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1.
Front Endocrinol (Lausanne) ; 12: 664839, 2021.
Article in English | MEDLINE | ID: mdl-34122338

ABSTRACT

Background: Malabsorption of levothyroxine (LT4) is a common problem faced in clinical practice. It is usually solved, if there are no complexities including gastrointestinal absorption disorder, by taking medicines on an empty stomach and avoiding foods interfering with LT4. Herein we present a rare case of a patient exhibiting malabsorption of LT4 with decreased membranous expression of ileal transporters. Case: The 22-Year-old female presented with sustained hypothyroid status despite medication of 7.8 µg/kg LT4. Medical history and LT4 absorption test (the absorption rate 8.4%) excluded pseudomalabsorption. No organic gastrointestinal disorder was found in the patient by blood chemistry, endoscopies, and abdominal computed tomography scan. The immunohistochemical analysis showed decreased membranous expression of LAT1 and LAT2 in distal ileum and ascending colon in the patient compared to 20 controls who have no thyroid disease. The expression of MCT8 in colon appeared at both nucleus and brush border in the patient, while it was limited to brush border in controls. The expression of other transporters was similar between the patient and controls. Conclusion: The changes of the expression of LAT1 and LAT2 in this patient showing LT4 malabsorption might help to understand the role of intestinal transporters in the absorption of LT4 in humans. The functional relevance of the decrement of LAT1 and LAT2 in this patient remains to be elucidated.


Subject(s)
Adaptor Proteins, Signal Transducing/metabolism , Hypothyroidism/drug therapy , Large Neutral Amino Acid-Transporter 1/metabolism , Malabsorption Syndromes/diagnosis , Thyroxine/pharmacokinetics , Adaptor Proteins, Signal Transducing/genetics , Adult , Case-Control Studies , Female , Humans , Hypothyroidism/metabolism , Hypothyroidism/pathology , Large Neutral Amino Acid-Transporter 1/genetics , Malabsorption Syndromes/genetics , Malabsorption Syndromes/metabolism , Prognosis , Thyroxine/therapeutic use , Tissue Distribution , Young Adult
2.
Cardiovasc Diabetol ; 15(1): 108, 2016 08 05.
Article in English | MEDLINE | ID: mdl-27491472

ABSTRACT

BACKGROUND: This study investigated the association between serum gamma-glutamyltransferase (GGT) level and subclinical atherosclerosis in patients with type 2 diabetes. METHODS: This cross-sectional study involved 1024 patients with type 2 diabetes mellitus. Measurement of brachial-ankle pulse wave velocity (baPWV; as a marker of arterial stiffness) and an ultrasound assessment of carotid atherosclerosis were performed. Subclinical atherosclerosis was defined by the presence of a high baPWV (≥1720 cm/s), carotid atherosclerosis (intima-media thickness >0.8 mm or the presence of plaques), and carotid stenosis (≥50 % of luminal narrowing). The subjects were stratified into quartiles according to GGT level, and the relationship between GGT level and subclinical atherosclerosis was analysed. RESULTS: Serum GGT levels were closely associated with obesity, atherogenic dyslipidemia, and metabolic syndrome. However, serum GGT levels did not show a linear association with baPWV, carotid intima-media thickness, or plaque grade. The prevalence of high baPWV, carotid atherosclerosis, and carotid stenosis did not differ between the quartiles in men and women. Multivariate logistic regression analyses revealed no association between GGT level and high baPWV, carotid atherosclerosis, and carotid stenosis, either as continuous variables or quartiles. CONCLUSIONS: Serum GGT levels were significantly associated with obesity, atherogenic dyslipidaemia, and metabolic syndrome, but not with the early and late stages of atherosclerotic vascular changes, in patients with type 2 diabetes. Serum GGT level may not be a reliable marker of subclinical atherosclerosis in type 2 diabetes.


Subject(s)
Atherosclerosis/blood , Atherosclerosis/metabolism , Biomarkers/analysis , Diabetes Mellitus, Type 2/blood , gamma-Glutamyltransferase/metabolism , Adult , Aged , Atherosclerosis/complications , Blood Glucose/physiology , Diabetes Mellitus, Type 2/complications , Female , Humans , Male , Metabolic Syndrome/blood , Middle Aged , Obesity/blood
3.
Endocrine ; 50(2): 405-12, 2015 Nov.
Article in English | MEDLINE | ID: mdl-25846483

ABSTRACT

Several studies have suggested that bilirubin, a potent innate antioxidant, plays a protective role against cardiovascular and microvascular disease. This study investigated the association between serum concentrations of total bilirubin (TB) and the presence of diabetic peripheral neuropathy (DPN) in Korean diabetic patients. This cross-sectional study involved 1207 patients aged more than 30 years with type 2 diabetes. DPN was assessed according to clinical symptoms and physical examinations using Michigan Neuropathy Screening Instrument examination score, 10-g monofilament sensation, and current perception threshold. The subjects were stratified into gender-specific tertiles based on TB values, and the relationship between the TB values and DPN was analyzed. Compared with patients within the lowest TB tertile, those with higher TB levels consisted of patients with shorter duration of diabetes, lower HbA1c, better renal function, and less autonomic neuropathy, retinopathy, and albuminuria. Serum TB levels were inversely associated with DPN. In multivariate analysis for the development of DPN after adjusting for potential confounding factors including retinopathy, albuminuria, and autonomic neuropathy, the TB levels were inversely associated with the presence of DPN, both as a continuous variable [odds ratio (OR) per log standard deviation (SD) 0.79; 95% confidence interval (CI) 0.65-0.97; P = 0.022] and when categorized in tertiles (the highest vs. the lowest tertile; OR 0.63; 95% CI 0.40-0.99; P = 0.046). Low serum bilirubin levels are significantly associated with DPN, independently of classic risk factors and other microvascular complications. Further investigation is necessary to determine whether serum bilirubin has a prognostic significance on DPN.


Subject(s)
Bilirubin/blood , Diabetes Mellitus, Type 2/blood , Diabetic Neuropathies/blood , Adult , Aged , Cross-Sectional Studies , Diabetes Mellitus, Type 2/epidemiology , Diabetic Neuropathies/epidemiology , Female , Humans , Male , Middle Aged , Republic of Korea/epidemiology
4.
Eur Arch Otorhinolaryngol ; 272(5): 1181-8, 2015 May.
Article in English | MEDLINE | ID: mdl-25636252

ABSTRACT

A globus sensation is one of the most common complaints in otolaryngologic clinics, and laryngopharyngeal reflux is the most common cause. However, thyroid nodules also can cause globus symptoms. The purpose of this study was to identify the characteristics of thyroid nodules that cause globus. We selected patients prospectively with a single thyroid nodule on ultrasonograms. Patients with other causes of globus symptoms were excluded using questionnaires, fiber optic laryngoscopic examinations, and a psychiatric screening tool. In total, 175 patients were enrolled. Patients were divided into two groups according to globus symptoms. Ultrasonographic characteristics and clinicopathological parameters were compared between the groups. Among various clinicopathologic and ultrasonographic parameters, size and horizontal location of the thyroid nodule showed significant differences between the groups. Nodules larger than 3 cm and those located anterior to the trachea had a tendency to cause globus symptoms. Regarding horizontal location, nodules that all parts were located anterior to the trachea showed a higher tendency to cause globus symptoms than nodules that only some parts were located anterior to the trachea. In conclusion, thyroid nodules with specific size and location can cause globus symptoms, and this finding can be indicated in patient counseling. Also, conservative treatments or thyroidectomy may be helpful in relieving patients' globus symptoms.


Subject(s)
Conversion Disorder , Laryngopharyngeal Reflux/diagnosis , Thyroid Gland , Thyroid Nodule , Adult , Aged , Conversion Disorder/diagnosis , Conversion Disorder/etiology , Conversion Disorder/physiopathology , Diagnosis, Differential , Disease Management , Female , Humans , Laryngoscopy/methods , Male , Mental Status Schedule , Middle Aged , Organ Size , Surveys and Questionnaires , Symptom Assessment/methods , Thyroid Gland/diagnostic imaging , Thyroid Gland/surgery , Thyroid Nodule/diagnosis , Thyroid Nodule/diagnostic imaging , Thyroid Nodule/physiopathology , Thyroid Nodule/therapy , Thyroidectomy/methods , Ultrasonography
5.
J Gastroenterol Hepatol ; 30(4): 733-41, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25318838

ABSTRACT

BACKGROUND AND AIM: Growing evidence suggests that non-alcoholic fatty liver disease (NAFLD) is interrelated with renal dysfunction and disturbed bone metabolism, both of which play a key role in calcium and phosphorus homeostasis. We investigated the association between NAFLD and serum calcium and phosphorus levels in Korean subjects. METHODS: We performed a cross-sectional analysis of 16,592 subjects undergoing a general health checkup. NAFLD was assessed based on ultrasonographically detected fatty liver in the absence of excessive alcohol consumption and other causes of liver disease. RESULTS: The proportion of the population with fatty liver detected by ultrasonography was 43.2% for males and 17.6% for females. We observed that a higher serum albumin-corrected calcium (Ca(c)) level was associated with smoking, hypertension, and unfavorable metabolic parameters in both genders, but the serum phosphorus levels showed an inconsistent correlation with metabolic abnormalities. After adjusting for age, gender, waist circumference, body mass index, smoking status, exercise, diabetes, hypertension, lipid profiles, and renal function, serum Cac , phosphorus, and Cac -phosphorus products were independent risk factors for fatty liver (odds ratio [OR]: 1.71, 95% confidence interval [CI]: 1.49-1.95, P < 0.001; OR: 1.34, 95% CI: 1.22-1.48, P < 0.001; and OR: 1.20, 95% CI: 1.14-1.26, P < 0.001, respectively), and the risk of fatty liver increased in a graded manner over the quartiles. CONCLUSION: Serum calcium and phosphorus levels are significantly associated with NAFLD. Further investigation is needed to verify whether calcium and phosphorus levels indicate a higher risk of NAFLD.


Subject(s)
Calcium/blood , Non-alcoholic Fatty Liver Disease/diagnosis , Phosphorus/blood , Adult , Asian People , Biomarkers/blood , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/epidemiology , Non-alcoholic Fatty Liver Disease/etiology , Republic of Korea/epidemiology , Risk Factors
6.
PLoS One ; 9(10): e109251, 2014.
Article in English | MEDLINE | ID: mdl-25299316

ABSTRACT

BACKGROUND: Considerable evidence suggests that bilirubin is a potent physiologic antioxidant that may provide important protection against cardiovascular disease (CVD) and inflammation. We investigated the relationship between serum total bilirubin (TB) levels and arterial stiffness, measured by the brachial-ankle pulse wave velocity (baPWV), in patients with type 2 diabetes. METHODS: We conducted a cross-sectional analysis of 1,711 subjects with type 2 diabetes (807 men and 904 women; mean age, 57.1 years). The subjects were stratified based on gender-specific tertiles of TB values, and a high baPWV was defined as greater than 1,745 cm/s ( >75th percentile). RESULTS: The serum TB concentration was negatively correlated with the duration of diabetes, HbA1c, the 10-year Framingham risk score, and baPWV and was positively correlated with high-density lipoprotein cholesterol and the eGFR in both genders. Inverse association between TB categories and unadjusted prevalence of high PWV was only observed in women. After adjusting for confounding factors, the TB levels were inversely associated with a greater risk of a high baPWV, both as a continuous variable [a 1-SD difference; odds ratio (OR), 0.70; 95% confidence interval (CI), 0.54-0.90; P = 0.005] and when categorized in tertiles (the highest vs. the lowest tertile; OR, 0.49; 95% CI, 0.28-0.85; P = 0.011) in women but not in men. The relationship remained significant even after adjusting for retinopathy and nephropathy. CONCLUSIONS: Low TB levels were significantly associated with arterial stiffness in Korean women with type 2 diabetes. Our data suggested that bilirubin may protect against macrovascular disease in diabetic women.


Subject(s)
Arteries/physiopathology , Bilirubin/blood , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/physiopathology , Vascular Stiffness/physiology , Ankle/physiology , Ankle Brachial Index/methods , Asian People , Blood Flow Velocity/physiology , Cardiovascular Diseases/blood , Cardiovascular Diseases/physiopathology , Cholesterol, HDL/blood , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pulsatile Flow/physiology , Pulse Wave Analysis/methods , Risk Factors
7.
Int J Endocrinol ; 2014: 104318, 2014.
Article in English | MEDLINE | ID: mdl-24872812

ABSTRACT

We investigated whether thyroid function could identify obesity phenotype in euthyroid subjects. A cross-sectional analysis was performed among nondiabetic, euthyroid subjects. We stratified subjects into four groups by BMI and insulin resistance (IR). Of 6241 subjects, 33.8% were overweight or obese (OW/OB) and 66.2% were normal weight (NW). Free thyroxine (FT4) levels were negatively associated with body mass index, waist circumference, triglyceride, c-reactive protein, and HOMA-IR and positively with high-density lipoprotein cholesterol in both genders. In multivariate regression analysis, FT4 level, a continuous measurement, was negatively correlated with HOMA-IR (ß = -0.155, P < 0.001 in men; ß = -0.175, P < 0.001 in women). After adjustment for age, sex, metabolic, and life style factors, subjects in the lowest FT4 quartile had an odds ratio (OR) for IR of 1.99 (95% confidence interval 1.61-2.46), as compared to those in the highest quartile. The association between low FT4 and IR remained significant in both NW and OW/OB subgroups. In conclusion, low normal FT4 levels were independently related to IR in NW and OW/OB euthyroid subjects. Further studies are needed to investigate the mechanisms by which low FT4 levels are linked to high IR in euthyroid ranges.

8.
Head Neck ; 36(12): E131-5, 2014 Dec.
Article in English | MEDLINE | ID: mdl-24599702

ABSTRACT

BACKGROUND: Recent advances in genetics revealed that 25% to 30% of head and neck paragangliomas (PGLs) are inherited tumors associated with germline mutation, mainly in the succinate dehydrogenase (SDH) gene. METHODS: DNA was isolated from whole blood and polymerase chain reaction (PCR) products were sequenced with an ABI3730 × 1 Genetic Analyzer. RESULTS: A 30-year-old Korean woman underwent resection of a carotid PGL. Fourteen years later, she was readmitted for a cervical mass. (18) F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT revealed a hot spot in the adrenal gland, besides the carotid mass. Surgical pathology confirmed recurrence of the carotid PGL and a concomitant pheochromocytoma. Genetic analysis revealed SDHD c.119del T (p.I40TfsX46) mutation. One daughter has been identified as a carrier. CONCLUSION: We found a novel SDHD mutation from a Korean family that shows similar clinical features to those in other SDHD mutations, mostly from Western countries. Further studies are needed to determine whether similar genotype-phenotype correlations exist in the Asian patients with familial PGLs.


Subject(s)
Adrenal Gland Neoplasms/genetics , Carotid Body Tumor/genetics , Germ-Line Mutation/genetics , Neoplasms, Multiple Primary/genetics , Pheochromocytoma/genetics , Succinate Dehydrogenase/genetics , Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/therapy , Adult , Carotid Body Tumor/diagnosis , Carotid Body Tumor/therapy , Female , Humans , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/genetics , Neoplasm Recurrence, Local/therapy , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Multiple Primary/therapy , Pheochromocytoma/diagnosis , Pheochromocytoma/therapy
9.
Hormones (Athens) ; 12(3): 461-5, 2013.
Article in English | MEDLINE | ID: mdl-24121388

ABSTRACT

A diagnosis of central hypothyroidism (CH) can be missed easily or delayed without a high index of suspicion due to normal or slightly altered thyroid stimulating hormone (TSH) levels during the initial screening test for thyroid dysfunction. A correct diagnosis of CH is very important for safely treating patients. Specifically, doctors must ensure a proper evaluation of combined adrenal insufficiency to prevent a fatal adrenal crisis. Here we report a case of CH combined with secondary adrenal insufficiency in a 42-year-old woman with Dyke-Davidoff-Masson syndrome, which is a rare neurological disease.


Subject(s)
Adrenal Insufficiency/diagnosis , Hypothyroidism/diagnosis , Adult , Child , Female , Humans , Hypothalamic Diseases/complications , Infant , Meningitis/complications , Seizures/etiology
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