleks te time modificira gensku ekspresiju ciljnih stanica. Amiodaron je jedan od najčešće
upotrebljavanih antiaritmika i rabi se u liječenju širokog spektra aritmija, najčešće tahiaritmija. U svom sastavu sadrži velik
udio joda, što je, uz intrinzični učinak lijeka, temelj utjecaja na tireoidnu funkciju. Smatra se kako 15%-20% bolesnika liječenih
amiodaronom razvija neki oblik tireoidne disfunkcije. Amiodaron može biti uzrokom razvoja amiodaronom izazvane
hipotireoze (amiodarone-induced hypothyroidism, AIH) ili amiodaronom izazvane tireotoksikoze (amiodarone-induced thyrotoxicosis,
AIT). AIT se češće razvija u područjima sa smanjenim, dok se AIH razvija u područjima s dovoljnim unosom joda.
Razlikujemo dva tipa AIT; tip 1 je češći u bolesnika s podležećom tireoidnom patologijom, najčešće nodoznom strumom ili
latentnom Gravesovom (Basedowljevom) bolešću, dok se tip 2 najčešće razvija u prethodno zdravoj štitnjači. AIH je znatno
češća u bolesnika s otprije poznatim Hashimotovim tireoiditisom. Opisani su i miješani oblici bolesti. Bolesnike liječene
amiodaronom potrebno je redovito pratiti, laboratorijski i klinički, kako bi se pravodobno otkrila bilo kakva odstupanja u
tireoidnoj funkciji. Temelj liječenja AIH-a je nadomjesna terapija levotiroksinom. Često u tim slučajevima nije potrebno
izostavljati amiodaron iz terapije. AIT tipa 1 liječi se tireostaticima, kao i ostale tireotoksikoze. Ako je moguće, preporuča se
prekinuti podležeća amiodaronska terapija. Nasuprot AIT tipa 1, temeljni patofiziološki supstrat kojega je povećana sinteza i
otpuštanje tireoidnih hormona, u AIT tipu 2 osnova je destruktivni tireoiditis uzrokovan amiodaronom, dezetilamiodaronom
kao njegovim glavnim metabolitom i povećanim unosom joda. Osnova liječenja tog tipa bolesti je glukokortikoidna terapija.
A case of an unusual left ventricular outflow tract obstruction by mitral valve pathology in a 35-year old female with diabetes and end-stage renal disease is presented in the study. The patient ...sufferedfrom fever of an unknown origin after lower-leg amputation. Although the wound healed well, fever persisted for three weeks despite a triple antibiotic treatment until the infection was resolved with vancomycin.Three months later echocardiography displayed a floating mass attached to mitral valve, producing a newly developed systolicmurmur and a mild haemodynamic obstruction of the left ventricular outflow tract. The calcified vegetation was probably formed during an unrecognized subacute infective endocarditis.
Ischemia-modified albumin (IMA) is a potentially valuable biochemical marker of myocardial ischemia. The aim of our study was to define the kinetics and to determine the diagnostic value of IMA in ...detection of myocardial ischemia by using a model of exercise-stress induced transitory ischemia.
The study included 43 consecutive patients with positive exercise stress test and coronary artery disease confirmed by coronary angiography (ischemic group) and 22 healthy volunteers with negative exercise stress test (control group). IMA plasma levels were measured before and at nine time points after exercise over a 6-hour period.
IMA kinetics was significantly different between the ischemic and control group (p = 0.03). In the ischemic group, IMA plasma levels peaked between the 3rd and 4th hour after exercise. However, due to large interindividual differences in the time-to-peak IMA values, a standard IMA kinetics curve could not be defined for the patients with transitory myocardial ischemia. On the other hand, with the cutoff value of a 10.6% relative increase, sensitivity and specificity of IMA for the detection of myocardial ischemia were sufficiently high at 81% and 82%, respectively.
Although an optimum time for the detection of recent myocardial ischemia by a single IMA sampling could not be defined, serial measurements of IMA can be a useful biochemical tool for the detection of myocardial ischemia in patients with doubtful exercise stress test results.
Aim
Hypothyroidism is a common clinical problem that is successfully treated with hormone substitutes in the form of levothyroxine (LT4). LT4 is a drug with a narrow therapeutic index and is usually ...administered by strict rules, standardly at least half an hour before breakfast. The aim of this study was to investigate a possible effect of different timings of administration on thyroid function status and lipid profile.
Methods
The study included patients with the diagnosis of primary hypothyroidism, which were using a stable dose of levothyroxine. They were randomized into three different groups regarding the timing of LT4 administration in a crossover fashion. Each timing regimen lasted for at least 8 weeks; timing regimen A—half an hour before breakfast; timing regimen B—an hour before the main meal of the day; timing regimen C—at bedtime (minimally 2 h after dinner). The hormones (TSH, fT3, fT4) and lipid profile (triglycerides, HDL-, LDL-, and total cholesterol) were measured before the study, at the beginning of every timing regimen and at the end of the study.
Results
Altogether, 84 patients finished the study. Different timings of LT4 administration were non-inferior in comparison to the standard one and between each other. Median differences in TSH level between baseline and timing regimens were: baseline vs.
A
= −0.017 95% C.I. (−0.400–0.192); baseline vs.
B
= −0.325 95% C.I. (−0.562–0.023); baseline vs.
C
= −0.260 95% C.I. (−0.475–0.000). There were no statistically significant differences in either TSH, fT4, or fT3 when compared between all three timing regimens of LT4 administration and the baseline. There were no statistically significant differences in any of the lipid profile parameters (triglycerides, HDL-, LDL-, and total cholesterol) when compared between all three timing regimens of LT4 administration and the baseline.
Conclusion
The three investigated timing regimens of LT4 administration were equally efficient and offer additional options regarding the treatment individualization.
PDF
