Selenium supplementation in inactive moderate to severe Graves' orbitopathy patients: a randomized controlled trial

PURPOSE

This study was designed to evaluate the effect of selenium supplementation in inactive moderate-severe Graves' orbitopathy (GO) patients.

METHODS

This study was a single-center, placebo-controlled, double-masked, randomized trial. Inactive moderate-severe GO participants were randomized to receive six months of 200 micrograms/day of selenium supplementation or placebo. Thorough eye exams, clinical activity score (CAS), Graves' Ophthalmopathy quality of life questionnaire (GO-QOL), and serum selenium level were evaluated at baseline and 6 months after the interventions. The chi-squared or Fisher's exact test was used to compare categorical variables. The t-test and the paired t-test were used to compare continuous variables between two independent samples and two dependent samples, respectively.

RESULTS

A total of 25 participants were enrolled, 13 in the selenium group and 12 in the placebo group. Both groups had adequate baseline serum selenium levels at 98.96 ± 15.63 mcg/L and 102.55 ± 17.71 mcg/L, respectively. After 6 months of intervention, the selenium group showed a greater improvement in palpebral aperture (mean difference: -1.4 ± 1.7 mm, p = .04) compared to the placebo group (-0.3 ± 2.7 mm). Notably, 5(41.67%) people in the placebo group developed larger palpebral apertures. Proptosis, ocular motility, and soft tissue signs did not change significantly. GO-QOL and CAS score improvement showed no statistically significant difference between both groups. Minor adverse effects were observed.

CONCLUSIONS

Selenium supplementation has a positive effect on eyelid aperture even in inactive moderate-to-severe GO patients with a sufficient baseline selenium level.

Association of osteoporosis and sarcopenia with fracture risk in transfusion-dependent thalassemia

Patients with transfusion-dependent thalassemia (TDT) have an increased risk of osteoporosis and fractures. They also have several potential factors associated with sarcopenia. There has been currently no study on sarcopenia and its association with falls and fractures in TDT. This study aims to determine the prevalence of and factors associated with osteoporosis, fragility fractures, and sarcopenia in adults with TDT. A cross-sectional study was conducted at the hematologic clinic at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Clinical data and laboratory testing were collected. Bone mineral density and morphometric vertebral fracture were assessed. Sarcopenia was defined using the 2014 and 2019 Asian Working Group for Sarcopenia (AWGS) criteria. We included 112 TDT patients aged 35.1 ± 12.5 years. The prevalence of osteoporosis was 38.4%. Fragility fractures were found in 20.5% of patients. Lower BMI (OR 0.29; 95% CI 0.12-0.72, P = 0.007) and hypogonadal state (OR 3.72; 95% CI 1.09-12.74, P = 0.036) were independently associated with osteoporosis. According to the 2014 AWGS criteria, the prevalence of overall sarcopenia and severe sarcopenia was 44.6% and 13.4%, respectively. Severe sarcopenia was strongly associated with fragility fractures (OR 4.59, 95% CI 1.21-17.46, P = 0.025). In conclusion, osteoporosis, fragility fractures, and sarcopenia were prevalent in adults with TDT. Severe sarcopenia was associated with fragility fractures. Early osteoporosis and sarcopenia screening and prevention may reduce fracture risk and its complications in these patients.

Effects of Phosphate Binders on Bone Biomarkers and Bone Density in Hemodialysis Patients

BACKGROUNDS

The incidences of osteoporosis, fracture, and vascular calcification increase concordantly with the progression of chronic kidney disease (CKD). CKD-mineral bone disease (CKD-MBD) induced by hyperphosphatemia is a major pathophysiologic mechanism. The effects of phosphate binders on bone turnover biomarkers and bone mineral density (BMD) in hemodialysis patients are still inconclusive. Our aim is to demonstrate the effects of these phosphate binders on different aspects of CKD-MBD.

METHODS

We conducted a prospective cohort of 65 hemodialysis patients to investigate the effect of 12-month monotherapy of phosphate binders composing calcium-based phosphate binders (CPB) or non-calcium-based phosphate binders (NCPB), including sevelamer and lanthanum, on bone turnover biomarkers and BMD changes. The performance of bone turnover biomarkers to predict low BMD was attentively determined.

RESULTS

When compared with CPB, NCPB use was associated with higher levels of bone turnover biomarkers. NCPB was also associated with lower BMD at lumbar and distal radius. Total procollagen type 1 N-terminal propeptide (P1NP), bone-specific alkaline phosphatase (BALP), and tartrate-resistant acid phosphatase 5b (TRAP5b) provided the best performance for diagnosing low BMD in hemodialysis patients.

CONCLUSIONS

Switching from CPB to NCPB might increase bone biomarkers and prevent the development of adynamic bone disease. On the contrary, NCPB should be cautiously used in hemodialysis patients who already had low BMD. P1NP, BALP, and TRAP5b could be used to guide the appropriate management, including anti-resorptive and anabolic medications, and predict low BMD in hemodialysis patients treated with phosphate binders. This article is protected by copyright. All rights reserved.

Usefulness of (99m)Tc-pertechnetate whole body scan with neck and chest SPECT/CT for detection of post-surgical thyroid remnant and metastasis in differentiated thyroid cancer patients

OBJECTIVE

The aim of the study was to evaluate the usefulness of (99m)Tc-pertechnetate whole body scan (WBS) with neck and chest SPECT/CT for detection of post-surgical thyroid remnant and metastasis in differentiated thyroid cancer (DTC) patients.

METHODS

Fifty-six post total thyroidectomy patients were included. All patients were prospectively imaged with (99m)Tc-pertechnetate WBS with neck and chest SPECT/CT before (131)I ablation. The post-ablative (131)I WBS with SPECT/CT was performed at 5-7 days after receiving (131)I. Both scans were directly compared to determine the concordance of sites and number of remnant and metastasis.

RESULTS

Overall per-patient analysis, the percentage of concordance between two scans was 96.4%. In thyroid bed, lymph node, lung and bone subgroups, the percentage of concordance between two scans was 96.4, 92.9, 98.2 and 100%, respectively. All of them show good correlation with unweighted kappa between 0.7 and 1. Overall per-lesion analysis, the percentage of concordance between two scans was 84%. In thyroid bed, lymph node, lung and bone subgroups, the percentage of concordance between two scans was 89.5, 55, 82.6 and 50%, respectively.

CONCLUSIONS

Pre-ablative pertechnetate WBS with neck and chest SPECT/CT has good correlation for the detection of post-surgical thyroid remnant, cervical node and discrete lung nodule metastasis as compared to (131)I WBS with SPECT/CT per-patient basis. Because (131)I therapeutic activity is desired base on metastatic site and less concerning about the number of lesions, pre-ablative (99m)Tc-pertechnetate WBS with SPECT/CT was a good alternative tool to avoid radioiodine stunning in post-surgical DTC patients.

Utility of 8F-FDG PET/CT in well differentiated thyroid carcinoma with high serum antithyroglobulin antibody

OBJECTIVE

Evaluate the utility of 18F-FDG PET/CT in the follow-up of differentiated thyroid cancer (DTC) patients with high serum antithyroglobulin antibody (TgAb) but negative serum thyroglobulin (Tg) measurements and negative 131I whole-body scans (WBS).

MATERIAL AND METHOD

The present study included 22 consecutive patients with high serum TgAb levels. They had negative serum Tg measurements and negative 131I WBS. PET/CT was performed 60 min after intravenous injection of 227.55-455.47 MBq (6.15-12.31 mCi) of 18F-FDG using a combined PET/CT scanner. Co-registered CT images were used to differentiate physiologic from pathologic tracer uptake. Findings on 18F-FDG PET/CT were correlated with tissue pathology follow-up imaging or clinical follow-up served as a reference.

RESULTS

Twenty-two well differentiated thyroid cancerpatients participated. Twelve had positive findings on 18F-FDG PET/CT six were true positives and six were false-positives. 18F-FDG PET/CT results were true negative in 10 patients and the authors found no false-negative patients in the present study. The overall sensitivity, specificity and accuracy of 18F-FDG PET/CT were 100%, 62.5% and 72.7%, respectively. TgAb levels, which are appropriated for sending DTC patient who are 131I WBS negative but have elevated serum TgAb levels to undergo 18F-FDG PET/CT scan, should be more than or equal to 414.6 IU/ml. Results should be highly consider positive if max SUV value is equal or greater than 4.5.

CONCLUSION

18F-FDG PET/CT is a useful tool for localizing recurrent or metastatic DTC patients, who have negative 131I WBS but elevated serum TgAb levels. The authors recommend its use in clinical management of selected cases regardless of the TgAb level being more than or equal to 415 IU/ml.

Bone mineral density and body composition in prepubertal and adolescent patients with the classical form of 21-hydroxylase deficiency

OBJECTIVES

To evaluate bone mineral density (BMD) and body composition in prepubertal and adolescent patients with the classical form of 21-hydroxylase deficiency.

MATERIAL AND METHOD

The authors measured height, weight and used dual energy x-ray absorptiometry (DEXA) to evaluate lumbar spine, whole body BMD and body composition in 10 prepubertal and adolescent patients with the classical form of 21-hydroxylase deficiency. Serum hormone concentrations (17-hydroxyprogesterone, dehydroepiandrosterone sulfate) were also measured. Results were compared with those of age- and sex-matched controls.

RESULTS

Seven patients were adolescent (4 girls and 3 boys; age range, 9.0-19.6 years) and three patients were prepubertal. (2 girls and 1 boy; age range, 6.5-8.6 years). There were no significant differences in age, height z-score, weight z-score and body mass index between the patients with congenital adrenal hyperplasia (CAH) and controls. DEXA showed no differences between each group in whole body BMD, but showed significantly elevated areal regional BMD at the lumbar spine (L1-L4) in CAH patients. However four of the 10 CAH patients and 6 of the 10 controls had osteopenia. The BMD z-score at the lumbar spine was significantly correlated with increasing weight z-score in both CAH patients and controls. When CAH patients with osteopenia were compared with those with normal BMD, there was a trend toward lower weight z-score, higher dose of glucocorticoids and longer duration of treatment among the osteopenic patients, but it did not reach statistical significance.

CONCLUSION

Classical 21-hydroxylase deficiency patients treated with long-term glucocorticoids did not have impaired bone mineral density compared with healthy, age and sex-matched controls. However, the reference data for BMD in the Thai pediatric population is lacking and the number of studied participants was limited so we need further studies.

Bone mineral density and body composition in Thai Precocious Puberty girls treated with GnRH agonist

Treatment of true Precocious Puberty (PP) with GnRH agonist can improve final adult height by suppressing gonadotropin and sex hormone levels that delays the fusion of long bone epiphyseal growth plates. However, deprivation of estrogen may affect the acquisition of peak bone mass, especially in individuals with low calcium intake. Ten Thai girls with idiopathic true PP were evaluated for Bone Mineral Density (BMD) and body composition by DXA scanner (Hologic, Inc) before and after GnRH agonist therapy for 1 year. During treatment, all children were allowed to consume a normal diet without extra calcium supplementation. In addition, serum calcium, phosphate, alkaline phosphatase and osteocalcin were also measured. The results showed that GnRH agonist could improve predicted adult height from 149.4 +/- 5.4 to 153.6 +/- 6.8 cm (p < 0.001). Serum osteocalcin, representing the bone marker formation, decreased from 184.2 +/- 66.7 to 108.6 +/- 35.3 ng/mL (p = 0.012) However, the treatment had no negative effects on BMD lumbar spine and total BMD but increased percentage of fat mass from 25.7 +/- 5.2 to 31.6 +/- 5.5%. (p =0.007). In conclusion, treatment with GnRH agonist in Thai girls with true PP for 1 year can improve PAH without negative effects on BMD but a longer period of treatment needs to be studied.