Thyrotoxicosis following SARS-COV-2 vaccination: a case series and discussion.

AIM: To describe a case series of thyrotoxicosis likely triggered by SARS-CoV-2 vaccination and to warn physicians about this potential correlation. To report clinical, laboratory and imaging findings and provide further information that goes in line with the underlying mechanisms. METHODS: Single-center case series based on all the information collected in the hospital medical records, as well as the temporal sequence between the onset of symptoms and COVID-19 vaccination. RESULTS: We report 8 cases with thyrotoxicosis after SARS-CoV-2 vaccination. 4 cases of Graves' disease (GD), 2 cases of subacute painful thyroiditis (SAT), 1 case of concurrent GD and SAT and 1 case of atypical subacute thyroiditis. Five patients received BNT162b2 mRNA vaccine, 3 patients 1273 mRNA vaccine. The onset of symptoms following vaccination ranged from 10 to 14 days in six of eight patients and from 7 to 8 weeks in two patients. CONCLUSIONS: Several hypotheses have been proposed to explain the potential correlation between SARS-CoV-2 vaccination and thyrotoxicosis, including immune system hyper-stimulation, molecular mimicry and Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). We should pay greater attention to thyroid disorders in patients receiving vaccine against SARS-CoV-2.

Management of malignant insulinoma

AIM: Malignant insulinoma is an infrequent functional endocrine tumor of the pancreas. Adequate therapy is a demanding challenge for oncologists and endocrinologists. OBJECTIVE: To evaluate the results of multidisciplinary management of malignant insulinoma. MATERIALS AND METHODS: Retrospective review of patients with malignant insulinoma treated from 1995 to 2011. RESULTS: Seven patients with malignant insulinoma were included: four males and three females; median age was 61.8 years (range 37-78). Six tumors were sporadic and one was diagnosed in a patient with a type 1 multiple endocrine neoplasia (MEN-1). Surgery was performed in six cases and one patient was considered unresectable. Hypoglycemias persisted in all cases and somatostatin analogs, glucocorticoids and diazoxide were used. Two patients received everolimus. Other techniques were chemoembolization and internal radiation therapy with yttrium-90. Successful liver transplant was done in the patient with MEN-1. CONCLUSION: hypoglycemia management is complex and requires multiple therapies. Further evaluations will be necessary to determine the best treatment (AU)

Management of malignant insulinoma.

AIM: Malignant insulinoma is an infrequent functional endocrine tumor of the pancreas. Adequate therapy is a demanding challenge for oncologists and endocrinologists. OBJECTIVE: To evaluate the results of multidisciplinary management of malignant insulinoma. MATERIALS AND METHODS: Retrospective review of patients with malignant insulinoma treated from 1995 to 2011. RESULTS: Seven patients with malignant insulinoma were included: four males and three females; median age was 61.8 years (range 37-78). Six tumors were sporadic and one was diagnosed in a patient with a type 1 multiple endocrine neoplasia (MEN-1). Surgery was performed in six cases and one patient was considered unresectable. Hypoglycemias persisted in all cases and somatostatin analogs, glucocorticoids and diazoxide were used. Two patients received everolimus. Other techniques were chemoembolization and internal radiation therapy with yttrium-90. Successful liver transplant was done in the patient with MEN-1. CONCLUSION: Hypoglycemia management is complex and requires multiple therapies. Further evaluations will be necessary to determine the best treatment.

Implementación de la estrategia basal plus en la práctica clínica / Basal plus strategy implementation in clinical practice

El tratamiento con insulina puede ser necesario en la diabetes tipo 2, dado que muchos pacientes, con el tiempo, no consiguen alcanzar o mantener los objetivos glucémicos para prevenir las complicaciones crónicas asociadas a la hiperglucemia sostenida. Inicialmente, la adición de insulina basal al tratamiento previo con agentes orales suele ser la pauta más habitual. Esta estrategia se basa en el control óptimo de la glucemia en ayunas. Sin embargo, un porcentaje significativo de pacientes no consiguen alcanzar o mantener el objetivo de HbA1c <=7%, debido a que presentan elevaciones excesivas de la glucemia posprandial. En consecuencia, el paso siguiente en la intensificación deltratamiento podría ser la adición de una dosis única de insulina prandial antes de la comida que provoca la mayor excursión posprandial (estrategia basal plus), manteniendo el tratamiento previo con insulina basal y agentes orales. Este régimen ha demostrado ser sencillo, eficaz y adecuado para un gran número de pacientes. Además, en caso necesario, facilita la introducción progresiva de inyecciones adicionales de insulina prandial hasta una estrategia bolo basal. En este artículo se resumen las recomendaciones de un grupo de trabajo multidisciplinar para una adecuada implementación de la estrategia basal plus en la práctica clínica habitual (AU)

Insulin treatment may be necessary in type 2 diabetes, because many patients are not able overthe time to achieve or maintain glycemic targets to prevent chronic complications associated to sustained hyperglycemia. Initially, addition of basal insulin to previous treatment with oral agentsis the most commonly used regimen. This strategy is based on optimal control of fasting plasma glucose. However, a significant proportion of patients does not achieve or maintain HbA1c target <=7%, because they show excessive postprandial glucose values. Therefore, the next step for intensification of treatment might be the addition of a single dose of prandial insulin before the main meal, which is associated with the greatest postprandial glucose excursion (basal plus strategy), maintaining previous treatment with basal insulin and oral agents. This regimen has demonstrated to be easy to use, effective and appropriate for many patients. Furthermore, if necessary, it makes easier progressive introduction of additional injections of prandial insulin until the basal bolus strategy. In this manuscript, recommendations from a multidisciplinary working group are summarized for an adequate implementation of the basal plus strategy in the routine clinical practice (AU)

Bocio endémico en la Comunidad Valenciana / Endemic goiter in the autonomous community of Valencia (Spain)

No disponible

[Endemic goiter and iodine deficiency: are they still a reality in Spain]. / Bocio endémico y déficit de yodo: 'sigue siendo una realidad en España?

OBJECTIVE: To estimate the prevalence of goiter and iodine deficiency in a health district in the Autonomous Community of Valencia, given the absence of data in this region of Spain. MATERIAL AND METHODS: We conducted a descriptive, epidemiologic, cross-sectional study, stratified by age and sex, in four interior regions of the province of Valencia. We selected students aged from 6 to 14 years old in 20 centers. Thyroid examination was performed by means of palpation and inspection (goiter > or = 0B). Urinary iodine excretion was analyzed in a routine urine sample. Sociodemographic and anthropometric data, as well as nutritional iodine status, were recorded in a standardized survey. In children with goiter, thyroid-stimulating hormone (TSH), free T4, and antithyroid antibodies were determined. RESULTS: We studied 928 children (478 boys and 450 girls). The prevalence of goiter was 33.7 % (95 % CI: 30.7-36.9 %). There were no significant differences in the prevalence of goiter by age or sex, but an inverse correlation was detected between the prevalence of goiter and parental socioeconomic position. Mean urinary iodine excretion was 155 .g/l, with no significant correlation with the prevalence of goiter. In children with goiter, 13 had positive antithyroid antibodies, 18 had high TSH (subclinical hypothyroidism), and one had suppressed TSH (subclinical hyperthyroidism). CONCLUSIONS: There is endemic goiter in the region studied. Urinary iodine levels were in the normal range and could be interpreted as indicating a transition phase to an improvement in iodine deficiency. Autoimmune diseases would only explain 4 % of cases of goiter.

Bocio endémico y déficit de yodo: ¿sigue siendo una realidad en España? / Endemic goiter and iodine deficiency: are they still a reality in Spain?

Objetivo Determinar la prevalencia de bocio y déficit de yodo en comarcas del interior de la Comunidad Valenciana, dada la ausencia de datos en esta comunidad autónoma. Material y métodos Se trata de un estudio epidemiológico, descriptivo, transversal, estratificado por sexo y edad en cuatro comarcas del interior de la provincia de Valencia. Se estudiaron escolares de 6 a 14 años en 20 centros. La exploración tiroidea se realizó mediante palpación e inspección (bocio ≥ 0B). Se determinó la yoduria en una muestra de orina casual. Se recogieron datos de filiación, antropométricos, y una encuesta sobre el estado nutricional de yodo. En niños con bocio se determinó la hormona tiroestimulante (TSH), la tiroxina libre (T4L) y los anticuerpos antitiroideos. Resultados Se estudiaron 928 niños (478 varones y 450 mujeres). La prevalencia de bocio fue de 33,7 % (IC 95 %: 30,7-36,9). No se hallaron diferencias significativas por edad ni por sexo, aunque sí una correlación inversamente proporcional entre prevalencia de bocio y nivel instrucción paternos. La mediana de yoduria fue 155 μg/l, sin observar una correlación significativa con la prevalencia de bocio. Entre los niños con bocio 13 presentaron los anticuerpos antitiroideos positivos, 18 la TSH elevada (hipotiroidismo subclínico) y uno la TSH suprimida (hipertiroidismo subclínico). Conclusiones Existe una endemia bociosa en las comarcas estudiadas de la Comunidad Valenciana. Los valores de yodurias normales podrían interpretarse como una fase de transición hacia una mejoría del déficit de yodo en esta zona. La patología autoinmune explicaría sólo un 4 % de bocios

Objective To estimate the prevalence of goiter and iodine deficiency in a health district in the Autonomous Community of Valencia, given the absence of data in this region of Spain. Material and methods We conducted a descriptive, epidemiologic, cross-sectional study, stratified by age and sex, in four interior regions of the province of Valencia. We selected students aged from 6 to 14 years old in 20 centers. Thyroid examination was performed by means of palpation and inspection (goiter ≥ 0B). Urinary iodine excretion was analyzed in a routine urine sample. Sociodemographic and anthropometric data, as well as nutritional iodine status, were recorded in a standardized survey. In children with goiter, thyroid-stimulating hormone (TSH), free T4, and antithyroid antibodies were determined. Results We studied 928 children (478 boys and 450 girls). The prevalence of goiter was 33.7 % (95 % CI: 30.7-36.9 %). There were no significant differences in the prevalence of goiter by age or sex, but an inverse correlation was detected between the prevalence of goiter and parental socioeconomic position. Mean urinary iodine excretion was 155 μg/l, with no significant correlation with the prevalence of goiter. In children with goiter, 13 had positive antithyroid antibodies, 18 had high TSH (subclinical hypothyroidism), and one had suppressed TSH (subclinical hyperthyroidism). Conclusions There is endemic goiter in the region studied. Urinary iodine levels were in the normal range and could be interpreted as indicating a transition phase to an improvement in iodine deficiency. Autoimmune diseases would only explain 4 % of cases of goiter