Epidemiology, risk factors and prognosis of Interferon alpha induced thyroid disorders. A Prospective Clinical Study.

INTRODUCTION: Hepatitis C virus (HCV) infection is a worldwide problem and hepatitis, which is its natural unfavourable course, is still a challenge for hepatologist. At present, standards of treatment are changing from combined therapy with interferon alpha (IFN-α) and ribavirin to new antiviral drugs. The current classification divides interferon induced thyroid diseases (IITD) into two groups: autoimmune (Hashimoto disease, Graves disease, positive antithyroid autoantibodies in euthyroid patients) and non-autoimmune (destructive thyroiditis, non-autoimmune hypothyroidism). A common complication of cytokine therapy is the induction of antithyroid autoantibodies de novo without thyroid dysfunction. During therapeutic regimens combined with ribavirin, destructive thyroiditis with typical biphasic course is more common than in IFN-α monotherapy. Clinically, overt pathologies often have discrete symptoms, which cause diagnostic and therapeutic dilemmas. AIMS: The aim of this study was to estimate IITD occurrence, to find risk factors for IITD development. MATERIAL AND METHODS: The study group consisted of 66 patients treated for HCV infection. Before and during antiviral therapy, hormonal (TSH, fT4, fT3), immunological (thyroid autoantibodies), ultrasonographic and genetic (HLA-A2) parameters were evaluated. RESULTS: Hormonal disturbances were detected in 24.2% of patients; however, 43.9% of patients had positive thyroid autoantibodies (de novo) without hormonal imbalance. Multivariate analysis revealed the following: female sex, elevated TSH level, occurrence of anti-TPO autoantibodies (TPO-Ab), and increased blood velocity in thyroid arteries are risk factors for IITD development. IN CONCLUSION: Thyroid disorders are common during IFN-α therapy. Previous epidemiological data seem to be underestimated. Important risk factors for IITD development are: female sex, elevated serum TSH concentration (≥2.5 µU/mL), positive TPO-Ab and increased blood velocity in thyroid arteries.

Self-diagnosis of hyperparathyroidism during pregnancy resulting in parathyroidectomy and uncomplicated delivery.

Primary hyperparathyroidism is a condition with hypercalcemia and elevated parathyroid hormone (PTH). Typically, treating patients with such disease does not pose a problem for doctors, unless the patient is pregnant. Firstly, pregnancy may mask signs of hypercalcemia. Secondly, treatment should be applied with special care for immature fetus. If undiagnosed and untreated, it is life-threatening for the mother and the baby. The main cause of primary hyperparathyroidism is parathyroid adenoma, which should be removed surgically in second trimester. If the patient is monitored by a multidisciplinary team, the risk of mortality and pregnancy loss is reduced.

Hormonal activity in clinically silent adrenal incidentalomas.

INTRODUCTION: The rapid development of modern imaging techniques, has led to an increase in accidentally discovered adrenal masses without clinically apparent hormonal abnormalities. Such tumours have been termed "incidentalomas". The diagnostic work-up in patients with adrenal incidentalomas is aimed at the determination of hormonal activity of the tumour and identification of patients with potentially malignant tumours. The aim of our study was a retrospective analysis of selected clinical characteristics and hormonal studies in accidentally discovered adrenal tumours. MATERIAL AND METHODS: Fourty hundred sixty-three patients with serendipitously discovered adrenal masses, diagnosed and treated in the Department of Endocrinology and Internal Diseases, Medical University of Gdansk as well as in the affiliated Endocrinology Clinic between 1993 and October of 2009 were included in the analysis. Out of all patients, 245 were referred for adrenalectomy. RESULTS: We found that clinically "silent" tumours often demonstrate subclinical hormonal activity. In our report, increased 24-h urinary excretion of cortisol correlated positively with tumour size (p < 0.001). Moreover, a statistical relationship was demonstrated between tumour size and serum cortisol concentration assessed in the 1 mg dexamethasone suppression test (p < 0.001). Increased values of dehydroepiandrosterone/dehydroepiandrosterone sulphate were more often found in malignant than in benign tumours (p < 0.01). Urinary concentrations of 17-ketosteroids correlate positively with diagnosis of adrenocortical cancer (p = 0.02). CONCLUSIONS: We found that clinically "silent" tumours often demonstrate subclinical hormonal activity (subclinical Cushing syndrome, subclinical pheochromocytoma, low-symptomatic adrenocortical cancer).

From struma ovarii to Hashimoto disease--an unusual diagnosis of primary hypothyroidism: case report.

CAPSULE: Authors report a case of a 52-year-old woman after struma ovarii with chronic lymphocytic inflammation excision. Finally thyroxin treatment was started and patient's hypothyroidism symptoms diminished. CASE SUMMARY: Struma ovarii is a type of mature teratoma in which thyroid tissue forms the main component. In most cases struma ovarii is composed of normal thyroid tissue while lymphocytic thyroiditis in struma ovarii occurs very rarely. The authors report a case of a 52-year-old woman after ovarian tumor excision. In histopatholgical examination struma ovarii with chronic lymphocytic inflammation was diagnosed. Additional studies revealed a typical ultrasonographic picture of Hashimoto disease in the thyroid gland and an increased concentration of thyroglobulin antibodies. A final diagnosis of Hashimoto disease was confirmed. Initially, thyroid gland function was normal but 11 months after surgery, supplementation therapy with thyroxin was administered. In this case, an early diagnosis of Hashimoto disease resulted from excision of struma ovarii with chronic lymphocytic inflammation. It induced early thyroxin treatment and allowed to reduce hypothyroidism symptoms.

Homocysteine, folate, and cobalamin levels in hyperthyroid women before and after treatment.

INTRODUCTION: Hyperhomocysteinaemia is an independent risk factor for premature atherosclerotic vascular disease and venous thrombosis. Hypothyroidism is associated with mild hyperhomocysteinaemia. The aim of the present study was to assess plasma total homocysteine (tHcy) and its determinants (folate, cobalamin) in hyperthyroid patients before and after treatment. MATERIAL AND METHODS: Thirty hyperthyroid and thirty healthy premenopausal women were studied. The hyperthyroid patients were investigated in the untreated state and again after restoration of euthyroidism. The levels of homocysteine, folate, cobalamin, and thyroid stimulating hormone (TSH), free thyroxine (fT(4)), free triiodothyronine (fT(3)), and renal function were measured before and after treatment. RESULTS: In hyperthyroidism, tHcy was lower than in the control group. The serum level of folate was higher and serum cobalamin was lower in the hyperthyroid state. Following antithyroid drug therapy, tHcy significantly increased and folate decreased. The level of cobalamin remained unchanged. Univariate analysis in the hyperthyroid group indicated that tHcy significantly negatively correlated only with fT(3). CONCLUSIONS: Lower homocysteine levels in hyperthyroid state can be explained by the influence of thyroid hormone. High level of folate is only partially responsible for these changes.

[One-year follow-up of TSH level and thyroid volume in patients with bone marrow or peripheral blood hematopoietic stem cell transplantation following chemotherapy]. / Stezenie TSH oraz objetosc tarczycy u chorych w pierwszym roku po przeszczepieniu komórek hematopoetycznych szpiku lub krwi obwodowej po przygotowaniu chemioterapia.

UNLABELLED: Bone Hematopoietic Stem Cell Transplantation (HSCT) following high-dose chemo- and radiotherapy became treatment of choice in various numbers of hematological and hereditary or acquired immune disorders. Protocols preparing to allogenic transplantation have a few aims: eradication of neoplastic disease, suppression of defense system of recipient (reduction of transplant rejection), preparation of bone marrow microenvironment to implantation donor's cells. Chemotherapy is combined with acute side effects as nausea, vomiting, diarrhea, hair loss, mucositis, and hemorrhagic cystitis. Late toxic effects also appear, it require prolonged observation and care. Among them most common is dysfunction of thyroid and gonads in adults and growth inhibition in children. The aim of this study was prospective evaluation of thyroid function in adults with autologous and allogeneic BMT or HSCT following myeloablative chemotherapy. MATERIAL AND METHODS: 23 patients (16 females and 7 males) treated in Department of Hematology and Transplantology Medical University of Gdansk were included. Average age was 34.3 years with range from 17-50 years. Each patient had endocrinological interview, physical examination of thyroid, TSH level assessment and ultrasonographic thyroid volume measurement before HSCT Identical control examinations were performed in third and twenty month after transplantation. TSH level and thyroid volume were tested for significant differences before and after transplantation using paired t-tests. A P-value of < 0.05 was considered statistically significant. RESULTS: 12 months after HSCT following myeloablative chemotherapy we noted on average decrease in volume of thyroid from 17,5 ml to 13.5 ml (females to 9.7 ml). This difference was statistically significant with p = 0.002. Also 12 months after the procedure progressive rise in TSH level was noted from 2.0 mU/l to 3.2 mU/l. Nevertheless this tendency was not statistically significant with p = 0.08. CONCLUSIONS: We suggest control of TSH, fT4 level and thyroid ultrasound examination at least twice--before and 12 months after transplantation. Myeloablative chemotherapy before HSCT may cause early (after 3 months) hypothyroidism--it may last one year after procedure. In case of high TSH level we suggest individually adapted L-thyroxine replacement therapy.

[Side effects during interferon-alpha therapy of hepatitis C with special consideration of thyroid dysfunction]. / Powiklania leczenia interferonem alfa wirusowego zapalenia watroby typu C ze szczególnym uwzglednieniem zaburzen funkcji tarczycy.

Hepatitis C virus infection is a worldwide problem and its natural, unfavorable course is still a challenge for the hepatologist. The standard of treatment is combined therapy with interferon-alpha and ribavirin. This therapy is related to a wide spectrum of side effects that significantly reduce quality of life. Approximately 90% of patients suffer from at least one adverse effect; 15% will therefore have reduced drug dose and 5% will discontinue treatment. The most common acute side effects are flu-like symptoms and chronic effects are hematological, neuropsychiatric, and endocrinological (mainly the thyroid). The latest classification divides interferon-induced thyroid diseases into two groups: autoimmune (Hashimoto disease, Graves-Basedow disease, positive antithyroid autoantibodies in euthyroid patients) and non-autoimmune (destructive thyroiditis, non-autoimmune hypothyroidism). The most common complication of cytokine therapy is the induction of antithyroid autoantibodies de novo without thyroid dysfunction. It seems that destructive thyroiditis with typical biphasic course is more common in therapeutic regimens with ribavirin than in interferon-alpha monotherapy. Clinically overt pathologies very often have very discrete symptoms which cause diagnostic and therapeutic dilemmas. Interferon-induced thyroid disorders are usually mild and sometimes self-limiting; nevertheless, every overt thyroid disease requires endocrinological consultation and possible treatment. In this review the most important current information related to hepatitis C, interferon alpha and ribavirin therapy, and thyroid disorders is collected. A new classification of interferon-induced thyroid disease is proposed.

Ovarian thecoma with androgenic manifestations in a postmenopausal woman.

A 50-year-old woman, who presented with progressive androgenization, central obesity and severe hypertension, was initially suspected to have an adrenal virilizing tumor. Her serum testosterone level was in the male range (9.3-11.6 ng/ml) and was not suppressed with dexamethasone. Although no pathological abdominal or pelvic mass was detected, total hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathological examination revealed a theca-cell tumor of the right ovary. Postoperatively the testosterone level returned to normal and the patient had regression of virilism. Our case illustrates that a virilizing ovarian tumor can be small and elude imaging studies, but may be detected by means of well-considered clinical management.

[Incidentally discovered adrenal masses in the Department of Internal Medicine, Endocrinology and Hemostatic Disorders, Medical University of Gdansk]. / Przypadkowo wykryte guzy nadnerczy w materiale Kliniki Chorób Wewnetrznych, Endokrynologii i Zaburzen Hemostazy Akademii Medycznej w Gdansku.

UNLABELLED: Clinically silent adrenal masses (incidentaloma) are incidentally discovered lesions when noninvasive imaging methods (ultrasonography--USG, computer tomography--CT, magnetic resonance imaging--MRI) are performed for the reason other than known or suspected adrenal disease. Most of studies report the prevalence of adrenal incidentaloma range between 1 and 10% in radiological series. MATERIAL AND METHODS: Between 1993 and 03.2004 we observed 198 patients with incidentalomas of adrenal glands (144 females--72.7% and 54 males--27.3%). RESULTS: After endocrinological evaluation, 164 patients were qualified for surgery. In 119 (72.5%) cases open adrenalectomy was performed, and in 45 (27.5%) laparoscopic adrenalectomy was done. Adrenocortical adenoma was diagnosed in 54.9%, adrenal hyperplasia in 8.5%, adrenal carcinoma in 6.7%, pheochromocytoma in 12.9% (in 3.1% of all cases malignant pheochromocytoma was diagnosed), in 4.9% others malignant tumors (primary or metastatic), in 4.9% adrenal cysts and in 7.1% other rare adrenal pathologies were found. CONCLUSION: All malignancies were found in tumors with the diameter over 3 cm. In tumors with diameter over 6 cm malignant cases were found in 70.8%.