Germline polymorphisms of the NOD2 pathway may predict the effectiveness of radioiodine in differentiated thyroid cancer treatment.

PURPOSE: Differentiated thyroid cancer (DTC) presents a complex clinical challenge, especially in patients with distant metastases and resistance to standard treatments. This study aimed to investigate the influence of specific genes and their germline single nucleotide polymorphisms (SNPs) linked to both inflammatory processes and other neoplasms on the clinical and pathological characteristics of DTC, particularly their potential impact on radioiodine (RAI) treatment efficacy. METHODS: This retrospective analysis involved a cohort of 646 patients diagnosed with DTC after thyroidectomy. Study covering 1998-2014, updated in 2023, included 567 women and 79 men (median age: 49; range: 7-83). SNP selection targeted functional significance, while mutational status was assessed by pyrosequencing for comprehensive characterization. Patient genetic profiles were assessed for associations with disease characteristics, RAI response, and cancer pathology. RESULTS: Significant correlations emerged between certain SNPs and DTC features. Notably, the NOD2 c.802 T > C variant (rs2066842) was identified as a marker distinguishing between papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC). Moreover, the c.802 T allele was associated with an enhanced response to RAI treatment, indicating a more substantial decrease in posttreatment stimulated thyroglobulin (sTg) concentrations. The NFKB1A allele c.126A (rs696) exhibited connections with lower FTC stages and a reduced probability of multifocality. CONCLUSION: This study explored the molecular mechanisms of particular SNPs, highlighting the role of NOD2 in innate immunity and the stress response, and its potential impact on RAI efficacy. This research underscores the clinical promise of SNP analysis and contributes to personalized treatment strategies for DTC, emphasizing the relevance of genetic factors in cancer progression and treatment outcomes.

Treatment of Obesity with Thyroid hormones in Europe. Data from the THESIS* Collaboration.

PURPOSE: The use of thyroid hormones (TH) to treat obesity is unsupported by evidence as reflected in international guidelines. We explored views about this practice, and associations with respondent characteristics among European thyroid specialists. METHODS: Specialists from 28 countries were invited to a survey via professional organisations. The relevant question was whether "Thyroid hormones may be indicated in biochemically euthyroid patients with obesity resistant to lifestyle interventions". RESULTS: Of 17,232 invitations 5695 responses were received (33% valid response rate; 65% women; 90% endocrinologists). Of these, 290 (5.1%) stated that TH may be indicated as treatment for obesity in euthyroid patients. This view was commoner among non-endocrinologists (8.7% vs. 4.7%, p < 0.01), private practice (6.5% vs. 4.5%, p < 0.01), and varied geographically (Eastern Europe, 7.3%; Southern Europe, 4.8%; Western Europe, 2.7%; and Northern Europe, 2.5%). Respondents from Northern and Western Europe were less likely to use TH than those from Eastern Europe (p < 0.01). Gross national income (GNI) correlated inversely with this view (OR 0.97, CI: 0.96-0.97; p < 0.001). Having national guidelines on hypothyroidism correlated negatively with treating obesity with TH (OR 0.71, CI: 0.55-0.91). CONCLUSIONS: Despite the lack of evidence, and contrary to guidelines' recommendations, about 5% of respondents stated that TH may be indicated as a treatment for obesity in euthyroid patients resistant to life-style interventions. This opinion was associated with (i) respondent characteristics: being non-endocrinologist, working in private practice, treating a small number of hypothyroid patients annually and (ii) national characteristics: prevalence of obesity, Eastern Europe, low GNI and lack of national hypothyroidism guidelines.

Decreased staging of differentiated thyroid cancer in patients with chronic lymphocytic thyroiditis.

PURPOSE: The biological association between chronic lymphocytic thyroiditis (CLT) and differentiated thyroid cancer (DTC) has not been elucidated yet. The aim of the study was to assess whether the presence of CLT exerts any influence on clinical or histological presentation of DTC. METHODS: Nine hundred and seven consecutive patients with DTC treated in the years 1998-2016 were divided into two groups according to the presence or absence of concomitant CLT. The statistical differences were analysed. RESULTS: Out of 907 patients included in the study, 331 were diagnosed with DTC and CLT (studied group), while 576 patients with DTC but without CLT constituted a control group. The distribution of papillary and follicular thyroid cancer did not differ. In CLT group, the prevalence of pT1 was greater than for pT2-pT4 DTC (P = 0.0003; OR = 1.69, 95% CI 1.27-2.24) compared to controls (68.3 vs. 56.1%, respectively). The presence of multifocal lesions was similar. The thyroid capsule infiltration without extrathyroidal invasion (P < 0.0001; OR = 0.21, 95% CI 0.14-0.31) was more frequent in the studied group, unlike extracapsular invasion, which was significantly more often present in patients with DTC but without CLT (P = 0.004; OR = 1.66; 95% CI 1.17-2.34) as well as nodal involvement (P = 0.048; OR = 0.65, 95% CI 0.42-0.99). CONCLUSIONS: The collected data indicate a protective role of CLT in preventing the spread of the DTC. The presence of CLT might limit tumour growth to the primary site.

Risk of malignant neoplasms in acromegaly: a case-control study.

PURPOSE: Acromegaly is a chronic disease resulting from pathological oversecretion of growth hormone and subsequently insulin growth factor-1. Several complications of the disease have been reported, including cardiovascular diseases, respiratory disorders but also increased risk of benign and malignant neoplasms. The aim of the study was to evaluate the risk of malignant neoplasms in the patients with acromegaly in comparison with the control group. PATIENTS AND METHODS: Medical documentation of acromegalic patients treated in one medical center between 2005 and 2016 has been analyzed. Results were compared with sex- and age-matched group of subjects with prolactinomas and hormonally inactive pituitary lesions hospitalized in the same department. RESULTS: Two hundred patients with acromegaly were included. Control group was composed of 145 patients. Any malignant neoplasm in anamnesis was present in 27 (13.5 %) patients with acromegaly and six (4.1 %) subjects from control group (p = 0.003). Thyroid cancer was present in 14 (7.0 %) patients with acromegaly and two (1.4 %) in control group (p = 0.02). Breast cancer was present in seven women (5.4 % of women) in acromegaly group but none of subjects in control group (p = 0.02). Colon cancer-4 (2.0 %) patients in acromegaly group and 0 in control group (p = 0.14). CONCLUSIONS: Malignant neoplasms are significantly more common in patients with acromegaly. Particularly, risk of thyroid cancer was increased over fivefold. Systematic screening for neoplastic diseases should be important part of follow-up in these patients. Further case-control studies are strongly indicated to evaluate which neoplasms are more common in acromegalic patients and what is the exact risk of malignancy.

Pulsatility index in carotid arteries is increased in levothyroxine-treated Hashimoto disease.

The aim of this case-control study was to evaluate carotid hemodynamic variables and traditional cardiovascular risk factors in women with Hashimoto thyroiditis (HT). The study group consisted of 31 females with HT on levothyroxine (L-T4) and 26 euthyroid women with HT without L-T4 matched for age and body mass index (BMI) as controls. Carotid intima-media thickness (CIMT), carotid extra-media thickness (CEMT), and pulsatility indexes in common carotid artery (PI CCA) and in internal carotid artery (PI ICA) were measured. BMI, waist circumference, lipid profile, fasting glucose and insulin levels, and parameters of thyroid function [TSH, free thyroxine (FT4) and antithyroperoxidase antibodies (TPOAbs)] were assessed. The study and the control groups did not differ in age, BMI, waist circumference, lipid profile, fasting glucose, and insulin levels. Results are expressed as median (IQR). Treated HT group had higher FT4 levels than nontreated [17.13 (5.11) pmol/l vs. 14.7 (2.27) pmol/l; p=0.0011] and similar TSH [1.64 (2.08) IU/ml vs. 2.07 (3.14) IU/ml; p=0.5915]. PI CCA and PI ICA were higher in the study group than in controls (p=0.0224 and p=0.0477, respectively). The difference remained statistically significant for PI ICA and PI CCA after adjustment for other variables (coefficient=0.09487; standard error=0.04438; p=0.037 and coefficient=0.1786; standard error=0.0870; p=0.0449, respectively). CIMT and CEMT were similar in both groups (p=0.8746 and p=0.0712, respectively). Women with HT on L-T4 replacement therapy have increased PI in common and internal carotid arteries than nontreated euthyroid HT patients. Therefore, it seems that hypothyroidism, but not autoimmune thyroiditis per se, influences arterial stiffness.

Cushing's syndrome in pregnancy: a case report and mini review of the literature.

Adrenal diseases in pregnant women are diagnosed relatively rarely. The main cause of hypercortisolemia during pregnancy is Cushing's syndrome related to adrenal adenoma. It is important to diagnose Cushing's syndrome in pregnant women because it can lead to significant maternal and foetal complications and morbidity. However, due to physiological endocrine changes and symptoms in pregnant women the diagnosis of this disorder can be a challenge. One current case describes a 38-year-old pregnant woman with hypertension, oedema and an adrenal tumour. At the beginning, Conn syndrome was suspected, but after careful analysis Cushing's syndrome (with an adenoma of the right adrenal gland) was diagnosed. After delivery and 5 weeks of pharmacological treatment the patient underwent right side adrenalectomy by laparoscopy.

Thyroid hormones affect plasma ghrelin and obestatin levels.

Using radioimmunoassay, the effects of thyroid hormones on plasma total ghrelin (Gh) and obestatin (Ob) concentrations were evaluated in thyrotoxic patients with an excess of thyroid hormones and in hypothyroid patients lacking endogenous thyroid hormones. 24 patients with thyrotoxicosis, 25 hypothyroid patents after total thyreoidectomy performed due to thyroid cancer, and 17 control subjects were examined. Compared with the controls, the ghrelin and obestatin were elevated in hypothyroidism, while they were decreased in thyrotoxicosis. The plasma Gh and Ob levels differ depending on the thyroid function. In thyroid hormones deficiency, plasma Gh and Ob are increased, while in patients with excess of thyroid hormones, the levels of both Gh and Ob are definitely lower. Gh/Ob ratio is higher in hypothyroidism than in control subjects and thyrotoxic patients.

The effect of endocrine disruptors on the reproductive system - current knowledge.

OBJECTIVE: Chemicals that disrupt the endocrine homeostasis of the human body, otherwise known as endocrine disruptors (EDCs), are found in the blood, urine, amniotic fluid, or adipose tissue. This paper presents the current knowledge about EDCs and the reproductive system. MATERIALS AND METHODS: The article is an overview of the impact of EDCs and their mechanism of action, with particular emphasis on gonads, based on the information available on medical databases (PubMed, Web of Science, EMBASE and Google Scholar, EMBASE and Web of Science) until May 2021. RESULTS: EDCs occur in everyday life, e.g., they are components of adhesives, brake fluids, and flame retardants; they are used in the production of polyvinyl chloride (PVC), plastic food boxes, pacifiers, medicines, cosmetics (bisphenol A, phthalates), hydraulic fluids, printing inks (polychlorinated biphenyls - PCBs), receipts (bisphenol A, BSA) and raincoats (phthalates); they are also a component of polyvinyl products (e.g. toys) (phthalates), air fresheners and cleaning agents (phthalates); moreover, they can be found in the smoke from burning wood (dioxins), and in soil or plants (pesticides). EDCs are part of our diet and can be found in vegetables, fruits, green tea, chocolate and red wine (phytoestrogens). In addition to infertility, they can lead to premature puberty and even cause uterine and ovarian cancer. However, in men, they reduce testosterone levels, reduce the quality of sperm, and cause benign testicular tumors. CONCLUSIONS: Therefore, this article submits that EDCs negatively affect our health, disrupting the functioning of the endocrine system, and particularly affecting the functioning of the gonads.

Effect of lithium carbonate on the function of the thyroid gland: mechanism of action and clinical implications.

Lithium carbonate, a drug known for more than 100 years, has been successfully used as a psychiatric medication. Currently, it is a commonly used drug to treat patients with unipolar and bipolar depression, and for the prophylaxis of bipolar disorders and acute mania. Lithium salts may cause the development of goiter, hypothyroidism, or rarely hyperthyroidism. The present review examined the current state of knowledge on the effect of lithium carbonate on the thyroid gland. The Pubmed database and Google Scholar were searched for articles related to the effects of lithium therapy on the thyroid gland function published up to February 2020. Studies that examined the mechanism of action of lithium at the molecular level, including pharmacokinetics, and focused on its effects on the thyroid gland were included. Lithium as a mood-stabilizing drug has a complex mechanism of action. Because of the active transport of Na+/I- ions, lithium, despite its concentration gradient, is accumulated in the thyroid gland at a concentration 3 - 4 times higher than that in the plasma. It can inhibit the formation of colloid in thyrocytes, change the structure of thyroglobulin, weaken the iodination of tyrosines, and disrupt their coupling. In addition, it reduces the clearance of free thyroxine in the serum, thereby indirectly reducing the activity of 5-deiodinase type 1 and 2 and reducing the deiodination of these hormones in the liver. Taken together, this review provides recommendations for monitoring the thyroid gland in patients who require long-term lithium therapy. Prior to the initiation of lithium therapy, thyroid ultrasound should be performed, and the levels of thyroid hormones (fT3 and fT4), TSH, and antithyroid peroxidase and antithyroglobulin antibodies should be measured. If the patient shows normal thyroid function, TSH level measurement and thyroid ultrasound should be performed at 6- to 12-month intervals for long term.

Two coexisting heterozygous frameshift mutations in PROP1 are responsible for a different phenotype of combined pituitary hormone deficiency.

The role of genetic background in childhood-onset combined pituitary hormone deficiency (CPHD) has been extensively studied. The major contributors are the PROP1, POU1F1, LHX3, LHX4 and HESX1 genes coding transcription factors implicated in pituitary organogenesis. The clinical consequences of mutations encompass impaired synthesis of a growth hormone (GH) and one or more concurrent pituitary hormones (i.e. LH, FSH, TSH, PRL). Manifestation of the disorder may vary due to various mutation impacts on the final gene products or an influence of environmental factors during pituitary organogenesis. We describe the clinical and molecular characteristics of two brothers aged 47 and 39 years presenting an uncommon manifestation of congenital hypopituitarism. Sequencing of the PROP1, POU1F1, LHX3, LHX4 and HESX1 genes was performed to confirm the genetic origin of the disorder. A compound heterozygosity in the PROP1 gene has been identified for both probands. The first change represents a mutational hot spot (c.150delA, p.R53fsX164), whereas the second is a novel alteration (p.R112X) that leads to protein disruption. Based on precise genetic diagnosis, an in silico prediction of a p.R112X mutation on protein architecture was performed. The resulting clinical phenotype was surprisingly distinct compared to most patients with genetic alterations in PROP1 reported in the current literature. This may be caused by a residual activity of a newly identified p.R112X protein that preserves over 70 % of the homeodomain structure. This examination may confirm a key role of a DNA-binding homeodomain in maintaining PROP1 functionality and suggests a conceivable explanation of an unusual phenotype.

Utility of PET/CT in the diagnosis of recurrent ovarian cancer depending on CA 125 serum level.

UNLABELLED: The aim of this study was to estimate the diagnostic value of common application of CA 125 level measurement and 18F-FDG PET/CT examination in patients with a suspicion of recurrent ovarian cancer. PATIENTS, METHODS: A retrospective analysis was performed on a group of 68 patients aged 31-77 (average 57.7) with a suspicion of relapsing ovarian cancer who had CA 125 serum level measurement and PET/CT examination done with a maximum interval of 60 days. RESULTS: PET/CT examination result was positive in 33 patients (48.5%) and negative in 35 (51.5%). Level of CA 125 was significantly higher in women with a positive PET/CT result than in patients with a negative one (average 199.9 U/ml and 15.7 U/ml, respectively, p < 0.001). Nevertheless, comparison of CA 125 level in groups defined according to the localization of the relapse showed no significant differences. Moreover, the ROC analysis revealed that the optimal cut-off point of CA 125 concentration to predict positive PET/CT result was 17.6 U/ml. Area under the curve was 0.91. Sensitivity, specificity and accuracy in prognosticating positive PET/CT result for the selected cut-off point of 17.6 U/ml were 90.9%, 80.0% and 85.3%, respectively. CONCLUSION: CA 125 level does not depend on the localization of the recurrence. PET/CT is particularly useful in patients with a suspicion of relapsing ovarian cancer with CA 125 value of at least 17.6 U/ml.

Use of 99Tcm-MIBI scintigraphy in the evaluation of perfusion improvement after myocardial revascularization with the use of the left internal thoracic artery.

In spite of successful revascularization, in a significant group of patients myocardial ischaemia is present after surgery. The final effect of surgery depends on preoperative left ventricular function, initial coronary artery status, completeness of revascularization, the use of arterial or venous grafts, and many other factors. The aim of our 99Tcm-MIBI scintigraphy study was to examine the improvement of perfusion in the left anterior descending artery (LAD) vascular territory after revascularization with the use of the left internal thoracic artery (LITA), with respect to the LAD diameter and use of additional venous graft to diagonal artery. The study group consisted of 45 subjects (42 male, three female) aged 34-68 years (mean age 50.9+/-8.3 years) recruited from patients in whom LITA was grafted into LAD. The operation and postoperative period was uneventful in all patients. Two weeks before, and 3-4 months after surgery, dipyridamole-rest sestamibi SPECT were performed. The revascularization significantly improved both stress (deltaPI = 0.77+/-0.66; P < 0.001) and rest (deltaPI = 0.32+/-0.60; P < 0.001) perfusion of the LAD territory. The improvement was slightly better in patients who received two grafts (deltaPI = 1.42+/-0.91) for the LAD territory in comparison to the group revascularized only with LITA (deltaPI = 0.80+/-0.69; P = patients who received an arterial bypass to the LAD artery the perfusion was abnormal in all eight patients after anterior myocardial infarction and in 39% of patients without a history of infarction. The perfusion improvement was the best when the diameter of LAD was > or = 1.5 mm (deltaPI = 0.88+/-0.95). The independent predictors of perfusion improvement were the number of segments with reversible perfusion defect within the revascularized area (beta = 0.84, P < 0.001), the diameter of revascularized artery (beta = 0.17, P = 0.03) and the presence of pathological Q wave at preoperative ECG (beta = -0.20, P = 0.02). We conclude that the degree of perfusion improvement in the LAD territory after revascularization with the use of LITA depends on the diameter of bypassed coronary artery, completeness of revascularization and the reversibility of preoperative perfusion defect.

[The evaluation of goiter frequency and iodine prophylaxis efficiency in children population in Wielkopolska area from 1992 to 1998]. / Ocena czestosci wystepowania wola i skutecznosci profilaktyki jodowej u dzieci na terenie Wielkopolski w latach 1992-1998.

The aim of the study was to compare the current state and efficiency of iodine prophylaxis during the last six years. The study included 800 children from the rural and urban area (462 children in 1992 and 338 children in 1998) with the proportional sex and age (8-13 years) distribution, 24.936 newborns (9875 in 1992/1993 and 15.061 - mostly in the early part of 1998). The thyroid size (by USG), serum thyroglobulin (TG) concentration, urinary iodine (UI) concentration, %age of neonatal-TSH above 5 micro U/ml were evaluated using current ICCIDD and WHO criteria. The prevalence of goiter detected in children population in 1992 was 26% (recount by current criteria), in the early part of 1998 it was reduced to 21%. Parallelly, mean urinary iodine concentration increased from 49 micro g/l to 79 micro g/l. The reduction of goiter prevalence was associated with the reduction of mean serum thyroglobulin concentration from 26 ng/ml to 18 ng/ml. In the group of newborns the %age of TSH results above 5 micro U/ml decreased from 6 to 2.6%. Generally, the study proved significant increase of iodine prophylaxis efficiency in Wielkopolska Region in the period of the last six years, but it is still the area with mild iodine deficiency, which suggests the necessity of using other forms of iodine prophylaxis except for salt iodization. The obtained results suggest the necessity to extend the study on the role of other goitrogenic factors, which are probably present in the whole Wielkopolska Region.

[Accuracy of ultrasound-guided fine-needle aspiration biopsy in diagnosis of changes in thyroid nodular lesions]. / Skutecznosc celowanej biopsji aspiracyjnej cienkoiglowej w diagnostyce zmian guzowatych tarczycy.

The aim of this study was to compare the results of US-FNAB with definitive histological examination of thyroid nodular lesions. 590 patients who underwent surgery were reviewed (473 females, 117 males, ranging in age from 9 to 81 years, average 36 years). Histological evaluation of cytologically diagnosed benign nodules revealed nodular goiter in 407 cases (91.5%), Hashimoto's thyroiditis in 2 (0.4%), follicular adenoma in 31 (7%), papillary carcinoma in 2 (0.4%) and follicular carcinoma in 3 (0.7%). In the cytological group of follicular nodule (n = 71) histological diagnoses included: nodular goiter in 11 cases (15.5%), follicular adenoma in 36 (50.7%), papillary carcinoma in 2 (2.8%), follicular carcinoma in 20 (28.2%). The diagnosis of papillary carcinoma (n = 65) was confirmed histologically in 59 cases (90.8%), in the remaining 6 cases Hashimoto's thyroiditis and medullary carcinoma were diagnosed. In the cases diagnosed cytologically as medullary carcinoma (n = 8) histological diagnoses included: medullary carcinoma in 7 cases (87.5%). The cytological diagnosis of anaplastic carcinoma (n = 1) was confirmed histologically. These results support the value of US-FNAB in the diagnostics of thyroid neoplasms. US-FNAB performance was as follows: sensitivity 78%, specificity 97%, accuracy 92%, 2.3% of false positive and 6.1% of false negative results.

[Prevalence of goiter in children of the Poznan province]. / Czestosc wystepowania wola u dzieci w województwie Poznanskim.

The aim of our study was the evaluation of goiter prevalence in the children in Poznan and surrounding towns and villages. In 3065 children 4-16 years old the thyroid size and serum concentration of T3, T4 and TSH were determined. Our results indicate that the goiter prevalence in the group of investigated children was 20%. We also observed that the changes in the concentration of thyroid hormones and TSH were not associated with the clinical symptoms of thyroid gland dysfunction.

[Influence of radioactive contamination and iodine prophylaxis after the Czernobyl disaster on thyroid morphology and function of the Poznan region]. / Wplyw skazenia radioaktywnego i profilaktyki jodowej w nastepstwie awarii reaktora atomowego w Czarnobylu na morfologie i czynnosc tarczycy mieszkanców regionu Poznanskiego.

The radioactive contamination of Poznan Region was recognized after Chernobyl accident as average. The predicted values of minimal (inhalation) and maximal (inhalation and ingestion) committed dose equivalent to the thyroid varied from 2.5 (min) to 24.7 (max) mSv in different groups of adults and children. To follow up the results of iodine prophylaxis and some aspects of possible thyroid gland morphological and functional changes 11086 persons were carefully investigated clinically and biochemically. Among these 11086 persons were 42.6% males and 57.4% females both adults from 17 till 40 year and children up do 16 years. The following parameters were reviewed: pregnancy, time of residence in the region, thyroid abnormalities, family history concerning thyroid diseases, iodine intake in April and May 1986 with possible side effects, changes in the thyroid size observed before and after 1986, degree and kind of thyroid enlargement, serum concentration of T3, T4, TSH, ATMA and ATG titre and finally the effectiveness of thyroid blockade at 24, 48 and 72 h after ingestion of Lugol's solution. Side effects of the ingestion of potassium iodide from 30-70 mg were observed in 153 cases, 36 of them consulted medical doctors but in no case the side effects (dominated by vomiting) threatened the life. In the investigated group were 144 pregnant women. Majority, because 88% of them delivered the baby on or after time and 6.9% before time, 4.9% of natural abortions were noted but non artificial. In the group of children thyroid gland abnormalities before 1986 were reported in 3 cases in 23 after 1986 it is after Chernobyl accident. This information is interesting but needs more precise analysis of different dependencies occurring. The data obtained indicated the existence in Poznan. Region the goiter endemy because 27.5% of investigated children and adults had goiter classified as grades O-B, I, II and III. The elevation or diminution of T3 values were noted in 1164 cases, for T4 in 418 cases and for TSH in 1412 cases. The presence of antimembrane and antithyroglobulin antibodies were observed in 303 cases. All persons with changes observed in thyroid morphology and function are periodically controlled and the results will be published separately. The investigations performed and results presented concern the early aspects of radioactive contamination and effects of iodine prophylaxis. The answer regarding late effects including thyroid cancer needs further multi year studies for which the clinical material investigated in different parts of Poland and well documented should be used as model group for further periodical studies.

The results of epidemiological studies concerning iodine deficiency and goiter in Poznan Region (Poznan coordinating center).

The studies concerning iodine deficiency and occurrence of goiter, being a fragment of the program covering different parts of Poland, included 2620 children of age between 7 and 12 years attending randomly chosen schools situated in towns and villages of Poznan, Pila, Leszno, Konin, Kalisz, Bydgoszcz and Zielona Góra districts. Among the children studied, 1009 children (522 boys and 487 girls) attended town schools, and 1611 (774 boys and 837 girls) country schools. All children were subjected to anamnesis by using a standard questionnaire. Also physical examination of the thyroid aimed at the evaluation of size and morphology of the gland was carried out by palpation (according to the obligatory WHO scale) and by ultrasonography. Urine samples were taken from the majority of children for the determination of urinary excretion of iodine. In 736 (28.1%) of the studied children an enlargement of the thyroid was found. Among these children 253 are inhabitants of towns (this number represents 27.8% of all urban children studied) and 483 are inhabitants of villages (30% of all rural children studied). In 92.7% of cases the goiter could be classified as type IB according to WHO and in 56 cases it was of nodular character. There was a clear relation between the incidence of goiter and the age of the children studied. Frequency distribution of goiter in the individual age groups was as follows: for urban children--21.8% in age group of 7-8 years, 23.5% in age group of 9-10 years and 29.7% in age group 11-12 years, and for rural children the corresponding values were 21.1%, 30.2% and 38.2%. Mean urinary iodine excretion was 96 micrograms/L (median 84 micrograms/L) for urban children, and 87 micrograms/L (median 64 micrograms/L) for rural children. Among 2620 answers concerning the use of iodized salt in the household, only 980 (37.1%) were positive. In towns, the use of iodized salt declared about 41% of families and in villages about 35%. Altogether, among 736 cases of goiter, 464 are children not using iodized salt. Only in 272 cases goiter appeared despite the use of iodized salt. The data concerning family occurrence of goiter and the type of iodized salt used can be treated as approximate because of subjective character. According to the results obtained, the region covered by the study falls according to the WHO and ICCIDD classification to the category of an area of mild iodine deficiency requiring more intensive iodine prophylaxis.

Increased serum osteoprotegerin in patients with primary adrenal insufficiency receiving conventional hydrocortisone substitution.

Patients treated for primary adrenal insufficiency (PAI) are at risk of steroid over-replacement, which may affect their skeleton. The study was aimed to investigate the effect of steroid substitution on serum osteoprotegerin and receptor activator of nuclear factor kappa-beta ligand (RANKL) levels in relation to bone mineral density (BMD) in PAI. Eighty patients (mean age 47.2±14.5 years, mean hydrocortisone dose 0.49±0.14 mg/kg/day) and 63 healthy subjects were included. Serum osteoprotegerin, RANKL, 25-hydroxyvitamin D3, calcium, phosphate, alkaline phosphatase, intact parathormone, and dehydroepiandrosterone-sulfate levels were evaluated in patients and controls. BMD was assessed in affected subjects using dual-energy X-ray absorptiometry. Mean osteoprotegerin concentration in PAI patients appeared significantly higher vs. controls (p=0.002), while RANKL levels were similar (p=0.430). Serum osteoprotegerin increased with age (p<0.001), but showed no correlation with daily hydrocortisone dose. Osteoprotegerin was negatively correlated with serum dehydroepiandrosterone-sulfate (p=0.008) and with BMD at the lumbar spine (p<0.001) and femoral neck (p=0.003). RANKL correlated negatively with PAI duration (p=0.029) and positively with daily hydrocortisone dose (p=0.018). Lumbar spine osteoporosis and osteopenia were found in 12 and 31 patients, respectively, whereas in femoral neck: in 5 and 33 individuals. Patients with osteoporosis displayed higher osteoprotegerin levels, but after the age-adjustment the correlation was lost. In conclusion, increased osteoprotegerin in PAI might reflect a compensatory response to enhanced bone resorption due to exogenous steroid excess and/or result from a deficit in adrenal androgens. RANKL levels remain within normal range on standard steroid replacement.

[Evaluation of thyroid structure and function in patients with Turner syndromes]. / Ocena struktury i czynnosci tarczycy u chorych z zespolem Turnera.

The aim of our study was an estimation of thyroid structure and function in 37 patients with Turner syndrome aged from 19 to 60 years and in control group of healthy women. In each case the following studies were performed: cytogenetic examination, thyroid ultrasonography, serum total and free thyroid hormones, TSH, thyroglobulin (Tg), thyroid hormones binding globulin (TBG), antithyroglobulin and antithyroperoxidase antibodies (anti-Tg and anti-TPO) levels. In Turner syndrome ultrasonographic volume of the thyroid was significantly lower than in control group (11.03 vs 16.98 cm3). Abnormalities of thyroid function were found in 8 (22%) studied cases (subclinical primary hypothyroidism in 16%, full-clinical primary hypothyroidism in 3% and hyperthyroidism in course of Graves disease in 3%). Serum elevated antithyroid antibodies were present in 62% cases of Turner syndrome and were significantly higher than in control group (16%). In Turner syndrome thyroid diseases are more frequent than in healthy population. Every patient with Turner syndrome needs routine diagnostics of the thyroid structure and function.

Short-term pre-surgical treatment with somatostatin analogues, octreotide and lanreotide, in acromegaly.

Eighteen patients with symptoms of active acromegaly were treated with somatostatin analogues for 4 weeks before surgery. Both before and after the treatment, levels of growth hormone (GH), prolactin (PRL), insulin growth factor -I (IGF-I), luteotropin (LH), folliculostimulin (FSH) and subunit alpha of glycoprotein hormones were estimated. Glucose tolerance test, magnetic resonance imaging (MRI) examination, sight acuity and field of vision tests were also performed. The same tests were performed on ten control patients with clinically and biochemically active acromegaly, subjected to surgery but not treated with somatostatin analogues. In six patients treated with somatostatin analogues GH levels decreased significantly to less than 5 ng/ml and in two patients remained elevated while in 10 patients GH level decreased and ranged from 6.1 to 42.9 ng/ml. In 13 patients we observed a decrease in IGF-I to normal levels (<400 ng/dl) and in 3 patients we noted a decrease to levels slightly higher than normal. There was also a slight decrease in alpha subunit concentration. In the glucose inhibition test 4 patients demonstrated normalized GH levels. In patients with elevated PRL and TSH levels, treatment with somatostatin analogues induced their decrease. No changes were observed in levels of LH and FSH. After therapy MRI examination disclosed a decrease in tumor volume in two patients (by 20 and 25%, respectively) and no changes in tumor size in 16 patients. The two patients with a decreased tumor volume also showed normalized glucose tolerance tests. All patients manifested an improved clinical condition. Neurosurgeons disclosed a decreased tumor consistency which greatly facilitated surgical procedure. Our studies documented favourable effects of somatostatin analogues on the assayed hormone levels, and on the general condition of the patients as well as on the course of the surgical procedure itself.