Graves' disease induced by Alemtuzumab in relapsing-remitting multiple sclerosis patients: an observational study in a reference center.

OBJECTIVES: Graves' disease induced by Alemtuzumab (GD-IA) is one of the most frequently observed adverse events in patients with multiple sclerosis (MS) treated with this drug. The aim of this study is the sequencing and description of these events, along with the identification of the risk factors leading to their development. MATERIALS AND METHODS: We conducted a retrospective observational study identifying patients with relapsing-remitting multiple sclerosis (RRMS) and GD-IA, studying their baseline clinical features and variables related to the natural history of the disease. RESULTS: A total of 121 participants treated with Alemtuzumab were included, of whom 41 developed GD-IA (33.9%). A higher percentage of first-degree relatives with autoimmune thyroid disease was documented in the subgroup who developed the abovementioned event (14.6% vs 1.5%; p < 0.01). A total of 70.7% of patients diagnosed with GD-IA (n = 29/41) had fluctuations in thyroid function during follow-up, and 24.4% (n = 10/41) required total thyroidectomy for resolution of the condition. In 54.8% of participants diagnosed with GD-IA, a pattern of significant TSH decline was identified in the month prior to diagnosis of the event, with high predictive ability and associated with a more favorable clinical course (fewer weeks to normalization of thyroid function, HR = 8.99; 95% CI [2.11-38.44]; p = 0.0003). CONCLUSION: GD-IA has an atypical course compared to classical forms of the disease. The identification of risk factors for the development of the disease before starting treatment with Alemtuzumab and early monitoring of thyroid function once this treatment is initiated prove to be useful strategies in the diagnosis and clinical management of this condition.

[Thyroid dysfunction in pregnancy. Consensus document. Andalusian Society of Endocrinology and Nutrition (SAEN)]. / Abordaje del manejo de la disfunción tiroidea en la gestación. Documento de consenso de la Sociedad Andaluza de Endocrinología y Nutrición (SAEN).

A position statement on the diagnosis and treatment of thyroid dysfunction in pregnancy has been agreed on behalf of The Sociedad Andaluza de Endocrinología y Nutrición (SAEN), based on a review of the literature to date and all good clinical practice guidelines. The document is set out in different sections as regards the diagnosis and treatment of, overt and subclinical hypo- and hyperthyroidism, isolated hypothyroxinaemia and postpartum thyroiditis. It also justifies the implementation of universal screening for thyroid dysfunction in pregnancy, and provides practitioners who care for these patients with tool for rational decision making.

Growth hormone secretion in normal prepubertal children: importance of relations between endogenous secretion, pulsatility and body mass.

OBJECTIVE: Although a negative relation between GH secretion and body mass has been described, few studies have been carried out in prepubertal subjects of normal weight and height. The aim of the present study was to examine the relations between GH secretion, pulsatility and body mass throughout the wide range of weights in normal prepubertal children. METHODS: We determined integrated GH concentrations during the day (IC-GHD), night (IC-GHN), and 24 hours (IC-GH24) in 46 prepubertal children (26 males, 20 females) of normal height and growth velocity and with a Z-score (BMI-SD) between +2 and -2 SD. In addition, in 28 of these patients randomized by their BMI-SD, the secretory profile was studied by the Pulsar program: area under curve (AUC), peak number (NP), high spontaneous peak of secretory profile (HSP), and area of pulses (AP) which were considered large (L) or small (S) if their amplitude was greater or less than 4 micrograms/l (8 mU/l). RESULTS: BMI-SD correlated negatively with IC-GH (IC-GHD, IC-GH24, r = -0.58, P < 0.001) and with Pulsar parameters r = -0.48, P < 0.001; IC-GHN, r = -0.45, P < 0.001; (AUC-24, r = -0.73, P < 0.0001; HSP, r = -0.65, P < 0.0001). The NP correlated negatively with BMI-SD (r = -0.51, P < 0.005) at the expense of NLP (r = -0.54, P < 0.003) without being significantly correlated with NSP. This inverse correlation between BMI-SD and NLP was greater during daytime (NLDP, r = -0.60, P < 0.001) and was not significant at night. NSP did not correlate with BMI-SD. A similar relation was observed with respect to pulse area (ALP, r = -0.38, P < 0.05; ALDP, r = -0.46, P < 0.02;) and was not significant for ALP during the night or for ASP in any period. CONCLUSIONS: We suggest that it should be necessary to relate GH secretion to body mass in prepubertal children before defining their secretion as normal or pathological.

[Hyperthyroidism and hemodialysis]. / Hipertiroidismo y hemodiálisis.

We present the case, clinical following and successful therapy of a patient undergoing maintenance hemodialysis that presents hyperthyroidism secondary to Jod Basedow phenomenon associated to multinodular goitre previous. This case is an unusual complication for subjects in regular hemodialysis (in the bibliography revised only three cases were described in the past years) and of difficulty therapeutic management being our limited experience. In our patient, the antiseptic application with iodo solutions in the arteriovenous fistula could be representing the main cause for the hyperthyroidism. Conventional carbimazole doses keep controlling the thyroid hyper-function. Afterwards the definitive treatment with radioiodine was a safe and effective method for a long-term control.