Emotional functions in transsexuals after the first step in physical transformation.

Transsexuals have to face multiple medical, social and bureaucratic problems. These problems are not only encountered before the transformation, but also during and after medical procedures. In the search for improvement of transsexual individuals' quality of life during therapy, it seems desirable to supplement hormonal treatments with psychological explorations. This study was conducted with the aim of defining emotional conditions and included 28 transsexual female-to-male (F/M) patients and two gender-divided control groups (males and females) of similar age. The following psychometric scales were used: CECS (Courtauld Emotional Control Scale constructed by M. Watson and S. Greer in the Polish Adaptation by Z. Juczynski), ISCL (the Polish Adaptation of the State-Trait Anxiety Inventory for Adults by T. Sosnowski), and GSES (the Polish Adaptation of the R. Schwarzer, M. Jerusalem Generalized Self-Efficacy Scaleby Z. Juczynski and K. Wrzesniewski). Transsexual F/M patients appeared very similar to males in the male control group in terms of their subjective selfefficacy and state-trait anxiety, while their subjective belief of anxiety and fear control was more comparable to that of the female controls. It was also found to be statistically significantly lower than in the male controls.

Radioiodine therapy in patients with type II amiodarone-induced thyrotoxicosis.

INTRODUCTION: The treatment of amiodarone-induced thyrotoxicosis (AIT) still remains a clinical challenge, requiring the cooperation of both endocrinologists and cardiologists. Unfortunately, even today AIT is related to significantly increased mortality. OBJECTIVES: The aim of this study was to compare the efficacy of radioidine therapy for type II AIT in 2 groups of patients: with high or normal radioiodine uptake and treated by amiodarone (AM) in the past (AM- group) and with low radioiodine uptake and currently treated with AM (AM+ group). PATIENTS AND METHODS: The AM- group included 57 patients and the AM+ group, 49. All patients received iodine-131 at a dose of 22mCi~800. Patient data were collected for over 2 years. RESULTS: After radioiodine administration, serum thyroid-stimulating hormone levels in the AM- group and AM+ group were 0.0 ±0.0 and 0.0 ±0.0, respectively, at 1 month; 1.2 ±3.3 and 0.6 ±1.2, respectively, at 12 months; and 4.2 ±3.6 and 1.9 ±0.8, respectively, at 2 years. All differences between the groups were statistically significant (P <0.0001). Free triiodothyronine and thyroxine levels were significantly higher in the AM+ group compared with the AM- group. During follow-up, death occurred in 22 patients in the AM+ group and 6 patients in the AM- group. CONCLUSIONS: Radioiodine treatment is a safe and effective therapeutic modality for patients with type II AIT despite low radioiodine uptake, especially for patients with contraindications to other types of treatment (eg, thyroidectomy). Moreover, since thyrotoxicosis in patients with AIT is a significant risk factor for increased mortality, and since there are no alternative antiarrythmic treatments, radioiodine administration seems to be the only effective therapeutic modality.

Differences in the psychological and hormonal presentation of lean and obese patients with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders found in women of reproductive age. Differences in hormonal and metabolic profiles are observed in groups of patients with normal and elevated BMI. Cause of disturbances observed in the two groups of patients with PCOS is analyzed. The aim of the study is to assess whether psychological parameters of lean and obese patients with PCOS are comparably significantly different and whether there is a correlation between these characteristics and the concentration of various hormones. PARTICIPANTS AND PROCEDURES: The study consisted of 20 patients with diagnosed polycystic ovary syndrome and 20 healthy women of similar age. Both groups were stratified according to BMI. Specific psychological parameters and hormones were estimated in all patients. RESULTS: In our study, we found that patients with BMI <25 represented personality traits associated with lower resistance to stress. We also observed significantly higher ACTH levels in the same group as compared to patients with BMI >25. A correlation between plasma ghrelin and the severity of anxiety experienced by test subjects was also observed. CONCLUSION: The type of personality and emotional disorders in lean PCOS patients may lead to the activation of the hypothalamic-pituitary-adrenal (HPA) axis and disturbences in hypothalamic-pituitary-ovary (HPO) axis. The results suggest participation of primary hypothalamic dysfunction in the pathogenesis of PCOS in patients with specific fenotype. Ghrelin is a hormone that may affect the symptoms of PCOS in lean patients. Psychological therapy should be considered as a permanent element in the therapeutic plan provided to PCOS patients.

Medical errors - not only patients' problem.

INTRODUCTION: Medical error is often a traumatic experience not only for patients but also for doctors. However, patients as victims get much more publicity than those responsible for actual errors. The authors of the study conducted research to learn about Polish doctors' opinions on and reactions to medical errors and how they affect their further professional activity and psychological status. The aim of this study was to evaluate the impact of involvement in medical errors of doctors of different specialties and different age. MATERIAL AND METHODS: The research was conducted in a group of 100 doctors of different specialties. Respondents anonymously completed an experimental survey comprising 6 groups of multiple choice questions concerning such issues as awareness of the nature of medical error, legal liability of the perpetrator, consequences of medical error for further professional activity, the function of the Patients' Rights Representative and consequences of publishing the problem. RESULTS: The results indicate many negative effects of medical errors on physicians, such as common fear of making an error (82%), increased caution (52%), disadvantageous security measures while performing one's duties (57%), worsening of doctor-patient relations (67%), loss of social trust (62%) and increased treatment costs (40%). Forty five percent of the surveyed doctors declared that patients need the Patients' Rights Representative and 39% claimed it does not affect their work. CONCLUSIONS: Given the significant burden on physicians' health, well-being and performance associated with medical errors, health care institutions should take this into account and provide physicians with formal systems of support.

[The etiology of Graves' disease--current state of knowledge]. / Etiologia choroby Gravesa--aktualny stan wiedzy.

Graves' disease (GD) is an autoimmune thyroid disease of unknown etiology. Recently, it is assumed that the occurrence of GD co-existence with endogenous factors (genetic and interthyroid) and exogenous (environmental). Autoantibodies against the TSHR are a key element leading to the occurrence of autoimmune thyroid disease. TSHR stimulating antibodies dominate and lead to the development of hyperthyroidism. Among the environmental factors which directly affecting the defect-suppressor T cells can be calculated: infections, smoking, stress, excessive iodine intake, certain medications, therapy with radioiodine. Scientific reports in recent years allow more and better understand the mechanisms leading to the development CD at the molecular level. Linked to this is the hope of creating new treatments and prevention strategies.

[Effect of amiodarone on the thyroid function and safety of the therapy--what's new]. / Wplyw amiodaronu na funkcje tarczycy a bezpieczenstwo terapii--co nowego?

This paper presents the current state of knowledge on the effects of amiodarone (AM) on the thyroid gland function, including the question of epidemiology, pathogenesis and prognostic factors. Of all the antiarrhythmic drugs hitherto used, AM has the most adverse effects on the thyroid gland. In patients receiving AM, it may lead to a development of a full- symptomatic hyperthyroidism (AIT-Amiodarone-induced thyrotoxicosis) and hypothyroidism (AIH - Amiodarone-induced hypothyroidism). The time from the start of the treatment of AM to the onset of symptoms of thyrotoxicosis is varied and amounts approximately to 3 years. The AIT may develop up to 2 years after the cessation of the AM treatment because of the accumulation of the drug and its metabolites in the body. The AIT treatment is complicated and often requires multiple treatment methods, such as: antithyroid drugs, glucocorticoids, iopanic acid, plasmapheresis, thyroidectomy and radioiodine. AIH is associated with the Wolff-Chaikoffa phenomenon. Thyroid hormone synthesis is impaired by blocking iodine organification. Hypothyroidism can also arise and be exacerbated by the output of thyroid disease - autoimmune diseases. The paper also devotes much attention to the relationship between smoking and the toxicity of AM. The components of tobacco smoke increase the activity of enzymes involved in the metabolism of AM. Increased concentrations of desetyloamiodarone in lung tissue may be responsible for the increased toxicity in the lungs in smokers. In addition, the paper presents a new antiarrhythmic drug - dronedarone (DN), an attractive alternative, but, because of the high risk of heart failure, stroke and death from cardiovascular disease, with a limited potential.

[The problem of cigarette smoking in the workplace]. / Problem palenia tytoniu w miejscu pracy.

European countries take various actions to reduce smoking, including an introduction of appropriate legislation. In Poland, the main piece of legislation is the Act of 9 November 1995 on protection of health against the consequences of tobacco use and their products. Among the places where smoking is prohibited, the document mentions all indoor areas of workplaces, among others. At the same time, the law allows smoking in designated areas. However, since the introduction of an amendment effected more than a year ago, the employer is not legally obliged to create a smoking room. Furthermore, the employer has been empowered to impose even an outright ban on smoking in indoor workplaces and on the company premises. In the event of a breach of this prohibition by the employee, a fine or a penalty for breach of order may be imposed. It is also admissible to offer an incentive for non-smoking employees in the form of bonuses for greater efficiency on the part of workers.

Smoking and endocrine disorders.

Patients suffering from endocrine disorders, which affect the function of central nervous system, need a special care and approach in the process of smoking cessation. The process of informing about negative effects of smoking addiction, including potential aggravation of the disease, has to be specially tailored to the need of the patient and the type of the disease. The informing physician should also serve as a model by not smoking and try to confirm the patient about positive benefits of quitting smoking.

Emotions and features of temperament in patients with Addison's disease.

INTRODUCTION: Patients with Addison's disease experience many somatic and psychic changes, which decrease their quality of life. The aim of the study was to evaluate the "psychological equipment" of these patients to cope with stress connected with this chronic disease and the challenge of constant treatment. MATERIAL AND METHODS: Fifteen patients (13 female, 2 male) were included in the study. Standard psychological tests were used to assess anxiety, temperament, depression, and emotional intelligence. RESULTS: The results show that patients with Addison's disease have not only increased levels of anxiety and fear, and over-reaction to stimuli, but decreased performance efficiency and need for social contact as well. Such psychological characteristics may result in difficulties in doctor-patient communication, aggravation of patients' feelings, limitation of patients' involvement in therapy, and, finally, a decrease the effectiveness of therapy. CONCLUSIONS: The temperamental characteristics and personal traits of patients with Addison's disease seem not to be useful in stressful events, and psychological support can be helpful in the effective therapy of these patients. (Pol J Endocrinol 2010; 61 (1): 90-92).

Smoking and thyroid diseases--what is new?

Cigarette smoking has multiple effects on the thyroid gland, which is associated with important clinical implications such as increased risk and severity of autoimmune thyroid disorders, especially Graves' ophthalmopathy. The influence of cigarette smoking is mainly associated with the pharmacological action of nicotine and also with toxins such as thiocyanate. The present review of relevant literature concentrates on the effect of smoking on the Graves' ophthalmopathy and other autoimmune thyroid disorders (such as Hashimoto's disease). The effect of passive smoking on children and the influence of smoking on the fetus is also shown. In contrast, the protective influence of cigarette smoke on thyroid cancer is also widely observed.

Psychological and legal aspects of quitting smoking in thyroid patients.

Finally, our study describes observations related to psychological and legal aspects of smoking quitting in Poland. It has been noticed that quitting of smoking needs individual therapeutic approach. The intensity and period of addict has to be consider the same as coexistence of somatic illness. The role of neurotic personality in connection with psychosomatic diseases and wide adaptation of procedure to patient's condition has been also underlined.

Subclinical hyperthyroid patients' knowledge about radioiodine therapy--the key role of medical information.

OBJECTIVES: Many patients with a chronic disease are dissatisfied with the information they are given. A brief questionnaire completed by patients would assist health professionals to identify areas of information needed to be provided, tailored to the patient's mental condition. AIM: The aim of our study was to assess how often thyroid patients report being adequately informed about iodine treatment in connection with their real need thereof, emotional state and acceptance of the disease. METHODS: One hundred outpatients who had presented subclinical hyperthyroidism "[19 men (19%), 81 women (81%); mean (SD±) age 53±14,range 18-77 yr ] treated with radioiodine (RAI) responded to an Experimental Questionnaire, 54 of them answered to AIS, HADS-M and Beck Inventory measuring their acceptance of the illness and depressive symptoms, 37 of them answered the Patient Request Form (PRF). RESULTS: The obtained results indicated that about 50% of patients treated with 131I therapy did not receive suitable information about their treatment. Neither written information prepared by the specialist, nor verbal information given by physicians were adequate for specific problems of study group. The examined patients presented with a comparable intensity of three distinct types of requests: for explanation and reassurance, for emotional support, and for investigation and treatment. The acceptance of their disease was mediocre for most of the study group. CONCLUSION: We conclude that the reported lack of satisfaction with medical information in study group was associated with depressive symptoms influencing cognitive efficiency, patients' great need of emotional and cognitive support, influencing the acceptance of their disease, and social prejudice to radioiodine (as a method of treatment), worrying them additionally. All thyroid patients even these with subclinical symptoms of hyperthyroidism should be treated with specific attention by physicians, especially during information process.

Smoking and thyroid disease--review of literature.

Smoking has multiple effects on the thyroid gland, which is associated with important clinical implications such as the increased risk and severity of autoimmune thyroid disorders especially Graves disease. The influence of tobacco smoking is mainly associated with pharmacological action of nicotine and also with toxins such as thiocyanate. The present review of the relevant literature concentrates on the effect of smoking on the Graves ophthalmopathy and autoimmune thyroid disorders such as Hashimoto disease. The effect of passive smoking on children and the influence of smoking on foetus are also shown. In contrast, the protective influence of tobacco on the thyroid cancer is also widely noticed. Finally, our study describes observations related to the psychological and legal aspects of smoking.

[Psychological view of thyroid cancer and in hyperthyroid Graves' patients - comparative exploration]. / Porównawcze badania psychologiczne chorych z rakiem tarczycy oraz z nadczynnoscia tarczycy w przebiegu choroby Gravesa-Basedowa.

INTRODUCTION: The aim of study was the evaluation of association between psychometric factors in patients with thyroid cancer and in Graves' hyperthyroid patients. MATERIAL AND METHODS: We examined 50 patients with differentiated thyroid cancer, 42 females (84.75%), 8 males aged from 32 to 64 yr. (x +/- SD: 43 +/- 8.17 yr.) and 50 hyperthyroid patients, 45 (90%) females and 5 (10%) males corresponding aged. We used the following methods: the EAS Temperament Survey (EASD) in addition for adults, EPQ Eysenck Personality Questionnaire, Polish Abbreviated Form of the MMPI (DKO-74) and Beck's Depression Scale. We compared the scores of thyroid cancer patients and hyperthyroid patients. RESULTS: We have interpreted obtained results in both groups as similarly in: mild sense depression, high emotional control, high social dependence, ambiverssion, mild level of emotional mental balance. CONCLUSION: Results of our explorations appears great psychological similarity between differentiated thyroid patients and hyperthyroid patients.

[The level of cotinine - marker of tobacco smoking, in patients with hyperthyroidism]. / Stezenie kotyniny - markera nikotynizmu - u pacjentów z nadczynnoscia tarczycy.

INTRODUCTION: Orbitopathy associated with Graves' disease TAO (thyroid associated orbitopathy) is likewise connected with environmental factors including tobacco smoking. Tobacco smoking increases the risk of ophthalmologic pathology and leads to the orbital tissue damage due to the hypoxia. The aim of the study was to correlate the concentration of urinecotinine (marker of tobacco smoking) in Graves' disease patients with TAO with points received on the Fagerström questionnaire. MATERIALS AND METHODS: Thirty women with different degree of exacerbation of TAO in Graves' disease (34.28 +/- 12.04 yr.) were examined. As control we used 29 women with Graves' disease without TAO (29.35 +/- 12.33 yr.). The diagnosis was established according to level of TSH and level of thyrotropin receptor antibodies (TRAb). Measure of tobacco smoking or exposure to second hand tobacco smoke ETS (environmental tobacco smoke) carried out according to the Fagerström questionnaire, and measured cotinine level (the major metabolite of nicotine in urine). The level of clinical ophtalmopathy was measured according to the CAS (Clinical Activity Score) scale and degree of progression of TAO according to American Thyroid Association (NOSPECS scale). Additionally increase of exophthalmus was measured using the Hertl's exophthalmometer. RESULTS: In the group with TAO: 19 (63.3%) persons had mild exophthalmos (according to CAS), medium in 13 (43.3%) patients, and pronounced exophthalmous in 10 (33%) patients. There was statistically significant difference in the level of TRAb (18.4 +/- 8.2 vs. 5.1 +/- 3.4 IU/l; p < 0.0001) between TAO and controls. There was no correlation between TSH (0.6 +/- 0.02 vs. 0.4 +/- 0.04; p = 0.18) and fT4 (38.8 +/- 29.3 vs. 26.1 +/- 17.3; p = 0.026) in both analyzed groups. Smokers and non-smokers with TAO had no statistically significant in level of TRAb (Mann-Whitney test p = 0.16). No correlation was found between smoking tobacco (cotinine level) and the level of TRAb in patients with TAO (Pearson r = 0.28 p = 0.58). There was a statistically significant difference between the level of urine cotinine in smoking patients with TAO in the highest level of ophthalmopathy exacerbation (> 24 mm; > or = 4 points according to CAS) and those without TAO (Mann-Whitney's test p = 0.04). CONCLUSIONS: 1. In patients with Graves' disease with TAO the highest score of tobacco smoking has been found in persons with the highest ophthalmopathy exacerbation. 2. Estimation of cotinine concentration in urine is the most objective and useful method of tobacco smoking.

[Depression and anxiety in patients with adrenal tumor incidentally found on abdominal imaging performed for other indications]. / Depresja i lek u chorych z guzem nadnercza wykrytym podczas badan prowadzonych z innych wskazan.

OBJECTIVE: The aim of this study was to assess the level of anxiety and depression in patients with non-secreting adrenal incidentaloma. MATERIAL AND METHODS: The study group comprised 26 patients (16 women, 10 men, mean age 45, SD 11 yrs). The Polish version of the State-Trait Anxiety Inventory was used to assess anxiety level, and the Beck Depression Inventory was used to measure depression symptoms. RESULTS: The anxiety level was increased (median: 45.6 for state, and 46.5 for trait), and mild depression was present, with 13.5 scores on Beck's scale. CONCLUSIONS: Adrenal incidentaloma is associated with increased anxiety and depression.

[Tobacco smoking in patients with hyperthyroidism]. / Nikotynizm u chorych z nadczynnoscia tarczycy.

The objective of this study was to determine the impact of cigarette smoking in hyperthyroidism patients. The study group included patients with Graves-Basedow disease (GB): n = 317 (32.9%), patients with Graves' ophthalmopathy (GO): n = 108 (11.2%), patients with toxic nodular goiter (TNG) n = 511 (53%) and 28 (2.9%) patients with toxic adenoma (TA). Evaluation of tabacco smoking and exposure to environmental tobacco smoke (ETS) was performed on the base of questionnaire acording to Fagerström test. The comparison of GO and GB indicate increased tabacco smoking in GO (OR = 0.36; 95%CI: 0.22-0.59). The frequencies of tacacco smoking displayed significantly increased in GB and TNG patients (OR=0.39; 95%CI: 0.28-0.56). Further analys of patients with GO and TA presented statistcal significance in group of smoking and non-smoking (OR=0.26; 95%CI: 0,073-0,95). In other cases we didn't found a significant influence of tobacco smoking on thyroid disease. The effect of smoking was more pronounced in Graves' patients (particulary in the patients with GO) than in other thyroid patients. Smoking among patients with thyroid disease (GO and GB disease) is associated with developing of anxiety and fright, depression and problems with social relations sphere.

[Urinary cotinine in patients with hyperthyroidism]. / Kotynina w moczu u pacjentów z nadczynnoscia tarczycy.

The aim of our study was an analysis of cotynine, the main nicotine metabolite in the urine among hyperthyroid patients. The study group included 39 females and 4 males. The mean age was 35.59+/-14.22 yrs. (range: 18-73 yrs.; median: 32 yrs) among hyperthyroid patients suffering from: Graves-Basedow disease (GB), Graves' Ophtalmopathy (GO) and toxic nodular goiter (TNG). To evaluate the nicotine smoking intensity and ETS Environmental Tobacco Smoke, the urine analysis of cotynine level were performed. According to the statistical analysis using the Mann-Whitney test, the statistically significant difference between the level of cotynine among smokers suffering from GO and Graves-Basedow disease was revealed (p = 0.03). Similar results were obtained among the GO and TNG (p=0.02) using t-Student test with Welsch correction. To compare, there was no stastistically significant difference between the GB and TNG series (p=0.4). In the group of smoking patients with GO we found out incresed level of urine cotinine than in smoking patients with GB and TNG. We didn't found differences between GB and TNG in depends on an urine analysis of cotynine level.

[Quality of life in Graves' ophthalmopathy (continuation of research)]. / Jakosc zycia pacjentów z orbitopatia w przebiegu choroby Graves-Basedowa (kontynuacja badán).

The previous research concerning "quality of life" in Graves patients with ophthalmopathy appeared to be a very important direction in health promotion. This drives us to continue enhancement of the quality of life in this group. The biggest deficiency we found to be in the life sphere activity and professional activity, interpersonal relations and positive self-estimation. We analyzed 48 women with Graves' Ophthalmopathy from 32 to 64 yr., average 43 SD 8,17. We used the following experimental methods: Quality of Life Experimental Inventory, Temperament Inventory (Eas-D). In Addition for Adults, STAI Questionnaire (State-Trait Anxiety Inventory) and Beck's Depression Scale. We interpreted obtained results as: 1. anxiety tendency, 2. subjective decreased mood, 3. decreased social contact tendency.

[Smoking among thyroid patients]. / Palenie wsród pacjentów tyreologicznych.

UNLABELLED: The effects of cigarette smoking on the thyroid disease (Graves disease, toxic nodular goiter, toxic adenoma) have been studied for years. However, the effect of smoking on thyroid function is still controversial. OBJECTIVES: To determine the impact of cigarette smoking on the development of above-mentioned thyroid disease. PATIENTS METHODS: Study of 405 individuals with different thyroid disease. Information on thyroid disease and smoking habits was gathered by Fagerström questionnaire, and the patients' endocrinologist or general practitioner verified the diagnosis. RESULTS: The effect of smoking was more pronounced in Graves' patients than in other thyroid patients. We found out significant number of patients with toxic nodular goiter. CONCLUSIONS: Smoking is associated with an developing clinically thyroid disease--especially Graves disease. We also suggest the connection between psychological traits and smoking in this group of patients, corresponding with our previous examinations.