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Pierantoni F, Dionese M, Basso U, Lai E, Cavasin N, Erbetta E, Mattana A, Bimbatti D, Zagonel V, Lonardi S, Maruzzo M. The prognostic Value of Thyroid Hormone Levels in Immunotherapy-Treated Patients With Metastatic Urothelial Carcinoma. Clin Genitourin Cancer 2023; 21:e378-e385. [PMID: 37164813 DOI: 10.1016/j.clgc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION A low fT3/fT4 ratio has been associated with a poorer prognosis in patients treated for different solid malignancies. However, the prognostic role of baseline thyroid function in patients with metastatic urothelial carcinoma (mUC) has not yet been established. PATIENTS AND METHODS We analyzed 72 consecutive immunotherapy-treated patients with mUC from a single institution. We recorded clinical data, baseline blood test results, and oncological outcomes. We stratified patients into three groups according to the fT3/fT4 ratio value and analyzed differences in progression-free survival (PFS), overall survival (OS), and radiological response in the three groups. We also conducted univariate and multivariate analyses to identify prognostic factors for PFS and OS. RESULTS The median PFS in the low, intermediate, and high fT3/fT4 ratio groups was 2.2, 4.1, and 8.2 months, respectively (P < 0.01). The median OS in the low, intermediate, and high fT3/fT4 groups was 3.6, 10.3, and 19.1 months, respectively (P < .01). The low fT3/fT4 ratio maintained its prognostic role independently of other prognostic factors. Patients with a high fT3/fT4 ratio had an increased radiological response. CONCLUSION Thyroid hormone impairment, as measured by the fT3/fT4 ratio, is a strong prognostic factor in patients treated with immunotherapy for urothelial carcinoma.
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Affiliation(s)
| | - Michele Dionese
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy
| | - Umberto Basso
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy
| | - Eleonora Lai
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy; Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Nicolò Cavasin
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy; Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Elisa Erbetta
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy; Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Alvise Mattana
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy
| | - Davide Bimbatti
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy
| | - Vittorina Zagonel
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy
| | - Sara Lonardi
- Oncology Unit 3, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy
| | - Marco Maruzzo
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy.
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Caccese M, Desideri I, Padovan M, Bruno F, Cerretti G, Fiorentino A, Denaro L, Chioffi F, Della Puppa A, Maccari M, Cavallin F, Coppola M, Pittaro A, Rudà R, Livi L, Lombardi G. Association between thyroid function and regorafenib efficacy in patients with relapsed wild-type IDH glioblastoma: a large multicenter study. J Neurooncol 2023; 163:377-383. [PMID: 37264256 PMCID: PMC10322943 DOI: 10.1007/s11060-023-04356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE Regorafenib demonstrated encouraging results in recurrent glioblastoma patients. Some studies showed that changes in circulating thyroid hormones (fT3, fT4, fT3/fT4 ratio) can be considered as prognostic factors in patients with various types of tumors. We designed this study to investigate the relationship between baseline thyroid variables and outcome in IDH-wild type GBM patients who were treated with regorafenib. METHODS This multicenter retrospective study included recurrent IDH-wild-type glioblastoma patients treated with regorafenib. Only patients with baseline thyroid function values (TSH, fT3, fT4, fT3/fT4 ratio) available were evaluated. RANO criteria were used to analyze neuroradiological response. Survival curves were estimated using the Kaplan-Meier method. The relationships between baseline thyroid variables (TSH, fT3, fT4, fT3/fT4) and survival (PFS, OS) were investigated with Cox regression models. RESULTS From November 2015 to April 2022, 134 recurrent IDH-wildtype GBM patients were treated with regorafenib and 128 of these had information on baseline thyroid function value. Median follow-up was 8 months (IQR 4.7-14.0). Objective Response Rate was 9% and Disease Control Rate was 40.9%. Median PFS was 2.7 months (95%CI 2.2-3.6) and median OS was 10.0 months (95%CI 7.0-13.0). Lower baseline TSH value in the blood was correlated with a higher rate of disease progression to regorafenib (p = 0.04). Multivariable analyses suggested a non-linear relationship between PFS (p = 0.01) and OS (p = 0.03) with baseline fT3/fT4 ratio. CONCLUSION In recurrent wild-type IDH glioblastoma patients, baseline fT3/fT4 ratio showed a non-linear relationship with survival, with different impacts across the spectrum of fT3/fT4 ratio. Moreover, baseline TSH may be a predictor of regorafenib activity.
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Affiliation(s)
- Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy.
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Francesco Bruno
- Division of Neuro-Oncology, Department Neuroscience, University and City of Health and Science Hospital, Turin, Italy
| | - Giulia Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Alba Fiorentino
- Department of Medicine, LUM Giuseppe Degennaro University, Casamassima, Bari, Italy
| | - Luca Denaro
- Academic Neurosurgery, Department of Neurosciences DNS, University of Padua, Padua, Italy
| | - Franco Chioffi
- Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Alessandro Della Puppa
- Neurosurgical Clinical Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi Hospital, University of Florence, Florence, Italy
| | - Marta Maccari
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | | | - Marina Coppola
- Pharmacy, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Alice Pittaro
- Radiology Unit, Department of Imaging and Medical Physics, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Roberta Rudà
- Division of Neuro-Oncology, Department Neuroscience, University and City of Health and Science Hospital, Turin, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
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Bilha SC, Hogas S, Hogas M, Marcu S, Leustean L, Ungureanu MC, Branisteanu DD, Preda C. Thyroid, Gonadal and Adrenal Dysfunction in Kidney Transplant Recipients: A Review for the Clinician. Biomolecules 2023; 13:920. [PMID: 37371500 DOI: 10.3390/biom13060920] [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: 03/29/2023] [Revised: 05/13/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
While chronic kidney disease-associated mineral and bone disorders (CKD-MBD) prevail in the endocrinological assessment of CKD patients, other endocrine abnormalities are usually overlooked. CKD is associated with significant thyroid, adrenal and gonadal dysfunction, while persistent and de novo endocrinological abnormalities are frequent among kidney transplant recipients (KTR). Low T3 levels prior to transplantation may help identify those at risk for delayed graft function and are often found in KTR. Thyroid surveillance after kidney transplantation should be considered due to structural anomalies that may occur. Despite the rapid recovery of gonadal hormonal secretion after renal transplantation, fertility is not completely restored. Testosterone may improve anemia and general symptoms in KTR with persistent hypogonadism. Female KTR may still experience abnormal uterine bleeding, for which estroprogestative administration may be beneficial. Glucocorticoid administration suppresses the hypothalamic-pituitary-adrenal axis in KTR, leading to metabolic syndrome. Patients should be informed about signs and symptoms of hypoadrenalism that may occur after glucocorticoid withdrawal, prompting adrenal function assessment. Clinicians should be more aware of the endocrine abnormalities experienced by their KTR patients, as these may significantly impact the quality of life. In clinical practice, awareness of the specific endocrine dysfunctions experienced by KTR patients ensures the correct management of these complications in a multidisciplinary team, while avoiding unnecessary treatment.
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Affiliation(s)
- Stefana Catalina Bilha
- Endocrinology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Simona Hogas
- Nephrology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihai Hogas
- Physiology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Stefan Marcu
- Nephrology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Letitia Leustean
- Endocrinology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Maria-Christina Ungureanu
- Endocrinology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dumitru D Branisteanu
- Department of Medicine, Charles E. Smith College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Cristina Preda
- Endocrinology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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Dai JJ, Du DF, Ma G, Jiang MJ. Association between serum-free thyroxine level and all-cause mortality in critically ill patients: a retrospective study from MIMIC-IV. Front Endocrinol (Lausanne) 2023; 14:1164369. [PMID: 37305055 PMCID: PMC10248474 DOI: 10.3389/fendo.2023.1164369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background Low thyroxine (T4) levels have been observed in critically ill patients; however, controversial results regarding T4 supplemental therapy are reported. The association between serum free T4 (FT4) levels and mortality in critically ill patients has not been fully established and needs to be clarified. Methods Data from the Medical Information Mart for Intensive Care (MIMIC)-IV were collected and analyzed. The association between FT4 level and 30-day mortality after ICU admission was analyzed using Kaplan-Meier curves, spline smoothing fitting, martingale residuals of the null Cox model, and restricted cubic spline (RCS). Logistic regression, Cox regression, and receiver operating characteristic curve (ROC) were used to uncover the relationship and predictive value of serum FT4 and 30-day mortality in critically ill patients. Results In the final analysis, 888 patients were enrolled, and the serum FT4 levels were divided into four groups. A significant difference in 30-day mortality was observed between the four groups. Kaplan-Meier curves also presented significantly higher 30-day mortality in groups 1 and 2 (p < 0.0001). Further multivariance logistic regression showed that group 1 with FT4 levels lower than 0.7 μg/dl can predict 30-day mortality (odds ratio (OR) = 3.30, 95% confidence interval (CI) = 1.04-11.31). Spline smoothing fitting analysis showed a "V"-shaped line between 30-day mortality and FT4 level within 0-3 μg/dl. Further RCS analysis showed that the risk of death decreased rapidly as FT4 levels increased when serum FT4 levels were lower than 1.2 μg/dl and started to become flat afterward. The area under the ROC of the lower FT4 level to predict 30-day mortality was 0.833 (95% CI = 0.788-0.878). Both multivariant Cox regression and logistic regression showed that FT4 levels lower than 1.2 μg/dl can independently predict 30-day mortality when adjusted for other potential confounders (HR = 0.34, 95% CI = 0.14-0.82; OR = 0.21, 95% CI = 0.06-0.79, respectively), but its predictive power disappeared when adjusted for T3 or total T4. Conclusion Serum FT4 levels were significantly negatively associated with 30-day mortality when they were lower than 1.2 μg/dl and could predict the risk of 30-day mortality. A higher FT4 level is potentially related to increased 30-day mortality.
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Affiliation(s)
- Juan-Juan Dai
- Department of Intensive Care Unit, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ding-Fu Du
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Gang Ma
- Department of Intensive Care Unit, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ming-Jie Jiang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Miao X, Fu X, Liu H, Gu Z, Li C, Wang K, Chen X, Lyu Z, Yan S. Analysis of clinical features and 7-year all-cause mortality in older male patients with non-thyroidal illness syndrome on general wards. Eur Geriatr Med 2023; 14:363-371. [PMID: 36947334 PMCID: PMC10031173 DOI: 10.1007/s41999-023-00761-6] [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: 10/31/2022] [Accepted: 02/22/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Older patients with non-thyroidal illness syndrome (NTIS) have a poor prognosis. However, there are few studies on the association of NTIS and mortality among older inpatients on general wards. In a 7-year retrospective observational study, we aimed to investigate the clinical features of NTIS and the association of NTIS and all-cause mortality in older inpatients. METHODS A total of 959 older male inpatients whose average age was 86.3 ± 8.1 years were enrolled and divided into the NTIS group and non-NTIS group. Cox models were performed to explore the association of thyroid hormone level and mortality. RESULTS Patients had more respiratory disease and chronic kidney disease in the NTIS than in the non-NTIS group, especially in primary nursing care, respiratory failure and haemodialysis patients; serum total protein, albumin, prealbumin, haemoglobin, uric acid and high-density lipoprotein cholesterol levels were lower, and urea nitrogen and fasting blood glucose levels were higher, in the NTIS than in the non-NTIS group. Patients in the NTIS group had a lower survival rate over 7 years follow-up (P < 0.01). A lower free T3 level was associated with all-cause mortality with a HR of 1.50 (1.36, 1.66). Lower free T4 level was associated with reduced all-cause mortality with a HR of 0.91 (0.88, 0.94) even after adjusting for confounding factors (P < 0.01). CONCLUSIONS Among older male inpatients, the survival rate was lower in the NTIS group. A reduced free T3 level with low albumin and Hb levels was associated with all-cause mortality; moreover, a higher free T4 in the normal range may be a strong predictor for long-term mortality risk in hospitalised older male patients.
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Affiliation(s)
- Xinyu Miao
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiaomin Fu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hongzhou Liu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zhaoyan Gu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Chunlin Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Kun Wang
- Department of Neurology, The 3rd Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei Province, China
| | - Xuefeng Chen
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zhaohui Lyu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Shuangtong Yan
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Aomura D, Kurasawa Y, Harada M, Hashimoto K, Kamijo Y. Early detection of thiamine deficiency by non-thyroidal illness syndrome in a hemodialysis patient. CEN Case Rep 2023; 12:110-115. [PMID: 36018508 PMCID: PMC9892385 DOI: 10.1007/s13730-022-00729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/18/2022] [Indexed: 02/05/2023] Open
Abstract
An 88-year-old male patient on maintenance hemodialysis (HD) therapy experienced gradual losses in appetite and liveliness during the course of 1 month. Physical examinations revealed no abnormalities. However, blood testing indicated non-thyroidal illness syndrome (NTIS) typically observed in patients with severe illness, with serum levels of thyroid stimulating hormone, free triiodothyronine, and free thyroxine of 0.17 μIU/mL, < 1.0 pg/mL, and 0.23 ng/dL, respectively. Brain magnetic resonance imaging to exclude the possibility of central hypothyroidism unexpectedly displayed slight abnormalities inside of the thalami that were characteristic of Wernicke's encephalopathy. Additional examination disclosed low serum thiamine of 20 ng/mL. Thiamine injections of 100 mg at every HD treatment rapidly restored his appetite, liveliness, and NTIS findings. HD patients are at a particularly high risk of thiamine deficiency (TD) and associated severe symptoms due to losses of thiamine during HD sessions. However, its non-specific initial symptoms, including decreases in appetite and liveliness, as well as undetectability in routine blood tests complicate early detection, resulting in underdiagnosis and more severe outcomes. In the present case, TD manifested only as non-specific symptoms and was ultimately revealed by the presence of NTIS, which was resolved with thiamine supplementation. Thus, NTIS might assist in the early detection of TD as an initial sign in HD patients.
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Affiliation(s)
- Daiki Aomura
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
- Department of Health Promotion Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Yukifumi Kurasawa
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Department of Internal Medicine, Yodakubo Hospital, 2857 Furumachi, Nagawa, Nagano, 386-0603, Japan
| | - Makoto Harada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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KAPLAN İ, CAN C, KÖMEK H, KEPENEK F, SOYLU H, ERDUR E, AGÜLOĞLU N, GÜNDOĞAN C. Is there an association between thyroid function tests and 18F FDG PET/CT parameters in untreated cancer patients? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1107903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives: We aimed to investigate the association between the extent of disease, 18F FDG PET/CT parameters (SUVmax and the highest SUVmax) and thyroid function tests (TFT) (TSH, FT4, FT3, FT3/FT4 ratio, AntiTG, and AntiTPO) in untreated cancer patients.
Material and Method: One hundred and seventy-nine patients who underwent FDG PET/CT for metabolic characterization and staging in our clinic between May 2020 and November 2020 were included in the study. Patients were divided into two groups as malignant and benign according to histopathology findings. Thyroid function tests were ordered from all patients at the time of PET/CT imaging. The association between the presence of local lymph node metastasis, distant metastases and thyroid function tests as well as the association between PET/CT parameters and thyroid function tests in benign and malignant groups were statistically analyzed.
Results: Thyroid function tests did not exhibit a significant difference between patients with malignant and benign disease (p> 0.05). Univariate logistic regression analysis revealed that age, FT4 value, and the FT3/F4 ratio were significant parameters in predicting distant metastases. These parameters were also significant in predicting mortality. Multivariate logistic regression analysis showed that age was an independent prognostic factor predicting mortality.
Conclusion: Thyroid function tests are not decisive in differentiating malignant and benign lesions. While no statistically significant correlation was observed between thyroid function tests and PET/CT parameters, univariate analyses revealed that especially FT4 and FT3/FT4 ratio were significant in predicting disease extent and mortality in malignant disease. Age was found to be an independent prognostic factor in predicting mortality.
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Affiliation(s)
- İhsan KAPLAN
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Canan CAN
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Halil KÖMEK
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Ferat KEPENEK
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Hikmet SOYLU
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, ENDOCRINOLOGY AND METABOLIC DISEASES
| | - Erkan ERDUR
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, ONCOLOGY
| | - Nurşin AGÜLOĞLU
- UNIVERSITY OF HEALTH SCIENCES, İZMİR DR. SUAT SEREN HEALTH RESEARCH CENTER FOR PULMONOLOGY AND THORACIC SURGERY, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Cihan GÜNDOĞAN
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
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Hu X, Wang H, Yuan D, Qu H, Li Y, Wang N, Wang X, Liu X, Xu H, Zhang Y, Wang X. An Extended Prognostic Index of the ISSWM Score Based on Thyroid Complications in Waldenström Macroglobulinemia/Lymphoplasmacytoid Lymphoma. Front Oncol 2022; 12:870258. [PMID: 35646661 PMCID: PMC9136013 DOI: 10.3389/fonc.2022.870258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/04/2022] [Indexed: 12/23/2022] Open
Abstract
Waldenström macroglobulinemia/lymphoplasmacytoid lymphoma (WM/LPL) is a rare lymphoproliferative neoplasm characterized by clonally related lymphocytes, lymphoplasmacytic cells, and plasma cell proliferation. WM/LPL patients commonly present with elevated immunoglobulin, predominantly immunoglobulin M (IgM). Previous studies reported that thyroid dysfunction was associated with the development and progression of solid tumors. However, only limited information is available on the correlation between thyroid complications and lymphoid malignancies. The aim of our study was to explore the prognostic significance of thyroid complications in WM/LPL. Herein, 13.3% of WM/LPL patients were diagnosed with thyroid complications, which were significantly associated with unfavorable progression-free survival (PFS), overall survival (OS), and adverse treatment response. Co-existing thyroid disease was significantly related to alleviated serum IgM levels, providing an answer to practical problems. Furthermore, the presence of thyroid complications was identified as an independent prognostic indicator for PFS in WM/LPL. Incorporating the ISSWM score with thyroid complications was superior to ISSWM alone in risk stratification and prognostic prediction. Furthermore, subgroup analyses of WM/LPL patients revealed that subclinical hypothyroidism predicted undesirable outcomes at the early stage. These results were also supported by independent microarray dataset analyses. In conclusion, the primary strength of this study is that it provides robust real-world evidence on the prognostic role of thyroid complications, highlighting further clinical concerns in the management of WM/LPL patients.
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Affiliation(s)
- Xinting Hu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
| | - Hua Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
| | - Dai Yuan
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huiting Qu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Li
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Na Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xianghua Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Liu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongzhi Xu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ya Zhang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Xin Wang, ; Ya Zhang,
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Xin Wang, ; Ya Zhang,
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9
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Zhang JG, Fu SM, Liu F, Wan JG, Wu SB, Jiang GH, Tao WQ, Zhou W, Qian KJ. Correlation and Prognostic Assessment of Low T3 Syndrome and Norepinephrine Dosage for Patients with Sepsis: A Retrospective Single-Center (Cohort) Study. Int J Gen Med 2022; 15:4837-4847. [PMID: 35585999 PMCID: PMC9109978 DOI: 10.2147/ijgm.s362748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/27/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose To investigate the correlation and prognostic significance of low triiodothyronine (T3) syndrome and norepinephrine dosage in patients with sepsis and septic shock. Methods This single-center, retrospective, cohort study enrolled 169 patients with sepsis and septic shock that were admitted to the intensive care unit of First Hospital of Nanchang, Nanchang, China from June 2017 to July 2019. All included patients were followed up for 28 days or died, whichever was earlier. Patients with free T3 (FT3) of <3.1 pmol/L were considered with low T3 syndrome. The correlation and prognostic significance of the FT3 and maximum dosage of norepinephrine (MDN) within 72 h, as well as other clinical indicators, were analyzed by using correlation analysis, principal component analysis, receiver operating characteristic curve, Youden index, and logistic regression. Results A total of 138 patients were allocated to the low T3 group. FT3 inversely correlated with the Sequential Organ Failure Assessment (SOFA) score within 24 h, fluid resuscitation volume within 24 h, and lactic acid levels, and positively correlated with the mean arterial pressure. The critical values of age, SOFA, and MDN for predicting the 28-day mortality were 79.5 years, 8.5 points, and 0.61 µg/kg/min, respectively. The mortality of the low T3 and normal T3 groups was similar. Considering the MDN of 0.61 µg/kg/min as the cutoff value, the mortality between the two groups was significantly different. Conclusion Among patients with sepsis and septic shock, FT3 was inversely correlated with the disease severity. An MDN ≥ 0.61 µg/kg/min within 72 h may be an important prognostic indicator.
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Affiliation(s)
- Jian-guo Zhang
- Department of Critical Care Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Department of Infection, First Affiliated Hospital of Nanchang University, Nanchang, Jianxi, People’s Republic of China
- Department of Critical Care Medicine, Linyi People’s Hospital, Linyi, Shandong, People’s Republic of China
| | - Shang-miao Fu
- Department of Critical Care Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Fen Liu
- Department of Critical Care Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Jian-guo Wan
- Department of Critical Care Medicine, First Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Shu-bing Wu
- Department of Critical Care Medicine, First Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Guang-hui Jiang
- Department of Critical Care Medicine, First Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Wen-qiang Tao
- Department of Critical Care Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Wen Zhou
- Department of Critical Care Medicine, First Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
- Wen Zhou, Department of Critical Care Medicine, First Hospital of Nanchang, No. 128 Xiangshan North Road, Nanchang, Jiangxi, 330006, People’s Republic of China, Email
| | - Ke-jian Qian
- Department of Critical Care Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Correspondence: Ke-jian Qian, Department of Critical Care Medicine, First Affiliated Hospital of Nanchang University, No. 17 YongwaiZheng Street, Nanchang, Jiangxi, 330006, People’s Republic of China, Email
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10
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Maruzzo M, Verzoni E, Vitale MG, Dionese M, Buti S, Galli L, Zivi A, Watutantrige-Fernando S, Zielli T, Zanardi E, Sabbatini R, Basso U, Zagonel V, Procopio G. Prognostic Value of Thyroid Hormone Ratio in Patients With Advanced Metastatic Renal Cell Carcinoma: Results From the Threefour Study (Meet-URO 14). Front Oncol 2021; 11:787835. [PMID: 34900742 PMCID: PMC8655227 DOI: 10.3389/fonc.2021.787835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Thyroid hormone impairment, represented as an alteration in levels of thyroid hormones and a lower fT3/fT4 ratio, has been correlated with a worse prognosis for both cancer and non-cancer patients. The role of baseline thyroid function in patients with metastatic renal cell carcinoma (mRCC) however, has not been studied yet. Materials and Methods We recorded clinical data, baseline biochemical results, and oncological outcomes from 10 Oncology Units in Italy. We stratified patients into three groups according to the fT3/fT4 ratio value and subsequently analyzed differences in progression-free survival (PFS) and overall survival (OS) in the three groups. We also performed univariate and multivariate analyses to find prognostic factors for PFS and OS. Results We analyzed 134 patients treated with systemic treatment for mRCC. Median PFS in the low, intermediate, and high fT3/fT4 ratio group were 7.5, 12.1, and 21.7 months respectively (p<0.001); median OS in the three groups were 36.5, 48.6, and 70.5 months respectively (p =0.006). The low fT3/fT4 ratio maintained its prognostic role at the multivariate analysis independently from IMDC and other well-established prognostic factors. The development of iatrogenic hypothyroidism was not associated with a better outcome. Conclusion We found that baseline thyroid hormone impairment, represented by a low fT3/fT4 ratio, is a strong prognostic factor in patients treated for mRCC in first line setting and is independent of other parameters currently used in clinical practice.
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Affiliation(s)
- Marco Maruzzo
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Elena Verzoni
- Genito-Urinary (GU) Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Michele Dionese
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy.,Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Sebastiano Buti
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Luca Galli
- Oncology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Andrea Zivi
- Oncology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Sara Watutantrige-Fernando
- Hereditary Tumor Unit, Istituto Oncologico Veneto, IOV - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Teresa Zielli
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Martino Hospital, Genova, Italy
| | - Roberto Sabbatini
- Oncology Unit, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Umberto Basso
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Vittorina Zagonel
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Giuseppe Procopio
- Genito-Urinary (GU) Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Istituto Nazionale dei Tumori, Milano, Italy
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11
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Netti GS, Rotondi M, Di Lorenzo A, Papantonio D, Teri A, Schirone M, Spadaccino F, Croce L, Infante B, Perulli R, Coperchini F, Rocchetti MT, Iannelli G, Fortunato F, Prato R, Castellano G, Gesualdo L, Stallone G, Ranieri E, Grandaliano G. Nocturnal haemodialysis is associated with a reduced occurrence of low triiodothyronine serum levels in haemodialysed patients. Clin Kidney J 2020; 13:450-460. [PMID: 32699626 PMCID: PMC7367136 DOI: 10.1093/ckj/sfaa003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/11/2019] [Indexed: 12/28/2022] Open
Abstract
Background End-stage renal disease (ESRD) is associated with a broad spectrum of morphological and functional thyroid disorders. Recent studies have shown that low free triiodothyronine (fT3) levels are related to inflammatory status and endothelial activation in ESRD patients on haemodialysis (HD). Limited data exist about a possible relationship between dialysis regimen, namely long nocturnal haemodialysis (LNHD), and thyroid function parameters. The aim of this study was to evaluate the relationship between dialysis regimen and thyroid function, and consequently with the main patient outcomes. Methods To this purpose, we performed a retrospective, single-centre cohort study including 220 incident chronic HD patients treated during an 8-year period (from January 2010 to December 2017). The main clinical and haematochemical parameters, including thyroid function, were evaluated and related to the main patient outcomes. Results Patients with low fT3 levels (<3.05 ng/mL) showed significantly lower survival rates than patients with normal fT3 levels (>3.05 ng/mL) (P < 0.001), although there were no substantial differences in the demographic and clinical characteristics between the two groups. After propensity score 1:3 matching of 25 patients treated with nocturnal HD to 75 patients treated with diurnal HD, LNHD patients showed significantly higher survival rates (88.0% versus 61.3%, P = 0.001) and lower incidence of cardiovascular events than patients on diurnal dialysis (8.0% versus 40.0%, P = 0.001). Moreover, an 8-year time-dependent analysis showed that at any time, except for baseline, the rate of patients with fT3 levels >3.05 ng/mL was significantly higher in LNHD patients than in patients treated with diurnal dialysis. Conclusions Our data suggest that the application of alternative dialysis regimens, also reducing the frequency of low T3, could ameliorate outcomes and therefore reduce the incidence of cardiovascular events in HD patients.
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Affiliation(s)
- Giuseppe Stefano Netti
- Clinical Pathology Unit and Center for Molecular Medicine, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mario Rotondi
- Internal Medicine and Endocrinology Unit, Laboratory for Endocrine Disruptors, ICS Maugeri I.R.C.C.S, University of Pavia, Pavia, Italy
| | - Adelaide Di Lorenzo
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Domenico Papantonio
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonino Teri
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Morena Schirone
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Federica Spadaccino
- Clinical Pathology Unit and Center for Molecular Medicine, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Laura Croce
- Internal Medicine and Endocrinology Unit, Laboratory for Endocrine Disruptors, ICS Maugeri I.R.C.C.S, University of Pavia, Pavia, Italy
| | - Barbara Infante
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Rossella Perulli
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesca Coperchini
- Internal Medicine and Endocrinology Unit, Laboratory for Endocrine Disruptors, ICS Maugeri I.R.C.C.S, University of Pavia, Pavia, Italy
| | - Maria Teresa Rocchetti
- Clinical Pathology Unit and Center for Molecular Medicine, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppina Iannelli
- Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesca Fortunato
- Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Rosa Prato
- Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppe Castellano
- Nephrology Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Loreto Gesualdo
- Nephrology Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Stallone
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Elena Ranieri
- Clinical Pathology Unit and Center for Molecular Medicine, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppe Grandaliano
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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12
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Xiong H, Yan P, Huang Q, Shuai T, Liu J, Zhu L, Lu J, Shi X, Yang K, Liu J. A prognostic role for non-thyroidal illness syndrome in chronic renal failure:a systematic review and meta-analysis. Int J Surg 2019; 70:44-52. [PMID: 31437639 DOI: 10.1016/j.ijsu.2019.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/24/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic renal failure (CRF) is a serious disease that has become a burden on global and local economics and public health. In addition, non-thyroidal illness syndrome (NTIS) has become increasingly more prevalent in CRF patients. MATERIALS AND METHODS A data search was conducted on the PubMed/Medline, Cochrane Library, Web of Science, Embase, and CBM databases to identify studies up to November 1st, 2018, that compared low T3 and normal T3 levels in patients with CRF. Data analysis was done by calculating the relative risks (RR) and 95% confidence intervals (95% CI) and continuous variables were described by weighted mean difference (WMD) and 95% CI. The efficacy outcomes included renal function and mortality. The Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality scale were used to assess the quality of the cohort and cross-sectional studies, respectively. A funnel plot was used to identify publication bias. RESULTS Seventeen studies with a total of 4593 patients were finally included in the analysis. Among the 17 studies, 11 reported the mortality of CRF patients with low T3 and normal T3 levels. Subgroups were assigned according to different follow-up times and different methods of treatment. The mortality rate in the low T3 group was much higher than in the normal T3 group. 11 studies reported creatinine (Cr) results in patients with low T3 and normal T3 levels and our analysis found no significant differences between the two groups (95%CI: 0.46-0.25; P-heterogeneity = 0.000; P = 0.559). Five studies reported uric acid results and we found no significant differences between the two groups (95%CI: 0.08-0.22; P-heterogeneity = 0.438; P = 0.377). Five studies reported the urea levels in the two groups and our analysis found no significant differences (95%CI: 1.60-1.23; I2 = 0.0%; P-heterogeneity = 0.498;P = 0.798). CONCLUSION Low T3 had a greater impact on the short-term prognosis of patients with CRF than on the long-term prognosis. NTIS did not cause substantial kidney damage.
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Affiliation(s)
- Huaiyu Xiong
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Peijing Yan
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Institute of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Qiangru Huang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Tiankui Shuai
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Jingjing Liu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Lei Zhu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Jiaju Lu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Xiue Shi
- Institute of Evidence Based Rehabilitation Medicine of Gansu Province, Lanzhou, 730000, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Institute of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, China; Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, 730000, China; Institute of Evidence Based Rehabilitation Medicine of Gansu Province, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
| | - Jian Liu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.
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13
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Lin KY, Wang SY, Jiang H, Chen HC, Wu ZY, Guo YS, Zhu PL. Negative association between free triiodothyronine level and contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention. BMC Nephrol 2019; 20:201. [PMID: 31159763 PMCID: PMC6545736 DOI: 10.1186/s12882-019-1386-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/15/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A low FT3 level is significantly associated with a variety of kidney disease and acute myocardial infarction (AMI). However, it remains unclear whether low FT3 is associated with CI-AKI in patients who underwent pPCI. METHODS Single-center retrospective study evaluated 363 STEMI patients undergoing pPCI. Patients were classfied into 2 groups, low FT3 group (FT3 < 3.1 pmol/L) and normal FT3 group (FT3 ≥ 3.1 pmol/L);CI-AKI was defined as an increase in the serum creatinine levels of ≥50% or 0.3 mg/dL above the baseline level within 48 h after contrast medium exposure. RESULTS Overall, 80(22.0%) patients had low FT3, and 59(16.3%) patients developed CI-AKI. The incidence of CI-AKI and in-hospital mortality was significantly higher in patients with low FT3 than normal (31.3% vs 12.0%; 15.0% vs 3.2%, respectively, both p < 0.0001). Multivariate logistic regression analysis indicated that low FT3 was an independent predictor of CI-AKI (odds ratio [OR] = 2.62, 95%CI:1.35-5.07, p < 0.05). In addition, low FT3 was associated with an increased risk of all-cause mortality during a mean follow-up period of 20 months (hazard ratio [HR] = 2.54, 95%CI:1.15-5.60, p < 0.05). CONCLUSION Low FT3 was associated with CI-AKI, short- and long-term mortality in STEMI patients after pPCI.
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Affiliation(s)
- Kai-Yang Lin
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Sun-Ying Wang
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Hui Jiang
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Han-Chuan Chen
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Zhi-Yong Wu
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Yan-Song Guo
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China.
| | - Peng-Li Zhu
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China.
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14
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Xu J, Wang L. Low T3 Syndrome as a Predictor of Poor Prognosis in Patients With Pyogenic Liver Abscess. Front Endocrinol (Lausanne) 2019; 10:541. [PMID: 31447784 PMCID: PMC6691090 DOI: 10.3389/fendo.2019.00541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/19/2019] [Indexed: 01/25/2023] Open
Abstract
Aim: There is an association between the low triiodothyronine (T3) state and the poor prognosis for severe acute conditions. However, the correlation between thyroid dysfunction and pyogenic liver abscess (PLA) is unclear. This study aims to figure out how low T3 syndrome is related to the poor prognosis in PLA patients as well as estimate the serum T3 predictive value. Methods: The study consecutively enrolled 240 PLA patients in total with a 3 month followed-up period, and defined low T3 syndrome as low T3 level together with non-thyroid disease. Researchers implemented multivariate logistic regression analyses, univariate analysis, as well as receiver-operating characteristic (ROC) curve analysis. Results: Patients with low T3 syndrome had a higher mortality rate (14.3 vs. 2.0%), acute hepatic failure (6.8 vs. 1.0%), and septic shock (12.1 vs. 3.0%) than patients with normal levels of T3 (all P < 0.05). Low T3 syndrome served as an independent predictor of death [odds ratio (OR) = 5.03, 95% of confidence interval (CI) = 1.09-23.05], and all adverse outcomes [odds ratio (OR) = 3.63, 95% of confidence interval (CI) = 1.84-7.17] following the adjustment of potential confounders in the logistic model. T3 had the largest area under the ROC curve (AUC) than T4, FT3, FT4, and TSH in death prediction (AUC = 0.901, cut-off value = 0.70 nmol/L, P < 0.01), and all adverse outcomes (AUC = 0.743, cutoff value = 0.83 nmol/L, P < 0.01). Conclusions: It seems that low T3 syndrome can predict the prognosis of PLA in clinical practice in future.
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15
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Lin HJ, Lin CC, Lin HM, Chen HJ, Lin CC, Chang CT, Chou CY, Huang CC. Hypothyroidism is associated with all-cause mortality in a national cohort of chronic haemodialysis patients. Nephrology (Carlton) 2018; 23:559-564. [PMID: 28346975 DOI: 10.1111/nep.13049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 12/27/2022]
Abstract
AIM The prevalence of hypothyroidism is high in haemodialysis (HD) patients and hypothyroidism increases all-cause mortality in HD patients. Comorbidities are common in HD patients and are associated with both mortality and hypothyroidism. The aim of the study is to explore the effect of the interactions of comorbidities and hypothyroidism on all-cause mortality in HD patients. METHOD Patients with hypothyroidism (ICD-9-CM 244.0, 244.1, and 244.9) and matched patients without hypothyroidism in the Registry for Catastrophic Illness Patient Database of Taiwan Health Insurance from 2000 to 2010 were analyzed. The association of hypothyroidism and risk of all-cause mortality was analyzed using Cox proportional hazard regression. RESULT Nine hundred and eight HD patients with hypothyroidism and 3632 sex-, age-, gender- matched HD patients without hypothyroidism were analyzed. Hypothyroidism was associated with increased all-cause mortality with an adjusted hazard ratio of 1.22 [95% confidence interval (CI): 1.10-1.36, P < 0.001]. TRT may decrease mortality associated with hypothyroidism (P < 0.001). There was a significant interaction (P = 0.04) between diabetes and hypothyroidism. There was no significant interaction found in hypothyroidism and the following comorbidities: hyperlipidaemia, hypertension, chronic obstructive pulmonary disease, coronary artery disease, stroke, peripheral arterial disease, asthma, congestive heart failure and cancer. CONCLUSION Hypothyroidism is associated with increased all-cause mortality in chronic HD patients. The interaction of hypothyroidism and diabetes, but not other common comorbidities in HD patients, has an effect on mortality risks.
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Affiliation(s)
- Hsuan-Jen Lin
- Division of Nephrology, Department of Internal Medicine, Asia University Hospital, Wufeng, Taichung, Taiwan.,Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan
| | - Chung-Chih Lin
- Division of Nephrology, Department of Internal Medicine, Asia University Hospital, Wufeng, Taichung, Taiwan
| | - Hsuan Ming Lin
- Division of Nephrology, Department of Internal Medicine, Tainan Municipal Annan Hospital- China Medical University, Wufeng, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Wufeng, Taichung, Taiwan.,College of Medicine, China Medical University, Wufeng, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Wufeng, Taichung, Taiwan.,College of Medicine, China Medical University, Wufeng, Taichung, Taiwan.,Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital, Wufeng, Taichung, Taiwan
| | - Chiz-Tzung Chang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan.,College of Medicine, China Medical University, Wufeng, Taichung, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Department of Internal Medicine, Asia University Hospital, Wufeng, Taichung, Taiwan.,Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan.,College of Medicine, China Medical University, Wufeng, Taichung, Taiwan.,Department of Biotechnology, Asia University, Wufeng, Taichung, Taiwan
| | - Chiu-Ching Huang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan.,College of Medicine, China Medical University, Wufeng, Taichung, Taiwan
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16
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Schirripa M, Pasqualetti G, Giampieri R, Scartozzi M, Lonardi S, Rumanò L, Bergamo F, Stragliotto S, Murgioni S, Alberti G, Rizzato MD, Prete AA, Puzzoni M, Pusceddu V, Ziranu P, Pani F, Mariotti S, Zagonel V, Monzani F, Loupakis F. Prognostic Value of Thyroid Hormone Ratios in Patients With Advanced Metastatic Colorectal Cancer Treated With Regorafenib: The TOREADOR Study. Clin Colorectal Cancer 2018; 17:e601-e615. [DOI: 10.1016/j.clcc.2018.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/03/2018] [Accepted: 05/31/2018] [Indexed: 12/27/2022]
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17
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Panuganti PL, Hinkle SN, Rawal S, Grunnet LG, Lin Y, Liu A, Thuesen ACB, Ley SH, Olesen SF, Zhang C. Lactation Duration and Long-Term Thyroid Function: A Study among Women with Gestational Diabetes. Nutrients 2018; 10:nu10070938. [PMID: 30037073 PMCID: PMC6073731 DOI: 10.3390/nu10070938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022] Open
Abstract
Lactation is associated with reduced postpartum weight retention and a lower risk of several cardiometabolic disorders in population-based studies. We examined the association between lactation and long-term thyroid function among women with history of gestational diabetes mellitus (GDM), a high-risk population for subsequent metabolic complications. The study included 550 women who developed GDM in the Danish National Birth Cohort (1996–2002) and followed-up in the Diabetes & Women’s Health Study (2012–2014). We assessed adjusted associations between cumulative lactation duration and concentrations of thyroid stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) measured at follow-up. Women with longer cumulative lactation duration tended to have higher fT3 levels (adjusted β and 95% confidence interval (CI) for ≥12 months vs. none: 0.19 (0.03–0.36); p-trend = 0.05). When restricted to women with a single lifetime pregnancy to control for parity (n = 70), women who lactated for >6 months (vs. none) had higher fT3 levels (0.46 pmol/L (0.12–0.80); p-trend = 0.02) and a higher fT3:fT4 ratio (0.61 (0.17–1.05); p-trend = 0.007). Our findings suggested that a longer duration of lactation may be related to greater serum fT3 levels and fT3:fT4 ratio 9–16 years postpartum among Danish women with a history of GDM. The association was particularly pronounced among women who only had one lifetime pregnancy.
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Affiliation(s)
- Pranati L Panuganti
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA.
- The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
| | - Stefanie N Hinkle
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA.
| | - Shristi Rawal
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA.
- Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, NJ 07107, USA.
| | - Louise G Grunnet
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark.
- Department of Endocrinology, Rigshospitalet University Hospital, DK-2200 Copenhagen, Denmark.
- The Danish Diabetes Academy, DK-5000 Odense, Denmark.
| | - Yuan Lin
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA.
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA.
| | - Aiyi Liu
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA.
| | - Anne C B Thuesen
- Department of Endocrinology, Rigshospitalet University Hospital, DK-2200 Copenhagen, Denmark.
| | - Sylvia H Ley
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Sjurdur F Olesen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark.
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA.
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18
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Guarnizo-Poma M, Paico-Palacios S, Pantoja-Torres B, Lazaro-Alcantara H, Urrunaga-Pastor D, Benites-Zapata VA. Association between free thyroid hormones values and the lipid profile in middle-aged women with chronic symptoms. Diabetes Metab Syndr 2018; 12:531-535. [PMID: 29610063 DOI: 10.1016/j.dsx.2018.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/26/2018] [Indexed: 02/08/2023]
Abstract
AIMS To determine the association between the thyroid hormones(FT3, FT4 and TSH) and the lipid profile markers(HDL-c, LDL-c and triglycerides) values in middle-aged women with no metabolic disorders and recurrent chronic symptomatology. MATERIALS AND METHODS We carried out an analytical cross-sectional study in euthyroid women with recurrent chronic symptoms of at least six months with no apparent diagnosis who attended the endocrinological gynaecology outpatient service of a private clinic in Lima-Peru during 2012-2014. Participants who met the eligibility criteria were evaluated according to their thyroid hormones(FT3, FT4 and TSH) and lipid profile markers(HDL-c, LDL-c and triglycerides) values. We elaborated univariate/multivariate linear regression models to evaluate the association between the thyroid markers and the lipid profile levels. The reported association measure was the beta coefficient(β) with its respective p-value. RESULTS We analyzed 211 participants, the average age was 44.9 ± 14.0(SD) years, the FT3 and FT4 mean levels were 3.2 ± 0.4 pg/mL and 1.2 ± 0.2 ng/dL respectively, while the TSH median was 2.8(IQR:1.9-4.0) μU/mL. The mean or median levels of LDL-c, HDL-c and triglycerides were of 137.5 ± 37.9 mg/dL, 54.0 ± 15.0 mg/dL and 118.5(IQR:79.5-169.5) mg/dL respectively. In the multivariate linear regression model between the FT3 and LDL-c levels, we found that for each increase in a FT3 unit, the LDL-c values decreased on average 30.85 mg/dL(p < 0.01). We found no statistically significant associations in the other multivariate models of linear regression, among the other thyroid hormones and lipid markers. CONCLUSION We found an inverse association between the FT3 and LDL-c values in women with chronic gynaecological symptoms.
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19
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Gao R, Chen RZ, Xia Y, Liang JH, Wang L, Zhu HY, Zhu Wu J, Fan L, Li JY, Yang T, Xu W. Low T3 syndrome as a predictor of poor prognosis in chronic lymphocytic leukemia. Int J Cancer 2018; 143:466-477. [PMID: 29457831 DOI: 10.1002/ijc.31327] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/04/2018] [Accepted: 02/14/2018] [Indexed: 01/09/2023]
Abstract
Low triiodothyronine (T3) state is associated with poor prognosis in critical acute and prolonged illness. However, the information on thyroid dysfunction and cancer is limited. The aim of our study was to evaluate the prognostic value of low T3 syndrome in chronic lymphocytic leukemia (CLL). Two hundred and fifty-eight patients with detailed thyroid hormone profile at CLL diagnosis were enrolled. Low T3 syndrome was defined by low free T3 (FT3) level accompanied by normal-to-low free tetraiodothyronine (FT4) and thyroid-stimulating hormone (TSH) levels. A propensity score-matched method was performed to balance the baseline characteristics. Multivariate Cox regression analyses screened the independent prognostic factors related to time-to-first-treatment (TTFT) and cancer-specific survival (CSS). Area under the curve (AUC) assessed the predictive accuracy of CLL-International Prognostic Index (IPI) together with low T3 syndrome. The results showed that 37 (14.34%) patients had low T3 syndrome, which was significantly associated with unfavorable TTFT and CSS in the propensity-matched cohort, and it was an independent prognostic indicator for both TTFT and CSS. Serum FT3 level was positively related to protein metabolism and anemia, and inversely related to inflammatory state. Patients with only low FT3 demonstrated better survival than those with synchronously low FT3 and FT4, while those with synchronously low FT3, FT4 and TSH had the worst clinical outcome. Low T3 syndrome together with CLL-IPI had larger AUCs compared with CLL-IPI alone in TTFT and CSS prediction. In conclusion, low T3 syndrome may be a good candidate for predicting prognosis in future clinical practice of CLL.
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Affiliation(s)
- Rui Gao
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Rui-Ze Chen
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Yi Xia
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jin-Hua Liang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Li Wang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hua-Yuan Zhu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jia- Zhu Wu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Lei Fan
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jian-Yong Li
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Tao Yang
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Wei Xu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
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20
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Abstract
Thyroid hormones influence renal development, kidney hemodynamics, glomerular filtration rate and sodium and water homeostasis. Hypothyroidism and hyperthyroidism affect renal function by direct renal effects as well as systemic hemodynamic, metabolic and cardiovascular effects. Hypothyroidism has been associated with increased serum creatinine and decreased glomerular filtration rate. The reverse effects have been reported in thyrotoxicosis. Most of renal manifestations of thyroid dysfunction are reversible with treatment. Kidney disease may also cause thyroid dysfunction by several mechanisms. Nephrotic syndrome has been associated to changes in serum thyroid hormone concentrations. Different forms of glomerulonephritis and tubulointerstitial disease may be linked to thyroid derangements. A high prevalence of thyroid hormone alteration has been reported in acute kidney injury. Thyroid dysfunction is highly prevalent in chronic kidney disease patients. Subclinical hypothyroidism and low triiodothyronine syndrome are common features in patients with chronic kidney disease. Patients treated by both hemodialysis and peritoneal dialysis, and renal transplantation recipients, exhibit thyroid hormone alterations and thyroid disease with higher frequency than that found in the general population. Drugs used in the therapy of thyroid disease may lead to renal complications and, similarly, drugs used in kidney disorders may be associated to thyroid alterations. Lastly, low thyroid hormones, especially low triiodothyronine levels, in patients with chronic kidney disease have been related to a higher risk of cardiovascular disease and all-cause mortality. Interpretation of the interactions between thyroid and renal function is a challenge for clinicians involved in the treatment of patients with thyroid and kidney disease.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology, Hospital Ramón y Cajal, Ctra. De Colmenar, Km 9,100, 28034, Madrid, Spain.
| | - María Auxiliadora Bajo
- Department of Nephrology, Hospital La Paz, Madrid, Spain
- Department of Health Sciences, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rafael Selgas
- Department of Nephrology, Hospital La Paz, Madrid, Spain
- Department of Health Sciences, Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan José Díez
- Department of Endocrinology, Hospital Ramón y Cajal, Ctra. De Colmenar, Km 9,100, 28034, Madrid, Spain
- Department of Medicine, University de Alcalá de Henares, Madrid, Spain
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21
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Gao R, Liang JH, Wang L, Zhu HY, Wu W, Wu JZ, Xia Y, Cao L, Fan L, Yang T, Li JY, Xu W. Low T3 syndrome is a strong prognostic predictor in diffuse large B cell lymphoma. Br J Haematol 2017; 177:95-105. [PMID: 28146267 DOI: 10.1111/bjh.14528] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 11/23/2016] [Indexed: 12/22/2022]
Abstract
The aim of this study was to evaluate the prognostic effect of low triiodothyronine (T3) syndrome on patients with diffuse large B cell lymphoma (DLBCL). A hundred and eighty-eight patients with detailed thyroid hormone levels at diagnosis of DLBCL were enrolled. Low T3 syndrome was defined as a low serum free T3 (FT3) level with low or normal serum free tetraiodothyronine (FT4) and thyroid stimulating hormone levels. Multivariate Cox regression analysis was used to screen prognostic factors associated with progression-free survival (PFS) and overall survival (OS). Receiver-operator characteristic curves and the corresponding areas under the curve were calculated to assess the predictive accuracy of International Prognostic Index (IPI) and low T3 syndrome. Twenty-four patients were diagnosed with low T3 syndrome, which was associated with worse PFS and OS in the rituximab era. It was an independent prognostic factor for PFS and OS, especially for those with IPI 0-2, extranodal sites ≤1 and stage III-IV. Synchronously low FT3 and FT4 had poorer survival outcome compared to only low FT3 and adding criterion of low T3 syndrome improved the prognostic capacity of IPI for predicting PFS and OS in DLBCL. Low T3 syndrome was found to be a strong prognostic predictor in DLBCL.
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Affiliation(s)
- Rui Gao
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China.,Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Jin-Hua Liang
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China
| | - Li Wang
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China
| | - Hua-Yuan Zhu
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China
| | - Wei Wu
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China
| | - Jia-Zhu Wu
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China
| | - Yi Xia
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China
| | - Lei Cao
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China
| | - Lei Fan
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China
| | - Tao Yang
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Jian-Yong Li
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China
| | - Wei Xu
- Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Centre for Cancer Personalized Medicine, Nanjing, China
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22
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Flores Gama C, Rosales LM, Ouellet G, Dou Y, Thijssen S, Usvyat L, Zhang H, Kuntsevich V, Levin NW, Kotanko P. Plasma Gelsolin and Its Association with Mortality and Hospitalization in Chronic Hemodialysis Patients. Blood Purif 2017; 43:210-217. [DOI: 10.1159/000452731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Human plasma gelsolin (pGSN) is an actin-binding protein that is secreted into the extracellular fluid, with the skeletal muscle and myocardial tissues being its major source. Depletion of pGSN has been shown to be related to a variety of inflammatory and clinical conditions. Methods: pGSN levels were prospectively determined in prevalent maintenance hemodialysis (HD) patients from 3 U.S. dialysis centers. Demographics (age, time since dialysis initiation, race, gender, body height and weight, comorbidities), inflammatory markers (C reactive protein, CRP; interleukin 6, IL-6), free triiodothyronine (fT3), and routine laboratory parameters were obtained. We performed Kaplan-Meier and Cox proportional hazard survival analysis for all-cause and cardiovascular mortality, and recurrent event survival analysis for hospitalization. Results: We studied 153 patients; mean age was 60.5 ± 14.7; 52% were males. The mean pGSN level was 6,617 ± 1,789 mU/ml. In univariate analysis, pGSN was positively correlated with body mass index (r = 0.2, p = 0.01), pre-HD serum albumin (r = 0.247, p = 0.002), and pre-HD serum creatinine (r = 0.381, p < 0.001), and inversely with age (r = -0.286, p < 0.001), CRP (r = -0.311, p < 0.001), and IL-6 (r = -0.317, p < 0.001). In the adjusted analysis, the associations with CRP and creatinine were retained. pGSN levels tended to be lower in patients who died (p = 0.08). There was no association with all-cause or cardiovascular mortality, or all-cause hospitalization. Of note, fT3 was lower in patients who died (p = 0.001). Conclusions: Even though pGSN was inversely correlated with age, CRP and IL-6, suggesting that inflammation may influence pGSN, lower pGSN levels were not associated with hospitalization, all-cause and cardio-vascular mortality in this patient population.
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23
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Chuang MH, Liao KM, Hung YM, Chou YC, Chou P. Association of TSH Elevation with All-Cause Mortality in Elderly Patients with Chronic Kidney Disease. PLoS One 2017; 12:e0168611. [PMID: 28045962 PMCID: PMC5207752 DOI: 10.1371/journal.pone.0168611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/02/2016] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) is a widespread condition in the global population and is more common in the elderly. Thyroid-stimulating hormone (TSH) level increases with aging, and hypothyroidism is highly prevalent in CKD patients. However, the relationship between low thyroid function and mortality in CKD patients is unclear. Therefore, we conducted a retrospective cohort study to examine the relationship between TSH elevation and all-cause mortality in elderly patients with CKD. This retrospective cohort study included individuals ≥65 years old with CKD (n = 23,786) in Taipei City. Health examination data from 2005 to 2010 were provided by the Taipei Databank for Public Health Analysis. Subjects were categorized according to thyroid-stimulating hormone (TSH) level as follows: low normal (0.34<TSH<1.074 mIU/L), middle normal (1.074≤TSH≤2.46 mIU/L), high normal (2.46<TSH<5.2 mIU/L), elevated I (5.2≤TSH<10 mIU/L), and elevated II (TSH≥10 mIU/L). Risk of mortality was evaluated using a Cox proportional hazard regression model adjusted for sex, age, hypertension, diabetes mellitus, CKD stage, serum albumin, high-density lipoprotein cholesterol, uric acid, hemoglobin, body mass index, glutamic-pyruvic transaminase, smoking, alcohol consumption, and history of cardiovascular disease (coronary artery disease, congestive heart failure, cerebral vascular disease), history of cancer, and history of chronic obstructive pulmonary disease. Our results showed that compared to the reference group (middle normal TSH), the risk of all-cause mortality was increased in the elevated I group (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.02–1.45) and elevated II group (HR, 1.30; 95% CI, 1.00–1.69). We found a significant association between TSH elevation and all-cause mortality in this cohort of elderly persons with CKD. However, determining the benefit of treatment for moderately elevated TSH level (5.2–10 mIU/L) in elderly patients with CKD will require a well-designed randomized controlled trial.
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Affiliation(s)
- Mei-hsing Chuang
- Division of Family Medicine, Department of Community Medicine, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Kuo-Meng Liao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Yao-Min Hung
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yi-Chang Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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24
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Xu H, Brusselaers N, Lindholm B, Zoccali C, Carrero JJ. Thyroid Function Test Derangements and Mortality in Dialysis Patients: A Systematic Review and Meta-analysis. Am J Kidney Dis 2016; 68:923-932. [PMID: 27596516 DOI: 10.1053/j.ajkd.2016.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND We evaluated current evidence associating thyroid function test result derangements with risk for mortality in patients with chronic kidney failure treated by long-term dialysis. STUDY DESIGN Systematic review and meta-analysis of cohort studies. SETTING & POPULATION Dialysis patients. SELECTION CRITERIA FOR STUDIES We searched PubMed, Web of Science, Science Citation Index, Cochrane Library, and Embase databases from inception through December 2015. PREDICTORS Hypothyroidism (thyrotropin level greater than reference range) and low triiodothyronine (T3) and thyroxine (T4) levels. OUTCOMES All-cause and cardiovascular mortality. RESULTS 12 studies involving 14,766 participants (4,450 deaths) were identified. Of those, 6 studies provided data for cardiovascular mortality (2,772 participants with 327 cardiovascular deaths). Overall, confidence in the available evidence was moderate. Pooled adjusted HRs for all-cause mortality associated with hypothyroidism, low T3 level, and low T4 level were 1.24 (95% CI, 1.14-1.34), 1.67 (95% CI, 1.23-2.27), and 2.40 (95% CI, 1.47-3.93), respectively. Pooled adjusted HRs for cardiovascular mortality associated with low T3 and T4 levels were 1.84 (95% CI, 1.24-2.74) and 3.06 (95% CI, 1.29-7.24), respectively. LIMITATIONS Fewer studies reporting on T4 and thyrotropin outcomes. CONCLUSIONS In patients treated with long-term dialysis, (cardiovascular) mortality is consistently higher in the presence of thyroid function test result derangements.
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Affiliation(s)
- Hong Xu
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Nele Brusselaers
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Carmine Zoccali
- Division of Nephrology, Dialysis and Kidney Transplantation, CNR Hospital, Reggio Calabria, Italy
| | - Juan Jesús Carrero
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Gastrointestinal symptoms and disorders in patients with eating disorders. Clin J Gastroenterol 2015; 8:255-63. [PMID: 26499370 DOI: 10.1007/s12328-015-0611-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/07/2015] [Indexed: 12/14/2022]
Abstract
The two most clinically serious eating disorders are anorexia nervosa and bulimia nervosa. A drive for thinness and fear of fatness lead patients with anorexia nervosa either to restrict their food intake or binge-eat then purge (through self-induced vomiting and/or laxative abuse) to reduce their body weight to much less than the normal range. A drive for thinness leads patients with bulimia nervosa to binge-eat then purge but fail to reduce their body weight. Patients with eating disorders present with various gastrointestinal disturbances such as postprandial fullness, abdominal distention, abdominal pain, gastric distension, and early satiety, with altered esophageal motility sometimes seen in patients with anorexia nervosa. Other common conditions noted in patients with eating disorders are postprandial distress syndrome, superior mesenteric artery syndrome, irritable bowel syndrome, and functional constipation. Binge eating may cause acute gastric dilatation and gastric perforation, while self-induced vomiting can lead to dental caries, salivary gland enlargement, gastroesophageal reflux disease, and electrolyte imbalance. Laxative abuse can cause dehydration and electrolyte imbalance. Vomiting and/or laxative abuse can cause hypokalemia, which carries a risk of fatal arrhythmia. Careful assessment and intensive treatment of patients with eating disorders is needed because gastrointestinal symptoms/disorders can progress to a critical condition.
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