SERUM ZONULIN LEVELS IN HYPOTHYROID AND EUTHYROID PATIENTS WITH HASHIMOTO'S THYROIDITIS - A PILOT STUDY.

Context: Human zonulin is a protein that regulates the intercellular tight junctions in various tissues and organs of the human body. Hashimoto's thyroiditis (HT) is one of the most common endocrine autoimmune disorder, but the role of increased intestinal permeability in its pathogenesis is still being studied. Objective and design: This pilot cross-sectional study investigates serum zonulin concentration in adults with Hashimoto's thyroiditis and assesses the relationship between zonulin levels, clinical hormonal and immunological characteristics. Subjects and methods: A group of 62 adults with HT participated in this study and were divided into three groups: hypothyroid (n=33) euthyroid (n=25) and hyperthyroid (n=4). Serum zonulin was determined using an ELISA method. Results: Age, gender and BMI were different between groups (hypothyroid and euthyroid ones). Serum zonulin values ranged from 2.6 to 198.0 ng/mL in participants. A direct positive correlation was found between serum zonulin levels and weight and BMI (r = 0.351, p = 0.008 and r = 0.236, p = 0.05, respectively). Conclusions: There is no correlation between zonulin and thyroid hormones or autoantibodies in Hashimoto thyroiditis patients. There is a difference in zonulin levels between the studied groups, but they are not statistically significant.

Therapeutic efficacy of "Milgamma" in patients with painful diabetic neuropathy.

Forty-five diabetes patients with painful peripheral polyneuropathy were enrolled in a 3-month observational study comparing the therapeutic efficacy of Milgamma tablets (50 mg benfothiamine and 0.25 mg cyancobalamine) with parallel randomized treatment assignment with the conventional vitamin B complex treatment regimen Neurobex. Thirty patients in group one were randomized to receive two Milgamma tablets qid for three weeks followed by 1 Milgamma tablet tid for 9 weeks. In group two 15 patients received two Neurobex tablets tid for the entire 3-month study period. Therapeutic efficacy was assessed on the basis of within-patient differences in pain severity between Milgamma and Neurobex-treated patients and in vibration perception thresholds using the Rydel-Seiffer biothesiometer at baseline and at the end of the study. Statistically significant relief of both background and peak neuropathic pain was achieved in all of the Milgamma-treated patients and vibration perception thresholds dramatically improved with a median of 1.56 measured on the biothesiometer scale (t = 3.24, P < 0.01). The sensory symptoms improvement was insignificant in the Neurobex-treated patient group and the changes in the vibration perception thresholds failed to reach statistical significance. The therapeutic efficacy of Milgamma was greater in patients with early-stage diabetes as compared with those with advanced diabetic neuropathy. No adverse reactions were observed following the administration of the medication. Our results underscore the importance of Milgamma tablets as an indispensable element in the therapeutic regimen of patients with painful diabetic polyneuropathy.

Percutaneous ethanol sclerotherapy of autonomous thyroid nodules: preliminary results.

Percutaneous ethanol sclerotherapy was applied to 20 patients (17 women and 3 men, aged 30 to 77 yrs) with autonomous thyroid nodules. The patients either were contraindicated because of hazardous concomitant diseases or refused surgical or 131I treatment. Ethanol (95 alc%) was injected in 4 to 6 sessions at a mean dose of 0.63 ml/cc nodular tissue. Physical examination, T3, T4 and TSH assays, thyroid scintigraphy, sonography, and fine needle aspiration biopsy were used to evaluate the treatment results within a 12-month follow-up. Two months after ethanol injection all patients showed an improvement; in six patients the symptoms recurred in the 6th month. Two of them underwent a second cycle of ethanol injection. 12 months later an euthyroid state was maintained in 16 (80%) patients, while 4 (20%) did not respond to the treatment. The treatment results were markedly determined by the nodule size as no effect was achieved in nodules larger than 15-20 ml in volume. This method appears to be an appropriate and harmless alternative to the surgical and 131I treatment of autonomous thyroid nodules less than 15-20 ml in volume, especially in patients with grave concomitant diseases.

Immune profile and thyroid function in patients with rheumatoid arthritis.

Thyroid autoantibodies and thyroid function were studied in 175 patients with rheumatoid arthritis (ARA criteria, 1987). The study included 149 women and 26 men aged (54.7 +/- 13.1) all treated in the Clinic of Rheumatology, Higher Medical Institute, Plovdiv. A control group comprising 72 healthy subjects (aged 51.2 +/- 3.2) was used. Rheumatoid factor (RF) (latex agglutination test and Waaler-Rose test), antithyroglobulin (TAT) and antimicrosomal antibodies (MAT), thyroid stimulating hormone (TSH) and the free fraction of thyroxine (FT4) were measured. 69.7% of all patients tested positive for RF by the latex test and 64.5% by the Waaler-Rose test. TAT was found in 55 (31.4%), MAT in 26 (14.8%) from all the examined, which is significantly greater in comparison with the controls (p < 0.05). The thyroid gland was in a euthyroid state in most of the RA patients although MAT and/or TAT were detected in them. The results suggest existence of two autoimmune diseases - rheumatoid arthritis and Hashimoto's thyroiditis and raise the question of whether they are not manifestations of a single autoimmune disease with different body organ localisation.