Thyroid function disorders are the most common endocrine disorders in humans. They are frequently diagnosed, with prevalence varying between 2 and 6%, and a female to male ratio of up to 10:1. Disorders of thyroid function in the narrower... more
Thyroid function disorders are the most common endocrine disorders in humans. They are frequently diagnosed, with prevalence varying between 2 and 6%, and a female to male ratio of up to 10:1. Disorders of thyroid function in the narrower sense are presented by its hyperactivity or underactivity, although there are conditions that lead to an increased concentration of thyroid hormones, without its increased activity. In iodine-sufficient regions, the most common cause of hyperthyroidism, as well as hypothyroidism, is an autoimmune disease of the thyroid. For hyperthyroidism, it is Graves' disease, with typical symptoms and signs of hypermetabolism. The diagnosis of hyperthyroidism is based on suppressed TSH and elevated fT4 (free, and in the differential diagnosis, elevated TSH-receptor-antibodies are crucial for Graves' disease. Management of Graves' disease relies on three equally potent approaches: medical therapy, ablative treatments with 131I-radiotherapy-RAI, and t...
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Background: Although thyroid hormones have significant effect on cardiovascular system, the impact of subtle thyroid dysfunction such as subclinical hypothyroidism (SCH) remains to be determined. We investigated coronary flow reserve... more
Background: Although thyroid hormones have significant effect on cardiovascular system, the impact of subtle thyroid dysfunction such as subclinical hypothyroidism (SCH) remains to be determined. We investigated coronary flow reserve (CFR) in patients with subclinical hypothyroidism. Methods: Thirty two subjects with SCH and eighteen control subjects with normal serum thyroid hormones and thyroid-stimulating hormone (TSH) levels were included in the study. TSH, free thyroxine, free triiodothyronine, glucose, insulin, HbA1c, cholesterol, triglyceride and plasma levels of C-reactive protein were measured. Coronary diastolic peak flow velocities in left anterior descending coronary artery were measured at baseline and after adenosine infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocity. Results: CFR values were not significantly different between the two groups (SCH 2.76±0.35 vs controls 2.76±0.42). There was a significant correlation of CFR with w...
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There are three basic modalities for the treatment of thyrotoxicosis: thyrosuppresive drug therapy, ablation with radioactive iodine and surgical treatment. Patients who do not achieve adequate thyrotoxicosis control, as was the case of... more
There are three basic modalities for the treatment of thyrotoxicosis: thyrosuppresive drug therapy, ablation with radioactive iodine and surgical treatment. Patients who do not achieve adequate thyrotoxicosis control, as was the case of described patient, have a high mortality rate due to the possibility of developing a thyroid storm. The use of drug therapy for hyperthyroidism, as the first line of treatment, is associated with the appearance of various side effects, as was the case in our patient. Side effects of Methimazole are dose-dependent, while in the case of Propylthiouracil, the occurrence of side effects is not clearly dose-dependent. In the case of the described patient, all alternative, lesser known modalities for the treatment of hyperthyroidism were applied, after the occurrence of adverse reactions to thyrosuppressive therapy. Sodium perchlorate, ie. Sodium with perchloric acid is rarely used in the treatment of hyperthyroidism, as in cases of severe idiosyncratic re...
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OBJECTIVE Malignancies and autoimmune thyroid disease are still controversial, but recent studies prove that a long lasting thyroid disease may be linked with malignancy, e.g. papillary thyroid carcinoma in patients with Hashimoto... more
OBJECTIVE Malignancies and autoimmune thyroid disease are still controversial, but recent studies prove that a long lasting thyroid disease may be linked with malignancy, e.g. papillary thyroid carcinoma in patients with Hashimoto thyroiditis. Having in mind that thyrotropin is a thyroid growth factor, the relationship between its serum values, as well as the levels of anti-peroxidase and anti-thyroglobulin antibodies and thyroid malignancy in patients with nodular thyroid goiter was examined. PATIENTS AND METHODS Six-hundred-thirty-seven medical records, which included the thyroid fine-needle aspiration cytology were retrospectively evaluated. Patients were grouped regarding the levels of thyrotropin, anti-peroxidase and anti-thyroglobulin antibodies (in or out of the reference ranges) and compared with cytology findings for establishing their prognostic potential for malignancy. RESULTS Elevated serum thyrotropin (≥ 4.5 mIU/L) was found in 27.3% of patients with thyroid malignancy...
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Research Interests: Humanities and Medicine
ObjectiveInterleukin 6 (IL6) has the ability to influence each level of the hypothalamo-pituitary–adrenocortical (HPA) axis. The aim of the study was to test whether IL6 concentration correlates with the adrenal cortex response to ACTH in... more
ObjectiveInterleukin 6 (IL6) has the ability to influence each level of the hypothalamo-pituitary–adrenocortical (HPA) axis. The aim of the study was to test whether IL6 concentration correlates with the adrenal cortex response to ACTH in healthy humans. We postulated that higher basal IL6 concentration would be associated with the higher cortisol response to the stimulation.Design and methodsBasal IL6 concentration was measured and a low dose (1 μg) ACTH test was performed to assess cortisol response. Twenty-seven apparently healthy subjects (11 male, 16 female, mean age 31.1 years, age range 22–47 years) were included in the study.ResultsData are presented as mean±s.e.m. Basal IL6 level was 0.84±0.10 pg/ml. Basal cortisol was 351.9±18.3 nmol/l. Maximal cortisol during synacthen test was 653.0±20.6 nmol/l. Maximal cortisol increment was 301.1±20.0 nmol/l. IL6 concentration was not correlated with basal or maximal cortisol concentration, but correlated significantly with cortisol in...
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Summary Background Primary aldosteronism (PA) is associated with increased prevalence of metabolic disorders (impaired glucose and lipid metabolism and insulin resistance), but also with more frequent cardiovascular, renal and central... more
Summary Background Primary aldosteronism (PA) is associated with increased prevalence of metabolic disorders (impaired glucose and lipid metabolism and insulin resistance), but also with more frequent cardiovascular, renal and central nervous system complications. Methods Biochemical and clinical parameters were retrospectively analysed for 40 patients with PA caused by aldosterone-producing adenoma (APA) and compared to the control groups of 40 patients with nonfunctioning adrenal adenoma (NFA) and essential hypertension (HT), and 20 patients with adrenal Cushing syndrome (CS) or subclinical CS (SCS). Results Systolic, diastolic and mean arterial blood pressures were significantly higher in the PA group (p=0.004; p=0.002; p=0.001, respectively) than in NFA+HT group. PA patients had longer hypertension history (p=0.001) than patients with hypercorticism and all had hypokalaemia. This group showed the smallest mean tumour diameter (p<0.001). The metabolic syndrome was significantl...
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Purpose: The aim of this study was to assess the relationship between adrenal incidentaloma size, cortisol secretion suppressibility by Dexamethasone and relevant clinical and laboratory parameters. Methods: This retrospective study... more
Purpose: The aim of this study was to assess the relationship between adrenal incidentaloma size, cortisol secretion suppressibility by Dexamethasone and relevant clinical and laboratory parameters. Methods: This retrospective study included all patients diagnosed with adrenal incidentaloma and admitted to the single department of the Clinic of endocrinology, Diabetes and Diseases of Metabolism during the period from 2012 till the end of 2019. The inclusion criterion was the presence of an asymptomatic adrenal mass on imaging not performed for suspected adrenal disease. The study group included 197 subjects. Adrenal masses were detected using CT or NMR scan. We analysed the correlation between tumour size and relevant hormonal and clinical parameters. Results: We found a significant positive correlation between incidentaloma size and morning cortisol, cortisol after overnight Dexamethasone, and a significant negative correlation between incidentaloma size and morning ACTH, and hip T...
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Research Interests: Treatment Outcome, Medicine, Therapeutic drug monitoring, Humans, Female, and 15 moreHormones, Male, Diplopia, Middle Aged, Adult, Time Factors, Retrospective Studies, Glucocorticoids, Predictive value of tests, Methylprednisolone, Severity of Illness Index, Adverse effect, Tolerability, Patient selection, and Prednisone
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Introduction. In interpreting thyroid hormones results it is preferable to think of interference and changes in concentration of their carrier proteins. Outline of Cases. We present two patients with discrepancy between the results of... more
Introduction. In interpreting thyroid hormones results it is preferable to think of interference and changes in concentration of their carrier proteins. Outline of Cases. We present two patients with discrepancy between the results of thyroid function tests and clinical status. The first case presents a 62-year-old patient with a nodular goiter and Hashimoto thyroiditis. Thyroid function test showed low thyroid-stimulating hormone (TSH) and normal to low fT4. By determining thyroid status (?SH, T4, fT4, T3, fT3) in two laboratories, basal and after dilution, as well as thyroxine-binding globulin (TBG), it was concluded that the thyroid hormone levels were normal. The results were influenced by heterophile antibodies leading to a false lower TSH level and suspected secondary hypothyroidism. The second case, a 40-year-old patient, was examined and followed because of the variable size thyroid nodule and initially borderline elevated TSH, after which thyroid status showed low level of ...
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Hypothyroid Graves' ophthalmopathy is a rare condition, present in about 3% of all cases. Since thyroid-stimulating antibodies could be detected in a majority of euthyroid and hypothyroid Graves' patients, the most probable... more
Hypothyroid Graves' ophthalmopathy is a rare condition, present in about 3% of all cases. Since thyroid-stimulating antibodies could be detected in a majority of euthyroid and hypothyroid Graves' patients, the most probable explanation for unincreased thyroid function is a reduction of tissue capability to response to stimulation. We present a 57-yr-old man visited the hospital with signs and symptoms typical of hypothyroidism. Since TSH was 77 IU/ml, FT4 6.8 pmol/l and TPO Ab 4828 IU/ml, the treatment with 100 mcg/day T4 was started. Three months later, when euthyroid, he developed Graves' ophthalmopathy with slight proptosis, moderate palpebral edema, conjuctival injection and chemosis, reduction of visual acuity to 0.7, diplopia and secondary glaucoma. He had no palpable goiter and ultrasound revealed small (V 5 cm3), diffuse hypoechoic thyroid. Orbital computed tomography (CT) showed a pronounced enlargement of all extraocular muscles (9-15 mm). TSH receptor antibodies were 65 U/l. Patient was treated with two doses of 0.5 g intravenous methylprednisolone during three days, followed by oral prednisone 40 mg/day tapered to 10 mg/day in four weeks. Six courses of therapy were performed. There were no significant side effects during the treatment. A prompt improvement of visual acuity, intraocular pressure and inflammatory signs was noticed, but diplopia became permanent. Orbital CT revealed a significant reduction of all rectus muscles (2-10mm). TSH receptor antibodies were 10 U/l, TPO Ab 8603 IU/ml. He developed cataract on his left eye and refused extraocular muscle surgery since he lost diplopia. Conclusion: Hypothyroid Graves' disease reflects a subtle relations between destructive changes in the thyroid gland and autoimmune mechanisms involved in thyroid pathology.