High-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone analogs (GnRHa) and levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis: a case series with long-term follow up.

Objective: This research was conducted to assess the long-term outcomes of a combination treatment of High-intensity focused ultrasound (HIFU) ablation, gonadotropin-releasing hormone analogs (GnRHa) and Levonorgestrel-releasing intrauterine system (LNG-IUS) for women with adenomyosis (AD).Methods: One hundred and forty-two patients with AD were enrolled and treated with HIFU conservative treatment in combination with adjuvant therapy of GnRHa and LNG-IUS. All the cases were followed up to 5 years after treatment. The volumes of uteri, AD lesions, and menstrual blood, and dysmenorrhea scores were measured. Also, the incidences of recurrence and complications were recorded.Results: Both the uterine and lesion volumes significantly decreased after treatment. The uterine volume gradually reduced after treatment, reaching the lowest level of 122.07 ± 44.12 cm3 at 12 months after treatment, with an average reduction rate of 45%, and then increased slightly, maintaining a reduction rate of about 35% compared with the baseline level. Similar decreases in AD lesion volumes, dysmenorrhea scores, and menstrual flow were also demonstrated. Hemoglobin levels increased. Moreover, the long-term recurrence rates were low, with 5.68% and 7.91% in dysmenorrhea and menorrhagia, respectively. No serious complications or adverse events were reported.Conclusions: HIFU ablation, in combination with GnRHa and LNG-LUS, might be a safe and effective alternative in the treatment for women with adenomyosis.

Different levels of thyroid hormones between impaired fasting glucose and impaired glucose tolerance: free T3 affects the prevalence of impaired fasting glucose and impaired glucose tolerance in opposite ways.

CONTEXT: There is an association between thyroid disorders and diabetes mellitus. OBJECTIVE: To investigate thyroid hormone levels in different glucose metabolic statuses, analyse relationships between thyroid hormone levels and different categories of prediabetes and metabolic parameters within a large euthyroid nondiabetic population. METHODS: A total of 3328 subjects without diabetes or thyroid dysfunction were included in this cross-sectional study. Subjects were divided in to four groups [normal glucose tolerance (NGR), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and combined glucose intolerance (CGI)] according to the results of oral glucose tolerance test. Participants were then divided into four groups according to the quartile of free T3 (FT3) in their blood. RESULTS: Subjects with IFG had higher levels of FT3 and ratio of FT3 to FT4 (FT3/FT4), but lower level of free T4 (FT4) than subjects with IGT. FT3/FT4 was negatively associated with postprandial plasma glucose (PPG) [standardized ß (ß) = -0·087; P < 0·001]. The prevalence of IFG and CGI was increased with the level of FT3, while the prevalence of IGT was decreased with the level of FT3 (P for trend: <0·001, 0·003 and <0·001, respectively). FT3 was negatively associated with the risk of IGT (OR = 0·409, 95% CI 0·179-0·935), whereas FT4 was positively associated with the risk of IGT (OR = 1·296, 95% CI 1·004-1·673). CONCLUSIONS: Free thyroid hormone levels were different between subjects with IFG and IGT. FT3 affects the prevalence of IFG and IGT in opposite ways. The difference in thyroid hormone levels may play an important role in the different pathological mechanisms of IFG and IGT.