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Panagoulias I, Charokopos N, Thomas I, Spantidea PI, de Lastic AL, Rodi M, Anastasopoulou S, Aggeletopoulou I, Lazaris C, Karkoulias K, Leonidou L, Georgopoulos NA, Markou KB, Mouzaki A. Shifting gears: Study of immune system parameters of male habitual marathon runners. Front Immunol 2023; 13:1009065. [PMID: 36713459 PMCID: PMC9880332 DOI: 10.3389/fimmu.2022.1009065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
Aim Marathon is a running event in which athletes must cover a distance of 42.195 km. In addition to participating in marathons, marathoners have incorporated extensive running into their lifestyle. In the present study, we investigated the effect of long-term strenuous exercise in the form of marathon running on the immune system. Methods & Results We collected peripheral blood samples from 37 male marathoners before/after a race and 37 age/sex/body mass index (BMI)-matched healthy sedentary controls. Hematological and biochemical tests revealed race-induced leukocytosis attributable to neutrophilia and significant increases in plasma lactate dehydrogenase (LDH), creatine phosphokinase (CPK), and cortisol concentrations. Phenotypic analysis of lymphocytes revealed race-induced significant decrease in the number of lymphocytes, memory helper T (Th) cells, naive, memory and activated cytotoxic T (Tc) cells, natural killer (NK), NKT, and B1 cells, and a significant increase in the number of activated Th and regulatory Th cells (Tregs). Compared with controls, marathoners maintained significantly lower levels of memory and activated Th cells and higher levels of activated Tc and B1 cells. Measurement of plasma cytokine levels revealed a pro-inflammatory cytokine polarization that increased after the race. Examination of gene expression of cytokines and Th-cell signature transcription factors in peripheral blood mononuclear cells revealed a significant decrease in tumor necrosis factor α (TNF-α) and interleukin (IL)-17, and a significant increase in IL-6, IL-10 and forkhead box P3 (FoxP3) after the race. Compared with controls, marathoners maintained significantly higher levels of TNF-α. Assessment of the suppressive capacity of Tregs in co-cultures of isolated effector Th cells and Tregs showed significantly increased suppressive capacity of marathoners' Tregs after the race. Conclusions Compared with controls, marathoners live with permanent changes in certain immune parameters. Marathoners exhibit a stable pro-inflammatory cytokine polarization that increases after the race and is counterbalanced by increased numbers of Tregs overexpressing FoxP3 and having increased suppressive capacity.
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Affiliation(s)
- Ioannis Panagoulias
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Nikolaos Charokopos
- Department of Respiratory Medicine, General Hospital of Pyrgos “Andreas Papandreou”, Pyrgos, Greece
| | - Iason Thomas
- Allergy Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Panagiota I. Spantidea
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Anne-Lise de Lastic
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Maria Rodi
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Spyridoula Anastasopoulou
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Ioanna Aggeletopoulou
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Charalampos Lazaris
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Kiriakos Karkoulias
- Division of Respiratory Medicine, Department of Internal Medicine, Patras University Hospital, Patras, Greece
| | - Lydia Leonidou
- Division of Infectious Diseases, Department of Internal Medicine, Patras University Hospital, Patras, Greece
| | - Neoklis A. Georgopoulos
- Division of Endocrinology, Department of Internal Medicine, Patras University Hospital, Patras, Greece
| | - Kostas B. Markou
- Division of Endocrinology, Department of Internal Medicine, Patras University Hospital, Patras, Greece
| | - Athanasia Mouzaki
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, Patras, Greece,*Correspondence: Athanasia Mouzaki,
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Bountouris P, Markantes GK, Mamali I, Markou KB, Michalaki MA. Benign thyroid nodules respond to a single administration of 0.3mg recombinant human thyrotropin with highly variable volume increase. Front Endocrinol (Lausanne) 2022; 13:1066379. [PMID: 36714577 PMCID: PMC9875562 DOI: 10.3389/fendo.2022.1066379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The nature of thyroid nodules is heterogenous. Most of them are benign and, in the absence of pressure symptoms of adjunct structures, no treatment is needed. Our objective was to investigate the acute effects of a low dose of recombinant human TSH (rhTSH) on the volume of benign thyroid nodules. METHODS we studied 27 nodules (14 isoechoic and 13 hypoechoic) in 15 (11 women and 4 men; mean age: 51.0 ± 15.9 years) consecutive patients with one to three well-separated asymptomatic benign thyroid nodules. All subjects were euthyroid, with negative thyroid antibodies, and none received levothyroxine. The total thyroid volume and thyroid nodule volume were sonographically determined by two independent examiners (P.B. and M.M.) before, 48 hours and 6 months post intramuscular (IM) administration of 0.3mg rhTSH, and the mean values of the two examiners' measurements were used; thyroid function tests were obtained at the same time points. RESULTS The mean volume of isoechoic nodules increased by 57.3%, of hypoechoic nodules by 46.6% and of the surrounding thyroid parenchyma by 70.4% 48 hours post-rhTSH; mean volumes had returned to baseline levels 6 months later. A large variance in the volume change responses was observed. The relative change in nodule volume (defined as the percent change in nodule volume divided by the percent change in the surrounding parenchyma) from baseline to 48 hours was significantly higher in isoechoic versus hypoechoic nodules (p<0.05). CONCLUSIONS A single dose of 0.3 mg rhTSH transiently increased the volume of benign thyroid nodules. The increase was more pronounced in isoechoic nodules and had a great variability. Our findings could be useful in the management of benign thyroid nodules, by helping in understanding which nodules would be more responsive to TSH suppression therapy.
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Markantes GK, Karakioulaki M, Papanikolopoulou S, Theodoropoulou A, Markou KB, Vagenakis AG, Spyridonidis T, Goulis DG, Michalaki MA. Improving the prediction of persistent and recurrent differentiated thyroid cancer using the American Thyroid Association 2015 risk stratification system. Hormones (Athens) 2021; 20:761-768. [PMID: 34383288 DOI: 10.1007/s42000-021-00313-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The 2015 American Thyroid Association risk stratification system (ATA RSS) is used in patients with differentiated thyroid carcinoma (DTC) to assess their risk of persistent/recurrent disease. Our aims were to validate the 2015 ATA RSS in a registry of DTC patients and to examine whether the addition of factors not included in it, such as pre-radioactive iodine therapy stimulated thyroglobulin (pre-RAI sTg), gender, and age could increase its predictive ability. METHODS We studied 403 patients with DTC, treated at a tertiary center from 1990 to 2018 and subjected to total thyroidectomy. All patients had received RAI therapy, except those with low-risk papillary microcarcinoma. RESULTS Of our patients, 81.9% were women and 91.1% had papillary thyroid carcinoma. After a median follow-up of 5.0 years, 53 cases of persistent and 21 cases of recurrent disease were recorded. The proportion of variance explained (PVE) regarding the outcome (presence or absence of recurrent/persistent disease) using the 2015 ATA RSS alone was 18.3% (persistence) and 16.9% (recurrence), increasing to 74.4% and 52.0%, respectively, when pre-RAI sTg was added to the logistic regression model. Gender and age were not associated with the disease outcome. In ROC analysis, pre-RAI sTg had a high predictive value for persistent (AUC 0.983, 95% CI 0.962-1.000) and recurrent disease (AUC 0.856, 95% CI 0.715-0.997). The optimal cut-offs and sensitivity, specificity, and positive and negative predictive value for pre-RAI sTg were the following: for persistence 12.75 ng/ml, 100%, 90.5%, 64%, and 100%, and for recurrence 8.05 ng/ml, 77.8%, 85.5%, 36.8%, and 97%. CONCLUSIONS The 2015 ATA RSS displayed moderate performance in predicting recurrent/persistent disease in patients with DTC, which improved with the inclusion of pre-RAI sTg values; pre-RAI sTg was an independent predictor of the disease outcome, with high negative prognostic value.
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Affiliation(s)
- Georgios K Markantes
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Meropi Karakioulaki
- 1st Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavroula Papanikolopoulou
- 1st Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Theodoropoulou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Kostas B Markou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Apostolos G Vagenakis
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Trifon Spyridonidis
- Department of Nuclear Medicine, University Hospital of Patras, Patras, Greece
| | - Dimitrios G Goulis
- 1st Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marina A Michalaki
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece.
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Assimakopoulos SF, Markantes GK, Papageorgiou D, Mamali I, Markou KB, Marangos M, Michalaki MA. Low serum TSH in the acute phase of COVID-19 pneumonia: thyrotoxicosis or a face of "non-thyroidal illness syndrome"? Clin Chem Lab Med 2021; 59:e420-e423. [PMID: 34246200 DOI: 10.1515/cclm-2021-0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Stelios F Assimakopoulos
- Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece.,Division of Infectious Diseases, University of Patras School of Health Sciences, Patras, Greece
| | - Georgios K Markantes
- Division of Endocrinology - Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Dimitris Papageorgiou
- Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Irene Mamali
- Division of Endocrinology - Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Kostas B Markou
- Division of Endocrinology - Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Markos Marangos
- Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece.,Division of Infectious Diseases, University of Patras School of Health Sciences, Patras, Greece
| | - Marina A Michalaki
- Division of Endocrinology - Department of Internal Medicine, University of Patras School of Health Sciences, Patras, Greece
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Markantes GK, Dimitropoulos K, Mamali I, Tseti I, Sakellaropoulos G, Markou KB, Michalaki MA. Therapeutic Equivalence of a New Preparation of Liquid Levothyroxine with Tablets in Patients with Overt Primary Hypothyroidism. Eur Thyroid J 2021; 10:59-64. [PMID: 33777820 PMCID: PMC7983587 DOI: 10.1159/000508216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A new liquid levothyroxine (LT4) dissolved in glycerol and water has recently been developed by a Greek pharmaceutical company (Uni-Pharma, Athens, Greece). OBJECTIVES To evaluate the therapeutic equivalence of this new liquid LT4 preparation versus the already existing tablet formulation of the same manufacturer, in order to obtain approval by the Greek National Organization for Medicines. METHODS This was a prospective, randomized, cross-over phase III study. The study included 50 patients (9 men and 41 non-pregnant women, with a mean age of 42.5 ± 12.5 years), with documented overt primary hypothyroidism. All subjects were well controlled on substitution therapy with various LT4 formulations. None of the patients had known LT4 malabsorption. The patients were randomized into 2 groups (A and B). The individuals of group A initially received T4® tablets for 10 ± 2 weeks and subsequently switched to T4® drops (100 μg/mL solution) at the same dose for another 10 ± 2 weeks. In group B, the reverse procedure was followed. Total T3 (T3), free T4 (fT4), and TSH were measured in all participants at enrollment and at the end of each 10 ± 2-week trial period. RESULTS Out of the 50 recruited patients, 6 were lost to follow-up and 5 were excluded due to non-compliance with the study protocol. In the 39 patients who completed the study, the serum TSH levels after 10 ± 2 weeks of treatment either with T4® tablets or with T4® drops did not differ (1.759 ± 1.104 vs. 2.076 ± 1.334 mIU/L, mean ± SD). CONCLUSIONS In hypothyroid patients, the new liquid LT4 preparation (T4® drops) is therapeutically equivalent to the tablet form (T4® tablets).
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Affiliation(s)
- Georgios K. Markantes
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Konstantinos Dimitropoulos
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Irene Mamali
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | | | | | - Kostas B. Markou
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
- *Kostas B. Markou, Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Rio-Patras, GR–26500 Patras (Greece),
| | - Marina A. Michalaki
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
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Markantes GK, Tsochatzis S, Panagopoulos K, Melachrinou M, Kyriazopoulou VE, Markou KB, Michalaki MA. A shift to more targeted thyroidectomies increased the detection of thyroid cancer and in particular low-risk papillary tumors in Southwestern Greece the decade 2007 to 2016. Laryngoscope Investig Otolaryngol 2020; 5:1260-1265. [PMID: 33364420 PMCID: PMC7752045 DOI: 10.1002/lio2.504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Data regarding thyroid cancer (TC) epidemiology in Greece in the last decade are scarce, so we investigated the trends in TC detection during 2007 to 2016. METHODS We retrospectively studied 2040 pathology reports of total thyroidectomies performed at our institution from 2007 to 2016. RESULTS A number of 478 cases of TC were identified in the studied decade. The overall incidence of TC among thyroidectomies rose over the years. The proportion of papillary T1 tumors among thyroidectomies increased in the second period of our study (2012-2016), while that of papillary T2 to T4 tumors and other TC subtypes remained unchanged. Papillary T1 tumors represented 63.6% of all TC cases and 75.3% of them were low-risk microcarcinomas (papillary thyroid microcarcinoma). The strategy of fine needle aspiration (FNA) prior to surgery in the management of thyroid nodules was adopted by more clinical endocrinologists in the area of Southwestern (SW) Greece in the second period of our study (2012-2016:29.7% vs 2007-2011:18.4%, P < .001). Consequently, the indication for thyroidectomy was set by FNA more frequently in 2012 to 2016 than in 2007 to 2011 (42.5% vs 26.4% of cases, P < .001). CONCLUSIONS The wider use of FNA in the triage of thyroid nodules led to increased rates of TC in thyroidectomies performed in SW Greece during the decade 2007 to 2016; low-risk, small papillary tumors represented the majority of TC cases.
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Affiliation(s)
- Georgios K. Markantes
- Division of Endocrinology, Department of Internal MedicineUniversity of Patras School of Health SciencesPatrasGreece
| | - Stylianos Tsochatzis
- Department of General SurgeryUniversity of Patras School of Health SciencesPatrasGreece
| | | | - Maria Melachrinou
- Department of PathologyUniversity of Patras School of Health SciencesPatrasGreece
| | - Venetsana E. Kyriazopoulou
- Division of Endocrinology, Department of Internal MedicineUniversity of Patras School of Health SciencesPatrasGreece
| | - Kostas B. Markou
- Division of Endocrinology, Department of Internal MedicineUniversity of Patras School of Health SciencesPatrasGreece
| | - Marina A. Michalaki
- Division of Endocrinology, Department of Internal MedicineUniversity of Patras School of Health SciencesPatrasGreece
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Ittermann T, Albrecht D, Arohonka P, Bilek R, de Castro JJ, Dahl L, Filipsson Nystrom H, Gaberscek S, Garcia-Fuentes E, Gheorghiu ML, Hubalewska-Dydejczyk A, Hunziker S, Jukic T, Karanfilski B, Koskinen S, Kusic Z, Majstorov V, Makris KC, Markou KB, Meisinger C, Milevska Kostova N, Mullen KR, Nagy EV, Pirags V, Rojo-Martinez G, Samardzic M, Saranac L, Strele I, Thamm M, Top I, Trofimiuk-Müldner M, Ünal B, Koskinen S, Vila L, Vitti P, Winter B, Woodside JV, Zaletel K, Zamrazil V, Zimmermann M, Erlund I, Völzke H. Standardized Map of Iodine Status in Europe. Thyroid 2020; 30:1346-1354. [PMID: 32460688 DOI: 10.1089/thy.2019.0353] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Knowledge about the population's iodine status is important, because it allows adjustment of iodine supply and prevention of iodine deficiency. The validity and comparability of iodine-related population studies can be improved by standardization, which was one of the goals of the EUthyroid project. The aim of this study was to establish the first standardized map of iodine status in Europe by using standardized urinary iodine concentration (UIC) data. Materials and Methods: We established a gold-standard laboratory in Helsinki measuring UIC by inductively coupled plasma mass spectrometry. A total of 40 studies from 23 European countries provided 75 urine samples covering the whole range of concentrations. Conversion formulas for UIC derived from the gold-standard values were established by linear regression models and were used to postharmonize the studies by standardizing the UIC data of the individual studies. Results: In comparison with the EUthyroid gold-standard, mean UIC measurements were higher in 11 laboratories and lower in 10 laboratories. The mean differences ranged from -36.6% to 49.5%. Of the 40 postharmonized studies providing data for the standardization, 16 were conducted in schoolchildren, 13 in adults, and 11 in pregnant women. Median standardized UIC was <100 μg/L in 1 out of 16 (6.3%) studies in schoolchildren, while in adults 7 out of 13 (53.8%) studies had a median standardized UIC <100 μg/L. Seven out of 11 (63.6%) studies in pregnant women revealed a median UIC <150 μg/L. Conclusions: We demonstrate that iodine deficiency is still present in Europe, using standardized data from a large number of studies. Adults and pregnant women, particularly, are at risk for iodine deficiency, which calls for action. For instance, a more uniform European legislation on iodine fortification is warranted to ensure that noniodized salt is replaced by iodized salt more often. In addition, further efforts should be put on harmonizing iodine-related studies and iodine measurements to improve the validity and comparability of results.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Diana Albrecht
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| | - Petra Arohonka
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Joao J de Castro
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, Portugal
| | - Lisbeth Dahl
- Food Security and Nutrition, Institute of Marine Research (IMR), Bergen, Norway
| | - Helena Filipsson Nystrom
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Simona Gaberscek
- Department of Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia
| | - Eduardo Garcia-Fuentes
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Monica L Gheorghiu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | | | - Sandra Hunziker
- Department of Health Sciences and Technology, ETH, Zürich, Switzerland
| | - Tomislav Jukic
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Borislav Karanfilski
- Centre for Regional Policy Research and Cooperation "Studiorum", Skopje, North Macedonia
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Zvonko Kusic
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Venjamin Majstorov
- Institute of Pathophysiology and Nuclear Medicine, Ss. Cyril and Methodius University, Skopje, Former Yougoslavian Rebublic of Macedonia
| | - Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Kostas B Markou
- Department of Endocrinology, Institute University of Patras Medical School, Patras, Greece
| | - Christa Meisinger
- Chair of Epidemiology, Ludwig-Maximilians Universität Munich, UNIKA-T Augsburg, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Neda Milevska Kostova
- Centre for Regional Policy Research and Cooperation "Studiorum", Skopje, North Macedonia
| | - Karen R Mullen
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Endre V Nagy
- Division of Endocrinology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Valdis Pirags
- Department of Internal Medicine, University of Latvia, Riga, Latvia
| | - Gemma Rojo-Martinez
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Mira Samardzic
- Department of Endocrinology and Diabetes, Institute for Sick Children, Podgorica, Montenegro
| | - Ljiljana Saranac
- Department of Pediatrics, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Ieva Strele
- Department of Internal Medicine, University of Latvia, Riga, Latvia
| | - Michael Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Işık Top
- Department of Public Health, Dokuz Eylul University Medical Faculty, İzmir, Turkey
| | | | - Belgin Ünal
- Department of Public Health, Dokuz Eylul University Medical Faculty, İzmir, Turkey
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lluis Vila
- Department of Endocrinology and Nutrition, Hospital de Sant Joan Despi Moisès Broggi, Barcelona, Spain
| | - Paolo Vitti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Benjamin Winter
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Katja Zaletel
- Department of Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | | | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Abstract
The aim of this review is to provide relevant information regarding the impact of thyroid disease, starting from birth and mainly concerning hyperthyroidism and hypothyroidism, on reproduction. Hyperthyroidism occurs much less commonly in children than hypothyroidism, with Graves' disease (GD) being the most common cause of thyrotoxicosis in children. Children born with neonatal GD have no defects in the reproductive system that could be related to hyperthyroidism. Current treatment options include antithyroid drugs (ATD), surgery, and radioactive iodine (RAI). In males, normal thyroid function seems important, at least in some parameters, for maintenance of semen quality via genomic or non-genomic mechanisms, either by locally acting on Sertoli cells, Leydig cells, or germ cells, or by affecting crosstalk between the HPT axis and the HPG axis. Sexual behavior may also be affected in thyroxic men, although many of these patients may have normal free testosterone levels. In women, menstrual irregularities are the most common reproduction-related symptoms in thyrotoxicosis, while this disorder is also associated with reduced fertility, although most women remain ovulatory. An increase in sex hormone-binding globulin (SHBG) and androgens, thyroid autoimmunity, and an impact on uterine oxidative stress are the main pathophysiological mechanisms which may influence female fertility. Thyroid hormones are responsible for normal growth and development during pre- and postnatal life, congenital hypothyroidism (CH) being the most common cause of neonatal thyroid disorders, affecting about one newborn infant in 3500. The reproductive tract appears to develop normally in cretins. Today, CH-screening programs allow for early identification and treatment, and, as a result, affected children now achieve normal or near-normal development. Hypothyroidism in males is associated with decreased libido or impotence. Although little is currently known about the effects of hypothyroidism on spermatogenesis and fertility, it has been established that sperm morphology and motility are mainly affected. In women of reproductive age, hypothyroidism results in changes in cycle length and amount of bleeding. Moreover, a negative effect on fertility and higher miscarriage rates has also been described.
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Affiliation(s)
- Gerasimos E Krassas
- IASEIO Medical Center, Tz. Kennendy 115B, Pylea, 55535, Thessaloniki, Greece.
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Michalaki MA, Vagenakis AG, Markou KB. Re: "Levothyroxine Replacement Therapy and Overuse: A Timely Diagnostic Approach" by Livadas et al.( Thyroid 2018:28;1580-1586). Thyroid 2019; 29:1168. [PMID: 31007136 DOI: 10.1089/thy.2018.0765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Markantes GK, Michalaki MA, Vagenakis GA, Lamari FN, Pitsi E, Eliopoulou M, Beratis NG, Markou KB. Plasma Beta-Glucuronidase Activity: A Novel Tool to Distinguish Type 1 from Type 2 Amiodarone-Induced Thyrotoxicosis? Eur Thyroid J 2019; 8:215-220. [PMID: 31602365 PMCID: PMC6738219 DOI: 10.1159/000500355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/11/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Amiodarone-induced thyrotoxicosis (AIT) is a common and deleterious side effect of amiodarone use. There are two types of AIT, characterized by distinct pathogenic mechanisms and, hence, different treatments. Discriminating between type 1 (AIT1) and type 2 (AIT2) AIT is often very challenging. Beta-glucuronidase (β-G) is a lysosomal enzyme released into the extracellular fluid during inflammation. OBJECTIVES To examine whether the determination of the plasma activity of β-G is useful in distinguishing AIT1 from AIT2. METHODS The study included 67 subjects: 9 with AIT1, 9 with AIT2, 14 with hyperthyroidism due to Grave's disease or toxic multinodular goiter, 14 with subacute thyroiditis, and 21 euthyroid controls. Thyroid function tests and plasma β-G activity were determined in all participants, while thyrotoxic patients also underwent thyroid ultrasound/scintigraphy and urine iodine excretion assessment. RESULTS Plasma β-G activity (expressed as mean ± SD in nmol 4-methylumbelliferone [4-MU]/mL plasma/h) in AIT2 was higher compared to AIT1 (2,263.6 ± 771 vs. 1,101.8 ± 201.9, p < 0.05) and similar to subacute thyroiditis (2,263.6 ± 771 vs. 2,083.2 ± 987.5, p = ns). β-G activity did not differ significantly between AIT1 and controls (1,101.8 ± 201.9 vs. 954.6 ± 248.6, p = ns). ROC curve analysis revealed that β-G activity had a high predictive value for destructive processes, namely AIT2 and subacute thyroiditis (AUC 0.846, 95% CI 0.748-0.943) and a cut-off value of 1,480.5 nmol 4-MU/mL plasma/h was able to discriminate between destructive and non-destructive thyroid conditions with 74% sensitivity and 82% specificity. CONCLUSION In our study, plasma β-G activity performed well in distinguishing AIT1 from AIT2. Further studies are warranted to establish its usefulness as a discriminator between the two AIT types.
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Affiliation(s)
- Georgios K. Markantes
- Division of Endocrinology – Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Marina A. Michalaki
- Division of Endocrinology – Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - George A. Vagenakis
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Athens, Greece
| | - Fotini N. Lamari
- Laboratory of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, University of Patras, Patras, Greece
| | - Efthymia Pitsi
- Laboratory of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, University of Patras, Patras, Greece
| | | | - Nicholas G. Beratis
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Kostas B. Markou
- Division of Endocrinology – Department of Internal Medicine, University of Patras Medical School, Patras, Greece
- *Kostas B. Markou, Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, GR–26500 Rio-Patras (Greece), E-Mail
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Markou KB, Georgopoulos N. Reviews based on the 17th "Endorama Meeting". Hormones (Athens) 2018; 17:437. [PMID: 30536046 DOI: 10.1007/s42000-018-0081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kostas B Markou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Neoklis Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Patras, Greece.
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Michalaki MA, Mamali I, Tsekouras A, Vlassopoulou B, Anastasiou E, Koukkou EG, Vagenakis AG, Sakellaropoulos G, Georgopoulos NA, Rashitov M, Azizov B, Ismailov S, Markou KB. Thyroid-stimulating hormone is not the primary regulator of thyroid development in euthyroid children and adolescents living in an iodine-replete area. Hormones (Athens) 2018; 17:391-396. [PMID: 30178396 DOI: 10.1007/s42000-018-0056-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/21/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVES It is known that there are multiple factors which can affect thyroid gland development during childhood and adolescence. Our aim was to investigate this issue by examining the relationships between age, sex, several anthropometric parameters, pubertal status, thyroid function tests, and iodine intake status with thyroid volume (TV) in children and adolescents. STUDY DESIGN This was a cross-sectional field study conducted in 11 representative cities and villages of Uzbekistan. Six hundred and ten children and adolescents participated. Anthropometric indices and TV were estimated. In addition, thyroid function tests (TFTs) and urinary iodine excretion (UIE) measures were obtained. RESULTS Median UIE was 151 μg/L, thus the studied areas were iodine-sufficient. TFTs fluctuated in both genders during childhood and adolescence and the thyroid growth spurt was observed, in both sexes, at the ages of 12 and 13 years, which coincided with the age of menarche in girls. Thyroid volume was positively correlated with body surface area (BSA) (r = 0.800, p < 0.001), age (r = 0.780, p < 0.001), fat-free mass (FFM) (r = 0.797, p < 0.001) and negatively correlated with serum TSH (r = -0.154, p = 0.05). No association between thyroid volume and UIE was observed. CONCLUSIONS In euthyroid children and adolescents living in iodine-replete areas, thyroid gland development appears to follow the pattern of linear growth and displays a growth spurt at the onset of puberty, probably due to the abrupt increase of circulating sex steroids. At this age, TSH does not appear to be the main regulator of thyroid gland development.
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Affiliation(s)
| | - Irene Mamali
- University οf Patras Medical School, Patras, Greece
| | | | | | | | | | | | | | | | - Murod Rashitov
- Republican Center of Scientific and Practical Endocrinology of Uzbekistan, Tashkent, Uzbekistan
| | - Bakhti Azizov
- Diamed Diagnostic Medicine, Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Said Ismailov
- Department of Endocrinology and Pediatric Endocrinology, Tashkent Pediatric Institute, Tashkent, Uzbekistan
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Koukkou EG, Markou KB. Re: "Thyroglobulin as a Functional Biomarker of Iodine Status in a Cohort Study of Pregnant Women in the United Kingdom" by Bath et al. (Thyroid 2017;27:426-433). Thyroid 2017; 27:1208. [PMID: 28599610 DOI: 10.1089/thy.2017.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Kostas B Markou
- 2 Division of Endocrinology, University Medical School, University Hospital , Patras, Greece
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Koukkou EG, Ilias I, Mamalis I, Markou KB. Pregnant Greek Women May Have a Higher Prevalence of Iodine Deficiency than the General Greek Population. Eur Thyroid J 2017; 6:26-30. [PMID: 28611945 PMCID: PMC5465751 DOI: 10.1159/000449285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adequate dietary iodine consumption, predicted via the urinary iodine concentration (UIC), is necessary for normal thyroid function and for the neurodevelopment of fetuses and neonates. The general population of Greece is considered to be iodine sufficient, but our preliminary findings suggest that Greek pregnant women are at risk of iodine deficiency. OBJECTIVE Our aim was to estimate the thyroid function and UIC in a representative population of pregnant Greek women. METHODS UIC and thyroid function were assessed in 1,118 women from 19 representative areas of the country. RESULTS The median UIC was found to be 127.1 µg/l (range 7.8-2,296), which is indicative of insufficient iodine intake according to the standard of the World Health Organization (WHO) for pregnant women. The median UIC was below the minimal recommended value of 150 µg/l in 61% of the women, and below 100 or 50 µg/l in 32 and 7%, respectively. An optimal iodine intake (150-250 µg/l) was observed in 26%, and was over the cut-off of 500 µg/l in 2% of the subjects. Serum thyrotropin significantly increased between trimesters, from 1.57 ± 1.2, to 1.68 ± 1.0 and to 2.02 ± 1.2 mU/l (p < 0.001). Serum-free thyroxine decreased significantly between trimesters, from 1.22 ± 0.34, to 1.01 ± 0.21 and 0.96 ± 0.2 ng/ml (p < 0.05). Serum thyroglobulin levels remained unchanged over the trimesters and were not correlated with UIC. CONCLUSIONS While the general population of Greece is iodine sufficient, these findings suggest that, according to the WHO, the majority of pregnant Greek women are iodine deficient. These data strongly suggest that a proactive policy should be developed to lower iodine deficiency risk in this population of women.
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Affiliation(s)
- Eftychia G. Koukkou
- Division of Endocrinology, Endocrine Unit, E Venizelou Hospital, Athens, Greece
| | - Ioannis Ilias
- Division of Endocrinology, Endocrine Unit, E Venizelou Hospital, Athens, Greece
| | - Irene Mamalis
- Division of Endocrinology, University Medical School, University Hospital, Rion-Patras, Greece
| | - Kostas B. Markou
- Division of Endocrinology, University Medical School, University Hospital, Rion-Patras, Greece
- *Kostas B. Markou, 6 Thisseos Street, GR−26500 Ovria Patras (Greece), E-Mail
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15
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Abstract
The recommended daily intake of iodide, is 150 μg for adolescents and adults, 250 μg for pregnancy and lactation. Thyroid gland is an effective collector of iodine. The active iodine uptake along the basolateral membrane of thyroid cell is followed by its transport to the apical edge of the cell and then to the follicle lumen. TSH acts through cAMP and stimulates NIS gene expression and protein synthesis. The major proportion of iodine in the thyroid gland is bound to Thyroglobulin. The non-organic intrathyroidal iodine is usually low, but significantly greater compared to plasma. Large doses of iodine reduce both the uptake and the organification (Wolff-Chaikoff effect) and cause partial inhibition of Tg proteolysis. The thyroid gland has several protective mechanisms resulting on the maintenance of normal thyroid function despite wide fluctuations of the daily iodine intake. Ingestion of several commonly used drugs and food conservatives results in acute or chronic excessive iodine intake. Failure to escape from the iodine induced organification inhibition can cause hypothyroidism, which is temporary and subsides after iodine exposure ceases. Iodine excess may also establish a status of excessive thyroid hormone synthesis and release, thus inducing autonomic thyroid function in iodopenic areas or can contribute to the development of iodine-induced hyperthyroidism in iodine abundant areas. The anti-arrhythmic Amiodarone, is a benzofuranic product with a very high iodine content, is associated with either hypo- or hyperthyroidism development. In the presence of defective auto-protective mechanisms, excessive iodine ingestion can divert the normal thyroid function.
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Affiliation(s)
| | - Nikolaos D Roupas
- University of Patras Medical School, University Hospital, Division of Endocrinology, Patras, Greece
| | - Kostas B Markou
- University of Patras Medical School, University Hospital, Division of Endocrinology, Patras, Greece -
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16
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Koukkou E, Ilias I, Mamalis I, Adonakis GG, Markou KB. Serum Thyroglobulin Concentration Is a Weak Marker of Iodine Status in a Pregnant Population with Iodine Deficiency. Eur Thyroid J 2016; 5:120-4. [PMID: 27493886 PMCID: PMC4949369 DOI: 10.1159/000446070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/08/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the reliability of thyroglobulin (Tg) as a marker of iodine status during pregnancy. DESIGN 299 women aged 30.5 ± 4.8 years (mean ± SD) were studied. METHODS In every subject, we measured urinary iodine concentration (UIC), serum thyrotropin (TSH), Tg, free thyroxine (fT4), Tg autoantibodies (TgAbs) and human chorionic gonadotropin (hCG) levels. We excluded samples with increased TgAbs from the analysis. RESULTS According to WHO criteria, the study population was iodine deficient in every trimester. Serum Tg levels did not differ during the three trimesters of pregnancy. Serum hCG levels fell significantly as pregnancies advanced. A weak, significantly negative correlation (limited to the 3rd trimester) was found between Tg and UIC (ρ = -0.187, p = 0.039). Serum fT4 decreased as pregnancies advanced and TSH increased. Serum fT4 was negatively correlated with TSH (ρ = -0.161, p = 0.006) and positively with hCG (ρ = +0.165, p = 0.005). The multiple regression equation of Tg based on hCG, TSH, UIC and trimester of pregnancy was significant but weak (F = 4.057, p = 0.003; R(2) = 0.055), with hCG as a significant predictor Tg (p for log hCG = 0.041). CONCLUSIONS Tg cannot be considered as a valid marker of iodine deficiency in pregnancy, at least in a mildly iodine-deficient environment. Further studies in a larger patient cohort with differences in iodine status, as well as studies on Tg changes after improving iodine status in pregnant women, are needed in order to corroborate these results.
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Affiliation(s)
- Eftychia Koukkou
- Department of Endocrinology, E Venizelou Maternity Hospital, Athens, Greece
| | - Ioannis Ilias
- Department of Endocrinology, E Venizelou Maternity Hospital, Athens, Greece
| | - Irene Mamalis
- Departments of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Georgios G. Adonakis
- Departments of Obstetrics and Gynecology, University of Patras Medical School, Patras, Greece
| | - Kostas B. Markou
- Departments of Endocrinology, University of Patras Medical School, Patras, Greece
- *Kostas B. Markou, MD, Thisseos Street 6, GR–26500 Ovria Patras (Greece), E-Mail
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Völzke H, Caron P, Dahl L, de Castro JJ, Erlund I, Gaberšček S, Gunnarsdottir I, Hubalewska-Dydejczyk A, Ittermann T, Ivanova L, Karanfilski B, Khattak RM, Kusić Z, Laurberg P, Lazarus JH, Markou KB, Moreno-Reyes R, Nagy EV, Peeters RP, Pīrāgs V, Podoba J, Rayman MP, Rochau U, Siebert U, Smyth PP, Thuesen BH, Troen A, Vila L, Vitti P, Zamrazil V, Zimmermann MB. Ensuring Effective Prevention of Iodine Deficiency Disorders. Thyroid 2016; 26:189-96. [PMID: 26700864 DOI: 10.1089/thy.2015.0543] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Programs initiated to prevent iodine deficiency disorders (IDD) may not remain effective due to changes in government policies, commercial factors, and human behavior that may affect the efficacy of IDD prevention programs in unpredictable directions. Monitoring and outcome studies are needed to optimize the effectiveness of IDD prevention. SUMMARY Although the need for monitoring is compelling, the current reality in Europe is less than optimal. Regular and systematic monitoring surveys have only been established in a few countries, and comparability across the studies is hampered by the lack of centralized standardization procedures. In addition, data on outcomes and the cost of achieving them are needed in order to provide evidence of the beneficial effects of IDD prevention in countries with mild iodine deficiency. CONCLUSION Monitoring studies can be optimized by including centralized standardization procedures that improve the comparison between studies. No study of iodine consumption can replace the direct measurement of health outcomes and the evaluation of the costs and benefits of the program. It is particularly important that health economic evaluation should be conducted in mildly iodine-deficient areas and that it should include populations from regions with different environmental, ethnic, and cultural backgrounds.
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Affiliation(s)
- Henry Völzke
- 1 Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Philippe Caron
- 2 Department of Endocrinology, Centre Hospitalier Universitaire de Larrey , Toulouse, France
| | - Lisbeth Dahl
- 3 Human Studies, National Institute of Nutrition and Seafood Research , Bergen, Norway
| | - João J de Castro
- 4 Department of Endocrinology, Hospital das Forças Armadas , Lisbon, Portugal
| | - Iris Erlund
- 5 Disease Risk Unit, National Institute for Health and Welfare , Helsinki, Finland
| | - Simona Gaberšček
- 6 Department of Nuclear Medicine, University Medical Centre , Ljubljana, Slovenia
| | - Ingibjörg Gunnarsdottir
- 7 Unit for Nutrition Research, University of Iceland and Landspitali National University Hospital , Reykjavik, Iceland
| | | | - Till Ittermann
- 1 Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Ludmila Ivanova
- 9 Faculty of Medicine, Sofia University Sv. Kliment Ohridski , Sofia, Bulgaria
| | - Borislav Karanfilski
- 10 Centre for Regional Policy Research and Cooperation "Studiorum," Skopje, Macedonia
| | - Rehman M Khattak
- 1 Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Zvonko Kusić
- 11 University of Zagreb, School of Medicine, Department of Oncology and Nuclear Medicine, University Hospital Centre Sestre Milosrdnice , Zagreb, Croatia
| | - Peter Laurberg
- 12 Departments of Endocrinology and Clinical Medicine, Aalborg University Hospital and Aalborg University , Aalborg, Denmark
| | - John H Lazarus
- 13 Institute of Molecular Medicine, Cardiff University , Cardiff, United Kingdom
| | - Kostas B Markou
- 14 Department of Endocrinology, Institute University of Patras Medical School , Patras, Greece
| | - Rodrigo Moreno-Reyes
- 15 Nuclear Medicine Department, Erasme Hospital, Université Libre de Bruxelles , Brussels, Belgium
| | - Endre V Nagy
- 16 Division of Endocrinology, University of Debrecen , Debrecen, Hungary
| | - Robin P Peeters
- 17 Department of Internal Medicine, Rotterdam Thyroid Center , Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Valdis Pīrāgs
- 18 Department of Internal Medicine, University of Latvia , Riga, Latvia
| | - Ján Podoba
- 19 Department of Endocrinology, Slovakian Medical University , Bratislava, Slovakia
| | - Margaret P Rayman
- 20 Department of Nutritional Sciences, Faculty Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
| | - Ursula Rochau
- 21 Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Science , Medical Informatics and Technology, Hall, Austria
| | - Uwe Siebert
- 21 Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Science , Medical Informatics and Technology, Hall, Austria
| | - Peter P Smyth
- 22 National University of Ireland, Galway and Centre for Public Health, Queen's University , Belfast, North Ireland
| | - Betina H Thuesen
- 23 Research Centre for Prevention and Health , The Capital Region of Denmark, Rigshospitalet, Glostrup, Denmark
| | - Aron Troen
- 24 Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem , Jerusalem, Israel
| | - Lluís Vila
- 25 Department of Endocrinology and Nutrition, Hospital de Sant Joan Despi Moisès Broggi , Barcelona, Spain
| | - Paolo Vitti
- 26 Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | | | - Michael B Zimmermann
- 28 Swiss Federal Institute of Technology , Zürich Department of Health Sciences and Technology, Zürich, Switzerland
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Michalaki M, Volonakis S, Mamali I, Kalfarentzos F, Vagenakis AG, Markou KB. Dietary iodine absorption is not influenced by malabsorptive bariatric surgery. Obes Surg 2015; 24:1921-5. [PMID: 24740595 DOI: 10.1007/s11695-014-1255-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bariatric surgery is accompanied by malabsorption of protein, carbohydrates, fats, vitamins, and trace elements. Iodine is essential to the synthesis of thyroid hormones. The aim of this study was to estimate the daily iodine intake in severely obese patients before and after bariatric surgery. METHODS Thirty-five severely obese patients (obese group) with a BMI of 51.3 ± 8.3 kg/m(2) were studied before, 3 months, and 6 months after bariatric surgery. Eleven out of 35 patients were subjected to gastric bypass operation Roux-en-Y and 24 were subjected to a variant of biliopancreatic diversion with long limb procedure. The patients did not use any iodine supplements and no iodine antiseptics were administered during the operation. The messmates of the patients, following a similar diet (control group) with a BMI of 31.2 ± 10.7 kg/m(2), were also studied. Serum T3, T4, TSH, thyroid peroxidase antibodies, urinary iodine excretion (UIE) in a spot urine, and thyroid volume were measured in all subjects, at baseline and at 3- and 6-month follow-up in the obese group. RESULTS UIE at baseline was similar in obese and control group (median (min-max), 129.5 (24.9-462) vs. 138.9 (30.8-381) μg/L, ns). In the obese group, a transient increase of UIE was observed 3 months after the operation and returned to baseline levels 6-months postsurgery. CONCLUSIONS The UIE is not reduced after malabsorptive bariatric surgery, although all stomach, duodenum, and a substantial part of jejunum were bypassed. It appears that iodine is absorbed sufficiently along the remaining gastrointestinal tract.
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Affiliation(s)
- M Michalaki
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Thisseos 6, Ovria, Patras, 26500, Greece
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Koukkou E, Kravaritis S, Mamali I, Markantes GG, Michalaki M, Adonakis GG, Georgopoulos NA, Markou KB. No increase in renal iodine excretion during pregnancy: a telling comparison between pregnant women and their spouses. Hormones (Athens) 2014; 13:375-81. [PMID: 25079462 DOI: 10.14310/horm.2002.1487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Adequate dietary iodine intake is necessary for normal thyroid gland function at all times, and most particularly during pregnancy. Increased iodine loss is cited, among other factors, as responsible for the increased iodine demand in this period. Our aim was to compare renal iodine excretion between women during all three pregnancy trimesters with that of their spouses and thereby to estimate the iodine intake in an a large sample of pregnant women in urban areas in Greece. DESIGN Four hundred twenty-four healthy pregnant women were included prospectively (residents of Athens n=218, residents of Patras n=206). The spouses of 177 of these women following the same diet were also studied. Determinations included serum FT4, TSH and aTPO and urinary iodine excretion (UIE). RESULTS No difference was found either in median UIE throughout pregnancy or between the UIE of the pregnant women and their spouses during the trimesters. Throughout pregnancy, mild iodine deficiency was noted and was classified as mild in 60%, moderate in 30% and severe in 10% of the women studied. Users of iodized salt had significantly higher median UIE compared with non-users. Serum FT4 levels decreased and TSH increased as pregnancy progressed. CONCLUSIONS Our study indicates that renal iodine excretion is not increased during pregnancy. This finding needs to be confirmed by further investigation in other populations with different iodine intakes. Thus, increased iodine requirements in pregnancy are possibly due to extra-renal causes. The population of pregnant women in Greek urban areas is mildly-and often moderately and severely-iodopenic and needs to be treated accordingly.
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Affiliation(s)
- Eftychia Koukkou
- Department of Endocrinology, "Elena Venizelou" Hospital, Athens, Greece
| | | | - Irene Mamali
- Department of Endocrinology, University of Patras; Greece
| | | | | | | | - Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Department of Endocrinology, University of Patras; Greece
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Michalaki M, Pylioti A, Loutas V, Mamali I, Markou KB. Absence of differences in urinary iodine excretion and thyroid function tests in operating room staff members using or not using iodine-containing antiseptic solutions. Thyroid 2013; 23:1659-60. [PMID: 23724900 DOI: 10.1089/thy.2013.0218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Marina Michalaki
- School of Health Sciences, University of Patras , Patras, Greece
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21
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Gkotsina M, Michalaki M, Mamali I, Markantes G, Sakellaropoulos GC, Kalfarentzos F, Vagenakis AG, Markou KB. Improved levothyroxine pharmacokinetics after bariatric surgery. Thyroid 2013; 23:414-9. [PMID: 23110329 DOI: 10.1089/thy.2011.0526] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The absorption of levothyroxine (LT4) is affected by many factors. Bariatric surgery is recommended in severely obese patients. The aim of this study was to determine the consequences of bariatric surgery on LT4 pharmacokinetic parameters, and to identify the regions of the gastrointestinal tract where LT4 is absorbed in patients with severe obesity before and after surgery. METHODS We studied 32 severely obese nonhypothyroid patients who underwent sleeve gastrectomy (SG; n=10), Roux-en-Y gastric bypass (RYGBP; n=7), or biliopancreatic diversion with long limbs (BPD-LL; n=15). Before surgery, from 8:00 a.m., blood samples were collected before and every 30 minutes after the oral administration of a solution of 600 μg of LT4. The same procedure was repeated 35 days after surgery. We estimated the pharmacokinetic parameters of LT4 before and after surgery, including the area under the curve (AUC), the peak thyroxine concentration (Cmax), and the time to peak thyroxine concentration (Tmax). RESULTS Following surgery, in the SG group, the mean AUC was higher than it was before surgery (18.97±6.01 vs. 25.048±6.47 [μg/dL]·h; p<0.01), whereas the values of Cmax and Tmax were similar to those before surgery. In the RYGBP group, mean AUC, Cmax, and Tmax were similar before and after surgery. In the BPD-LL group, mean AUC and Cmax were higher after surgery than before (14.18±5.64 vs. 25.51±9.1 [μg/dL]·h, p<0.001; 5.62±1.34 vs. 8.16±2.57 μg/dL, p<0.001, respectively), whereas Tmax was similar. CONCLUSIONS The pharmacokinetic parameters of LT4 absorption are improved following SG and BPD-LL types of bariatric procedures. We conclude that the stomach, the duodenum, and the upper part of the jejunum are not sites for LT4 absorption, because in the above-mentioned bariatric procedures these are bypassed or removed.
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Affiliation(s)
- Margarita Gkotsina
- Division of Endocrinology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
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Roupas ND, Mamali I, Maragkos S, Leonidou L, Armeni AK, Markantes GK, Tsekouras A, Sakellaropoulos GC, Markou KB, Georgopoulos NA. The effect of prolonged aerobic exercise on serum adipokine levels during an ultra-marathon endurance race. Hormones (Athens) 2013; 12:275-82. [PMID: 23933696 DOI: 10.14310/horm.2002.1411] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of prolonged intensive aerobic exercise and acute energy deficit (180 km ultra-marathon race) on serum leptin, adiponectin, resistin and visfatin levels and their association and interaction with serum cortisol and insulin levels in highly trained ultra-endurance runners. DESIGN The study included 17 highly trained ultra-endurance male athletes (mean age 51.29±6.84 years and body mass index (ΒΜΙ) 23.51±1.90) participating in the 5th Olympian Race held in Greece on May 2010. Anthropometric values were assessed; Serum cortisol, insulin, leptin, adiponectin, resistin and visfatin levels were measured at baseline, post-exercise and ~20 hours after the end of the race. RESULTS All hormonal values of the post-exercise and recovery status were corrected for plasma volume changes. The estimated energy deficit during the ultra-endurance event was about 5000 Kcal. At the end of the race serum resistin levels were elevated (p<0.001) and serum leptin levels were reduced (p<0.001) and failed to reach pre-exercise levels, although showing a tendency towards restoration. No significant changes were noted in serum adiponectin and visfatin levels. CONCLUSIONS Ultra-endurance aerobic exercise and acute negative energy balance lead to an up-regulation of serum resistin levels and a down-regulation of serum leptin levels.
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Affiliation(s)
- Nikolaos D Roupas
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, Patras, Greece
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Roupas ND, Mamali I, Armeni AK, Markantes GK, Theodoropoulou A, Alexandrides TK, Leglise M, Markou KB, Georgopoulos NA. The influence of intensive physical training on salivary adipokine levels in Elite Rhythmic Gymnasts. Horm Metab Res 2012; 44:980-6. [PMID: 22864904 DOI: 10.1055/s-0032-1321816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Exercise challenges homeostasis and establishes a new dynamic equilibrium. Elite Rhythmic Gymnasts (RG's) begin exercise at an early age, undergo physical and psychological stress, and adopt negative energy balance to retain a lean physique. The aim of the present study was to evaluate the effect of negative energy balance, acute and chronic exercise on salivary adiponectin, resistin and visfatin levels and their interaction with salivary cortisol, and insulin levels in elite RG's. This study is unique in character, as all variables were assessed on the field of competition. The study included 51 elite RG's participating in "Kalamata 2010 World Cup" in Kalamata, Greece on April 2010. Twenty-seven healthy age-matched girls were used as controls. Anthropometric values were assessed; baseline and post exercise salivary cortisol, insulin, adiponectin, resistin, and visfatin levels were measured. Comparisons regarding hormonal features between RG's and controls were adjusted for BMI and body fat percentage. Salivary adiponectin levels were higher (p<0.05) and visfatin lower (p=0.094) in RG's compared with controls, while no significant changes were observed regarding salivary cortisol, insulin, and resistin levels. In elite RG's acute intensive anaerobic exercise led to increased salivary insulin levels (p<0.001), reduced salivary adiponectin (p<0.001) and visfatin levels (p<0.05), and no changes in salivary resistin levels. Moreover, diurnal variation of salivary cortisol was lost. In elite RG's salivary adiponectin is upregulated and salivary visfatin is downregulated after chronic intensive exercise and negative energy balance, while both salivary adiponectin and visfatin levels are suppressed after short term intensive anaerobic exercise.
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Affiliation(s)
- N D Roupas
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Patras, Greece
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Pearce EN, Alexiou M, Koukkou E, Braverman LE, He X, Ilias I, Alevizaki M, Markou KB. Perchlorate and thiocyanate exposure and thyroid function in first-trimester pregnant women from Greece. Clin Endocrinol (Oxf) 2012; 77:471-4. [PMID: 22486757 DOI: 10.1111/j.1365-2265.2012.04407.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Thyroid hormone, requiring adequate maternal iodine intake, is critical for neurodevelopment in utero. Perchlorate and, less so, thiocyanate decrease uptake of iodine into the thyroid gland by competitively inhibiting the sodium/iodide symporter (NIS). It remains unclear whether environmental perchlorate exposure adversely affects thyroid function in first-trimester pregnant women. DESIGN Cross-sectional. PATIENTS 134 pregnant women from Athens, Greece, at mean ± SD 10·9 ± 2·3 weeks' gestation. MEASUREMENTS Urinary iodide, perchlorate, and thiocyanate and thyroid function tests were measured. RESULTS The median urinary iodide was 120 μg/l. Urinary perchlorate levels were detectable in all women: median (range) 4·1 (0·2-118·5) μg/l. Serum thyroperoxidase antibodies (TPO Ab) were detectable in 16% of women. Using Spearman's rank correlation analyses, there was no correlation between urinary perchlorate concentrations and serum TSH, although inverse correlations were seen between urine perchlorate and free T3 and free T4 values. In univariate analyses, urine thiocyanate was positively correlated with serum TSH, but was not associated with serum free T3 or free T4. Urine perchlorate was positively correlated with gestational age. In multivariate analyses adjusting for urinary iodide concentrations, urine thiocyanate, gestational age, maternal age and TPO Ab titres, urine perchlorate was not a significant predictor of thyroid function. CONCLUSIONS Low-level perchlorate and thiocyanate exposure is ubiquitous, but, in adjusted analyses, is not associated with alterations in thyroid function tests among mildly iodine-deficient Greek women in the first trimester of pregnancy.
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Affiliation(s)
- Elizabeth N Pearce
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA.
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Markou KB, Koukkou EG. The Greek population is iodine sufficient and not at risk of iodine-induced hyperthyroidism. J Nutr 2012; 142:1611; author reply 1612. [PMID: 22822183 DOI: 10.3945/jn.112.163980] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Georgopoulos NA, Theodoropoulou A, Roupas NA, Rottstein L, Tsekouras A, Mylonas P, Vagenakis GA, Koukkou E, Armeni AK, Sakellaropoulos G, Leglise M, Vagenakis AG, Markou KB. Growth velocity and final height in elite female rhythmic and artistic gymnasts. Hormones (Athens) 2012; 11:61-9. [PMID: 22450345 DOI: 10.1007/bf03401538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to determine the impact of intensive training on adult final height in elite female rhythmic and artistic gymnasts. METHODS The study included 215 rhythmic gymnasts (RG) and 113 artistic gymnasts (AG). RESULTS AG were below the 50th percentile, while RG were taller than average. Final adult height was lower than target height in AG, while in RG, it exceeded target height. AG started training earlier than RG (p<0.001) and reported lower intensity of training (p<0.001). RG were taller than AG, with higher target height, greater Δ final height-target height and lower body fat and BMI (p<0.001). Using multiple regression analysis, the main factors influencing final height were weight SDS (p<0.001), target height SDS (p<0.001) and age of menarche (p<0.001) for RG, and weight SDS (p<0.001) and target height SDS (p<0.001) for AG. CONCLUSION In both elite female RG and AG, genetic predisposition to final height was not disrupted and remained the main force of growth. Although in elite RG genetic predisposition for growth was fully preserved, in elite female AG final adult height falls shorter than genetically determined target height, though within the standard error of prediction.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Patras, Greece.
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Abstract
OBJECTIVE Elite male artistic gymnasts (AG) are exposed to high levels of physical and psychological stress during adolescence and experience a significant late maturation in both linear growth and pubertal development. The aim of the present study was to determine the impact of intensive physical training on the adult final height in elite male AG. METHODS This study is unique in character, as all variables were measured on the field of competition. The study was prospective and longitudinal; however, the current analysis of data is cross-sectional. Data from 86 elite male AG were obtained during the gymnastics competitions of European and World Championships. Clinical evaluation included height and weight measurements, as well as assessment of pubic hair and genital development according to Tanner's stages of pubertal development. The laboratory investigation included determination of skeletal maturation. All athletes completed a questionnaire that included questions on personal (onset and intensity of training, number of competitions per year) and family data (paternal and maternal heights). RESULTS Male AG were below the 50th percentile for both final height and weight. Elite male AG had final height standard deviation score (SDS) lower than their genetic predisposition. Final height SDS was correlated positively with target height SDS (r = 0.430, p < 0.001) and weight SDS (r = 0.477, p < 0.001) and negatively to the intensity of training (r = -0.252, p = 0.022). The main factors influencing final height, by multiple regression analysis were weight SDS (p < 0.001) and target height SDS (p = 0.003). CONCLUSION In elite maleAG, final height falls short of genetic predisposition, still well within normal limits. Considering medical and psychological risks in general, and based on the results of this research project, the International Federation of Gymnastics has increased the age limit for participants in international gymnastics competitions by 1 year.
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Affiliation(s)
- Neoklis A Georgopoulos
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, Patras, Greece.
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Mamali I, Roupas ND, Armeni AK, Theodoropoulou A, Markou KB, Georgopoulos NA. Measurement of salivary resistin, visfatin and adiponectin levels. Peptides 2012; 33:120-4. [PMID: 22108712 DOI: 10.1016/j.peptides.2011.11.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/06/2011] [Accepted: 11/06/2011] [Indexed: 12/23/2022]
Abstract
Hormonal determination in saliva offers several advantages. Peptides enter the salivary glands either by active transport mechanisms or are expressed and secreted by the salivary glands themselves. The collection of saliva is a noninvasive, easily repeatable and less stressful technique than blood withdrawal. The purpose of the present study was to introduce a method for measuring salivary resistin, visfatin and adiponectin levels and to evaluate their associations with serum levels. Resistin, visfatin and adiponectin levels were measured in serum and saliva of 50 healthy adult volunteers (17 male and 33 female) using commercial enzyme immunoassay kits for serum with minor modifications. The present study documented the determination of resistin and adiponectin levels in saliva and the significant correlation of salivary levels with serum levels (r=0.441, p<0.01 and r=0.347, p<0.05, respectively). Moreover, the identification of visfatin in saliva was achieved, but no significant correlation with serum visfatin levels was observed. To our knowledge, this is the first study to report the determination of resistin and visfatin in saliva and the significant correlation of salivary resistin with serum levels, while it confirmed the significant association between salivary and serum adiponectin. The introduction of salivary determinations of adipokines could contribute to the elucidation of the physiology and the role of the specific adipokines in various clinical conditions (obesity, insulin resistance, inflammation, reproduction, energy imbalance and stress response).
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Affiliation(s)
- Irene Mamali
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
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Michalaki MA, Gkotsina MI, Mamali I, Markantes GK, Faltaka A, Kalfarentzos F, Vagenakis AG, Markou KB. Impaired pharmacokinetics of levothyroxine in severely obese volunteers. Thyroid 2011; 21:477-81. [PMID: 21417917 DOI: 10.1089/thy.2010.0149] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Suppressive or replacement doses of levothyroxine (LT4) are affected by the rate and extent of the active ingredient absorbed, as well as by the lean body mass. Obesity has reached epidemic proportions worldwide and is related with many comorbidities. The aim of this study was to determine the pharmacokinetic parameters of LT4 in severely obese individuals and compared them with similar data in lean control subjects. METHODS We studied 62 euthyroid subjects who had negative tests for anti-thyroid peroxidise antibodies (Ab-TPO). Thirty eight of these subjects were severely obese but otherwise healthy (severe obese subjects [SOS] group). Twenty-four were healthy control subjects (control group), with a body mass index of 23.3 ± 1.7 kg/m(2). Subjects received 600 μg oral sodium LT4 after an overnight fast. Serum triiodothyronine (T3), T4, and thyroid-stimulating hormone were measured at baseline. Serum T4 and T3 was measured 0.5, 1, 1.5, 2, 2.5, 3, and 4 hours after LT4 administration. RESULTS Baseline serum T4 and thyroid-stimulating hormone concentrations were higher in the SOS group than in the control group; serum T3 was similar in the two groups. The corrected area under the curve and the maximum T4 concentration after LT4 administration were lower, whereas the time to maximum concentration from the baseline was higher in SOS than in the control group. The estimated plasma volume was higher in the SOS than in the control group. Mean serum T3 levels increased gradually during the four hours after LT4 administration in the control group. In contrast, they decreased gradually in the SOS group. CONCLUSIONS Severely obese individuals may need higher LT4 suppressive or replacement doses than normal-weight individuals due, among other factors, to impaired LT4 pharmacokinetic parameters. The latter could be attributed to their higher plasma volume and/or to delayed gastrointestinal LT4 absorption. T4 conversion to T3 might be defective in severe obesity.
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Affiliation(s)
- Marina A Michalaki
- Division of Endocrinology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
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Georgopoulos NA, Rottstein L, Tsekouras A, Theodoropoulou A, Koukkou E, Mylonas P, Polykarpou G, Lampropoulou E, Iconomou G, Leglise M, Vagenakis AG, Markou KB. Abolished circadian rhythm of salivary cortisol in elite artistic gymnasts. Steroids 2011; 76:353-7. [PMID: 21073886 DOI: 10.1016/j.steroids.2010.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 10/24/2010] [Accepted: 10/29/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of intensive physical exercise and acute psychological stress during high level athletic competition as reflected on the levels of salivary cortisol in elite artistic gymnasts (AGs). DESIGN The study included 239 AGs (142 females-97 males) who participated in the European Championship of Gymnastics in 2006 and 81 adolescents (40 females-41 males), matched for age, as controls. All athletes participated voluntarily in all or parts of the study, providing samples or data for each of the variables measured. Height, weight, body fat, lean body mass (LBM), bone age and Tanner stage of puberty were assessed and data concerning the time of thelarche, adrenarche and menarche as well as, the onset and the intensity (hours per week) of training were obtained. METHODS Saliva samples were collected, the morning before training and in the afternoon shortly after the competition. From controls, the saliva samples were collected in the morning. Cortisol concentrations were measured using a chemiluminescence method. Acute stress was assessed using a questionnaire designed for the study. RESULTS No difference was found between morning and afternoon salivary cortisol levels in both male and female AGs (females: AM: 15.45±7.45nmol/l vs PM: 15.73±9.38nmol/l; males: AM: 10.21±5.52nmol/l vs PM: 9.93±13.8nmol/l, p>0.05). Female AGs presented higher levels of morning salivary cortisol than female controls (p<0.05). Both male and female AGs had higher degree of psychological stress in comparison with controls (p<0.001, p<0.013, respectively). Female AGs had higher morning and afternoon salivary cortisol levels (p<0.01, p<0.01, respectively) and higher degree of stress (p<0.003) than males. CONCLUSIONS In elite AGs the diurnal rhythm of salivary cortisol has been abolished, probably due to the strenuous training and competition conditions. Female AGs presented higher levels of morning salivary cortisol and psychological stress compared to both male AGs and female controls. The long term consequences of these modifications of the HPA axis remain to be elucidated.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, University Hospital of Patras, Rio 26500, Patras, Achaia, Greece
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Karamanakos SN, Markou KB, Panagopoulos K, Karavias D, Vagianos CE, Scopa CD, Fotopoulou V, Liava A, Vagenas K. Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures. Hormones (Athens) 2010; 9:318-25. [PMID: 21112863 DOI: 10.14310/horm.2002.1283] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the rate of complications and the risk factors in relation to the extent of surgery in patients undergoing thyroidectomy in a tertiary university center. DESIGN Data were collected retrospectively from 2,043 consecutive patients who underwent thyroid surgery for various thyroid diseases at the University Hospital of Patras, Greece, between January 1996 and December 2007. Recurrent laryngeal nerve palsy (RLNP) and hypoparathyroidism were set as the primary end points, while hematoma and wound infection were set as the secondary endpoints. RESULTS Total, near-total and subtotal thyroidectomy was performed in 1,149,777 and 117 patients, respectively. Transient RLNP occurred in 34 (1.6%) and permanent in 19 (0.9%) patients. Multivariate logistic regression analysis showed that extended resection (OR-odds ratio-1.6), Graves' disease (OR 2.7), thyroiditis (OR 2.1), recurrent goiter (OR 2.3) and thyroid malignancy (OR 1.7) were all independent risk factors for transient RLNP, whereas Graves' disease (OR 2.2) and recurrent goiter (OR 1.7) emerged as independent risk factors for permanent RLNP. The rates of transient and permanent hypoparathyroidism were 27.8% and 4.8%, respectively. Multivariate analysis for transient hypoparathyroidism revealed that the extent of surgical resection (OR 2.2), Graves' disease (OR 2.1), recurrent goiter (OR 1.7), female gender (OR 1.5) and specimen weight (OR 1.6) were independent predictors. However, the extent of surgical resection (OR 2.7), Graves' disease (OR 1.8), recurrent goiter (OR 1.5) and malignant disease (OR 1.5) were independent risk factors for permanent hypoparathyroidism. Postoperative wound infection and hematoma occurred in 6 (0.3%) and 27 (1.3%) patients, respectively. No correlation was observed between wound infection or postoperative hemorrhage and the extent of surgery. CONCLUSIONS Despite the higher morbidity, total thyroidectomy is emerging as an attractive surgical option even for benign thyroid disease due to the risk of subclinical (occult) malignancy, the possibility of goiter relapse as well as of the increased risk of complications following reoperation.
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Abstract
Bone mass (BM) and skeletal size are similar in prepubertal girls and boys and double between the onset of puberty and early adult life. Sex steroids are responsible for the maturation in human skeleton, as well as for the sexual dimorphism, observed after the onset of puberty. Physical activity in childhood is critical for maximizing bone growth and thus for preventing osteoporosis during older age. Therefore, it constitutes the most effective prevention strategy available. In athletes, high-impact loading activities have been shown to improve BM, whereas in sports requiring a lean somatotype (therefore leading to a negative energy balance), the delay in skeletal maturation and pubertal development predisposes athletes to osteopenia and osteoporosis. Although the early onset of training, the continuous intensive exercise and its long duration attenuate bone acquisition, the excess mechanical load to which these athletes are exposed from a young age exerts beneficial effects on bone formation that lead to a positive net-effect on BM.
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Affiliation(s)
- Kostas B Markou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Patras, Greece.
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Georgopoulos NA, Roupas ND, Theodoropoulou A, Tsekouras A, Vagenakis AG, Markou KB. The influence of intensive physical training on growth and pubertal development in athletes. Ann N Y Acad Sci 2010; 1205:39-44. [PMID: 20840251 DOI: 10.1111/j.1749-6632.2010.05677.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Genetic potential for growth can be fully expressed only under favorable environmental conditions. Although moderate physical activity has beneficial effects on growth, excessive physical training may negatively affect it. Sports favoring restricted energy availability, in the presence of high energy expenditure, are of particular concern. In gymnastics, a different pattern in skeletal maturation and linear growth was observed, resulting in an attenuation of growth potential in artistic gymnasts (AG), more pronounced in males than in females. In female rhythmic gymnasts (RG), the genetic predisposition to growth was preserved owing to a late catchup growth phenomenon. In all other sports not requiring strict dietary restrictions, no deterioration of growth has been documented so far. Intensive physical training and negative energy balance alter the hypothalamic pituitary set point at puberty, prolong the prepubertal stage, and delay pubertal development and menarche in a variety of sports. In elite RG and AG, prepubertal stage is prolonged and pubertal development is entirely shifted to a later age, following the bone maturation rather than the chronological age.
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Affiliation(s)
- Neoklis A Georgopoulos
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, University Hospital, Patras, Greece.
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Georgopoulos NA, Saltamavros AD, Vervita V, Karkoulias K, Adonakis G, Decavalas G, Kourounis G, Markou KB, Kyriazopoulou V. Basal metabolic rate is decreased in women with polycystic ovary syndrome and biochemical hyperandrogenemia and is associated with insulin resistance. Fertil Steril 2009; 92:250-5. [PMID: 18678372 DOI: 10.1016/j.fertnstert.2008.04.067] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Revised: 04/25/2008] [Accepted: 04/28/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate basal metabolic rate (BMR) in women with PCOS and to determine its association with insulin resistance (IR). DESIGN Prospective assessment of BMR in women with PCOS. SETTING Outpatient clinic of the Division of Reproductive Endocrinology. PATIENT(S) The study included 91 Greek women with PCOS and biochemical hyperandrogenemia, with mean age 24.03 +/- 0.55 years and mean body mass index (BMI) 26.67 +/- 0.69 kg/m(2), and 48 matched regularly menstruating women, with mean age 26.33 +/- 0.93 years and mean BMI 23.35 +/- 0.85 kg/m(2), as control subjects. INTERVENTION(S) Assessment of BMR by indirect calorimetry, IR by HOMA and QUICKI indices, fasting insulin, and fasting glucose/insulin ratio. MAIN OUTCOME MEASURE(S) Reduced BMR in PCOS with or without IR. RESULT(S) Adjusted BMR was 1,868 +/- 41 kcal/day in the control group, 1,445.57 +/- 76 in all PCOS women, 1,590 +/- 130 in PCOS women without IR and 1,116 +/- 106 in PCOS women with IR. Adjusted BMR showed a statistically significant difference between women with PCOS and control subjects, with lowest values in the group of PCOS women with IR, even after adjusting all groups for age and BMI. CONCLUSION(S) Women with PCOS, particularly those with IR, present a significantly decreased BMR.
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Affiliation(s)
- Neoklis A Georgopoulos
- Division of Reproductive Endocrinology, University of Patras Medical School, University Hospital, Patras, Greece.
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Marioli DJ, Saltamavros AD, Vervita V, Koika V, Adonakis G, Decavalas G, Markou KB, Georgopoulos NA. Association of the 17-hydroxysteroid dehydrogenase type 5 gene polymorphism (-71A/G HSD17B5 SNP) with hyperandrogenemia in polycystic ovary syndrome (PCOS). Fertil Steril 2008; 92:648-52. [PMID: 18692800 DOI: 10.1016/j.fertnstert.2008.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Revised: 06/02/2008] [Accepted: 06/09/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the association of an activating single-nucleotide polymorphism (SNP) at position -71 of the promoter of 17beta-hydroxysteroid dehydrogenase type 5 gene (-71A/G HSD17B5 SNP) and polycystic ovary syndrome (PCOS) in a well characterized cohort of caucasian PCOS women with biochemical hyperandrogenemia. DESIGN The PCOS patients and unrelated healthy control subjects were genotyped for the -71A/G HSD17B5 SNP. The acquired genotypic data was tested for association with PCOS and other quantitative phenotypic traits of the syndrome in PCOS patients. SETTING Subjects were recruited from the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, at the University Hospital of Patras, Greece. Genotyping and biochemical determinations took place at the Laboratory of Molecular Endrocinology, University of Patras Medical School, Rion, Greece. PATIENT(S) Participants comprised 150 caucasian Greek PCOS women with biochemical hyperandrogenism and chronic anovulation and polycystic ovarian morphology on ultrasound and 51 healthy control subjects. MAIN OUTCOME MEASURE(S) HSD17B5 genotype, serum testosterone, serum androstenedione. RESULT(S) No association of the -71A/G HSD17B5 SNP with PCOS was detected. However, the -71G HSD17B5 variant was associated with increased serum testosterone levels and decreased androstenedione/testosterone ratio. CONCLUSION(S) The -71G HSD17B5 variant is not a major component of the molecular pathogenetic mechanisms of PCOS, although it might contribute to the severity of hyperandrogenemia in women with PCOS and biochemical hyperandrogenism.
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Affiliation(s)
- Dimitra J Marioli
- Division of Reproductive Endocrinology, University of Patras Medical School, University Hospital, Patras, Greece
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Michalaki M, Kyriazopoulou V, Paraskevopoulou P, Vagenakis AG, Markou KB. The odyssey of nontoxic nodular goiter (NTNG) in Greece under suppression therapy, and after improvement of iodine deficiency. Thyroid 2008; 18:641-5. [PMID: 18578614 DOI: 10.1089/thy.2007.0348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Nontoxic nodular goiter (NTNG) is common in endemic goiter regions. Thyroxine (T4) is often used to treat NTNG. There is little information regarding T4 treatment in regions that have recently become iodine sufficient. We studied the effect of T4 treatment on thyroid function tests in southwestern Greece (SWG), a recently iodine-sufficient area. METHODS We studied 827 residents of SWG (group A) to determine goiter prevalence, thyroid function, and urinary iodine concentration (UIC). Group B: 385 consecutive patients with thyroid dysfunction. Of these, 89 had NTNG and followed for 10 years on T4 treatment, and 296 had hyperthyroidism. Group C: 29 patients with NTNG, treated with triiodothyronine (T3) 50 mug/day and followed for 6 months. Measurements included serum T4 and 24-hour radioactive iodine uptake (RAIU) before and at the end of T3 administration. RESULTS The median UIC in group A was 114 microg/L. In group B (89 patients), the incidence of newly diagnosed hyperthyroidism was 5-7% per year with a cumulative percentage of 33% at the 10th year. The initial thyrotropin (TSH) was lower (0.78 +/- 0.51 mIU/L) in those who developed thyrotoxicosis compared to those who remained euthyroid (1.17 +/- 0.74 mIU/L) (p < 0.05). In 296 thyrotoxic patients, the incidence of autoimmune hyperthyroidism and toxic multi-nodular goiter (TMNG) was similar. In group C, 10/29 patients remained euthyroid and the 24-hour RAIU decreased by 49% during T3 treatment. Similarly, serum T4 decreased by 49%. In the remaining patients who developed hyperthyroidism, 24-hour RAIU and T4 were decreased by 19% and 22%, respectively. CONCLUSIONS In SWG, a recently iodine-sufficient region, the risk of developing hyperthyroidism in patients with NTNG after administration of 100-150 microg T4 is relatively high in those whose serum TSH before T4 treatment is in the lower normal range. Therefore, T4 treatment should be avoided in these patients.
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Affiliation(s)
- Marina Michalaki
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
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Markou KB, Tsekouras A, Anastasiou E, Vlassopoulou B, Koukkou E, Vagenakis GA, Mylonas P, Vasilopoulos C, Theodoropoulou A, Rottstein L, Lampropoulou E, Apostolopoulos D, Jabarov R, Vagenakis AG, Georgopoulos NA. Treating iodine deficiency: long-term effects of iodine repletion on growth and pubertal development in school-age children. Thyroid 2008; 18:449-54. [PMID: 18399768 DOI: 10.1089/thy.2007.0277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Iodine deficiency (ID) is still a major universal health problem. Iodine deficiency disorders (IDDs) affect people of all ages, among whom the most vulnerable are children and adolescents. The aim of the present study was to assess the long-term effects on growth and pubertal development of correcting severe ID in areas of Azerbaijan between 1999 and 2000. METHODS Iodized oil was administered orally to 293,000 children, aged 6-16 years. Among those, 364 children were randomly selected and were examined 1 year before the administration of iodized oil (Group I-neg, iodine negative) and 295 children (Group I-Rx, iodine treated) were examined 4 years (Group I-R x 4, iodine treated 4 years later; n = 173) or 5 years (Group I-R x 5, iodine treated 5 years later; n = 122) after the last dose of iodide. RESULTS In Group I-neg the median urine iodine concentration (UIC) (mcg/L) was 36 (mean: 36.272 +/- 11.036) and increased significantly (p < 0.001) in Group I-R x 4: 188 (mean: 230.969 +/- 155.818) and in Group I-R x 5: 175 (mean: 201.176 +/- 130.369). The prevalence of goiter was 99% in Group I-neg and 2% in Group I-R x 4. Children in Group I-Rx had a greater standard deviation score (SDS) for height (-0.1364 +/- 1.279, n = 294) than children in Group I-neg (-0.5019 +/- 1.17, n = 363) (p < 0.001, t = -3.817), which was more significant for boys. SDS for weight was similar in both groups (Group I-neg: -0.17 +/- 0.78, n = 363; Group I-Rx: -0.115 +/- 0.917, n = 294). The rate of puberty development as judged by the development of breast and pubic hair was normalized in both sexes after the correction of ID. CONCLUSIONS Our results demonstrate that long-term correction of severe ID leads to sustained improvement of linear growth accompanied by a normalization of the time of onset of pubertal development for both sexes.
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Affiliation(s)
- Kostas B Markou
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, University Hospital, Patras, Greece
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Spinos N, Terzis G, Crysanthopoulou A, Adonakis G, Markou KB, Vervita V, Koukouras D, Tsapanos V, Decavalas G, Kourounis G, Georgopoulos NA. Increased frequency of thyroid nodules and breast fibroadenomas in women with uterine fibroids. Thyroid 2007; 17:1257-9. [PMID: 17988198 DOI: 10.1089/thy.2006.0330] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Fibroids or leiomyomas or myomas of the uterus are the most common benign gynecologic disease, while fibroadenomas of the breast are most frequently seen in young women, usually within 20 years after puberty. Multiple tumors in one or both breasts are found in 10-15% of patients. Single thyroid nodules are much more common in women than in men, and their prevalence increases with age. The aim of the present study was to determine cross-sectionally the incidence of solitary thyroid nodules and fibroadenomas of the breast in women with uterine fibroids. In women with uterine adenomas, the frequency of fibroadenomas of the breast was 65% and of thyroid nodules was 38.7%, while in women with a normal uterus, the frequency was 35% and 20%, respectively. Therefore, women with uterine fibroids have an increased incidence of thyroid nodules (t = 4.68, p = 0.030) and of fibroadenomas of the breast (t = 11.74, p = 0.001).
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Affiliation(s)
- Nikitas Spinos
- Department of Obstetrics and Gynecology, University of Patras Medical School, Rio, Patras, Greece
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Theodoropoulou A, Vagenakis AG, Makri M, Markou KB. Thyroid hormone synthesis and secretion in humans after 80 milligrams of iodine for 15 days and subsequent withdrawal. J Clin Endocrinol Metab 2007; 92:212-4. [PMID: 17047024 DOI: 10.1210/jc.2006-1189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT In animals, acute iodine administration results in acute intrathyroidal inhibition of iodinations followed by escape of the inhibition if the excessive iodine intake continues. In humans, the intrathyroidal nonhormonal and hormonal iodine concentration after exposure to large doses of iodine for a relatively long period of time is not known. OBJECTIVE To determine whether, in human thyroid, administration of large doses of iodine for a relatively long time results in alterations of intrathyroidal hormonal (HI) T4 and T3 and total iodine (TI) content, as well as whether changes in serum concentration of thyroid hormones and TSH would occur after iodine administration or discontinuation. DESIGN In 33 euthyroid patients with single thyroid nodule or hyperparathyroidism, Lugol solution (80 mg iodine) was administered for 15 d before operation. Groups of six to eight patients underwent operation 0, 5, 10, and 15 d after iodine withdrawal. TI, HI in a sample of thyroid tissue, and serum concentration of T4, T3, and TSH were measured. In 21 normal euthyroid subjects who did not undergo operation, a similar protocol was used and serial blood measurements were taken. MAIN OUTCOME MEASURE Intrathyroidal TI, HI, and serum thyroid hormone and TSH measurements were the main outcome measure. RESULTS Intrathyroidal HI content and serum T4 and T3 were unchanged during and after iodine discontinuation. TI was increased during iodine administration and returned to control values 5 d after discontinuation of iodine. The ratio of HI/TI was decreased and returned to control values 15 d after the iodine was discontinued. Serum TSH was increased during iodine administration and returned to control values 10 d after iodine withdrawal. CONCLUSIONS In humans, administration of iodine for a relatively long period of time was accompanied by increased intrathyroidal TI, but no changes in HI or demonstrable increases of serum T4 and T3 were observed. It is hypothesized that the maintenance of normal intrathyroidal HI is the result of the combined inhibitory effect of iodine on thyroid hormone synthesis and on the release of T4 and T3 from the thyroid.
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Affiliation(s)
- Anastasia Theodoropoulou
- Department of Medicine, Division of Endocrinology, University of Patras Medical School, Patras 24500, Greece
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Mylonas PG, Makri M, Georgopoulos NA, Theodoropoulou A, Leglise M, Vagenakis AG, Markou KB. Adequacy of saliva 17-hydroxyprogesterone determination using various collection methods. Steroids 2006; 71:273-6. [PMID: 16430934 DOI: 10.1016/j.steroids.2005.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 11/07/2005] [Accepted: 11/16/2005] [Indexed: 11/17/2022]
Abstract
Steroids determination in saliva offers several advantages. The collection of saliva is a noninvasive, less stressful technique than blood withdrawal and reflects the circulating unbound fractions. The suitability of saliva for 17-hydroxyprogesterone and cortisol determinations has been documented in healthy subjects as well as in diseases like Congenital Adrenal Hyperplasia and Cushing syndrome. The aim of the study was to compare the influence of different collection methods on the results of 17-hydroxyprogesterone measurement in saliva collected by different ways, using commercially available RIAs developed for plasma. 17-hydroxyprogesterone was determined in 64 healthy adult volunteers (30 males, 34 females) in serum (Group SE) and in saliva collected before meals at 8-10 p.m. by directly spitting into a plastic tube (Group SP), using a cotton swab (Group SA) and using a polyester swab Salivette (Group SB). We used a commercially available direct radioimmunoassay without separation technique. The 17-hydroxyprogesterone mean values (ng/ml) were 1.16+/-1.3 (Group SE), 0.056+/-0.046 (Group SP), 0.089+/-0.048 (Group SA) and 0.058+/-0.049 (Group SB). The detection limit was 0.010 ng/ml. The correlations between the values in serum (Group SE) and in saliva were: r=0.77, p<0.05 (Group SP); r=0.62, p<0.05 (Group SA); r=0.70, p<0.05 (Group SB). The saliva values corresponding to the serum cut-off point of 3 ng/ml upper limit of normal values were in ng/ml 0.13 (Group SP), 0.16 (Group SA) and 0.11 (Group SB). In conclusion, 17-hydroxyprogesterone determinations in saliva using commercially available RIAs primarily developed for serum, is a reliable and easy to perform procedure. The three different methods of saliva collection showed 17-hydroxyprogesterone concentrations to have good agreement.
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Affiliation(s)
- Panagiotis G Mylonas
- Department of Internal Medicine, Division of Endocrinology, University Hospital of Patras Medical School, Patras, Greece
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Theodoropoulou A, Markou KB, Vagenakis GA, Benardot D, Leglise M, Kourounis G, Vagenakis AG, Georgopoulos NA. Delayed but normally progressed puberty is more pronounced in artistic compared with rhythmic elite gymnasts due to the intensity of training. J Clin Endocrinol Metab 2005; 90:6022-7. [PMID: 16118332 DOI: 10.1210/jc.2005-1762] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Elite gymnasts are subjected to intense training, which may alter pubertal development. OBJECTIVE The objective of the investigation was to study the impact of gymnastics on pubertal development in rhythmic (RGs) and artistic gymnasts (AGs). DESIGN Evaluation of somatometric parameters, pubertal stage, and intensity of training in the competition field were studied. SETTING The study was conducted at European and world championships of years 1997-2004. SUBJECTS Subjects included 433 elite RGs and 427 AGs, aged 11-23 yr. INTERVENTION There were no interventions. MAIN OUTCOME MEASURES Mean chronological and bone ages of each pubertal stage and their relation to the intensity of training were measured. RESULTS AGs and RGs showed a delay in skeletal maturation (Delta age-bone age, 2.13 and 1.28, respectively; P < 0.001). AGs were subjected to higher levels of physical training. Thelarche occurred at 12.9 yr for RGs and 13.2 yr for AGs (P = 0.003) and pubarche at 12.5 and 12.9 yr, respectively (P = 0.002). Puberty was delayed but normally progressed. AGs entered each pubertal stage later than RGs. The delay was influenced by the amount of energy output. Menarcheal age was 14.6 yr for RGs and 14.9 yr for AGs. Menarche was influenced in AGs by bone age (b = 0.333; t = 2.521; P = 0.020), pubarche (b = 0.322; t = 2.401; P = 0.026), and body fat (b = -0.458; t = -3.412; P = 0.003) and in RGs by bone age (b = 0.378; t = 3.689; P < 0.001) and pubarche (b = 0.525; t = 6.017; P < 0.001). CONCLUSION In RGs and AGs, pubertal development was shifted to a later age, maintaining a normal rate of progression, which followed the bone age. AGs, who were exposed to a greater and more sustained energy output than RGs, presented a more pronounced delay in both skeletal maturation and pubertal development.
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Affiliation(s)
- Anastasia Theodoropoulou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Rio-26500, Greece
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Georgopoulos NA, Markou KB, Theodoropoulou A, Vagenakis GA, Mylonas P, Vagenakis AG. Growth, pubertal development, skeletal maturation and bone mass acquisition in athletes. Hormones (Athens) 2004; 3:233-43. [PMID: 16982598 DOI: 10.14310/horm.2002.11132] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The genetic potentials for growth can be fully expressed only under favourable environmental conditions. Excessive physical training may negatively affect growth, especially during puberty. Sports that require a strict control of energy input in the presence of a high energy output are of particular concern. In gymnastics, a different pattern in skeletal maturation was observed, leading to an attenuation of growth potential ins Artistic Gymnasts (AG), more pronounced in males than in females, whereas in female Rhythmic Gymnasts (RG) the genetic predisposition to growth was preserved because of a late catch-up growth phenomenon. In all other sports not requiring strict dietary restrictions, no deterioration of growth has been documented. Intensive physical training and negative energy balance modify the hypothalamic pituitary set point at puberty, prolong the prepubertal stage and delay pubertal development and menarche in a variety of sports. In elite RG and AG the prepubertal stage is prolonged and pubertal development is entirely shifted to a later age, paralleling the bone age rather than the chronological age. Bone formation, and, consequently, BMD are enhanced by physical activity. In athletes, high-impact loading activities have been shown to improve BMD, while in sports requiring a lean somatotype, the delay in skeletal maturation and pubertal development, resulting from hypoestrogenemia, predisposes athletes to osteopenia. In AG, an increase in bone density is observed using the bone age as denominator.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, University Hospital, Patras, 26500, Greece
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Markou KB, Mylonas P, Theodoropoulou A, Kontogiannis A, Leglise M, Vagenakis AG, Georgopoulos NA. The influence of intensive physical exercise on bone acquisition in adolescent elite female and male artistic gymnasts. J Clin Endocrinol Metab 2004; 89:4383-7. [PMID: 15328065 DOI: 10.1210/jc.2003-031865] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2003] [Accepted: 03/28/2004] [Indexed: 02/12/2023]
Abstract
Physical exercise enhances bone acquisition during adolescence. The aim of the study was to evaluate the influence of intensive physical exercise on bone acquisition in adolescent elite artistic gymnasts. The study included 262 athletes (93 males and 169 females, aged 13-23 yr) participating in the 24th European Championship held in Greece. Bone age compared with chronological age was delayed by 2 yr for females (n = 120) and 1 yr for males (n = 68). For both sexes, the growth chart of bone mineral density (BMD) followed a normal pattern when estimated according to bone age rather than chronological age. For females, BMD was positively correlated with bone age, chronological age, height, body weight, body mass index, body fat, lean body mass, and with age of onset of training, and negatively with duration of exercise and intensity of training (P values range from <0.05 to <0.0001). Multiple regression analysis revealed that age of onset of training was the major parameter attenuating the effect of exercise on BMD (P < 0.001). The latter was related to the stage of puberty (P < 0.05). For males, BMD was correlated positively with bone age, height, body weight, and lean body mass (P values range from <0.01 to 0.0001). Multiple regression analysis revealed that the more powerful factor influencing BMD was weight (P < 0.01). In conclusion, bone acquisition in adolescents under intensive physical training follows the normal pattern only when estimated according to bone age. The age of onset, the duration, and the intensity of exercise attenuate the bone acquisition, at least in female artistic gymnasts.
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Affiliation(s)
- Kostas B Markou
- Division of Endocrinology, University of Patras Medical School, 26500 Patras, Greece
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Georgopoulos NA, Theodoropoulou A, Leglise M, Vagenakis AG, Markou KB. Growth and skeletal maturation in male and female artistic gymnasts. J Clin Endocrinol Metab 2004; 89:4377-82. [PMID: 15328064 DOI: 10.1210/jc.2003-031864] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2003] [Accepted: 03/29/2004] [Indexed: 11/19/2022]
Abstract
We studied 262 athletes who were 13-23 yr old. There were 93 male and 169 female artistic gymnasts (AG). This study is unique in character, because all variables were measured on the field of competition (24th European Championship). Male AG had a higher height SD score than female (P < 0.001), with a higher reported target height SD score (P < 0.001), a higher predicted final height (P = 0.007), a lower Delta height - target height (P < 0.001), a less delayed bone age (P < 0.001), a greater body mass index (BMI) (P < 0.001), a lower mean body fat (P<0.001), and an older age of onset of training (P < 0.001). In a subgroup of athletes who had reached final height, male AG had a higher weight SD score than female (t = 4.322, P < 0.001), with a higher reported target height SD score (t = 18.9, P<0.001), but a greater Delta final height-target height (t= 6.641, P < 0.001). Height SD score was positively correlated to reported target height SD score (P = 0.009 and P = 0.006, respectively) and to weight SD (P < 1 and P < 0.001, respectively) for both male and female AG, as well as to BMI for female AG (P<0.001), and negatively to Delta age - bone age (P < 0.001 and P = 0.003, respectively) and to predicted height SD score (P = 0.001 and P < 0.001, respectively). Using multiple regression analysis, height SD score was positively correlated to predicted height SD score for both male (P < 0.001) and female (P = 0.005) AG, as well as to weight SD score (P < 0.001) for female AG and negatively to BMI (P < 0.001) for female AG and to Delta age - bone age (P < 0.001) for male AG. In conclusion, a deterioration of growth in AG was observed. For both sexes, genetic predisposition to final height, although altered, was not disrupted.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, University of Patras Medical School, University Hospital, 26500 Patras, Greece
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Georgopoulos NA, Sykiotis GP, Sgourou A, Papachatzopoulou A, Markou KB, Kyriazopoulou V, Papavassiliou AG, Vagenakis AG. Autonomously functioning thyroid nodules in a former iodine-deficient area commonly harbor gain-of-function mutations in the thyrotropin signaling pathway. Eur J Endocrinol 2003; 149:287-92. [PMID: 14514342 DOI: 10.1530/eje.0.1490287] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Somatic activating mutations of the thyrotropin (thyroid-stimulating hormone (TSH)) receptor (TSHR) and G(alphas) protein have been detected in solitary toxic adenomas and toxic multinodular goiters, but their role in the pathogenesis of autonomous nodules is debated. The frequency of mutations is highly variable among populations and is inversely proportional to iodine intake. DESIGN AND PATIENTS We screened 28 clinically and histologically heterogeneous autonomous nodules from 24 Greek patients for the presence of TSHR and G(alphas) mutations. RESULTS By direct sequencing of genomic DNA, we detected 11 somatic heterozygous gain-of-function mutations in TSHR and one in G(alphas). Forty-three percent (12 of 28) of all nodules and 57% (four of seven) of solitary toxic adenomas harbored an activating mutation. Typical adenomas and hyperplastic nodules did not differ in mutation frequency. Substitutions I568T and T632I were detected in both histological types of nodules. CONCLUSIONS Our findings indicate that activating somatic mutations in the TSH signaling pathway are frequent in autonomous nodules in Greece. This may be due to earlier exposure of the population to iodine deficiency, which was corrected in Greece only over the past two decades. Gain-of-function mutations are shared by nodules with varying histological and clinical presentations. Thus, they may represent a common molecular mechanism underlying the pathogenesis of non-autoimmune thyroid autonomy.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Internal Medicine, School of Medicine, University of Patras, Patras, Greece
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Sykiotis GP, Neumann S, Georgopoulos NA, Sgourou A, Papachatzopoulou A, Markou KB, Kyriazopoulou V, Paschke R, Vagenakis AG, Papavassiliou AG. Functional significance of the thyrotropin receptor germline polymorphism D727E. Biochem Biophys Res Commun 2003; 301:1051-6. [PMID: 12589819 DOI: 10.1016/s0006-291x(03)00071-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In a toxic thyroid adenoma we identified a novel somatic mutation that constitutively activates the thyrotropin receptor (TSHR). Two heterozygous point mutations at adjacent nucleotides led to a substitution of alanine with asparagine at codon 593 (A593N) in the fifth transmembrane helix of TSHR. This somatic mutation resided on the same TSHR allele with the germline polymorphism D727E. The functional characteristics of the single TSHR mutants A593N and D727E and of the double mutant A593N/D727E were studied in transiently transfected COS-7 cells. The TSHR mutants A593N and A593N/D727E constitutively activated the cAMP cascade, whereas the D727E mutant did not differ from the wild-type TSHR. Surprisingly, the double mutant's specific constitutive activity was 2.3-fold lower than the A593N mutant. Thus, the polymorphism significantly ameliorates G(alphas) protein activation in the presence of the gain-of-function mutation A593N, although it is functionally inert in the context of the wild-type TSHR.
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Affiliation(s)
- Gerasimos P Sykiotis
- Department of Biochemistry, School of Medicine, University of Patras, 26110, Patras, Greece
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Markou KB, Paraskevopoulou P, Karaiskos KS, Makri M, Georgopoulos NA, Iconomou G, Mengreli C, Vagenakis AG. Hyperthyrotropinemia during iodide administration in normal children and in children born with neonatal transient hypothyroidism. J Clin Endocrinol Metab 2003; 88:617-21. [PMID: 12574190 DOI: 10.1210/jc.2002-020681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The aim of the present study was to examine the effects of chronic iodide administration in pharmacological doses on thyroid function in children with a history of transient congenital hypothyroidism (TCH). We hypothesized that such children may carry a previously undisclosed intrinsic intrathyroidal defect, rendering them susceptible to TCH. We administered for this 60-65 mg iodide daily for 60 d in 13 individuals with TCH (group A), 8 of their siblings (group B), 8 healthy controls (group C), and 11 normal adults (group D). Thyroid function was evaluated by measuring serum T(3), T(4), free T(3), free T(4), TSH, and thyroglobulin concentrations and autoantibodies against thyroid peroxidase and thyroglobulin at baseline at 15, 30, and 60 d during iodide administration, and 2 months after iodide withdrawal. Hyperthyrotropinemia greater than 4.2 mU/liter but not higher than 10 mU/liter with normal thyroid hormone concentrations was observed in one of the TCH group and in two of the group B siblings. During iodide administration, hyperthyrotropinemia was observed in 8 of 13 (62%) adolescents in group A, 4 of 7 (57%) in group B, and 6 of 8 (75%) in group C. None of the 11 adults (group D) developed hyperthyrotropinemia during iodide administration. Serum T(4) and free T(4) concentrations were decreased in all groups when compared with baseline values. The magnitude of the decrease of serum T(4) was identical in all groups (0.7-0.8 microg/dl). Thyroid enlargement was observed in all subjects and was more pronounced in children. There were no cases of subclinical and/or overt hyperthyroidism. After iodine withdrawal, serum TSH decreased in all groups and returned to baseline levels, as well as the thyroid volume. In conclusion, the hypothalamic-pituitary-thyroid axis of adolescents with TCH responds to pharmacological doses of iodide similarly to that observed in normal children. The hyperthyrotropinemia observed in the adolescents exposed to iodides may reflect incipient transient hypothyroidism or simply a brisk TSH response to a small serum T(4) decrease. Whatever the mechanism, chronic use of excessive quantities of iodide should be avoided until the end of puberty.
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Affiliation(s)
- Kostas B Markou
- Department of Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Patras GR-26500, Greece
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Markou KB, Georgopoulos NA, Makri M, Vlasopoulou B, Anastasiou E, Vagenakis GA, Kouloubi K, Theodosopoulos N, Lazarou N, Veizis A, Sakellaropoulos G, Vagenakis AG. Improvement of iodine deficiency after iodine supplementation in schoolchildren of Azerbaijan was accompanied by hypo and hyperthyrotropinemia and increased title of thyroid autoantibodies. J Endocrinol Invest 2003; 26:43-8. [PMID: 12762640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE In the mountainous areas of Azerbaijan the schoolchildren suffer from severe Iodine Deficiency (ID) with median Urinary iodine excretion (UIE) 36 mcg/l and prevalence of goiter 99% (estimated by US). In a population of 293,000 schoolchildren aged 8-14 y.o. we administered capsules containing 190 mg of iodized oil (Lipiodol-Guerbet, Cedex, France) twice yearly in 6 months apart (total 380 mg). The aim of the present study was to evaluate the efficacy, the benefits, as well as the possible side-effects in a follow-up period of 6 and 12 months after the initial administration of iodized oil. METHODS Six and 12 months after the initial administration of iodide, two representative samples of 391 and 326 children respectively were examined. The evaluation included: estimation of goiter by US, determination of UIE and serum measurements of T3, T4, TSH, Tg, autoantibodies against thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg). RESULTS There was an improvement in median UIE which increased from 36 mcg/l to 68 and 81 mcg/l after 6 and 12 months of treatment respectively. The prevalence of goiter decreased from 99% to 54% and 26% respectively. Tg was decreased at 6 and 12 months from the first administration, whereas TSH remained unchanged at 6 months and decreased at 12 months when compared to the latter value. Hypothyroidism was detected in 7% of children after iodide administration both at 6 and 12 months, but overt hypothyroidism was observed only in 0.5% at 12 months. Subclinical hyperthyroidism was detected in 2% and 6% after iodide administration both at 6 and 12 months. There was a significant increase in the title of thyroid auto antibodies in 6 months which was retained and increased in 12 months. There was no relation between the appearance of thyroid dysfunction and the positive thyroid auto antibodies. CONCLUSION The dose of 190 mg iodide administered twice yearly, improved iodine deficiency and endemic goiter in schoolchildren. The increase of UIE resulted from iodide administration, was accompanied by an increased title of thyroid auto-antibodies and an increased prevalence of hyper- and hypothyrotropinemia apparently of no autoimmune etiology.
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Affiliation(s)
- K B Markou
- Department of Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Patras, Greece
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Georgopoulos NA, Markou KB, Theodoropoulou A, Benardot D, Leglise M, Vagenakis AG. Growth retardation in artistic compared with rhythmic elite female gymnasts. J Clin Endocrinol Metab 2002; 87:3169-73. [PMID: 12107219 DOI: 10.1210/jcem.87.7.8640] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We studied 129 female rhythmic gymnasts (RG) and 142 female artistic gymnasts (AG) who participated in the 1999 Gymnastics World Championship for RG in Osaka, Japan, and the 1999 and 2001 Gymnastics World Championships for AG in Tianjin, China (n = 48), and Ghent, Belgium (n = 94), respectively. RG were taller than average, with a mean height SD score above the 50th percentile, whereas AG were relatively short, with a mean height SD score below the 50th percentile. Both RG and AG followed their respective reported target height SD score, which was above the 50th percentile for the RG and below the 50th percentile for the AG. The RG followed a growth pattern that was higher than their reported target height, whereas AG exhibited a negative growth pattern. RG and AG weighed less than the population mean, with the mean weight for age below the 50th percentile for both groups. RG were taller than AG (t = 17.15; P < 0.001), with a higher reported target height SD score (t = 6.44; P < 0.001), a greater Delta height-reported target height (t = 2.74; P < 0.001), and a lower mean body fat (t = -11.83; P < 0.001) and body mass index (t = -10.73; P < 0.001) than AG. AG started their training at an earlier age than RG (t = 4.13; P < 0.001). Using multiple regression analysis, actual height SD score was independently influenced positively by weight SD score for both RG (b = 0.421; t = 4.317; P < 0.001) and AG (b = 1.404; t = 16.514; P = <0.001), and by reported target height only for RG (b = 0.299; t = 3.139; P = 0.002), and negatively by body mass index only for AG (b = -0.80; t = -9.88; P < 0.001). In conclusion, in elite female AG, a deterioration of growth potential was observed, whereas in RG the genetic predisposition to growth was preserved.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Patras, 26500 Greece
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