A Giant Parathyroid Adenoma Presenting With Parathyroid Crisis.

Giant parathyroid adenomas (GPA) are a benign cause of primary hyperparathyroidism (PHPT) that might present similarly to parathyroid carcinomas (PC). Rarely, PHPT can present with a parathyroid crisis, a life-threatening decompensation with severe hypercalcemia.  A 77-year-old woman presented with lethargy and muscle weakness. Investigation revealed parathyroid hormone-dependent hypercalcemia and an enlarged parathyroid measuring 31x24 mm. The patient was submitted for parathyroidectomy. Histology showed no evidence of malignancy, confirming a GPA.  We report a GPA presenting with a parathyroid crisis. The clinical picture mimicked that of a PC. There are no clinical, analytical, or imagiological features pathognomonic of PC.

Immune checkpoint inhibitor-induced hypophysitis: clinical and biochemical features.

Immune checkpoint inhibitors are a very promising novel class of immune response-regulating drugs for cancer treatment. Hypophysitis is one of their most common immune-related adverse events, occurring in a significant proportion of patients. Since this is a potentially severe entity, regular hormone monitoring is recommended during treatment to allow for a timely diagnosis and adequate treatment. Identification of clinical signs and symptoms, such as headaches, fatigue, weakness, nausea and dizziness, can also be key for its recognition. Compressive symptoms, such as visual disturbances, are uncommon, as is diabetes insipidus. Imaging findings are usually mild and transient and can easily go unnoticed. However, the presence of pituitary abnormalities in imaging studies should prompt closer monitoring, as these can precede clinical manifestations. The clinical importance of this entity relates mainly to the risk of hormone deficiency, especially ACTH, which occurs in the majority of patients and is rarely reversible, requiring lifelong glucocorticoid replacement therapy.

Development and validation of the clinical report form for nodular thyroid pathologies

Abstract Objectives: The aim of this study is to develop and validate a novel clinical report form in the format of a structured interview to enable the characterization of the Portuguese population of the Baixo Vouga region with different subtypes of nodular thyroid pathologies (NTyPs). Materials and methods: A structured interview was developed and to the best of our knowledge, this is the first structured interview built and validated for that purpose in Portugal. Results: This structured interview enables the identification of possible correlations between each subtype of nodular lesions and sociodemographic data, consumption habits and lifestyle, endocrine history, and family predisposition. Conclusion: The novel structured interview will simultaneously, enable a detailed characterization of the group of patients with nodular thyroid lesions and will support future metabolomic studies.

Development and validation of the clinical report form for nodular thyroid pathologies.

Objective: The aim of this study is to develop and validate a novel clinical report form in the format of a structured interview to enable the characterization of the Portuguese population of the Baixo Vouga region with different subtypes of nodular thyroid pathologies (NTyPs). Materials and methods: A structured interview was developed and to the best of our knowledge, this is the first structured interview built and validated for that purpose in Portugal. Results: This structured interview enables the identification of possible correlations between each subtype of nodular lesions and sociodemographic data, consumption habits and lifestyle, endocrine history, and family predisposition. Conclusion: The novel structured interview will simultaneously, enable a detailed characterization of the group of patients with nodular thyroid lesions and will support future metabolomic studies.

Gestational Diabetes: Which Clinical (Pre)gestational Features Are Able to Predict Failure of Lifestyle Intervention?

Background Controversy exists regarding risk factors in pregnant women that might be associated with a higher probability of failure of lifestyle intervention in the treatment of gestational diabetes (GD). These pregnant women's risk factors may highlight the need for closer surveillance at an early stage of pregnancy. Aims To identify predictors of pharmacological therapy need in early and late GD. Methods This was a retrospective observational study including women with GD diagnosed in the first (group 1) or second trimester (group 2) according to the criteria proposed by the International Association of Diabetes Pregnancy Study Group (IADPSG), singleton pregnancy and follow-up between January 2015 and December 2018, divided according to treatment (lifestyle intervention or pharmacological treatment (metformin and/or insulin)). Results A total of 278 and 273 women were included in groups 1 and 2, of which 48.6% and 55.3% underwent non-pharmacological treatment, respectively. In group 1, women requiring pharmacological therapy tended to be older and have previous GD or family history of diabetes, higher body mass index (BMI) and higher fasting blood glucose (FBG) levels. In group 2, pharmacological treatment need was associated with multiparity, previous GD, higher BMI, higher fasting glucose value in the oral glucose tolerance test (OGTT), and higher OGTT value at 60 minutes. The independent risk factors identified for pharmacological treatment requirement were maternal age (OR 1.10 (1.05-1.16), p<0.001), previous GD (OR 2.70 (1.10-6.58), p=0.029) and FBG (OR 1.07 (1.00-1.14), p=0.048) in group 1 while BMI (OR 1.07 (1.02-1.13), p=0.012) and fasting glucose value in the OGTT (OR 1.03 (1.01-1.05), p=0.006) were the factors identified in group 2. The cut-off values for FBG and fasting glucose value in the OGTT that predicted the necessity of pharmacological treatment were 95.50 mg/dL and 88.50 mg/dL, respectively. Conclusions In early GD, closer surveillance is necessary for older women with a previous GD and an FBG ≥ 95.50 mg/dL. In late GD, pre-gestational BMI and a fasting glucose value in the OGTT ≥ 88.50 mg/dL should prevail.

Subclinical Hypothyroidism in Pediatric Age: How Important Is Autoimmunity?

Background The natural history of subclinical hypothyroidism (SHT) is influenced by the underlying etiology, being the most common Hashimoto's thyroiditis (HT) and isolated hyperthyrotropinemia (IH). Additionally, controversy exists surrounding the need for pharmacological treatment. Methods A retrospective observational study that included patients diagnosed with SHT caused by HT or IH at pediatric age, under levothyroxine therapy and with follow-up at Centro Hospitalar Baixo Vouga between January/2014 and July/2019. Patients with follow-up time <12 months or missing records were excluded. This study aims to compare clinical, analytical and echographic parameters and levothyroxine dose between patients with SHT caused by HT or IH. Results Sample of 39 patients with 16.5 ± 3.4 years, 22 (56.4%) females. There was a preponderance of females in the HT group and males in the IH (p=0.001). Changes in thyroid ultrasound were more prevalent in the HT group (85.7% vs 16.7%, p<0.001). The median initial and final doses of levothyroxine were higher in the HT group (p=0.016, p=0.011). There was a trend towards a higher levothyroxine discontinuation rate in the IH group (22.2% vs 4.8%, p=0.162). Two positive and statistically significant correlations were found between the level of anti-thyroid peroxidase antibodies (TPOAbs) and both the final levothyroxine dose (ρ=0.544; p=0.004) and the final weight-adjusted levothyroxine dose (ρ=0.434; p=0.027). Conclusions HT was more common in females and was associated with higher levothyroxine requirements and less likelihood of treatment discontinuation, especially if high TPOAbs levels. These results can be useful in the difficult daily decision of starting therapy, especially in milder forms of SHT.

Metabolic Profile Characterization of Different Thyroid Nodules Using FTIR Spectroscopy: A Review.

Thyroid cancer's incidence has increased in the last decades, and its diagnosis can be a challenge. Further and complementary testing based in biochemical alterations may be important to correctly identify thyroid cancer and prevent unnecessary surgery. Fourier-transform infrared (FTIR) spectroscopy is a metabolomic technique that has already shown promising results in cancer metabolome analysis of neoplastic thyroid tissue, in the identification and classification of prostate tumor tissues and of breast carcinoma, among others. This work aims to gather and discuss published information on the ability of FTIR spectroscopy to be used in metabolomic studies of the thyroid, including discriminating between benign and malignant thyroid samples and grading and classifying different types of thyroid tumors.