Patients with chronic hepatitis type C and interferon-alpha-induced hyperthyroidism in two-years clinical follow-up.

OBJECTIVES: Interferon-α (IFN-α) is a gold standard in the therapy of viral chronic hepatitis type C (CHC). However, such treatment might lead to thyroid dysfunction. Patients usually present hypothyroidism, but rarely also hyperthyroidism may develop. The aim of the study is to present two-year clinical follow-up of patients with CHC and IFN-α-induced hyperthyroidism (IIH), with special regard to the methods and efficacy of the therapy. METHODS: A group of 106 patients with CHC and IIH were analyzed. Subjects were divided into two groups according to etiology: group 1, with Graves' disease (GD) and group 2, with Hashitoxicosis (HT). The diagnosis of GD and HT was based on: clinical signs of hyperthyroidism, hormonal profile (TSH, fT4, fT3), level of thyroid autoantibodies (Tg-Abs, TPO-Abs, TSHRAbs). Treatment of hyperthyroidism was monitored by repeated clinical assessment and laboratory tests. RESULST: 28 patients (26 with GD of which 5 exhibited mild orbitopathy and 2 with HT) were treated with radioiodine [the average dose of was 17 mCi [668 MBq]. In adition 78 out of 80 patients with HT mostly ß-blocker therapy was successful (transient hyperthyroidism). At the end of the observation period, in group 1 remission was achieved in 17 (65.4%) cases, 6 (23.1%) patients showed hypothyroidism and 3 (11.5%) presented recurrence of hyperthyroidism. CONCLUSIONS: Most patients with IIH present Hashitoxicosis, while a minority of them develop Graves' disease. In a majority of patients with HT spontaneous remission of disease occurs. In patients with long-term hyperthyroidism, radioiodine therapy is an effective and well-tolerated.

[Effect of amiodarone on the thyroid function and safety of the therapy--what's new]. / Wplyw amiodaronu na funkcje tarczycy a bezpieczenstwo terapii--co nowego?

This paper presents the current state of knowledge on the effects of amiodarone (AM) on the thyroid gland function, including the question of epidemiology, pathogenesis and prognostic factors. Of all the antiarrhythmic drugs hitherto used, AM has the most adverse effects on the thyroid gland. In patients receiving AM, it may lead to a development of a full- symptomatic hyperthyroidism (AIT-Amiodarone-induced thyrotoxicosis) and hypothyroidism (AIH - Amiodarone-induced hypothyroidism). The time from the start of the treatment of AM to the onset of symptoms of thyrotoxicosis is varied and amounts approximately to 3 years. The AIT may develop up to 2 years after the cessation of the AM treatment because of the accumulation of the drug and its metabolites in the body. The AIT treatment is complicated and often requires multiple treatment methods, such as: antithyroid drugs, glucocorticoids, iopanic acid, plasmapheresis, thyroidectomy and radioiodine. AIH is associated with the Wolff-Chaikoffa phenomenon. Thyroid hormone synthesis is impaired by blocking iodine organification. Hypothyroidism can also arise and be exacerbated by the output of thyroid disease - autoimmune diseases. The paper also devotes much attention to the relationship between smoking and the toxicity of AM. The components of tobacco smoke increase the activity of enzymes involved in the metabolism of AM. Increased concentrations of desetyloamiodarone in lung tissue may be responsible for the increased toxicity in the lungs in smokers. In addition, the paper presents a new antiarrhythmic drug - dronedarone (DN), an attractive alternative, but, because of the high risk of heart failure, stroke and death from cardiovascular disease, with a limited potential.

Thyroid associated orbitopathy--medication, radioiodine or operation?

This paper presents the current state of knowledge on the treatment of ophthalmopathy in the process of the Grave's disease. The question of prevention occupies a special place in the process of treatment as it has been clearly shown that exophthalmos is strongly associated with cigarette smoking. Therefore, before proceeding with any treatment, the patient should be advised to quit smoking as soon as possible. Further on in the publication, various forms of therapy are presented. Because of the unknown etiology, only symptomatic treatment can be applied, which includes steroids, radiotherapy and surgery. Patient care of patients with ophthalmopathy is a challenge even for an experienced clinician. Each case requires an individual approach that would take into account the severity of eye changes.

[The problem of cigarette smoking in the workplace]. / Problem palenia tytoniu w miejscu pracy.

European countries take various actions to reduce smoking, including an introduction of appropriate legislation. In Poland, the main piece of legislation is the Act of 9 November 1995 on protection of health against the consequences of tobacco use and their products. Among the places where smoking is prohibited, the document mentions all indoor areas of workplaces, among others. At the same time, the law allows smoking in designated areas. However, since the introduction of an amendment effected more than a year ago, the employer is not legally obliged to create a smoking room. Furthermore, the employer has been empowered to impose even an outright ban on smoking in indoor workplaces and on the company premises. In the event of a breach of this prohibition by the employee, a fine or a penalty for breach of order may be imposed. It is also admissible to offer an incentive for non-smoking employees in the form of bonuses for greater efficiency on the part of workers.

Smoking and endocrine disorders.

Patients suffering from endocrine disorders, which affect the function of central nervous system, need a special care and approach in the process of smoking cessation. The process of informing about negative effects of smoking addiction, including potential aggravation of the disease, has to be specially tailored to the need of the patient and the type of the disease. The informing physician should also serve as a model by not smoking and try to confirm the patient about positive benefits of quitting smoking.

Subclinical hyperthyroid patients' knowledge about radioiodine therapy--the key role of medical information.

OBJECTIVES: Many patients with a chronic disease are dissatisfied with the information they are given. A brief questionnaire completed by patients would assist health professionals to identify areas of information needed to be provided, tailored to the patient's mental condition. AIM: The aim of our study was to assess how often thyroid patients report being adequately informed about iodine treatment in connection with their real need thereof, emotional state and acceptance of the disease. METHODS: One hundred outpatients who had presented subclinical hyperthyroidism "[19 men (19%), 81 women (81%); mean (SD±) age 53±14,range 18-77 yr ] treated with radioiodine (RAI) responded to an Experimental Questionnaire, 54 of them answered to AIS, HADS-M and Beck Inventory measuring their acceptance of the illness and depressive symptoms, 37 of them answered the Patient Request Form (PRF). RESULTS: The obtained results indicated that about 50% of patients treated with 131I therapy did not receive suitable information about their treatment. Neither written information prepared by the specialist, nor verbal information given by physicians were adequate for specific problems of study group. The examined patients presented with a comparable intensity of three distinct types of requests: for explanation and reassurance, for emotional support, and for investigation and treatment. The acceptance of their disease was mediocre for most of the study group. CONCLUSION: We conclude that the reported lack of satisfaction with medical information in study group was associated with depressive symptoms influencing cognitive efficiency, patients' great need of emotional and cognitive support, influencing the acceptance of their disease, and social prejudice to radioiodine (as a method of treatment), worrying them additionally. All thyroid patients even these with subclinical symptoms of hyperthyroidism should be treated with specific attention by physicians, especially during information process.

Smoking and thyroid diseases--what is new?

Cigarette smoking has multiple effects on the thyroid gland, which is associated with important clinical implications such as increased risk and severity of autoimmune thyroid disorders, especially Graves' ophthalmopathy. The influence of cigarette smoking is mainly associated with the pharmacological action of nicotine and also with toxins such as thiocyanate. The present review of relevant literature concentrates on the effect of smoking on the Graves' ophthalmopathy and other autoimmune thyroid disorders (such as Hashimoto's disease). The effect of passive smoking on children and the influence of smoking on the fetus is also shown. In contrast, the protective influence of cigarette smoke on thyroid cancer is also widely observed.

Psychological and legal aspects of quitting smoking in thyroid patients.

Finally, our study describes observations related to psychological and legal aspects of smoking quitting in Poland. It has been noticed that quitting of smoking needs individual therapeutic approach. The intensity and period of addict has to be consider the same as coexistence of somatic illness. The role of neurotic personality in connection with psychosomatic diseases and wide adaptation of procedure to patient's condition has been also underlined.

Smoking and thyroid disease--review of literature.

Smoking has multiple effects on the thyroid gland, which is associated with important clinical implications such as the increased risk and severity of autoimmune thyroid disorders especially Graves disease. The influence of tobacco smoking is mainly associated with pharmacological action of nicotine and also with toxins such as thiocyanate. The present review of the relevant literature concentrates on the effect of smoking on the Graves ophthalmopathy and autoimmune thyroid disorders such as Hashimoto disease. The effect of passive smoking on children and the influence of smoking on foetus are also shown. In contrast, the protective influence of tobacco on the thyroid cancer is also widely noticed. Finally, our study describes observations related to the psychological and legal aspects of smoking.

[Legal regulations knowledge among active and passive smokers]. / Znajomosc regulacji prawnych dotyczacych palenia tytoniu wsród czynnych i biernych palaczy.

In the recent years smoking problem is more visible in Europe as well as in Poland. European countries tried to limit smoking in different ways including suitable legal regulations. There came international legal documents. Besides of that some countries implemented solutions to protect passive smokers. Also in Poland there are legal acts protecting non-smokers from passive smoking. Those provide protection from nicotine smog in sufficient way but those are often ignored. More effort should be put in the implementation of existing acts. The main research objective of this document was to show the actual legal regulations knowledge about smoking and selling tobacco by active as passive smokers and their opinion on smoking prohibition in public places.