Features and outcome of differentiated thyroid carcinoma associated with Graves' disease: results of a large, retrospective, multicenter study.

BACKGROUND: Whether differentiated thyroid cancer (DTC) occurring concomitantly with Graves' disease (GD) is more aggressive and bound to a less favorable outcome is controversial. OBJECTIVE: Aim of this multicenter retrospective study was to compare baseline features and outcome of DTC patients with GD (DTC/GD+) or without GD (DTC/GD-). PATIENTS: Enrolled in this study were 579 patients referred to five endocrine units (Cagliari, Pavia, Pisa, Siena, and Varese) between 2005 and 2014: 193 patients had DTC/GD+ , 386 DTC/GD-. Patients were matched for age, gender and tumor size. They underwent surgery because of malignancy, large goiter size, or relapse of hyperthyroidism in GD. RESULTS: Baseline DTC features (histology, lymph node metastases, extrathyroidal extension) did not differ in the two groups, except for multifocality which was significantly more frequent in DTC/GD+ (27.5% vs. 7.5%, p < 0.0001). At the end of follow-up (median 7.5 years), 86% of DTC/GD+ and 89.6% DTC/GD- patients were free of disease. Patients with persistent or recurrent disease (PRD) had "biochemical disease" in the majority of cases. Microcarcinomas were more frequent in the DTC/GD+ group (60% vs. 37%, p < 0.0001) and had an excellent outcome, with no difference in PRD between groups. However, in carcinomas ≥ 1 cm, PRD was significantly more common in DTC/GD+ (24.4% vs. 11.5%; p = 0.005). In the whole group, univariate and multivariate analyses showed that GD+ , lymph node involvement, extrathyroidal invasion, multifocality and tall cell histotype were associated with a worse outcome. Female gender and microcarcinomas were favorable features. No association was found between baseline TSH-receptor antibody levels and outcome. Graves' orbitopathy (GO) seemed to be associated with a better outcome of DTC, possibly because patients with GO may early undergo surgery for hyperthyroidism. CONCLUSIONS: GD may be associated with a worse outcome of coexisting DTC only if cancer is ≥ 1 cm, whereas clinical outcome of microcarcinomas is not related to the presence/absence of GD.

Poverty and immigration as a barrier to iodine intake and maternal adherence to iodine supplementation.

PURPOSE: Iodine deficiency still remains a significant health issue worldwide. Pregnant and lactating women are at risk for iodine deficiency when living in mild iodine-deficient areas such as Italy. This study aims at evaluating the consumption of iodized salt, iodine-rich-foods and maternal micronutrient supplements in a group of women with limited access to the Italian National Health System. METHODS: A cross-sectional survey was conducted among immigrant and Italian women living in poverty and referring to 40 Non-Governmental Organization throughout Italy for their health needs. 3483 women answered the ad hoc questionnaire between January 2017 and February 2018. RESULTS: The consumption of iodized salt was very low, and even lower among immigrant women. Determinants of iodized salt consumption were the period spent in Italy for immigrant women and living in a family-type setting, parity and, particularly, the degree of education for Italian ones. 17.5% of immigrant women and 8.6% of the Italian ones reported a diagnosis of thyroid disease. 521 women, 75.4% of whom were immigrants, were pregnant or breast-feeding. The majority (57.3%) had no specific maternal supplementation. CONCLUSIONS: Both Italian and immigrating women with a low income or without access to the public health system have a poor adherence both to the salt iodization policy and to folic acid and iodine supplements in preconception and pregnancy. They also referred a low-frequency intake of iodine-rich-foods. The identification of barriers to health care access could be useful to promote specific health interventions in this target population.

Painful Hashimoto's thyroiditis: myth or reality?

Neck pain is a common complain, being in most cases due to non-thyroidal causes. However, a minority of patients suffer from painful thyroid diseases. Among them, sub-acute thyroiditis (SAT) is the most frequent one. Rare thyroid-related causes of neck pain include hemorrhage within a thyroid nodule as well as Riedel's thyroiditis and suppurative thyroiditis. In the last 30 years, a few cases of a painful variant of Hashimoto's thyroiditis (HT) have been described. Biochemical, ultrasound, and histologic features were clearly suggestive for HT in all of the published cases and definitely ruled out the diagnosis of SAT. While sound descriptions of painful HT are present in the literature, it is important to emphasize that only 20 cases were reported from the year 2000 until now. The condition, however, is clinically relevant because neck pain was reported to be refractory both to steroids and to other analgesic drugs, being thyroidectomy the only effective treatment for pain relief in these patients. This short review analyzes currently available data supporting a role for HT as a rare cause of neck pain.

[Anesthetic gases exposure: findings from a 13 year environmental and biological monitoring in a hospital company]. / Esposizione a gas anestetici: risultati di 13 anni di monitoraggio ambientale e biologico in un Azienda Ospedaliera.

The evolution of the modern anaesthesiologic technique aimed to detect more manageable and less toxic aesthetic gas, but adequately efficacy. This study considered the environmental and biological evaluation of the Careggi Hospital in Florence between 1991 and 2005. The pollution threshold of each aesthetic gas used (Nitrous oxide, Isoflurane and Sevoflurane) is reduced as time passed. The higher values about the pollution threshold have been found in the ophthalmology and in the otolaryngology operating room. We observed clinical and biological data of 74 health care workers (HCW). The anaesthetists and assistants were the more exposition. We didn't found any correlation between the exposure at gas and the clinical, and biological data. Some neurological and nonspecific symptoms (like head-ache and reduction of attention threshold) appear from the clinical informations; these symptoms suggest a possible effects on the HCW' health also for low pollution threshold.

Multiple serum inhibitors of lectin-induced lymphocyte proliferation in nephrotic syndrome.

Inhibitory activity on PHA- and Con A-induced lymphocyte proliferation was observed in the serum of 29 patients with nephrotic syndrome (NS); this inhibitory activity was present both in steroid-sensitive nephrotic syndrome (SSNS; 18 patients) and in NS due to other glomerulopathies (11 patients). In order to characterize the inhibitory activity, peripheral blood lymphocytes from normal donors were stimulated with various concentrations of Con A in culture medium supplemented with: (1) 20% SSNS serum, (2) various concentrations (1, 5 and 20%) of either SSNS serum or normal human serum (NHS) and (3) 20% of a serum prepared by mixing different proportions of SSNS and NHS. The results suggest that the inhibitory activity is due to at least two different factors: (a) inhibitor(s) acting competitively with the lectin Con A, and (b) inhibitor(s) neutralized by factor(s) present in NHS. A disturbance in the normal equilibrium between inhibiting and enhancing factors which results in overall inhibition might well be a consequence of the marked alteration in serum proteins characteristic of NS.