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Arellano-Llamas AA, Hernandez-Caballero A, Delgado-Mendoza E, Catalan-Ruiz MA. Van Wyk-Grumbach Syndrome and Gonadectomy. CHILDREN (BASEL, SWITZERLAND) 2024; 11:831. [PMID: 39062280 PMCID: PMC11274782 DOI: 10.3390/children11070831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024]
Abstract
Van Wyk-Grumbach syndrome (VWGS) refers to the development of peripheral precocious puberty, long-standing hypothyroidism, and gonadal masses; when not diagnosed, an unnecessary gonadectomy may be performed. Herein, we present a case of a 10-year-old girl with Down's syndrome, short stature, and vitiligo who presented to our hospital with vaginal bleeding and a palpable pelvic mass. Upon ultrasound and topographical examination, bilateral ovarian masses with negative tumor markers were detected. After bilateral gonadectomy, endocrine studies revealed profound hypothyroidism and peripheral puberty that led to the VWGS syndrome diagnosis (TSH 367.3 mUI/mL, isolated menstruation, indetectable LH, and elevated estradiol). Levothyroxine treatment improved obesity and short stature, and sexual hormone replacement began at 13 years of age. The literature on Van Wyk-Grumbach syndrome shows that it presents most often in women, and classic hypothyroidism symptoms always precede the diagnosis. Approximately 11% of patients have Down's syndrome, sometimes tumor markers are elevated, and some develop severe symptoms (myopathy, short stature, mental delay, ascites, pericardial effusion, Cullen's sign, pituitary hyperplasia, and severe anemia) that respond to levothyroxine treatment. Conclusions: Children with peripheral precocious puberty and gonadal masses must be studied for hypothyroidism before any radical decision is made.
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Affiliation(s)
| | - Alvaro Hernandez-Caballero
- Instituto Mexicano del Seguro Social, División de Evaluación de Tecnologías en Salud, Mexico City 02990, Mexico;
| | - Efren Delgado-Mendoza
- Instituto Mexicano del Seguro Social, UMAE Hospital General La Raza, Mexico City 02990, Mexico; (E.D.-M.); (M.A.C.-R.)
| | - Manuel Alejandro Catalan-Ruiz
- Instituto Mexicano del Seguro Social, UMAE Hospital General La Raza, Mexico City 02990, Mexico; (E.D.-M.); (M.A.C.-R.)
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Larik MO, Amir MA. Trends in thyrotoxicosis-related mortality in the United States from 1999 to 2020. Endocrine 2024; 84:874-879. [PMID: 38195967 DOI: 10.1007/s12020-024-03685-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/01/2024] [Indexed: 01/11/2024]
Abstract
PURPOSE Thyrotoxicosis is defined as a condition caused by excessive thyroid hormone concentrations, with the main cause being inappropriately increased thyroid hormone production. Existing literature indicates a correlation between thyrotoxicosis and mortality. Thus, this descriptive analysis was conducted to assess the demographic and regional trends of thyrotoxicosis-related mortality in the United States. METHODS Death certificates from the Center of Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) from 1999 to 2020 were retrieved for thyrotoxicosis-related mortality in the United States. The crude and age-adjusted mortality rates (AAMRs) per 1,000,000 population and annual percentage change (APCs) were calculated. RESULTS There were 33,253 thyrotoxicosis-related deaths from 1999 to 2020. Initially, the AAMR increased from 1999 to 2003 (APC: 3.09; 95% CI 0.83 to 8.16), followed by a steep decline from 2003 to 2008 (APC: -4.28; 95% CI -7.46 to -2.47), followed by a marginal decline from 2008 to 2018 (APC: -0.71; 95% CI -1.70 to 0.95), and concluded by a significant increase from 2018 to 2020 (APC: 11.72; 95% CI 5.06 to 15.32). Non-Hispanic (NH) Black or African American, Hispanic or Latino, and NH White populations demonstrated a significant rise in thyrotoxicosis-related mortality during 2018 to 2020. In contrast, the NH Asian or Pacific Islander population did not denote any significant variations within the included study timeframe. States including West Virginia, the District of Columbia, Vermont, California, and Montana were in the top 10th percentile of thyrotoxicosis-related mortality. CONCLUSION After an extended period of decline, the recent increments in thyrotoxicosis-related mortality rates are concerning. Further consideration is urged with respect to thyroid screening, especially among females, in order to reduce the overall thyrotoxicosis-related mortality.
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Affiliation(s)
- Muhammad Omar Larik
- Department of Medicine, Dow International Medical College, Karachi, Pakistan.
| | - Muhammad Ali Amir
- Department of Medicine, Dow International Medical College, Karachi, Pakistan
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Bablis P, Day RR, Bablis S, Pollard H. Treatment of Hypothyroidism and Stress Using Neuro-Emotional Technique (NET): A Case Study. Cureus 2024; 16:e58231. [PMID: 38745794 PMCID: PMC11092426 DOI: 10.7759/cureus.58231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
Hypothyroidism is generally considered an autoimmune condition, and typical medical management involves taking levothyroxine (synthetic thyroid hormone) for life. This case report details the results of a mind-body intervention (MBI) called the Neuro-Emotional Technique (NET) used to treat a 28-year-old Caucasian female presenting with symptoms and bloodwork markers associated with two years of hypothyroidism and a long history of stress. The patient's medical doctor provided a diagnosis of hypothyroidism after blood tests showed that thyroid-stimulating hormone (TSH) levels were high at 6.87 mIU/L (where the acceptable range is 0.40-3.50 mIU/L) and free T4 (FT4) levels were low at 8.6 pmol/L (where the acceptable range is 9.0-19.0 pmol/L). Psychometric tests were completed at baseline and after 12 weeks of treatment to evaluate changes in mental health and emotional well-being. The Adverse Childhood Experiences Questionnaire (ACE-Q) revealed a high degree of childhood trauma that may have predisposed to the underlying autoimmune thyroid dysfunction. At the conclusion of the treatment period, serum thyroid-stimulating hormone (TSH) and free T4 were within normal ranges and psychometric indicators normalized. We hypothesize that these changes may be due to the stress-reducing mechanism of NET and outline possible mechanisms via the Psycho-Immune-Neuroendocrine (PINE) network. The PINE network model asserts that chronic stress acts as a potential driver of pathophysiology that can lead to one or more medical and mental health conditions. While further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, the results of this case suggest that it may be pertinent to consider co-management of subclinical hypothyroidism with a relatively quick and cost-effective MBI such as NET.
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Affiliation(s)
- Peter Bablis
- Department of Maternal and Child Health and Precision Medicine, University Research Institute, Athens, GRC
- Department of Integrative and Complementary Medicine, Universal Health, Sydney, AUS
| | - Ryan R Day
- Department of Chiropractic, Universal Health, Sydney, AUS
| | - Sophia Bablis
- Department of Psychology, Universal Health, Sydney, AUS
| | - Henry Pollard
- Faculty of Health Sciences, Durban University of Technology, Durban, ZAF
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Mehta JM, Hiremath SC, Chilimba C, Ghasemi A, Weaver JD. Translation of cell therapies to treat autoimmune disorders. Adv Drug Deliv Rev 2024; 205:115161. [PMID: 38142739 PMCID: PMC10843859 DOI: 10.1016/j.addr.2023.115161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
Autoimmune diseases are a diverse and complex set of chronic disorders with a substantial impact on patient quality of life and a significant global healthcare burden. Current approaches to autoimmune disease treatment comprise broadly acting immunosuppressive drugs that lack disease specificity, possess limited efficacy, and confer undesirable side effects. Additionally, there are limited treatments available to restore organs and tissues damaged during the course of autoimmune disease progression. Cell therapies are an emergent area of therapeutics with the potential to address both autoimmune disease immune dysfunction as well as autoimmune disease-damaged tissue and organ systems. In this review, we discuss the pathogenesis of common autoimmune disorders and the state-of-the-art in cell therapy approaches to (1) regenerate or replace autoimmune disease-damaged tissue and (2) eliminate pathological immune responses in autoimmunity. Finally, we discuss critical considerations for the translation of cell products to the clinic.
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Affiliation(s)
- Jinal M Mehta
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Shivani C Hiremath
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Chishiba Chilimba
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Azin Ghasemi
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Jessica D Weaver
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA.
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5
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Ayala IN, Soto Jacome C, Toro-Tobon D, Golembiewski E, Garcia-Bautista A, Hidalgo J, Cordova-Madera S, Al Anbari R, Sohn R J, Singh Ospina N, Maraka S, Joseph M, Brito JP. Appropriateness of Levothyroxine Prescription: A Multicenter Retrospective Study. J Clin Endocrinol Metab 2024; 109:e765-e772. [PMID: 37656124 PMCID: PMC10795923 DOI: 10.1210/clinem/dgad517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023]
Abstract
CONTEXT Levothyroxine is one of the most prescribed medications in the United States. OBJECTIVE This study explores the appropriateness of levothyroxine prescriptions. METHODS A retrospective multicenter study was conducted on adult patients who were prescribed levothyroxine for the first time between 2017 and 2020 at three academic centers in the United States. We classified each case of levothyroxine initiation into one of three mutually exclusive categories: appropriate (clinically supported), indeterminate (clinically unclear), or nonevidence based (NEB, not clinically supported). RESULTS A total of 977 participants were included. The mean age was 55 years (SD 19), there was female (69%) and White race predominance (84%), and 44% had possible hypothyroid symptoms. Nearly half of the levothyroxine prescriptions were considered NEB (528, 54%), followed by appropriate (307, 31%) and indeterminate (118, 12%). The most common reason for NEB prescription was an index thyrotropin (TSH) value of less than 10 mIU/L without previous TSH or thyroxine values (131/528, 25%), for appropriate prescription, was overt hypothyroidism (163/307, 53%), and for an indeterminate prescription was a nonconfirmed subclinical hypothyroidism with TSH greater than or equal to 10 mIU/L (no confirmatory testing) (51/118, 43%). In multivariable analysis, being female (odds ratio [OR]: 1.3; 95% CI, 1.0-1.7) and prescription by a primary care provider (OR: 1.5; 95% CI, 1.2-2.0) were associated with NEB prescriptions. CONCLUSION There is a considerable proportion of NEB levothyroxine prescriptions. These results call for additional research to replicate these findings and to explore the perspective of those prescribing and receiving levothyroxine.
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Affiliation(s)
- Ivan Nicolas Ayala
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Cristian Soto Jacome
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - David Toro-Tobon
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Elizabeth Golembiewski
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Andrea Garcia-Bautista
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Jessica Hidalgo
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | | | - Raghda Al Anbari
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jessica Sohn R
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Section of Endocrinology, Medicine Service, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Marina Joseph
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
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Ghaemmaghami Z, Firoozbakhsh P, Gholami D, Khodabandelu S, Baay M, Alemzadeh-Ansari MJ, Mohebbi B, Hosseini Z, Boudagh S, Pouraliakbar H, Pasebani Y, Rafati A, Khalilpour E, Khalili Y, Arabian M, Maleki M, Bakhshandeh H, Sadeghipour P. Increased prevalence of thyroid dysfunction in Tehran - HAMRAH study. BMC Endocr Disord 2023; 23:270. [PMID: 38053115 DOI: 10.1186/s12902-023-01524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The aim of the current study is to assess the prevalence of different categories of thyroid dysfunction and their associated risk factors among the modern urban population of Tehran, the capital of Iran. METHODS The present investigation is a sub-study of the HAMRAH study, a population-based prospective study designed to assess the prevalence of traditional cardiovascular risk factors and their changes through a 10-year follow-up. 2228 (61% female) adults aged between 30 and 75 years old and with no overt cardiovascular diseases were selected through a multistage cluster randomized sampling. Blood levels of thyroid-stimulating hormone (TSH), thyroxin (T4), and triiodothyronine (T3) were measured with the aim of assessing the prevalence of abnormal thyroid function status among the modern urban Iranian population, and in order to report the total prevalence of participants with clinical hypo- or hyperthyroidism, the number of individuals taking thyroid-related drugs were added to the ones with overt thyroid dysfunction. A subgroup analysis was also performed to determine the associated risk factors of thyroid dysfunction. RESULTS The prevalence of thyroid dysfunction among the total population was 7% (95%CI: 5.9 - 8%) and 0.4% (95% CI: 0.1 - 0.6%) for subclinical and overt hypothyroidism, and 1.6% (95% CI: 1 - 2%) and 0.2% (95% CI: 0 - 0.3%) for subclinical and overt hyperthyroidism, respectively. Clinical thyroid dysfunction was detected in 10.3% of the study population (9.4% had clinical hypo- and 0.9% had clinical hyperthyroidism). In the subgroup analysis, thyroid dysfunction was significantly more prevalent among the female participants (P-value = 0.029). CONCLUSIONS In the current study, the prevalence of different categories of abnormal thyroid status, and also the rate of clinical hypo- and hyperthyroidism was assessed using the data collected from the first phase of the HAMRAH Study. In this study, we detected a higher prevalence of clinical and subclinical hypothyroidism among the Iranian population compared to the previous studies.
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Affiliation(s)
- Zahra Ghaemmaghami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Parisa Firoozbakhsh
- Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Delara Gholami
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sajad Khodabandelu
- Department of Biostatistics and Epidemiology, Student Research Committee, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammadreza Baay
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran
| | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran
| | - Shabnam Boudagh
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Yeganeh Pasebani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Ali Rafati
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Ehsan Khalilpour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran
| | - Yasaman Khalili
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Maedeh Arabian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran.
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran.
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Al Kindi RM, Al Riyami RA, Juma SY, Al Kiyumi MI. Adherence to levothyroxine treatment among patients with hypothyroidism in Oman: a national cross-sectional study. Curr Med Res Opin 2023; 39:1313-1319. [PMID: 37605332 DOI: 10.1080/03007995.2023.2250256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Hormone replacement therapy with levothyroxine is considered the treatment of choice for hypothyroidism; however, non-adherence is a major contributor to poor treatment outcomes. This study aimed to evaluate levels of drug adherence (DA) to levothyroxine therapy among Omani adults with hypothyroidism and to explore related sociodemographic and clinical factors. METHODS A national, multi-center, cross-sectional survey was carried out from August to December 2021 at 18 primary healthcare centers across all governorates of Oman. A total of 415 Omani adults were recruited. Data were collected using a pre-tested, Arabic-language questionnaire completed by trained researchers during face-to-face interviews with the participants. Level of DA was determined using the 8-item Morisky Medication Adherence Scale (MMAS-8). RESULTS A total of 400 Omani adults participated in the study (response rate: 96.4%). The mean age was 41.9 ± 12.4 years old (range: 18-78 years) and 90.3% were female. According to their MMAS-8 scores, 157 (39.2%), 139 (34.8%), and 104 (26.0%) participants demonstrated low, medium, and high DA, respectively. No significant correlations were observed between level of DA and any sociodemographic or clinical characteristics, including age, gender, education, duration of treatment, and family history of thyroid disease (p > 0.050). CONCLUSIONS Only a quarter of Omani patients with hypothyroidism reported high levels of adherence to levothyroxine treatment, likely as a result of lack of awareness of the disease and the importance of maintaining an euthyroid state. Further studies using more objective measures of DA are recommended to determine correlates of non-compliance to levothyroxine therapy among Omani patients.
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Affiliation(s)
- Rahma Mohamed Al Kindi
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, Oman
| | | | | | - Maryam Issa Al Kiyumi
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, Oman
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Kethidi N, Vedula S, Shihora D, Patel R, Park RCW. Extent of Surgery for Follicular Thyroid Carcinoma. Laryngoscope 2023; 133:993-999. [PMID: 36317788 DOI: 10.1002/lary.30441] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/15/2022] [Accepted: 09/18/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To examine the association between the extent of surgery and overall survival in follicular thyroid cancer (FTC) patients. STUDY DESIGN Retrospective analysis of the National Cancer Database (NCDB). METHODS Patients who underwent surgical intervention for FTC from 2004 to 2015 were selected. Patients were >18 years old, with tumor size 1-4 cm, no other malignancies, and >0 follow up time. Patients were divided into two cohorts based on extent of surgery: lobectomy (≥1 lobe resected) and thyroidectomy (total or near total resection). Pearson's chi-squared analysis was used to compare cohorts. Kaplan-Meier survival and Cox hazards models were utilized to determine overall survival between two cohorts with p < 0.05 used for significance. RESULTS A total of 6871 patients were identified with FTC, of which 1507 patients underwent lobectomy and 5364 patients underwent total thyroidectomy. There were no significant differences in patient demographics, comorbidity index, local spread, or tumor grade. Patients undergoing lobectomy had mean survival of 12.94 versus 12.71 years for those undergoing thyroidectomy. Extent of surgery was not associated with a significant difference in survival (5 years OS = 96% in lobectomy and 95.5% in total thyroidectomy, p = 0.08). Stratification by tumor grade resulted in no significant difference in survival between lobectomy and thyroidectomy. CONCLUSION Survival time was not significantly different in patients with more extensive resection of FTC. LEVEL OF EVIDENCE 3 Laryngoscope, 133:993-999, 2023.
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Affiliation(s)
- Nikhit Kethidi
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Sudeepti Vedula
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Dhvani Shihora
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Rushi Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Richard C W Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Czubek E, Alcer K, Varjacic M, Romaniuk P. The importance and effectiveness of nutritional counselling in patients with autoimmune thyroid diseases in Poland. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:63. [PMID: 36471304 PMCID: PMC9721046 DOI: 10.1186/s12962-022-00397-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/30/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Autoimmune thyroid diseases are the most common diseases in humans. Their pathogenesis is complex, pushing patients to search different ways of alleviating their effects, one of which is diet change. The aim of this study was to assess the role of medical personnel in shaping eating habits in patients with autoimmune thyroid disease based on experiences declared by patients. METHODS We examined 208 individuals, of which 205 were qualified for final investigation. We selected study participants using accidental sampling, based on their appearance in health care facilities, including the ones providing endocrinological advices. The relationships between the qualitative features were tested using the Chi-square test of independence, assuming the significance level of p < 0.05. In the case of the expected cardinality < 10, the Chi-square test with correction for Yates continuity was used, while for the cardinality < 5-the Fisher exact test. RESULTS People with thyroid disease are statistically more likely to use dietitian advice than people without thyroid disease. The highest percentage of respondents decided to modify their nutrition due to their own initiative. In addition, patients with autoimmune thyroid disease are statistically more likely to consider changing their diet to improve their well-being. The connection between the source of advice and modification of eating behaviour was also noted. CONCLUSION Thanks to the joint effort of medical staff, patients can receive reliable knowledge about their disease, treatment and nutrition adapted to their needs. Trial registration approved by the Bioethics Committee of Medical University of Silesia in Katowice (opinion no.: PCN/0022/KB1/80/2).
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Affiliation(s)
- Ewa Czubek
- grid.411728.90000 0001 2198 0923Department of Health Policy, Medical University of Silesia, Katowice, Poland
| | - Klaudia Alcer
- grid.411728.90000 0001 2198 0923Doctoral School, Faculty of Health Sciences, Department of Health Policy, Medical University of Silesia, Katowice, Poland
| | - Mirjana Varjacic
- grid.413004.20000 0000 8615 0106Department of Fertility Pathology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Piotr Romaniuk
- grid.411728.90000 0001 2198 0923Department of Health Policy, Medical University of Silesia, Katowice, Poland
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10
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Marcec R, Stjepanovic J, Likic R. Seasonality of Hashimoto Thyroiditis: Infodemiology Study of Google Trends Data. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e38976. [PMID: 38935939 PMCID: PMC11135219 DOI: 10.2196/38976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/24/2022] [Accepted: 08/15/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND Hashimoto thyroiditis (HT) is an autoimmune thyroid disease and the leading cause of hypothyroidism in areas with sufficient iodine intake. The quality-of-life impact and financial burden of hypothyroidism and HT highlight the need for additional research investigating the disease etiology with the aim of revealing potential modifiable risk factors. OBJECTIVE Implementation of measures against such risk factors, once identified, has the potential to lessen the financial burden while also improving the quality of life of many individuals. Therefore, we aimed to examine the potential seasonality of HT in Europe using the Google Trends data to explore whether there is a seasonal characteristic of Google searches regarding HT, examine the potential impact of the countries' geographic location on the potential seasonality, and identify potential modifiable risk factors for HT, thereby inspiring future research on the topic. METHODS Monthly Google Trends data on the search topic "Hashimoto thyroiditis" were retrieved in a 17-year time frame from January 2004 to December 2020 for 36 European countries. A cosinor model analysis was conducted to evaluate potential seasonality. Simple linear regression was used to estimate the potential effect of latitude and longitude on seasonal amplitude and phase of the model outputs. RESULTS Of 36 included European countries, significant seasonality was observed in 30 (83%) countries. Most phase peaks occurred in spring (14/30, 46.7%) and winter (8/30, 26.7%). A statistically significant effect was observed regarding the effect of geographical latitude on cosinor model amplitude (y = -3.23 + 0.13 x; R2=0.29; P=.002). Seasonal increases in HT search volume may therefore be a consequence of an increased incidence or higher disease activity. It is particularly interesting that in most countries, a seasonal peak occurred in spring and winter months; when viewed in the context of the statistically significant impact of geographical latitude on seasonality amplitude, this may indicate the potential role of vitamin D levels in the seasonality of HT. CONCLUSIONS Significant seasonality of HT Google Trends search volume was observed in our study, with seasonal peaks in most countries occurring in spring and winter and with a significant impact of latitude on seasonality amplitude. Further studies on the topic of seasonality in HT and factors impacting it are required.
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Affiliation(s)
- Robert Marcec
- Department of Internal Medicine, University of Zagreb School of Medicine and Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Josip Stjepanovic
- Department of Internal Medicine, University of Zagreb School of Medicine and Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Robert Likic
- Department of Internal Medicine, University of Zagreb School of Medicine and Clinical Hospital Centre Zagreb, Zagreb, Croatia
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Obsekov V, Kahn LG, Trasande L. Leveraging Systematic Reviews to Explore Disease Burden and Costs of Per- and Polyfluoroalkyl Substance Exposures in the United States. EXPOSURE AND HEALTH 2022; 15:373-394. [PMID: 37213870 PMCID: PMC10198842 DOI: 10.1007/s12403-022-00496-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/03/2022] [Accepted: 06/23/2022] [Indexed: 05/23/2023]
Abstract
Accelerating evidence confirms the contribution of per- and polyfluoroalkyl substances (PFAS) to disease burden and disability across the lifespan. Given that policy makers raise the high cost of remediation and of substituting PFAS with safer alternatives in consumer products as barriers to confronting adverse health outcomes associated with PFAS exposure, it is important to document the costs of inaction even in the presence of uncertainty. We therefore quantified disease burdens and related economic costs due to legacy PFAS exposures in the US in 2018. We leveraged systematic reviews and used meta-analytic inputs whenever possible, identified previously published exposure-response relationships, and calculated PFOA- and PFOS-attributable increases in 13 conditions. These increments were then applied to census data to determine total annual PFOA- and PFOS-attributable cases of disease, from which we calculated economic costs due to medical care and lost productivity using previously published cost-of-illness data. We identified PFAS-attributable disease costs in the US of $5.52 billion across five primary disease endpoints shown to be associated with PFAS exposure in meta-analyses. This estimate represented the lower bound, with sensitivity analyses revealing as much as $62.6 billion in overall costs. While further work is needed to assess probability of causation and establish with greater certainty effects of the broader category of PFAS, the results confirm further that public health and policy interventions are still necessary to reduce exposure to PFOA and PFOS and their endocrine-disrupting effects. This study demonstrates the large potential economic implications of regulatory inaction. Supplementary Information The online version contains supplementary material available at 10.1007/s12403-022-00496-y.
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Affiliation(s)
- Vladislav Obsekov
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY USA
| | - Linda G. Kahn
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY USA
| | - Leonardo Trasande
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY USA
- Department of Environmental Health, NYU Grossman School of Medicine, New York, NY USA
- NYU Wagner School of Public Service, New York, NY USA
- NYU School of Global Public Health, New York, NY USA
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