Endocrine manifestations in adults with 22q11.2 deletion syndrome: a retrospective single-center cohort study.

INTRODUCTION AND OBJECTIVE: Patients with the 22q11.2 deletion syndrome (22q11DS) frequently display cardiological and psychiatric diseases, but are also at increased risk for endocrine manifestations. The aim of this study was to evaluate the screening, prevalence, and management of hypoparathyroidism and thyroid disease in patients with 22q11DS, to evaluate the metabolic profile, and to compare these results with current literature and guidelines. DESIGN: We performed a retrospective study of patients with genetically confirmed 22q11DS, followed at the center for human genetics of the University Hospitals Leuven, resulting in a cohort of 75 patients. Medical history, medication, and laboratory results concerning hypoparathyroidism, thyroid dysfunction, and the metabolic profile were collected. RESULTS: Of the total cohort, 26 patients (35%) had at least one hypocalcaemic episode. During hypocalcaemia, parathyroid hormone (PTH) was measured in only 12 patients with 11 having normal or low PTH, confirming a diagnosis of hypoparathyroidism. Recurrent episodes of hypocalcaemia occurred in seventeen patients (23%). Adherence to the guidelines was low, with 13% of patients having a yearly serum calcium evaluation, 12% receiving daily calcium supplements, and 20% receiving non-active vitamin D. Hypothyroidism was present in 31 patients (44%) and hyperthyroidism in 6 patients (8%). Information on body mass index (BMI) was available in 52 patients (69%), of which 38% were obese (BMI ≥ 30 kg/m2). CONCLUSION: Hypoparathyroidism, hypothyroidism, and obesity are common endocrine manifestations in patients with 22q11DS but are probably underdiagnosed and undertreated, indicating the need for multidisciplinary follow-up including an endocrinologist.

A follow-up study on factors affecting the recovery of patients with hypothyroidism in different selenium environments.

BACKGROUND: Hypothyroidism is a major manifestation of autoimmune thyroid diseases (AITD). We previously reported that a low selenium (Se) status was linked to an elevated prevalence of thyroid diseases. We hypothesized that Se status may also influence the restoration of thyroid function. Thus, this study aimed to investigate the factors affecting the recovery of thyroid function in patients with (sub-)clinical hypothyroidism, with a specific focus on Se status. METHODS: We conducted a 6-year prospective cohort study comparing two counties with different Se concentrations. Demographic and disease data were collected from 1,190 individuals (549 Se-adequate and 641 Se-deficient) who completed a follow-up study in 2019. In addition, urinary iodine (I) levels, thyroid function, and serum and nail Se levels were measured. Logistic regression was used to investigate the relationship between Se deficiency and recovery of thyroid function. RESULTS: Sex and smoking status was similar between the two counties studied. Thyroid function recovery rate was significantly higher in Se-deficient counties (46.0% vs. 30.6%, P = 0.008). In the multivariate analysis, our results show that female sex (odds ratio [OR] (95% confidence interval [CI]) = 1.875 (1.080-3.257), P = 0.026] and increasing age [OR (95%CI) = 1.028(1.007-1.049), P = 0.009] were associated with the recovery rate. Additionally, our study revealed that while Se status was significant in the univariate analysis, this association appeared to disappear in the multivariate analysis. CONCLUSIONS: Female sex and increasing age have unfavorable effects on the recovery of thyroid function in patients over 30 years of age with (sub-) clinical hypothyroidism.

Investigating the effect of combined use of selenium and Myo-inositol supplements on thyroid function and autoimmune characteristics in thyroid disorders: a systematic review and meta-analysis.

BACKGROUND: This study aimed to systematically review the effect of selenium and inositol combination on thyroid function, autoimmune characteristics in thyroid diseases. RESEARCH DESIGN AND METHODS: To identify eligible studies, a systematic search was conducted in the PubMed/MEDLINE, Science-Direct, CINHAL, EMBASE, SCOPUS, Psychinfo, Cochrane, ProQuest, and Web of Science were searched using the main concepts, and all English-written articles that were published between 2007 and 2022 and had an available full text were examined. RESULTS: The data analysis of this research revealed that after the simultaneous use of selenium and inositol supplements, the level of Triiodothyronine(T3) increased by 0.105 in patients with thyroid disorders although this increase was not significant (P-value: 0.228). The level of Thyroxine (T4) significantly increased by 0.06 (P-value: 0.04). Anti-Thyroid Peroxidase Antibody (TPOAb) titer decreased by 119.36%, which was not significant (P-value: 0.070). Finally, the level of Thyroid-stimulating hormone (TSH) decreased by 1.45%, which was a significant change (P-value: 0.001). CONCLUSION: It was observed that simultaneous use of selenium and inositol supplements did not change the T3 and TPOAb titer levels; however, it leads to a decrease in TSH and increase in T4 levels. Further studies are required due to the limited number of studies.

Manejo del paciente con Hipertiroidismo en consulta externa de la Unidad Técnica de Endocrinología del Hospital Carlos Andrade Marín / Management of the patient with hyperthyroidism in the outpatient clinic of the Technical Unit of Endocrinology of the Endocrinology Technical Unit of the Carlos Andrade Marín Hospital

El hipertiroidismo es un trastorno caracterizado por el exceso de hormonas tiroideas. El déficit de yodo es un factor clave en dicha patología y en lugares con suficiencia del mismo se asocian a au-toinmunidad tiroidea. La prevalencia de hipertiroidismo mani-fiesto varía del 0,2% al 1,3% en áreas con suficiencia de yodo, sin embargo, esto puede variar en cada país por diferencias en umbrales de diagnóstico, sensibilidad de ensayo y población se-leccionada. Un reporte de The Third National Health and Nutri-tion Examination Survey (NHANES III) mostró que el hiperti-roidismo manifiesto se presenta en 0,7% de la población general e hipertiroidismo subclínico en el 1,7%1,2.En incidencia, la patología se asocia con la suplementación de yodo, con la mayor frecuencia en áreas de deficiencias, por au-mento de nódulos tiroideos en la población anciana, teniendo a regiones de áreas montañosas como América del Sur, África Central y suroeste de Asia dentro de este grupo. Un meta aná-lisis de estudios europeos mostró una incidencia general de 50 casos por 100000 personas/años1. En Ecuador, según los datos del Instituto Nacional de Estadísticas y Censos (INEC) del 2017, se reportaron 157 casos de hipertiroidismo, de los cuales la En-fermedad de Graves (EG) fue la causa más común, seguida por el bocio multinodular tóxico (BMNT) y finalmente el adenoma tóxico (AT) con una incidencia de 61 %, 24 % y 14 % respecti-vamente3.Los pacientes con esta patología tienen aumento de riesgo com-plicaciones cardiovasculares y mortalidad por todas las causas, siendo falla cardíaca uno de sus principales desenlaces, así el diagnóstico precoz evita estos eventos, principalmente en pobla-ción de edad avanzada.El presente protocolo se ha realizado para un correcto trata-miento de esta patología en el Hospital de Especialidades Carlos Andrade Marín (HECAM).

Hyperthyroidism is a disorder characterized by an excess of thyroid hormones. Iodine deficiency is a key factor in this pa-thology and in places with iodine deficiency it is associated with thyroid autoimmunity. The prevalence of overt hyperthyroidism varies from 0,2% to 1,3% in iodine-sufficient areas; however, this may vary from country to country due to differences in diag-nostic thresholds, assay sensitivity, and selected population. A report from The Third National Health and Nutrition Examina-tion Survey (NHANES III) showed that overt hyperthyroidism occurs in 0,7% of the general population and subclinical hyper-thyroidism in 1,7%1,2.In incidence, the pathology is associated with iodine supplemen-tation, with the highest frequency in areas of deficiencies, due to increased thyroid nodules in the elderly population, having regions of mountainous areas such as South America, Central Africa and Southwest Asia within this group. A meta-analysis of European studies showed an overall incidence of 50 cases per 100000 person/years1. In Ecuador, according to data from the National Institute of Statistics and Census (INEC) in 2017, 157 cases of hyperthyroidism were reported, of which, Graves' di-sease (GD) was the most common cause, followed by toxic mul-tinodular goiter (BMNT) and finally toxic adenoma (TA) with an incidence of 61 %, 24 % and 14 % respectively3.Patients with this pathology have an increased risk of cardiovas-cular complications and all-cause mortality, with heart failure being one of the main outcomes, so early diagnosis avoids these events, mainly in the elderly population.The present protocol has been carried out for the correct treat-ment of this pathology at the Carlos Andrade Marín Specialties Hospital (HECAM).

Knowledge, Attitude, and Practice of Yoga for Thyroid Dysfunction: A Cross-sectional Survey Using a Tableau Approach.

Context: Thyroid dysfunction is a common endocrine disorder. Lifestyle changes such as the use of complementary therapies namely yoga, regular physical activity, and proper diet may reduce the risk of endocrinal dysfunction and may help individuals to maintain a healthy weight. Objective: The study intended to evaluate thyroid patients' knowledge gaps with respect to, cultural beliefs about, and attitudes towards the practice of yoga as a therapeutic tool in India. Design: The research team conducted a cross-sectional survey electronically using a snowball sampling technique. Setting: The study took place at Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) Yoga University in Bengaluru, Karnataka, India. Participants: Participants were patients with thyroid dysfunction in India. Outcome Measures: The research team: (1) evaluated the overall awareness of, opinions about, and practice of yoga among participants, (2) correlated the findings with participants' sociodemographic characteristics, specific thyroid disease and comorbidities using the knowledge, attitude, and practice (KAP) model and Tableau analysis. Results: Among respondents, 192 patients were eligible to participate in the survey, out of which 31.8% were yoga practitioners and 68.2% weren't. All participants confirmed that they had heard the term yoga. The second group's awareness of yoga's use as a therapy was limited. Many nonpractitioners stated that they lacked knowledge of and feared injury from the practice of yoga, yet they showed interest in receiving yogic counseling. Of the 192 participants, 85.94% had received a clinical diagnosis of hypothyroidism, out of which 64% were female and 22% were male. The remaining 14% of participants had received other diagnosis along the spectrum of thyroid dysfunction. The prominent comorbidity was obesity at 28.13% among both genders, and in addition, 20.83% of females had polycystic ovarian syndrome. Conclusions: This study found an inadequate level of knowledge of yoga as a therapy among thyroid patients. Because yoga is progressive in improving endocrinal functions and is one of the complementary therapies for managing thyroid dysfunction, the research team recommends its integration into conventional medicine as an adjunct therapy. This study provides the scope for future studies about yoga and thyroid dysfunction among a wide range of age groups across the globe.

Factores clínicos y bioquímicos asociados con la tirotropina en embarazadas aparentemente sanas / Clinical and biochemical factors associated with thyrotropin in seemingly healthy pregnant women

Introducción: Los valores de tirotropina (TSH) pueden modificarse marcadamente durante el embarazo, en relación con diversos factores clínicos y bioquímicos. Objetivo: Identificar los factores clínicos y bioquímicos asociados con la tirotropina en embarazadas aparentemente sanas. Métodos: Estudio descriptivo, transversal, con 247 gestantes aparentemente sanas del municipio Plaza de la Revolución., en el periodo comprendido de septiembre de 2015 a enero de 2019. Variables analizadas: edad materna y gestacional, trimestre del embarazo, color de la piel, paridad, hábito de fumar, antecedentes familiares de enfermedad tiroidea (APF), consumo de suplementos con yodo, índice de masa corporal (IMC), presencia de bocio al examen físico, TSH, tiroxina total (T4t) y libre (T4l), triyodotironina total (T3t) y libre (T3l), gonadotropina coriónica (hCG), anticuerpos contra la peroxidasa tiroidea (AcTPO) y la tiroglobulina (AcTg) y yoduria. Resultados: La TSH (1,66 ± 0,91mUI/L) tuvo una asociación negativa con la edad materna (r = -0,17; p = 0,008), la paridad (nulíparas 1,80 ± 0,90 mUI/L, multíparas 1,45 ± 0,89 mUI/L; p = 0,003), los APF (positivos 1,56 ± 0,91 mUI/L, negativos 1,81 ± 0,89 mUI/L; p = 0,03), la T4t (r = -0,15; p = 0,02), la T4l (r = -0,23; p = 0,000) y la hCG (r = -0,52; p = 0,001). Mostraron una relación directa la edad gestacional (r = 0,25; p = 0,000) y el uso de suplementos yodados (consumo 1,96 ± 0,72mUI/L, no consumo 1,62 ± 0,93 mUI/L; p = 0,03). Conclusiones: La tirotropina presenta una relación inversa con la edad materna, la paridad, los antecedentes familiares de enfermedad tiroidea, la T4 total y libre, y la gonadotropina coriónica, y una relación directa con la edad gestacional y el consumo de suplementos con yodo(AU)

Introduction: Thyrotropin (TSH) values can be sharply modified during pregnancy, in relation to various clinical and biochemical factors. Objective: Identify clinical and biochemical factors associated with thyrotropin in seemingly healthy pregnant women. Methods: Descriptive, cross-sectional study with 247 seemingly healthy pregnant women from Plaza de la Revolution municipality in the period from September 2015 to January 2019. Variables analyzed: maternal and gestational age, trimester of pregnancy, skin color, pregnancies, smoking habit, family history of thyroid disease (APF), consumption of iodine supplements, body mass index (BMI), presence of goiter to physical examination, TSH, total and free (T4l) thyroxine (T4t), total (T3t) and free (T3l) triiodothyronine, chorionic gonadotropin (hCG), antibodies against thyroid peroxidase (AcTPO) and thyroglobulin (AcTg) and urinary iodine. Results: TSH (1.66 ± 0.91mUI/L) had a negative association with maternal age (r = -0.17; p x 0.008), pregnancy (nulliparas 1.80 ± 0.90 mUI/L, 1.45 ± 0.89 mUI/L; p x 0.003), APF (positive 1.56 ± 0.91 mUI/L, negative 1.81 ± 0.89 mUI/L; p x 0.03), the T4t (r = -0.15; p s 0.02), the T4l (r = -0.23; p x 0.000) and the hCG (r = -0.52; p x 0.001). They showed a direct relationship with gestational age (r x 0.25; p x 0.000) and the use of iodine supplements (consumption 1.96 ± 0.72mUI/L, not consumption 1.62 ± 0.93 mUI/L; p x 0.03). Conclusions: Thyrotropin has an inverse relationship with maternal age, pregnancies, family history of thyroid disease, total and free T4, and chorionic gonadotropin, and a direct relationship with gestational age and consumption of iodine supplements(AU)

Preoperative vitamin D deficiency is a risk factor for postoperative hypocalcemia in patients undergoing total thyroidectomy: retrospective cohort study

ABSTRACT BACKGROUND: The relationship between preoperative vitamin D deficiency and postoperative hypocalcemia in cases of total thyroidectomy (TT) is a matter of controversy and may vary according to geographical scenarios and populations. OBJECTIVE: The objective here was to evaluate whether preoperative vitamin D deficiency was associated with postoperative symptomatic hypocalcemia in a population in South America. DESIGN AND SETTING: Retrospective cohort study on data from all patients undergoing total thyroidectomy, with or without central compartment lymph node dissection, from January 2014 to December 2017, at the A. C. Camargo Cancer Center. METHODS: Patients with benign thyroid disease (Graves' disease, multinodular goiter or hyperthyroidism) or thyroid cancer who underwent primary total thyroidectomy with or without central compartment lymph node dissection were included. The exclusion criteria were simultaneous parathyroidectomy and conditions that could affect serum calcium levels. The data collected included patient demographics, thyroid pathology, extent of the surgical procedure and complications. Information on preoperative and postoperative calcium, parathyroid hormone (PTH) and vitamin D levels were retrieved from the medical records. RESULTS: 1,347 patients were assessed and postoperative hypocalcemia was diagnosed in 284 patients (21%). The vitamin D levels were considered deficient in 243 patients (18%). Postoperative hypocalcemia was diagnosed in 357 patients (31.5%). Multivariate analysis showed that central compartment dissection and preoperative total calcium and deficient vitamin D levels were significant risk factors for postoperative hypocalcemia. CONCLUSION: Deficient preoperative vitamin D levels were a significant risk factor for postoperative hypocalcemia. Preoperative oral supplementation should be considered, to minimize this risk.

High-intensity focused ultrasound ablation as a treatment for benign thyroid diseases: the present and future

High-intensity focused ultrasound (HIFU) is a promising ablation technique for benign thyroid nodules. Current evidence has found good short- to medium-term outcomes, similar to those of better-established ablation techniques such as radiofrequency and laser ablation. The fact that it does not require insertion of a needle into the target makes HIFU a truly non-invasive treatment. Although it is not without risks, its low risk profile makes it an attractive alternative to surgery. There is much room for future development, starting from expanding the current indications to enhancing energy delivery. Relapsed Graves disease and papillary microcarcinoma are diseases that can benefit from HIFU treatment. Its role in the mediation of immune responses and synergistic effects with immunotherapy are promising in the fight against metastatic cancers.

Estudio para reducir el dolor posoperatorio en pacientes sometidos a tiroidectomía total o disección cervical por patología tiroidea mediante crioterapia / Study to reduce postoperative pain in patients undergoing total thyroidectomy or cervical dissection for thyroid pathology by cryotherapy

Contexto: en la actualidad, la creciente incidencia de patología tiroidea amerita una mayor resolución quirúrgica que demanda manejo del dolor posquirúrgico, lo que amerita buscar métodos o terapias complementarias para atenuar el dolor. Objetivo: comparar el nivel de dolor posquirúrgico en pacientes sometidos a tiroidectomía total o disección cervical por patología tiroidea benigna o maligna mediante el uso de crioterapia comparado con métodos tradicionales, en los servicios de Cirugía General y Cirugía Oncológica del Hospital Eugenio Espejo de Quito. Sujetos y métodos: estudio epidemiológico, observacional, transversal, en 204 pacientes sometidos a tiroidectomía total o disección cervical, divididos en un grupo manejado con terapia analgésica estándar (paracetamol y tramadol) y un grupo control que recibió similar terapia farmacológica más crioterapia; en ambos grupos se valoró la escala de dolor (EVA) por 24 horas. Las variables cuantitativas se reportaron como promedios (desviación estándar) y las cualitativas con sus valores absolutos y relativos (porcentajes). La comparación de las variables cuantitativas se realizó previa prueba de normalidad, mientras que las variables cuantitativas que cumplieron criterios de normalidad se usó la t de Student para grupos independientes o sus equivalentes no paramétricos. Resultados: ambas terapias (cold pack y terapia estándar) disminuyen significativamente la percepción de dolor desde su primera evaluación (6 horas) hasta la valoración final (24 horas) (p <0,0001). La analgesia complementada con crioterapia (cold pack) supera al tratamiento estándar con analgésicos (p <0,0001). Para el grupo tratado con cold pack, el descenso de dolor fue 2 puntos de EVA (RIQ: 1,3 puntos; p < 0,001). Conclusión: el uso de la terapia combinada (analgesia estándar más crioterapia) redujo el dolor en dos puntos según la escala de dolor EVA, mostrando que la terapia combinada es superior en el manejo del dolor de acuerdo al grupo control.

Context: currently, the increasing incidence of thyroid pathology deserves a greater surgical resolution that demands the management of postoperative pain, which also deserve complementary methods or therapies to attenuate pain. Objective: to compare the level of postsurgical pain in patients under total thyroidectomy or cervical dissection, due to benign or malignant thyroid pathology, through the use of cryotherapy compared to traditional methods, in the General Surgery and Oncology Surgery services of the Eugenio Espejo Hospital in Quito. Subjects and methods: epidemiological, observational, crosssectional, performed in 204 patients under total thyroidectomy or cervical dissection, divided into a group managed with standard analgesic therapy (paracetamol and tramadol) and a control group that received similar pharmacological therapy plus cryotherapy. In both groups the pain scale (VAS) was assessed for 24 hours. Quantitative variables were reported as averages (standard deviation) and qualitative variables with their absolute and relative values (percentages). The comparison of the quantitative variables was carried out after a normality test, while the quantitative variables that met the normality criteria, "t" test was used for independent groups or their non-parametric equivalents. Results: both therapies (cold pack and standard therapy) significantly decrease the perception of pain from its first evaluation (6 hours) until the final evaluation (24 hours) (p <0.0001). Analgesia supplemented with cryotherapy (cold pack) exceeds the standard treatment with analgesics (p <0.0001). For the group treated with cold pack, the decrease in pain was 2 points of VAS (IQR: 1.3 points; p <0.001). Conclusion: the use of combined therapy (standard analgesia plus cryotherapy) reduced pain by two points according to the VAS pain scale, showing that the combined therapy is superior in pain management according to the control group

Use of prophylactic oral calcium after total thyroidectomy: a prospective study

ABSTRACT Objective The aim of this study was to evaluate the use of prophylactic oral calcium after total thyroidectomy in the prevention of symptomatic hypocalcemia, and to develop a rational strategy of oral calcium supplementation following this type of surgery. Subjects and methods Prospective study including 47 patients undergoing total thyroidectomy from January 2007 to February 2012. The patients were allocated to one of the following groups: I (no postoperative calcium) or II (oral calcium 3 g per day). Oral calcium was started at the first postoperative day and administered until the sixth postoperative day. The patients were followed up for a minimum of 6 months and evaluated with a minimum of five measurements of ionized calcium: preoperative, 16 hours after surgery, seventh postoperative day, and at postoperative days 90 (PO90) and 180 (PO180). The cohort included three men and 44 women, of whom 24 (51.9%) had benign thyroid disease, and 23 had suspected or confirmed malignant disease. Results When compared with Group II, Group I had significantly higher rates of postoperative biochemical hypocalcemia at PO1 and PO180, and of symptomatic hypocalcemia at PO1, PO7, and PO90. Other data were not significantly different between the groups. Conclusion We conclude that postoperative calcium supplementation effectively prevents symptomatic and biochemical hypocalcemia after total thyroidectomy, and can be safely used after this procedure. The presented strategy of oral calcium supplementation may be implemented in a viable manner.

Clinical Relevance of Environmental Factors in the Pathogenesis of Autoimmune Thyroid Disease

Genetic factors contribute for about 70% to 80% and environmental factors for about 20% to 30% to the pathogenesis of autoimmune thyroid disease (AITD). Relatives of AITD patients carry a risk to contract AITD themselves. The 5-year risk can be quantified by the so-called Thyroid Events Amsterdam-score, based on serum thyroid-stimulating hormone, thyroid peroxidase (TPO)-antibodies and family history. Subjects at risk may ask what they can do to prevent development of AITD. This review summarizes what is known about modulation of exposure to environmental factors in terms of AITD prevention. To stop smoking decreases the risk on Graves disease but increases the risk on Hashimoto disease. Moderate alcohol intake provides some protection against both Graves and Hashimoto disease. Low selenium intake is associated with a higher prevalence of thyroid autoimmunity, but evidence that selenium supplementation may lower TPO antibodies and prevent subclinical hypothyroidism remains inconclusive. Low serum vitamin D levels are associated with a higher prevalence of TPO antibodies, but intervention studies with extra vitamin D have not been done yet. Stress may provoke Graves hyperthyroidism but not Hashimoto thyroiditis. Estrogen use have been linked to a lower prevalence of Graves disease. The postpartum period is associated with an increased risk of AITD. Taking together, preventive interventions to diminish the risk of AITD are few, not always feasible, and probably of limited efficacy.

Local anesthesia with monitored anesthesia care for patients undergoing thyroidectomy: a case series / 대한마취과학회지

Because the current trend favors minimally invasive surgery for thyroid disease, increasing interest has developed for thyroidectomy under local anesthesia with monitored anesthesia care (MAC). Here, we retrospectively reviewed 18 cases of thyroidectomy performed under local anesthesia with MAC in a single center. All of the procedures were performed by a single surgeon, using local lidocaine infiltration around the incisional site and propofol plus remifentanil target-controlled infusion. Sore throat (4/18), hypocalcemia (1/18), and transient voice color change (1/18) were observed, but the patients recovered during the follow-up period. No cases of postoperative nausea and vomiting, hematoma, wound problems, or vocal cord paralysis were observed. Local anesthesia with MAC provided satisfactory sedation in most patients without conversion to general anesthesia.

Selenium Concentration in Korean Patients with Thyroid Disease: a Preliminary Report

BACKGROUND AND OBJECTIVES: Selenium is an important trace element for thyroid hormone metabolism, and its deficiency can cause hypothyroidism. Serum selenium concentration is the best biomarker to reflect selenium intake and reserve, although other markers can reflect. Therefore, we preliminarily assessed serum and urine selenium concentrations in patients with thyroid disease compared to those of a healthy population. We also investigated the correlation between serum and urine selenium concentration, thyroid hormone and urinary iodine concentration (UIC). MATERIALS AND METHODS: A total of 97 patients (32 men, 65 women, 52.4±14.7 years) with benign thyroid nodules or thyroid dysfunction who visited the Samsung Medical Center between 2008 and 2013 were included. Data for 175 healthy subjects provided by Lee et al. were used as the control. Serum T3, free T4, and thyroid stimulating hormone (TSH) were measured using commercialized RIA or IRMA kits. Serum/urine selenium and UIC were measured by inductively coupled plasma-mass spectrometry (ICP-MS). RESULTS: Median serum selenium concentration was 110 µg/L (95% CI, 73-156). Median urine selenium concentration was 66.3 µg/gCr (95% CI, 28.7-283.5). Compared to 175 healthy subjects (serum 84 µg/L [95% CI, 30-144], urine 34.5 µg/gCr [95% CI, 0.8-107.2]), serum and urine selenium concentrations of patients with thyroid disease were significantly higher than those of healthy subjects (p<0.001). Serum selenium concentration was significantly correlated with urine selenium concentration after log transformation (r=0.88, p=0.022), but was not significantly correlated with UIC, T3, free T4 and TSH. CONCLUSION: Selenium concentrations of patients with thyroid disease were significantly higher than those of healthy subjects. Serum selenium concentration was significantly correlated with urine selenium concentration.

Selenium Concentration in Korean Patients with Thyroid Disease: a Preliminary Report

BACKGROUND AND OBJECTIVES: Selenium is an important trace element for thyroid hormone metabolism, and its deficiency can cause hypothyroidism. Serum selenium concentration is the best biomarker to reflect selenium intake and reserve, although other markers can reflect. Therefore, we preliminarily assessed serum and urine selenium concentrations in patients with thyroid disease compared to those of a healthy population. We also investigated the correlation between serum and urine selenium concentration, thyroid hormone and urinary iodine concentration (UIC). MATERIALS AND METHODS: A total of 97 patients (32 men, 65 women, 52.4±14.7 years) with benign thyroid nodules or thyroid dysfunction who visited the Samsung Medical Center between 2008 and 2013 were included. Data for 175 healthy subjects provided by Lee et al. were used as the control. Serum T3, free T4, and thyroid stimulating hormone (TSH) were measured using commercialized RIA or IRMA kits. Serum/urine selenium and UIC were measured by inductively coupled plasma-mass spectrometry (ICP-MS). RESULTS: Median serum selenium concentration was 110 µg/L (95% CI, 73-156). Median urine selenium concentration was 66.3 µg/gCr (95% CI, 28.7-283.5). Compared to 175 healthy subjects (serum 84 µg/L [95% CI, 30-144], urine 34.5 µg/gCr [95% CI, 0.8-107.2]), serum and urine selenium concentrations of patients with thyroid disease were significantly higher than those of healthy subjects (p<0.001). Serum selenium concentration was significantly correlated with urine selenium concentration after log transformation (r=0.88, p=0.022), but was not significantly correlated with UIC, T3, free T4 and TSH. CONCLUSION: Selenium concentrations of patients with thyroid disease were significantly higher than those of healthy subjects. Serum selenium concentration was significantly correlated with urine selenium concentration.

Effect of selenium supplementation via Brazil nut (Bertholletia excelsa, HBK) on thyroid hormones levels in hemodialysis patients: a pilot study / Efecto de la suplementación de selenio a través de la nuez de Brasil (bertholletia excelsa, HBK) en los niveles de hormonas tiroideas en pacientes de hemodiálisis: un estudio piloto

Background: thyroid function depends on trace mineral selenium (Se), being at the active center of the iodothyronine deiodinase that catalyzes the conversion of the thyroxine (T4) to the active form of thyroid hormone, triiodothyronine (T3). Hemodialysis (HD) patients have reduced T3 levels partly due to impaired hormonal conversion that can be related to Se deficiency, a common feature in these patients. This study evaluated the effect of Brazil nuts (richest Se source) on thyroid hormone levels in HD patients. Methods: we performed an uncontrolled intervention with 40 HD patients (53.3 ± 16.1 yrs, dialysis vintage 62.0 (8.0 - 207.0) months) that received one nut (≈5g, average 58.1 mg Se/g) per day for three months. Se plasma levels were determined by atomic absorption spectrophotometry with hydride generation and, serum T3, free T4 (FT4), TSH as well as glutathione peroxidase (GPx) activity were measured by ELISA. Results: all patients were Se deficient and presented low T3 levels at baseline. After intervention, Se plasma levels (from 17.6 ± 11.6 to 153.4 ± 86.1 μg/L), GPx activity (from 33.7 ± 5.9 to 41.4 ± 11.2 nmol/min/mL), T3 (from 27.3 ± 8.8 to 50.2 ± 4.8ng/dL) and FT4 levels (0.87 ± 0.2 to 0.98 ± 0.4 ng/dL) were significantly increased (p < 0.05), while TSH levels were reduced (from 2.17 ± 1.3 to 1.96 ± 1.1 uUI/mL), but not significantly. Conclusion: in conclusion, increasing Se levels via Brazil nut supplementation was associated with improvement in thyroid hormone levels in HD patients, although the amount of Se given was not able to restore T3 to normal levels (AU)

Introducción: la función tiroidea depende de minerales traza de selenio (Se), que está en el centro activo de la deiodinasa yodotironina, que cataliza la conversión de la tiroxina (T4) a la forma activa de la hormona tiroidea, triyodotironina (T3). Hemodiálisis (HD) de los pacientes ha reducido los niveles de T3 de los pacientes, debido en parte a la conversión hormonal alterada que puede estar relacionada con la deficiencia de Se, una característica común en estos pacientes. Este estudio evaluó el efecto de las nueces de Brasil (la más rica fuente de Se) en los niveles de hormonas tiroideas en pacientes en HD. Métodos: se realizó una intervención no controlada con 40 pacientes en HD (53,3 ± 16,1 años, diálisis vendimia 62,0 (8,0 - 207,0 meses)), que recibieron una nuez (≈ 5, promedio 58,1 mg Se/g) por día durante tres meses. Determinaron los niveles plasmáticos de Se por espectrofotometría de absorción atómica con generación de hidruros y los niveles de T3, T4 libre (FT4), TSH en suero, así como la actividad de la glutatión peroxidasa (GPx) por ELISA. Resultados: todos los pacientes tenían niveles bajos de Se y T3 al inicio del estudio. Después de la intervención, los niveles plasmáticos de Se (de 17,6 ± 11,6 a 153,4 ± 86,1 mg/L), actividad GPx (de 33,7 ± 5,9 a 41,4 ± 11,2 nmol/min/ml), T3 (de 27,3 ± 8,8 a 50,2 ± 4,8 ng/dL) y T4L (0,87 ± 0,2 a 0,98 ± 0,4 ng/dL) se incrementaron significativamente (p <0,05), mientras que los niveles de TSH se redujeron (de 2,17 ± 1,3 a 1,96 ± 1,1 IUU/ml), pero no de forma significativa. Conclusión: en conclusión, el aumento de los niveles de Se vía suplementación con nuez brasileña se asocia con una mejoría en los niveles de hormonas tiroideas en pacientes en HD, aunque la cantidad de Se dada no fue capaz de restablecer la T3 a los niveles normales (AU)

Dietary Factors and the Risk of Thyroid Diseases: A Review

BACKGROUND AND OBJECTIVES: Diet is one of the major risk factors for thyroid diseases. It has been shown that high or excessive iodine intake is more likely to be a health concern in iodine-sufficient regions or regions where iodine deficiency previously existed due to the emergence of iodine-induced hypothyroidism or hyperthyroidism. Therefore, this review investigates the occurrence of thyroid diseases, and particularly hypothyroidism and hyperthyroidism, in populations with different levels of iodine intake and other dietary factors in various geographic regions. MATERIALS AND METHODS: A total of 856 articles published between January 1st, 1990 and March 31st, 2015, were identified. Epidemiological studies that showed an association between dietary factors and thyroid diseases were selected, yielding a total of 21 articles. RESULTS: Due to a sudden increase in iodine supplementation (i.e., via salt iodization), regions such as Denmark and China, where insufficient iodine intake previously existed, showed a significant increase in the occurrence of hypothyroidism compared with that of hyperthyroidism. Other dietary factors, such as nitrate intake, may increase the risk of the diseases, whereas a vegan diet and alcohol intake may lower the risk. CONCLUSION: The level of iodine intake is quite variable between individuals in different geographic regions, and the risk of thyroid diseases may also vary by age and gender. Therefore, monitoring of safe levels of iodine intake should be performed to prevent iodine-induced thyroid diseases.

Nutrición de yodo en mujeres embarazadas del área de Oviedo. ¿Es necesaria la suplementación con yodo? / Iodine nutrition in pregnant women from Oviedo area. Is iodine supplementation necessary?

INTRODUCCIÓN Y OBJETIVO: En Asturias, donde la deficiencia de yodo fue erradicada en los escolares en el año 2000, persistía una deficiencia de yodo en las mujeres embarazadas, por lo que se les recomendaba la utilización de suplementos yodados. El objetivo de este estudio es conocer la nutrición de yodo de las mujeres embarazadas de nuestra área y la necesidad o no de suplementos yodados. MATERIAL Y MÉTODOS: Durante mayo y junio de 2013 hemos estudiado la nutrición de yodo y la función tiroidea en el primer trimestre del embarazo de 173 mujeres del área sanitaria de Oviedo. RESULTADOS: La mediana de la yoduria fue 197 μg/L. Tomaban suplementos yodados el 47% de las mujeres, con una mediana de yoduria superior a la de las que no tomaban suplementos yodados (247 vs 138 μg/L; <0,001) y también una TSH superior (2,30 vs 1,94 mU/L), aunque no significativamente diferente. La yoduria fue también superior en las mujeres que tomaban más de 2 raciones de productos lácteos (mediana: 230 μg/L) que en aquellas que tomaban menos de 2 raciones (mediana: 191 μg/L). Dentro del grupo de mujeres que no tomaban suplementos yodados, aquellas que utilizaban habitualmente sal yodada en la cocina (47%), tenían una mediana de yoduria de 190 μg/L, indicativa de suficiencia de yodo. CONCLUSIÓN: En la actualidad los suplementos yodados serían innecesarios en las mujeres embarazadas de nuestra entorno que consumen de forma habitual sal yodada y la recomendación en estos casos debería ser la de continuar utilizando la sal yodada en la cantidad recomendada en la gestación, así como consumir al menos dos raciones diarias de leche o productos lácteos

BACKGROUND AND OBJECTIVE: In Asturias, where iodine deficiency was eradicated in school children by the year 2000, iodine deficiency persisted in pregnant women, who were recommended to use of iodine supplementation. The aim of this study was to determine the iodine nutrition of pregnant women in our area and whether or not iodine supplements are needed. MATERIAL AND METHODS: Throughout May and June 2013 we studied the iodine nutrition and thyroid function during the first trimester of pregnancy in 173 women in the health area of Oviedo. RESULTS: The median urinary iodine was 197 μg/L. Iodinated supplements were used by 47% of women, which had a yoduria median higher than those not taking iodinated supplements (247 vs. 138 μg/L; p < .001), and also a higher TSH (2.30 vs 1.94 mU/L) although not significantly different. Yoduria was also higher in women who took more than 2 servings of dairy products (median: 230 μg/L) than those who took less (median: 191 μg/L). Within the group of women who were not taking iodine supplements, those regularly using iodized salt in the kitchen (47%) had a median urinary iodine concentration of 190 μg/L indicating iodine sufficiency. CONCLUSIONS: Iodinated supplements seem unnecessary nowadays in pregnant women of Oviedo who regularly take iodized salt and our recommendation in these cases should be to continue the use of iodized salt in the recommended amounts during pregnancy and consume at least two daily servings of milk or dairy products

The multiple effects of thyroid disorders on bone and mineral metabolism / Os múltiplos efeitos das disfunções tireoidianas sobre o metabolismo osteomineral

Differently from most hormones, which commonly are specialized molecules able to influence other cells, tissues and systems, thyroid hormones (TH) are pleiotropic peptides, whose primordial function is difficult to identify. The complex action of TH on human economy can be easily witnessed by examining the diverse consequences of TH excess and deficiency during development and after maturity. In particular, different manifestations in bone modeling and remodeling reflect the circumstantial consequences of thyroid disturbances, which are age dependent. While hyperthyroidism during childhood enhances bone mineralization and accelerates epiphyseal maturation, in adults it induces bone loss by predominant activation of osteoclast activity. Furthermore, the syndrome of TH resistance is a multifaceted condition in which different sites exhibit signs of hormone excess or deficiency depending on the configuration of the TH receptor isoform. The investigation of the impact of TH resistance on the skeleton still remains to be elucidated. We present here a thorough review of the action of TH on bone and of the impact of thyroid disorders, including hyper- and hypothyroidism and the syndrome of TH resistance, on the skeleton.

Diferentemente da maioria dos hormônios, que usualmente são moléculas especializadas capazes de influenciar outras células, tecidos e sistemas, os hormônios da tireoide (HT) são peptídeos pleiotrópicos, cuja função primordial é difícil de identificar. A ação complexa dos HT na fisiologia humana pode ser facilmente reconhecida ao observar as diversas consequências do excesso e da deficiência de HT durante e após o pleno desenvolvimento. Em particular as diferentes manifestações na modelação e remodelação óssea refletem que as consequências esqueléticas das disfunções tireoidianas dependem das circunstâncias e variam com a idade. Enquanto o hipertireoidismo durante a infância aumenta a mineralização óssea e acelera a maturação epifisária, em adultos induz a perda óssea pela ativação predominante da ação osteoclástica. Além disso, a síndrome de resistência ao HT é uma condição multifacetada na qual diferentes tecidos apresentam sinais de excesso ou deficiência hormonal, dependendo da predominância da expressão das diversas isoformas do receptor de HT. O impacto da resistência ao HT sobre o esqueleto ainda é motivo de investigação. Apresentamos aqui uma revisão abrangente sobre as ações ósseas dos HT e o impacto no esqueleto dos distúrbios da tireoide, incluindo hipo e hipertireoidismo e síndrome de resistência ao HT.

Suplementación de yodo en la gestación y lactancia / Iodine supplementation in pregnancy and lactation

El beneficio de la suplementación con yodo durante la gestación en las áreas con deficiencia grave de yodo está bien establecido. En el año 2004 la Organización Mundial de la Salud incluyó a España entre los países con adecuada ingesta de yodo y varios estudios recientes confirman que la ingesta de yodo es suficiente en la población española. Los profesionales españoles, sin embargo, se han encontrado con recomendaciones contradictorias, lo que ha generado confusión e incertidumbre en la práctica a seguir en cuanto a la suplementación de yodo a la mujer gestante o en periodo de lactancia. A los clínicos e investigadores les preocupa que las situaciones de déficit de yodo leve o moderado puedan relacionarse con un peor desarrollo de los niños, pero la suplementación rutinaria de yodo en la gestación no está exenta de riesgo. PrevInfad considera que, al tratarse de una medida profiláctica que afecta a dos individuos -madre e hijo- y que se aplica al conjunto de una población sana, debe primar el principio de precaución y que no existen pruebas de calidad suficiente para determinar el balance entre los beneficios y los riesgos de la suplementación farmacológica de yodo durante la gestación y la lactancia, por lo que sugiere que no se realice esta intervención (AU)

The benefits of Iodine supplementation in Iodine-deficient areas are well established. The World Health Organization included Spain among the countries with an adequate Iodine intake in 2004 and some recent research papers confirm that Iodine intake is adequate in the Spanish population. Nevertheless, Spanish health professionals have been faced with contradictory recommendations, producing confusion and uncertainty in clinical practice referring to Iodine supplementation in pregnancy and breastfeeding mothers. Clinicians and researchers are concerned that mild or moderate Iodine deficiency could be related to underdevelopment in children, but routine Iodine supplementation in pregnancy is not risk free. The working group PrevInfad (Prevention in Childhood and Adolescence) considers that being a preventive intervention that applies to the total healthy population, the precaution principle must be prioritized, and that there is no evidence on the balance risk-benefit in the pharmacological Iodine supplementation during pregnancy and breastfeeding. For these reasons they suggest not making this intervention

Suplementación con yodo durante el embarazo y la lactancia. Toma de posición del Grupo de Trabajo de Trastornos relacionados con la Deficiencia de Yodo y Disfunción Tiroidea de la Sociedad Española de Endocrinología y Nutrición / Iodine supplementation during pregnancy and lactation. Position statement of the working group on disorders related to iodine deficiency and thyroid dysfunction of the Spanish Society of Endocrinology and Nutrition

La deficiencia de yodo grave y moderada durante el embarazo y la lactancia afecta a la función tiroidea de la madre y del neonato, así como al desarrollo neuropsicológico del niño. Estudios realizados en España confirman que la mayoría de las mujeres se encuentran en yododeficiencia durante la gestación y la lactancia. Las mujeres embarazadas, las que amamantan a sus hijos y las que planifican su gestación deberían recibir suplementos de yodo

Severe and mild iodine deficiency during pregnancy and lactation affects thyroid function of the mother and neonate as well as the infant's neuropsychological development. Studies performed in Spain confirm that most women are iodine deficient during pregnancy and lactation. Pregnant and breast feeding women and women planning to become pregnant should take iodine supplements