Presence of risk factors for thyroid cancer does not improve the performance of ultrasound screening for thyroid nodules in patients with obesity.

PURPOSE: It has been suggested, on a theoretical basis, that ultrasound screening of thyroid nodules in obese patients with additional risk factors (family history, chronic autoimmune thyroiditis or high thyrotropin) might be cost-effective for the early detection and treatment of thyroid cancer. The present study evaluates if this approach can be validated in a real clinical setting. METHODS: Patients with obesity who attended hospital-based clinics were evaluated for risk factors of thyroid cancer and ultrasound screened for thyroid nodularity. Detected nodules were evaluated according to current guidelines. RESULTS: A total of 429 patients were evaluated (70.2% women, mean age 49.1 ± 11.0, mean body mass index 42.6 ± 5.8 kg/m2 ). Risk factors were present in 129 (30.1%) patients. Thyroid nodules with indication for fine-needle aspiration biopsy were detected in 69 (16.1%). We did not find differences in the risk of harbouring thyroid nodules according to the presence of risk factors (no risk factors 16.6%, risk factors 14.1%, P = .64). No single risk factor conferred an increased risk for thyroid nodules During the screening procedure, four cases of thyroid cancer were detected, none of them with the evaluated risk factors. CONCLUSION: The presence of known risk factors for thyroid cancer does not improve the performance of a US screening strategy aimed at the detection of thyroid nodules in obese patients. According to current guidelines, screening for thyroid nodules in obese patients is not recommended regardless of the presence of thyroid cancer risk factors.

Prognostic Significance of Thyroglobulin Antibodies in Differentiated Thyroid Cancer.

OBJECTIVE: To investigate whether variations in thyroglobulin autoantibodies (TgAb) are related to the recurrence or persistence of differentiated thyroid carcinoma (DTC) and may therefore be useful as surrogate tumor markers. Design and Methods. We retrospectively studied 98 subjects (83 women, 47 ± 15 years old) from an initial cohort of 1017 patients treated for DTC in five hospitals, with positive TgAb at any time during the follow-up. Patients presented five different patterns of evolution of serum TgAb concentrations: (1) stable positive TgAb, (2) de novo appearance, (3) an increase of more than 50%, (4) TgAb levels from positive to negative, and (5) a decrease of more than 50%. RESULTS: In the group of 11 patients with stable TgAb, four cases presented persistence of the disease with structural incomplete response. In the group of 22 patients with sustained increasing trend rising more than 50% or de novo detectable TgAb levels, three patients were diagnosed with structural incomplete response. There was no evidence of recurrence or persistence of the disease in any of the 65 patients who showed a significant decrease in (n = 35) or disappearance of (n = 30) TgAb. CONCLUSIONS: Our results suggest that not only the appearance of a significant increase in TgAb but also stable concentrations of TgAb should be regarded as a sufficient risk condition for an active search for recurrent or persistent disease. Conversely, a significant decrease in TgAb levels can represent a good prognostic sign.

Are YouTube videos useful for patient self-education in type 2 diabetes?

OBJECTIVE: To evaluate the usefulness of YouTube videos as an educative tool for type 2 diabetes self-management. DESIGN: Search terms were "diabetes diet" and "diabetes treatment." Videos were jointly assessed by two reviewers. A third investigator evaluated a random sample to check for agreement. MAIN MEASURES: Usefulness defined as making reference to AAD7 Self-Care Behaviors™ and presence of misleading information. RESULTS: Of the 393 videos included, 42.2 percent (n = 166) classified as "alternative medicine." 40.2 percent (n = 158) contained useful information. 25.7 percent (n = 101) videos contained misleading information. Videos displaying "alternative medicine" professionals (60 out of 200) were less useful (17% vs 57%; p < 0.001) and more misleading (40% vs 2%; p < 0.001). CONCLUSION: The probability of finding videos that relate to AADE7™ self-care behaviors is below 50 percent. The odds of finding misleading information are high. Therefore, it is inadvisable for professionals to recommend the use of YouTube as an educating tool if specific videos are not suggested.

Use of communication technologies by people with type 1 diabetes in the social networking era. A chance for improvement.

AIMS: To evaluate the health-related use of Web 2.0 tools by patients with type 1 diabetes. METHODS: Cross-sectional survey assessing views and usage of the Internet, Apps and Web 2.0. RESULTS: Number of participants: 289 (age 42.8±13.5 years; diabetes duration 18.4±12.2 years; 58.7% males; 39% with an upper secondary or higher education level). Web 2.0 usage for health purposes was low with 19.6% and 14% of Web 2.0 members (147; 50.9%) having health-related contacts and posting health comments. Health-related Apps were used by 35.4% of Smartphone owners (161; 55.7%). 75.3% patients would share information online with professionals, preferably through e-mail (78.7%) rather than Facebook (47.7%). 141 (66.5%) of those willing to share information would participate in a professional-moderated Facebook group. CONCLUSIONS: Web 2.0 and Apps usage for health purposes is low. The difference between the use of Web 2.0 networks and the willingness to participate in professional-moderated Web 2.0 groups points to the need of a higher implication of health professionals in promoting Web 2.0 technologies if these are to be adopted in a clinical setting. Currently, e-mail is the tool to be considered when aiming to increase online communication with patients with type 1 diabetes.

A descriptive study of the characteristics of differentiated thyroid cancer in Catalonia during the period 1998-2012. The CECaT registry.

INTRODUCTION: The consortium for the study of thyroid cancer (CECaT), including 20 hospitals and one research institute, was recently created in Catalonia (Spain). One of the first initiatives of the group was to perform a descriptive analysis of the characteristics of patients with differentiated thyroid carcinoma (DTC). PATIENTS AND METHODS: The cohort included 1,855 patients from 11 hospitals treated over a period of 15 years (1998-2012). RESULTS: In this series, 1.470 (79.2%) patients were women. Mean age was 47.7 (15.7) years old. Age was significantly higher in male than in female patients, 49.3 (15) versus 47.3 (15.8); p=0.02. Papillary thyroid carcinoma accounted for 88.9% of cases. Mean tumor size was 21.5 (16) mm, and was significantly lower in females than in males, 20.1 (14.5) mm and 26.6 (20.3) mm respectively (p<0.001). After a follow-up period of 5.5 (3.7) years, information was available for 1,355 patient, of whom 1065 (78.6%) were free of disease, 239 (17.6%) had no tumor persistence, and 51 (3.8) % had died. The risk of persistent or recurrent disease was significantly associated to older age at diagnosis, male gender, larger tumor size, lymph node metastases at surgery, no signs of thyroiditis in the remaining thyroid tissue, and presence of vascular and/or extraglandular invasion. CONCLUSIONS: Patient characteristics analyzed are similar to those reported in other parts of the world.

Response to initial therapy of differentiated thyroid cancer predicts the long-term outcome better than classical risk stratification systems.

Objective. Although differentiated thyroid cancer (DTC) usually has an indolent course, some cases show a poor prognosis; therefore, risk stratification is required. The objective of this study is to compare the predictive ability of classical risk stratification systems proposed by the European Thyroid Association (ETA) and American Thyroid Association (ATA) with the system proposed by Tuttle et al. in 2010, based on the response to initial therapy (RIT). Methods. We retrospectively reviewed 176 cases of DTC with a median follow-up period of 7.0 years. Each patient was stratified using ETA, ATA, and RIT systems. Negative predictive value (NPV) and positive predictive value (PPV) were determined. The area under receiver operating characteristic (ROC) curve was calculated in order to compare the predictive ability. Results. RIT showed a NPV of 97.7%, better than NPV of ETA and ATA systems (93.9% and 94.9%, resp.). ETA and ATA systems showed poor PPV (40.3% and 41%, resp.), while RIT showed a PPV of 70.8%. The area under ROC curve was 0.7535 for ETA, 0.7876 for ATA, and 0.9112 for RIT, showing statistical significant differences (P < 0.05). Conclusions. RIT predicts the long-term outcome of DTC better than ETA/ATA systems, becoming a useful system to adapt management strategies.

Escape and lipodystrophy in acromegaly during pegvisomant therapy, a retrospective multicentre Spanish study.

BACKGROUND: Pegvisomant is an effective treatment for acromegaly. OBJECTIVE: To investigate escape (loss of biochemical control in patients previously controlled) and lipodystrophy in acromegalic patients treated with pegvisomant and to evaluate possible associations with clinical features. PATIENTS AND METHODS: Multicentre retrospective study involving 19 Spanish centres. RESULTS: Ninety-seven patients were included (59% women, mean age at diagnosis 42 ± 13 years, 80% macroadenomas); mean follow-up on pegvisomant was 5 ± 2·5 years, and 89 (92%) achieved normal IGF-1. Escape was reported in 30/89 (34%) of responders, after a mean treatment duration of 25 ± 21 months. The mean initial dose of pegvisomant was 11 ± 5 mg/day, and mean dose at escape was 14 ± 7 mg/day. Most patients (26/30, 87%) achieved control with dose increase (57%), additional medical treatment (3%) or both (27%). Mean new dose that controlled IGF-1 after escape was 20 ± 7 mg/day. Treatments associated were somatostatin analogues (SSA in 47%), cabergoline (CAB in 47%) and both (6%). Lipodystrophy was observed in 15 patients (13 females), mild in six, moderate in six, severe in three and persistent in four. Among patients with lipodystrophy, three escaped and three were nonresponders to pegvisomant. Four patients discontinued the drug, and four had dose reductions because of lipodystrophy. It tended to be more frequent in females (P = 0·06) and in patients treated with triple association SSA+CAB+PEG (P = 0·018). No relationship between escape and clinical variables was found, except prior CAB (P = 0·04) and metformin treatment (0·02) and grade of lipodystrophy (P = 0·02). CONCLUSIONS: A significant proportion of patients treated with pegvisomant escaped (34%); however, the majority (87%) was easily controlled with either dose increase, further medical treatment or both. Lipodystrophy developed in 15%, mostly females, and influenced the response to treatment.

[Atherogenic dyslipidemia in patients with type 1 diabetes mellitus]. / Dislipidemia aterogénica en pacientes con diabetes mellitus tipo 1.

BACKGROUND AND OBJECTIVE: To assess the prevalence of lipid abnormalities, with special emphasis on atherogenic dyslipidemia and its relationship with chronic complications in patients with type 1 diabetes mellitus (T1DM). PATIENTS AND METHOD: Cross-sectional study including all patients aged 18 and over, diagnosed of T1DM attending the outpatient clinic at Hospital del Mar and Hospital de Granollers, in Barcelona, during 2008. RESULTS: Of the 291 enrolled patients, 17.2 and 7.9% had high density lipoproteins (HDL) cholesterol<40 mg/dL (men) or<50mg/dL (women) and triglycerides>150 mg/dL, respectively. Hypoalphalipoproteinemic patients had a higher prevalence of peripheral neuropathy (28 vs. 7.1%, P<.001), macroalbuminuria (14 vs. 2.5%, P<.001) and higher concentrations of triglycerides (107.5 [55.8] vs. 82.7 [36] mg/dL, P<.0001) compared with those with normal/high HDL cholesterol levels. Hypertriglyceridemia was associated with increasing age (43.6 [11.2] vs. 37.6 [11.8] yr, P<.02), higher prevalence of hypertension (47.8 vs. 22.8%, P<.008), metabolic syndrome (82.6 vs. 22%, P<.001) and microangiopathic complications, lower insulin sensitivity (6.75 [2.1] vs. 8.54 [2.6] mg/Kg(-1)/min(-1), P<.004) compared with the normotriglyceridemic group. CONCLUSION: One in 5 patients with T1DM has hypoalphalipoproteinemia or hypertriglyceridemia and these conditions are associated with 3 fold-increase microangiopathy. Thus, in these patients glycemic and blood pressure but also lipid profile control must be optimum.

Prevalence and related factors with the presence of albuminuria and its stages in patients with type 1 diabetes mellitus.

BACKGROUND AND OBJECTIVES: Despite the beneficial effects of intensive insulin therapy, nephropathy continues to be a major concern in type 1 diabetes mellitus (DM). Given the scarce data on this subject in our population, we performed an observational study in order to analyse the prevalence of albuminuria and its stages in a series of patients with type 1 DM and to evaluate the related factors. PATIENTS AND METHODS: Cross-sectional study that included all patients aged 18 and over, diagnosed of type 1 DM for at least 6 months, consecutively attended during 2008 at the Hospital del Mar de Barcelona and Hospital Granollers. RESULTS: 291 patients were analysed and 46 (20.2%) had micro- or macroalbuminuria. Albuminuric patients, compared to those without were older (42.0±12.3 years vs. 37.1±11.5 years), had longer duration of diabetes (22.5±11.5 years vs. 14.1±10.1 years), and higher body mass index (26.3±3.7kg/m2 vs. 25.2±3.4kg/m2), glycosylated haemoglobin (8.15±1.5% vs. 7.59±1.4%) and systolic blood pressure (139.7±21.7 mmHg vs. 122.2±20.3mmHg). Multivariate analysis showed an independent association of albuminuria with diabetes duration (OR 1.081, 95% CI 1.038-1.126), triglyceride levels (OR 1.011, 95% CI: 1.002-1.018), smoking habit (OR 3.279, CI 95%: 1.114-9.654) and hypertension (OR 3.495, 95% CI: 1.074-11.368). CONCLUSION: In our series, one out of five patients with type 1 DM had micro- or macroalbuminuria, and its presence is associated with diabetes duration, triglyceride concentration, smoking and hypertension.

[Healthcare impact of introduction of thyroid ultrasound in a thyroid nodule pathology unit]. / Impacto asistencial tras la introducción de la ecografía tiroidea en una unidad monográfica de atención al nódulo tiroideo.

INTRODUCTION: Worldwide incidence of thyroid cancer has increased in recent decades. OBJECTIVE: To provide evidence of the diagnostic and care efficiency of a monographic thyroid nodule clinic integrating clinical examination, ultrasound examination, and cytology with on site evaluation. PATIENTS AND METHODS: Patients attending the monographic thyroid nodule clinic from January 2004 to June 2010. Two periods may be distinguished based on availability of ultrasound equipment at the time of the visit: a first period (P1: 01/2004-09/2007) where no ultrasound equipment was available at the clinic and FNA by palpation was performed, and a second period (P2: 10/2007-06/2010) where this equipment was available and ultrasound-guided FNA was performed. RESULTS: A total of 1036 patients [P1: 537 (52%), P2: 499 (48%)] were seen and enrolled. Diagnostic efficiency (P1 vs P2): 143 vs 181 patients were seen annually, p<0.001; FNA number/nodule: 1.68 vs 1.17, p<0.001; percent FNAs with inadequate material: 26% vs 5.3%, p<0.001; mean (SD) nodule size: 23.6 (12.4) vs 21.7 (11.7) mm, p 0.040; proportion of nodules examined less than 10mm in size: 9.9% vs 13.7%, p 0.030. Care efficiency: mean time (range) from the first visit to surgery indication: 332 (0-2177) vs 108 (0-596) days, p<0.001; proportion of patients referred for surgery due to suspect cytology/other reasons: 1.06 vs 2.21, p<0.001; and operated benign neoplasm/pathology: 0.47 vs 0.93, p=0.002. CONCLUSION: A monographic thyroid nodule clinic integrating clinical examination, ultrasound, and cytology evaluated on site increases diagnostic and care efficiency in patients with thyroid nodules.

Insulin resistance and hypertension in patients with type 1 diabetes.

AIM: The aims of this study were to determine the prevalence of hypertension in type 1 diabetes patients and to analyze its relationship with insulin resistance and other associated factors. DESIGN AND METHODS: A cross-sectional study on 291 patients with type 1 immune-mediated diabetes managed at two outpatient endocrinology clinics was performed. All participants were Caucasian, 18 years or older with type 1 diabetes duration of more than 6 months, who had completed the study protocol. Hypertension was defined as blood pressure ≥130/80 mmHg or use of antihypertensive medication, excluding angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers when used as treatment for micro- or macroalbuminuria. RESULTS: Hypertension was found in 87 [29.9% (95% confidence interval, or CI): 24.6%-35.2%] patients with type 1 diabetes. Hypertensive patients presented older age, male predominance, higher body mass index and overweight/obesity prevalence, and longer diabetes duration compared with normotensive patients. Insulin sensitivity quantified by estimated glucose disposal rate (eGDR) was lower in patients with hypertension compared with normotensives (5.2±1.4 vs. 9.1±1.2 mg kg(-1) min(-1), P<.001) and showed a negative correlation with systolic blood pressure level (r=-0.612, P<.01). In multivariate logistic regression analysis, eGDR, besides nephropathy, emerged significantly and independently associated with hypertension. An increment of 1 unit in insulin sensitivity assessed by eGDR was associated with a 5.7% decrease in hypertension prevalence (95% CI: 0.018-0.175) and the absence of nephropathy with an 88.2% decrease (95% CI: 0.15-0.92). CONCLUSIONS: Hypertension was present in approximately one third of patients with type 1 diabetes, especially in men, those with microangiopathy, overweight or obesity, older age and longer diabetes duration. Hypertension prevalence increased in parallel to the degree of renal impairment and was inversely related to insulin sensitivity.