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Moroto D, Torquato-Vieira ICO, Fiorin LB, Camacho CP, Castiglioni MLV, Maciel RMB, Furlanetto RP, Matsumura LK, Janovsky CCPS, Lindsey SC, Martins JRM. Long-Term Follow-up of Patients With Autonomous Thyroid Nodules Treated With Radioiodine. Clin Nucl Med 2024; 49:529-535. [PMID: 38619976 DOI: 10.1097/rlu.0000000000005189] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
PURPOSE This article aims to describe the presentation of Plummer disease and its evolution after radioiodine treatment and determine factors that may influence treatment efficacy. PATIENTS AND METHODS The sample included retrospective medical records of 165 adult patients with toxic nodular goiter treated with radioiodine between 1997 and 2017, followed up at a single thyroid center. RESULTS The efficacy of treatment with a single dose of radioiodine was higher than 90%. The mean radioiodine activity was 28.9 ± 3.4 mCi. The mean time between radioiodine performance and hyperthyroidism resolution was 3.6 ± 3.0 months, ranging from 1-12 months. After the first year, 33.9% of the patients were under hypothyroidism, 59.4% under euthyroidism, and 6.7% under hyperthyroidism. Among the nonresponders, the variables that showed statistical difference were the presence of multinodular goiter and the radioiodine activity (mean, 25.5 ± 6.5 mCi; median, 30 [15-30 mCi]). The cumulative rate of hypothyroidism was 48.9% over 20 years of follow-up. CONCLUSIONS Radioiodine therapy is an effective and safe treatment. In Plummer disease, high rates of euthyroidism are expected after the radioiodine treatment. Therapeutic failure was observed mainly in patients with larger multinodular goiters treated with lower doses of radioiodine. The evolution to hypothyroidism was mostly observed in younger patients with larger and uninodular goiters.
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Affiliation(s)
- Débora Moroto
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Isabel C O Torquato-Vieira
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Lia B Fiorin
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | | | - Mário Luiz V Castiglioni
- Division of Nuclear Medicine, Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Rui M B Maciel
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Reinaldo P Furlanetto
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Luiza K Matsumura
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | | | - Susan C Lindsey
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - João Roberto M Martins
- From the Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo
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Valente FOF, Camacho CP, Lindsey SC, Yang JH, Kunii IS, Santos RB, Kizys MML, Cerutti JM, Dias-da-Silva MR, Maciel RMB. RET 634 germline/gonadal mosaicism generating a second pathogenic amino acid change in multiple endocrine neoplasia type 2A. Am J Med Genet A 2024. [PMID: 38407483 DOI: 10.1002/ajmg.a.63576] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/03/2024] [Accepted: 02/10/2024] [Indexed: 02/27/2024]
Abstract
Genetic testing for germline RET pathogenic variants, which cause the Multiple Endocrine Neoplasia Type 2 (MEN2) syndrome, has become crucial in managing patients with medullary thyroid carcinoma (MTC). Classically, RET heterozygous missense pathogenic variants are transmitted in a Mendelian autosomal dominant pattern, of which germline/gonadal mosaicism has never been reported. We report the novel occurrence of a MEN2A patient's family in which the siblings inherited three different RET 634 genotypes: wild type (p.Cys634), p.Cys634Gly or p.Cys634Arg heterozygous pathogenic variants. We hypothesized that germline/gonadal mosaicism, derived from an inherited + early somatic mutation in the mother or a double de novo mutation during maternal embryogenesis, led to this rare event in the RET gene. Exome analysis of the proband's deceased mother's paraffin-embedded thyroid tissue confirmed the three nucleotides in the same 634 codon position. For the first time, we describe germline/gonadal mosaicism in RET, generating a second pathogenic amino acid change in the same codon causing MEN2A. Our finding shows that RET parental mosaicism, confirmed by somatic exome sequencing, might explain discrepant genotype cases in siblings with inherited cancers.
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Affiliation(s)
- Flávia O F Valente
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Cléber P Camacho
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Susan C Lindsey
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Ji H Yang
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Ilda S Kunii
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Roberto B Santos
- Division of Endocrinology, Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, Brazil
| | - Marina M L Kizys
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Janete M Cerutti
- Genetic Basis of Thyroid Tumor Laboratory, Division of Genetics, Department of Morphology and Genetics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Magnus R Dias-da-Silva
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Rui M B Maciel
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Barcelos RN, Camacho CP, da Conceição de O C Mamone M, Ikejiri ES, Vanderlei FAB, Yang JH, Padovani RP, Martins LAL, Biscolla RPM, Macellaro D, Lindsey SC, Maciel RMB, Martins JRM. Risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy in thyroid nodules with diameters greater than 4 centimeters. Arch Endocrinol Metab 2023; 67:e000644. [PMID: 37364146 PMCID: PMC10661008 DOI: 10.20945/2359-3997000000644] [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] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/04/2023] [Indexed: 06/28/2023]
Abstract
Objective The risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) of thyroid nodules (TN) with diameters ≥ 3-4 cm remains controversial. However, some groups have indicated surgical treatment in these patients regardless of the FNAB results. We aimed to evaluate the diagnostic accuracy of the FNAB in systematically resected ≥4 cm TN and if the risk of malignancy is higher in these patients. Subjects and methods We retrospectively evaluated 138 patients (142 nodules) with TN with diameters ≥4 cm who underwent thyroidectomy. Results The FNAB results were nondiagnostic/unsatisfactory (ND/UNS) in 2.1% of the cases and benign in 51.4%. They indicated atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 23.9% of cases, follicular neoplasia/suspicious for a follicular neoplasm (FN/SFN) in 9.2%, suspicion of malignancy (SUS) in 8.5%, and malignant in 4.9%. The histopathological analysis after thyroidectomy revealed a thyroid cancer rate of 100% in the FNABs classified as malignant, 33.3% in SUS cases, 7.7% in FN/SFN, 17.6% in AUS/FLUS, and 4.1% in benign FNABs. None of the ND/UNS FNABs were malignant. The global malignancy diagnosis was 14.8% (n = 21). However, the rate of false negatives for FNAB was low (4.1%). Conclusion We showed that the risk of malignancy in nodules with diameters ≥4 cm was higher compared to the risk of thyroid cancer in TN in general. However, we found a low rate of false-negative cytological results; therefore, our data do not justify the orientation of routine resection for these larger nodules.
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Affiliation(s)
- Rafaela N Barcelos
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Cléber P Camacho
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Laboratório de Inovação Molecular e Biotecnologia, Programa de Pós-graduação em Medicina, Universidade Nove de Julho (Uninove), São Paulo, SP, Brasil
| | - Maria da Conceição de O C Mamone
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Elza S Ikejiri
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Felipe A B Vanderlei
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Ji H Yang
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rosália P Padovani
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Leandro A L Martins
- Laboratório de Anatomia Clínica e Patológica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Rosa Paula M Biscolla
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Danielle Macellaro
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Susan C Lindsey
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rui M B Maciel
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Roberto M Martins
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil,
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Ettleson MD, Prieto WH, Russo PST, de Sa J, Wan W, Laiteerapong N, Maciel RMB, Bianco AC. Serum Thyrotropin and Triiodothyronine Levels in Levothyroxine-treated Patients. J Clin Endocrinol Metab 2023; 108:e258-e266. [PMID: 36515655 PMCID: PMC10413428 DOI: 10.1210/clinem/dgac725] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
CONTEXT Small adjustments in levothyroxine (LT4) dose do not appear to provide clinical benefit despite changes in thyrotropin (TSH) levels within the reference range. We hypothesize that the accompanying changes in serum total triiodothyronine (T3) levels do not reflect the magnitude of the changes in serum TSH. OBJECTIVE This work aims to characterize the relationships of serum free thyroxine (FT4) vs T3, FT4 vs TSH, and FT4 vs the T3/FT4 ratio. METHODS This cross-sectional, observational study comprised 9850 participants aged 18 years and older treated with LT4 from a large clinical database from January 1, 2009, to December 31, 2019. Patients had been treated with LT4, subdivided by serum FT4 level. Main outcome measures included model fitting of the relationships between serum FT4 vs TSH, FT4 vs T3, and FT4 vs T3/FT4. Mean and median values of TSH, T3, and T3/FT4 were calculated. RESULTS The relationships T3 vs FT4 and TSH vs FT4 were both complex and best represented by distinct, segmented regression models. Increasing FT4 levels were linearly associated with T3 levels until an inflection point at an FT4 level of 0.7 ng/dL, after which a flattening of the slope was observed following a convex quadratic curve. In contrast, increasing FT4 levels were associated with steep declines in TSH following 2 negative sigmoid curves. The FT4 vs T3/FT4 relationship was fit to an asymptotic regression curve supporting less T4 to T3 activation at higher FT4 levels. CONCLUSION In LT4-treated patients, the relationships between serum FT4 vs TSH and FT4 vs T3 across a range of FT4 levels are disproportionate. As a result, dose changes in LT4 that robustly modify serum FT4 and TSH values may only minimally affect serum T3 levels and result in no significant clinical benefit.
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Affiliation(s)
- Matthew D Ettleson
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois 60637, USA
| | | | | | - Jose de Sa
- Fleury Group, Sao Paulo, SP 04344, Brazil
| | - Wen Wan
- Section of General Medicine, University of Chicago, Chicago, Illinois 60637, USA
| | - Neda Laiteerapong
- Section of General Medicine, University of Chicago, Chicago, Illinois 60637, USA
| | - Rui M B Maciel
- Fleury Group, Sao Paulo, SP 04344, Brazil
- Department of Medicine, Federal University of Sao Paulo, Sao Paulo SP 04039, Brazil
| | - Antonio C Bianco
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois 60637, USA
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Maglione AV, do Nascimento BPP, Ribeiro MO, de Souza TJL, da Silva REC, Sato MA, Penatti CAA, Britto LRG, de Souza JS, Maciel RMB, da Conceição RR, Laureano-Melo R, Giannocco G. Triiodothyronine Treatment reverses Depression-Like Behavior in a triple-transgenic animal model of Alzheimer's Disease. Metab Brain Dis 2022; 37:2735-2750. [PMID: 35951206 DOI: 10.1007/s11011-022-01055-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
Alzheimer disease's (AD) is a neurodegenerative disorder characterized by cognitive and behavioral impairment. The central nervous system is an important target of thyroid hormones (TH). An inverse association between serum triiodothyronine (T3) levels and the risk of AD symptoms and progression has been reported. We investigated the effects of T3 treatment on the depression-like behavior in male transgenic 3xTg-AD mice. Animals were divided into 2 groups treated with daily intraperitoneal injections of 20 ng/g of body weight (b.w.) L-T3 (T3 group) or saline (vehicle, control group). The experimental protocol lasted 21 days, and behavioral tests were conducted on days 18-20. At the end of the experiment, the TH profile and hippocampal gene expression were evaluated. The T3-treated group significantly increased serum T3 and decreased thyroxine (T4) levels. When compared to control hippocampal samples, the T3 group exhibited attenuated glycogen synthase kinase-3 (GSK3), metalloproteinase 10 (ADAM10), amyloid-beta precursor-protein (APP), serotonin transporter (SERT), 5HT1A receptor, monocarboxylate transporter 8 (MCT8) and bone morphogenetic protein 7 (BMP-7) gene expression, whereas augmented superoxide dismutase 2 (SOD2) and Hairless gene expression. T3-treated animals also displayed reduced immobility time in both the tail suspension and forced swim tests, and in the latter presented a higher latency time compared to the control group. Therefore, our findings suggest that in an AD mouse model, T3 supplementation promotes improvements in depression-like behavior, through the modulation of the serotonergic related genes involved in the transmission mediated by 5HT1A receptors and serotonin reuptake, and attenuated disease progression.
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Affiliation(s)
- Andréa V Maglione
- Dept. Medicine, Laboratory of Endocrinology and Translational Medicine, Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo, Brazil
| | - Bruna P P do Nascimento
- Laboratory of Translational Medicine, Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo, Brazil
- Developmental Disorders Program, Center of Biological Science and Health, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Miriam O Ribeiro
- Developmental Disorders Program, Center of Biological Science and Health, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Talytha J L de Souza
- Dept. Medicine, Laboratory of Endocrinology and Translational Medicine, Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo, Brazil
| | - Renata E C da Silva
- Dept. Medicine, Laboratory of Endocrinology and Translational Medicine, Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo, Brazil
| | - Monica A Sato
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário FMABC, Santo André- Brazil, São Paulo, Santo André, Brazil
| | - Carlos A A Penatti
- Laboratory of Human Physiology, Universidade Nove de Julho, São Paulo, Brazil
| | - Luiz R G Britto
- Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, Brazil
| | - Janaina S de Souza
- Dept. Medicine, Laboratory of Endocrinology and Translational Medicine, Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo, Brazil
| | - Rui M B Maciel
- Dept. Medicine, Laboratory of Endocrinology and Translational Medicine, Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo, Brazil
| | - Rodrigo Rodrigues da Conceição
- Dept. Medicine, Laboratory of Endocrinology and Translational Medicine, Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo, Brazil.
| | - Roberto Laureano-Melo
- Laboratory of Physiopharmacoly and Behavior, Universidade de Barra Mansa, Rio de Janeiro, Brazil
| | - Gisele Giannocco
- Dept. Medicine, Laboratory of Endocrinology and Translational Medicine, Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo, Brazil.
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de Castro MV, Santos KS, Apostolico JS, Fernandes ER, Almeida RR, Levin G, Magawa JY, Nunes JPS, Bruni M, Yamamoto MM, Lima AC, Silva MVR, Matos LRB, Coria VR, Castelli EC, Scliar MO, Kuramoto A, Bruno FR, Jacintho LC, Nunes K, Wang JYT, Coelho VP, Neto MM, Maciel RMB, Naslavsky MS, Passos-Bueno MR, Boscardin SB, Rosa DS, Kalil J, Zatz M, Cunha-Neto E. Recurrence of COVID-19 associated with reduced T-cell responses in a monozygotic twin pair. Open Biol 2022; 12:210240. [PMID: 35104433 PMCID: PMC8807054 DOI: 10.1098/rsob.210240] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Recurrence of COVID-19 in recovered patients has been increasingly reported. However, the immune mechanisms behind the recurrence have not been thoroughly investigated. The presence of neutralizing antibodies (nAbs) in recurrence/reinfection cases suggests that other types of immune response are involved in protection against recurrence. Here, we investigated the innate type I/III interferon (IFN) response, binding and nAb assays and T-cell responses to severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) with IFN gamma (IFNγ) enzyme-linked spot assay (ELISPOT) in three pairs of young adult monozygotic (MZ) twins with previous confirmed COVID-19, one of them presenting a severe recurrence four months after the initial infection. Twin studies have been of paramount importance to comprehend the immunogenetics of infectious diseases. Each MZ twin pair was previously exposed to SARS-CoV-2, as seen by clinical reports. The six individuals presented similar overall recovered immune responses except for the recurrence case, who presented a drastically reduced number of recognized SARS-CoV-2 T-cell epitopes on ELISPOT as compared to her twin sister and the other twin pairs. Our results suggest that the lack of a broad T-cell response to initial infection may have led to recurrence, emphasizing that an effective SARS-CoV-2-specific T-cell immune response is key for complete viral control and avoidance of clinical recurrence of COVID-19.
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Affiliation(s)
- Mateus V. de Castro
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Keity S. Santos
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Juliana S. Apostolico
- Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Department of Microbiology, Immunology and Parasitology, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Edgar R. Fernandes
- Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Department of Microbiology, Immunology and Parasitology, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Rafael R. Almeida
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil
| | - Gabriel Levin
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil
| | - Jhosiene Y. Magawa
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - João Paulo S. Nunes
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Mirian Bruni
- Department of Parasitology, Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcio M. Yamamoto
- Department of Parasitology, Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariane C. Lima
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Monize V. R. Silva
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Larissa R. B. Matos
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vivian R. Coria
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Erick C. Castelli
- School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Marilia O. Scliar
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andreia Kuramoto
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Fernanda R. Bruno
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Lucas C. Jacintho
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Kelly Nunes
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jaqueline Y. T. Wang
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Veronica P. Coelho
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | | | | | - Michel S. Naslavsky
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Rita Passos-Bueno
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvia B. Boscardin
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil,Department of Parasitology, Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniela S. Rosa
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Department of Microbiology, Immunology and Parasitology, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Jorge Kalil
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil,Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil
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7
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Almeida RL, Ogihara CA, de Souza JS, Oliveira KC, Cafarchio EM, Tescaro L, Maciel RMB, Giannocco G, Sato MA. Regularly swimming exercise modifies opioidergic neuromodulation in rostral ventrolateral medulla in hypertensive rats. Brain Res 2022; 1774:147726. [PMID: 34785257 DOI: 10.1016/j.brainres.2021.147726] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/14/2021] [Accepted: 11/09/2021] [Indexed: 11/02/2022]
Abstract
Moderate exercise reduces arterial pressure (AP) and heart rate (HR) in spontaneously hypertensive rats (SHR) and changes neurotransmission in medullary areas involved in cardiovascular regulation. We investigated if regularly swimming exercise (SW) affects the cardiovascular adjustments mediated by opioidergic neuromodulation in the RVLM in SHR and Wistar-Kyoto (WKY) rats. Rats were submitted to 6 wks of SW. The day after the last exercise bout, α-chloralose-anesthetized rats underwent a cannulation of the femoral artery for AP and HR recordings, and Doppler flow probes were placed around the lower abdominal aorta and superior mesenteric artery. Bilateral injection of endomorphin-2 (EM-2, 0.4 mmol/L, 60 nL) into the RVLM increased MAP in SW-SHR (20 ± 4 mmHg, N = 6), which was lower than in sedentary (SED)-SHR (35 ± 4 mmHg, N = 6). The increase in MAP in SW-SHR induced by EM-2 into the RVLM was similar in SED- and SW-WKY. Naloxone (0.5 mmol/L, 60 nL) injected into the RVLM evoked an enhanced hypotension in SW-SHR (-66 ± 8 mmHg, N = 6) compared to SED-SHR (-25 ± 3 mmHg, N = 6), which was similar in SED- and SW-WKY. No significant changes were observed in HR after EM-2 or naloxone injections into the RVLM. Changes in hindquarter and mesenteric conductances evoked by EM-2 or naloxone injections into the RVLM in SW- or SED-SHR were not different. Mu Opioid Receptor expression by Western blotting was reduced in SW-SHR than in SED-SHR and SW-WKY. Therefore, regularly SW alters the opioidergic neuromodulation in the RVLM in SHR and modifies the mu opioid receptor expression in this medullary area.
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Affiliation(s)
- Roberto L Almeida
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário FMABC, Santo Andre, SP, Brazil
| | - Cristiana A Ogihara
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário FMABC, Santo Andre, SP, Brazil
| | | | - Kelen C Oliveira
- Dept. Medicine, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo M Cafarchio
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário FMABC, Santo Andre, SP, Brazil.
| | - Larissa Tescaro
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário FMABC, Santo Andre, SP, Brazil
| | - Rui M B Maciel
- Dept. Medicine, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Gisele Giannocco
- Dept. Medicine, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Monica A Sato
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário FMABC, Santo Andre, SP, Brazil
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8
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Maciel RMB, Maia AL. GLOBAL ENDOCRINOLOGY: Geographical variation in the profile of RET variants in patients with medullary thyroid cancer: a comprehensive review. Eur J Endocrinol 2021; 186:R15-R30. [PMID: 34757920 DOI: 10.1530/eje-21-0753] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/17/2021] [Accepted: 11/09/2021] [Indexed: 11/08/2022]
Abstract
Genetic variability in humans is influenced by many factors, such as natural selection, mutations, genetic drift, and migrations. Molecular epidemiology evaluates the contribution of genetic risk factors in the etiology, diagnosis, and prevention of a particular disease. Few areas of medicine have been so clearly affected by genetic diagnosis and management as multiple neoplasia type 2 (MEN2), in which activating pathogenic variants in the RET gene results in the development of medullary thyroid carcinoma (MTC), pheochromocytoma, and hyperparathyroidism in nearly 98, 50, and 25% of gene carriers, respectively. Here, we aimed to collect RET genotyping data worldwide to analyze the distribution and frequency of RET variants from a global perspective. We show that the mutational spectrum of RET is observed worldwide. The codon 634 variants seem to be the most prevalent, but there are differences in the type of amino acid exchanges among countries and in the frequencies of the other RET codon variants. Most interestingly, studies using haplotype analysis or pedigree linkage have demonstrated that some pathogenic RET variants have been transmitted to offspring for centuries, explaining some local prevalence due to a founder effect. Unfortunately, after almost three decades after the causative role of the germline RET variants has been reported in hereditary MTC, comprehensive genotyping data remain limited to a few countries. The heterogeneity of RET variants justifies the need for a global effort to describe epidemiological data of families with MEN2 to further understand the genetic background and environmental circumstances that affect disease presentation.
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Affiliation(s)
- Rui M B Maciel
- Laboratory of Molecular and Translational Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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9
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Castelli EC, de Castro MV, Naslavsky MS, Scliar MO, Silva NSB, Andrade HS, Souza AS, Pereira RN, Castro CFB, Mendes-Junior CT, Meyer D, Nunes K, Matos LRB, Silva MVR, Wang JYT, Esposito J, Coria VR, Bortolin RH, Hirata MH, Magawa JY, Cunha-Neto E, Coelho V, Santos KS, Marin MLC, Kalil J, Mitne-Neto M, Maciel RMB, Passos-Bueno MR, Zatz M. MHC Variants Associated With Symptomatic Versus Asymptomatic SARS-CoV-2 Infection in Highly Exposed Individuals. Front Immunol 2021; 12:742881. [PMID: 34650566 PMCID: PMC8506217 DOI: 10.3389/fimmu.2021.742881] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/06/2021] [Indexed: 12/11/2022] Open
Abstract
Despite the high number of individuals infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who develop coronavirus disease 2019 (COVID-19) symptoms worldwide, many exposed individuals remain asymptomatic and/or uninfected and seronegative. This could be explained by a combination of environmental (exposure), immunological (previous infection), epigenetic, and genetic factors. Aiming to identify genetic factors involved in immune response in symptomatic COVID-19 as compared to asymptomatic exposed individuals, we analyzed 83 Brazilian couples where one individual was infected and symptomatic while the partner remained asymptomatic and serum-negative for at least 6 months despite sharing the same bedroom during the infection. We refer to these as "discordant couples". We performed whole-exome sequencing followed by a state-of-the-art method to call genotypes and haplotypes across the highly polymorphic major histocompatibility complex (MHC) region. The discordant partners had comparable ages and genetic ancestry, but women were overrepresented (65%) in the asymptomatic group. In the antigen-presentation pathway, we observed an association between HLA-DRB1 alleles encoding Lys at residue 71 (mostly DRB1*03:01 and DRB1*04:01) and DOB*01:02 with symptomatic infections and HLA-A alleles encoding 144Q/151R with asymptomatic seronegative women. Among the genes related to immune modulation, we detected variants in MICA and MICB associated with symptomatic infections. These variants are related to higher expression of soluble MICA and low expression of MICB. Thus, quantitative differences in these molecules that modulate natural killer (NK) activity could contribute to susceptibility to COVID-19 by downregulating NK cell cytotoxic activity in infected individuals but not in the asymptomatic partners.
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Affiliation(s)
- Erick C. Castelli
- Department of Pathology, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
- Molecular Genetics and Bioinformatics Laboratory–Experimental Research Unit, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Mateus V. de Castro
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Michel S. Naslavsky
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Marilia O. Scliar
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Nayane S. B. Silva
- Molecular Genetics and Bioinformatics Laboratory–Experimental Research Unit, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Heloisa S. Andrade
- Molecular Genetics and Bioinformatics Laboratory–Experimental Research Unit, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Andreia S. Souza
- Molecular Genetics and Bioinformatics Laboratory–Experimental Research Unit, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Raphaela N. Pereira
- Molecular Genetics and Bioinformatics Laboratory–Experimental Research Unit, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Camila F. B. Castro
- Molecular Genetics and Bioinformatics Laboratory–Experimental Research Unit, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
- Centro Universitário Sudoeste Paulista, Avaré, Brazil
| | - Celso T. Mendes-Junior
- Departamento de Química, Faculdade de Filosofa, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Diogo Meyer
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Kelly Nunes
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Larissa R. B. Matos
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Monize V. R. Silva
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Jaqueline Y. T. Wang
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Joyce Esposito
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Vivian R. Coria
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Raul H. Bortolin
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Mario H. Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Jhosiene Y. Magawa
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia - Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Verônica Coelho
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia - Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Keity S. Santos
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia - Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Maria Lucia C. Marin
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia - Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Jorge Kalil
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia - Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | | | | | - Maria Rita Passos-Bueno
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
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10
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Idrees T, Prieto WH, Casula S, Ajith A, Ettleson M, Narchi FAA, Russo PST, Fernandes F, Johnson J, Mayampurath A, Maciel RMB, Bianco AC. Use of Statins Among Patients Taking Levothyroxine: an Observational Drug Utilization Study Across Sites. J Endocr Soc 2021; 5:bvab038. [PMID: 34141994 PMCID: PMC8204793 DOI: 10.1210/jendso/bvab038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Treatment with levothyroxine (LT4) that normalize serum thyrotropin (TSH) is expected to restore lipid metabolism. OBJECTIVE To assess statin utilization in LT4-treated patients through an observational drug utilization study. METHODS Three sites were involved: (1) 10 723 outpatients placed on LT4 during 2006-2019 identified from the Clinical Research Data Warehouse of the University of Chicago; (2) ~1.4 million LT4 prescriptions prepared by primary care physicians during January-December 2018, identified from the IQVIA™ database of medical prescriptions in Brazil; (30 ~5.4 million patient interviews during 2009-2019, including ~0.32 million patients on LT4, identified from the Fleury Group database in Brazil. RESULTS On site 1, initiation of therapy with LT4 increased the frequency of statin utilization (19.1% vs 24.6%), which occurred ~1.5 years later (median 76 weeks) and, among those patients that were on statins, increased intensity of treatment by 33%, despite normalization of serum TSH levels; on site 2, after matching for sex and age, the frequency of statins prescription was higher for those patients using LT4: females, 2.1 vs 3.4% (odds ratio [OR] 1.656 [1.639-1.673]); males, 3.1 vs 4.4% (OR 1.435 [1.409-1.462]); and, on site 3, after matching for sex and age, the frequency of statin utilization was higher in those patients using LT4: females, 10 vs 18% (OR 2.02 [2.00-2.04]); males, 15 vs 25% (OR 1.92 [1.88-1.96]); all P values were <.0001. CONCLUSION Prescription and utilization of statins were higher in patients taking LT4. The reasons for this association should be addressed in future studies.
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Affiliation(s)
- Thaer Idrees
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, IL 60637, USA
| | | | - Sabina Casula
- Department of Endocrinology, Miami Veterans Affairs Healthcare System, Miami, FL 33136, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33125, USA
| | - Aswathy Ajith
- Center for Research Informatics, University of Chicago, Chicago, IL 60637, USA
| | - Matthew Ettleson
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, IL 60637, USA
| | | | | | | | - Julie Johnson
- Center for Research Informatics, University of Chicago, Chicago, IL 60637, USA
| | - Anoop Mayampurath
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA
| | - Rui M B Maciel
- Fleury Group, Sao Paulo, SP 04344, Brazil
- Federal University of Sao Paulo, Sao Paulo, SP 04039, Brazil
| | - Antonio C Bianco
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, IL 60637, USA
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11
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Guastapaglia L, Kasamatsu TS, Nakabashi CCD, Camacho CP, Maciel RMB, Vieira JGH, Biscolla RPM. The role of a new polyclonal competitive thyroglobulin assay in the follow-up of patients with differentiated thyroid cancer with structural disease but low levels of serum thyroglobulin by immunometric and LC-MS/MS methods. Endocrine 2021; 72:784-790. [PMID: 33222120 DOI: 10.1007/s12020-020-02526-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/13/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aims of this study were to assess the role of an in-house competitive thyroglobulin assay (Tg-c) in the follow-up of metastatic differentiated thyroid carcinoma (DTC) patients who presented underestimated Tg measurements by immunometric assays (Tg-IMA) and to compare the results with IMA and LC-MS/MS Tg methods. METHODS This prospective study included 40 patients. Twenty-one with metastatic disease: 14 had Tg-IMA levels inappropriately low or undetectable (eight patients with positive and six with borderline TgAb) and seven had high Tg-IMA levels. Nineteen had an excellent response to therapy. The competitive assay employs a polyclonal antibody produced in rabbits immunized with human Tg, Tg labeled with biotin, and for the solid phase separation, a monoclonal anti-rabbit IgG antibody adsorbed to microtiter plates. RESULTS All 14 patients with structural disease and underestimated levels of Tg-IMA presented detectable Tg-c levels. The median Tg-c level in the group with positive TgAb was 183 µg/L (range: 22-710 µg/L), and 58 µg/L (range 23-148 µg/L) in the borderline TgAb group. The levels of Tg-LC-MS/MS were detectable in some patients (range < 0.5-18 µg/L). All seven patients with high Tg-IMA presented also high levels of Tg-c. Only 2/19 patients with excellent response had Tg-c levels above the functional sensitivity. CONCLUSIONS The competitive assay was able to detect Tg in all patients, even in the presence of serum TgAb, and may be an option in patients with underestimated Tg-IMA and relevant structural disease.
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Affiliation(s)
- Leila Guastapaglia
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Teresa S Kasamatsu
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Claudia Cristina D Nakabashi
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Fleury Medicina e Saúde, São Paulo, Brazil
| | - Cléber P Camacho
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Molecular Innovation and Biotechnology Laboratory, Medical Postgraduation Division, Universidade Nove de Julho (Uninove), São Paulo, Brazil
| | - Rui M B Maciel
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Fleury Medicina e Saúde, São Paulo, Brazil
| | - José Gilberto H Vieira
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Fleury Medicina e Saúde, São Paulo, Brazil
| | - Rosa Paula M Biscolla
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
- Fleury Medicina e Saúde, São Paulo, Brazil.
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12
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Bartolomeo CS, Alves TN, Lemes RMR, Ivanov GZ, Morais RLT, Costa AJ, Nishino MS, Bassani TB, Pereira GJS, Smaili SS, Maciel RMB, Okuda LH, Braconi CT, Maricatto JT, Janini LMR, Ureshino RP, Prado CM, Stilhano RS. ACE2 OVEREXPRESSION CHANGES THE SARS-COV-2 INFECTION PROFILE IN BEAS-2B CELLS. Cytotherapy 2021. [PMID: 33189572 PMCID: PMC8079860 DOI: 10.1016/j.jcyt.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Aims Methods Results Conclusion
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13
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Cafarchio EM, da Silva LA, Auresco LC, Rodart IF, de Souza JS, Antonio BB, Venancio DP, Maifrino LBM, Maciel RMB, Giannocco G, Aronsson P, Sato MA. Oxytocin Reduces Intravesical Pressure in Anesthetized Female Rats: Action on Oxytocin Receptors of the Urinary Bladder. Front Physiol 2020; 11:382. [PMID: 32435202 PMCID: PMC7218109 DOI: 10.3389/fphys.2020.00382] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/30/2020] [Indexed: 01/29/2023] Open
Abstract
Urinary bladder dysfunction affects several people worldwide and shows higher prevalence in women. Micturition is dependent on the Barrington’s nucleus, pontine urine storage center and periaqueductal gray matter, but other brain stem areas are involved in the bladder regulation. Neurons in the medulla oblongata send projections to hypothalamic nuclei as the supraoptic nucleus, which synthetizes oxytocin and in its turn, this peptide is released in the circulation. We investigated the effects of intravenous injection of oxytocin (OT) on the urinary bladder in sham and ovariectomized rats. We also evaluated the topical (in situ) action of OT on intravesical pressure (IP) as well as the existence of oxytocin receptors in the urinary bladder. In sham female Wistar rats, anesthetized with isoflurane, intravenous infusion of OT (10 ng/kg) significantly decreased the IP (–47.5 ± 1.2%) compared to saline (3.4 ± 0.7%). Similar effect in IP was observed in ovariectomized rats after i.v. OT (–41.9 ± 2.9%) compared to saline (0.5 ± 0.6%). Topical administration (in situ) of 0.1 mL of OT (1.0 ng/mL) significantly reduced the IP (22.3.0 ± 0.6%) compared to saline (0.9 ± 0.7%). We also found by qPCR that the gene expression of oxytocin receptor is present in this tissue. Blockade of oxytocin receptors significantly attenuated the reduction in IP evoked by oxytocin i.v. or in situ. Therefore, the findings suggest that (1) intravenous oxytocin decreases IP due to bladder relaxation and (2) OT has local bladder effect, binding directly in receptors located in the bladder.
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Affiliation(s)
- Eduardo M Cafarchio
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário Saúde ABC, Santo André, Brazil
| | - Luiz A da Silva
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário Saúde ABC, Santo André, Brazil
| | - Luciana C Auresco
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário Saúde ABC, Santo André, Brazil
| | - Itatiana F Rodart
- Department Collective Health, Human Reproduction and Genetics Center, Faculdade de Medicina do ABC, Centro Universitário Saúde ABC, Santo André, Brazil
| | | | - Bruno B Antonio
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário Saúde ABC, Santo André, Brazil
| | - Daniel P Venancio
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário Saúde ABC, Santo André, Brazil
| | - Laura B M Maifrino
- Laboratory of Histomophometry, Universidade São Judas Tadeu, São Paulo, Brazil
| | - Rui M B Maciel
- Department Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Gisele Giannocco
- Department Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Patrik Aronsson
- Department Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monica A Sato
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitário Saúde ABC, Santo André, Brazil
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Meuwese CL, van Diepen M, Cappola AR, Sarnak MJ, Shlipak MG, Bauer DC, Fried LP, Iacoviello M, Vaes B, Degryse J, Khaw KT, Luben RN, Åsvold BO, Bjøro T, Vatten LJ, de Craen AJM, Trompet S, Iervasi G, Molinaro S, Ceresini G, Ferrucci L, Dullaart RPF, Bakker SJL, Jukema JW, Kearney PM, Stott DJ, Peeters RP, Franco OH, Völzke H, Walsh JP, Bremner A, Sgarbi JA, Maciel RMB, Imaizumi M, Ohishi W, Dekker FW, Rodondi N, Gussekloo J, den Elzen WPJ. Low thyroid function is not associated with an accelerated deterioration in renal function. Nephrol Dial Transplant 2020; 34:650-659. [PMID: 29684213 DOI: 10.1093/ndt/gfy071] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is frequently accompanied by thyroid hormone dysfunction. It is currently unclear whether these alterations are the cause or consequence of CKD. This study aimed at studying the effect of thyroid hormone alterations on renal function in cross-sectional and longitudinal analyses in individuals from all adult age groups. METHODS Individual participant data (IPD) from 16 independent cohorts having measured thyroid stimulating hormone, free thyroxine levels and creatinine levels were included. Thyroid hormone status was defined using clinical cut-off values. Estimated glomerular filtration rates (eGFR) were calculated by means of the four-variable Modification of Diet in Renal Disease (MDRD) formula. For this IPD meta-analysis, eGFR at baseline and eGFR change during follow-up were computed by fitting linear regression models and linear mixed models in each cohort separately. Effect estimates were pooled using random effects models. RESULTS A total of 72 856 individuals from 16 different cohorts were included. At baseline, individuals with overt hypothyroidism (n = 704) and subclinical hypothyroidism (n = 3356) had a average (95% confidence interval) -4.07 (-6.37 to -1.78) and -2.40 (-3.78 to -1.02) mL/min/1.73 m2 lower eGFR as compared with euthyroid subjects (n = 66 542). In (subclinical) hyperthyroid subjects (n = 2254), average eGFR was 3.01 (1.50-4.52) mL/min/1.73 m2 higher. During 329 713 patient years of follow-up, eGFR did not decline more rapidly in individuals with low thyroid function compared with individuals with normal thyroid function. CONCLUSIONS Low thyroid function is not associated with a deterioration of renal function. The cross-sectional association may be explained by renal dysfunction causing thyroid hormone alterations.
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Affiliation(s)
- Christiaan L Meuwese
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Mark J Sarnak
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Michael G Shlipak
- Department of Medicine, UCSF School of Medicine, San Francisco, CA, USA
| | - Douglas C Bauer
- Department of Medicine, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of San Francisco, CA, USA
| | - Linda P Fried
- Mailman School of Public Health and Columbia University Medical Center, New York, NY, USA
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Policlinic Hospital, Bari, Italy
| | - Bert Vaes
- Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium.,Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
| | - Jean Degryse
- Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium.,Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bjørn O Åsvold
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trine Bjøro
- Department of Medical Biochemistry, Oslo University Hospital, and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars J Vatten
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Giorgio Iervasi
- National Council Research Institute of Clinical Physiology, Tuscany Region G. Monasterio Foundation, Pisa, Italy
| | - Sabrina Molinaro
- National Council Research Institute of Clinical Physiology, Pisa, Italy
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Geriatric Endocrine Unit, University Hospital of Parma, Parma, Italy
| | | | - Robin P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Robin P Peeters
- Department of Internal Medicine, Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Internal Medicine, Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henry Völzke
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research & German Centre of Cardiovascular Research, University of Greifswald, Greifswald, Germany
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,Medical School, The University of Western Australia, Crawley, Western Australia
| | - Alexandra Bremner
- School of Population Health, The University of Western Australia, Crawley, Western Australia
| | - José A Sgarbi
- Division of Endocrinology, Faculdade de Medicina de Marília, Marília, Brazil
| | - Rui M B Maciel
- Division of Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Misa Imaizumi
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Waka Ohishi
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
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15
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Bim LV, Navarro FCP, Valente FOF, Lima-Junior JV, Delcelo R, Dias-da-Silva MR, Maciel RMB, Galante PAF, Cerutti JM. Retroposed copies of RET gene: a somatically acquired event in medullary thyroid carcinoma. BMC Med Genomics 2019; 12:104. [PMID: 31288802 PMCID: PMC6617568 DOI: 10.1186/s12920-019-0552-1] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Different pathogenic germline mutations in the RET oncogene are identified in MEN 2, a hereditary syndrome characterized by medullary thyroid carcinoma (MTC) and other endocrine tumors. Although genetic predisposition is recognized, not all RET mutation carriers will develop the disease during their lifetime or, likewise, RET mutation carriers belonging to the same family may present clinical heterogeneity. It has been suggested that a single germline mutation might not be sufficient for development of MEN 2-associated tumors and a somatic bi-allelic alteration might be required. Here we investigated the presence of somatic second hit mutation in the RET gene in MTC. METHODS We integrated Multiplex Ligation-dependent Probe Amplification (MLPA) and whole exome sequencing (WES) to search for copy number alteration (CNA) in the RET gene in MTC samples and medullary thyroid cell lines (TT and MZ-CR-1). We next found reads spanning exon-exon boundaries on RET, an indicative of retrocopy. We subsequently searched for RET retrocopies in the human reference genome (GRCh37) and in the 1000 Genomes Project data, by looking for reads reporting joined exons in the RET locus or distinct genomic regions. To determine RET retrocopy specificity and recurrence, DNA isolated from sporadic and MEN 2-associated MTC (n = 37), peripheral blood (n = 3) and papillary thyroid carcinomas with RET fusion (n = 10) samples were tested using PCR-sequencing methodology. RESULTS Through MLPA we have found evidence of CNA in the RET gene in MTC samples and MTC cell lines. WES analysis reinforced the presence of the CNA and hinted for a retroposed copy of RET not found in the human reference genome and 1.000 Genomes Project. Extended analysis confirmed the presence of a somatic MTC-related retrocopy of RET in both sporadic and hereditary tumors. We further unveiled a recurrent (28%) novel point mutation (p.G548 V) found exclusively in the retrocopy of RET. The mutation was also found in cDNA of mutated samples, suggesting it might be functional. CONCLUSION We here report a somatic specific RET retroposed copy in MTC samples and cell lines. Our results support the idea that generation of retrocopies in somatic cells is likely to contribute to MTC genesis and progression.
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Affiliation(s)
- Larissa V Bim
- Laboratório As Bases Genéticas dos Tumores da Tiroide, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Fábio C P Navarro
- Centro de Oncologia Molecular, Hospital Sírio-libanês, São Paulo, SP, Brazil.,Departamento de Bioquímica, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Flávia O F Valente
- Laboratório de Endocrinologia Molecular e Translacional, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - José V Lima-Junior
- Laboratório As Bases Genéticas dos Tumores da Tiroide, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rosana Delcelo
- Departamento de Patologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Magnus R Dias-da-Silva
- Laboratório de Endocrinologia Molecular e Translacional, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rui M B Maciel
- Laboratório de Endocrinologia Molecular e Translacional, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Pedro A F Galante
- Centro de Oncologia Molecular, Hospital Sírio-libanês, São Paulo, SP, Brazil
| | - Janete M Cerutti
- Laboratório As Bases Genéticas dos Tumores da Tiroide, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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16
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de Souza JS, Ferreira DR, Herai R, Carromeu C, Torres LB, Araujo BHS, Cugola F, Maciel RMB, Muotri AR, Giannocco G. Altered Gene Expression of Thyroid Hormone Transporters and Deiodinases in iPS MeCP2-Knockout Cells-Derived Neurons. Mol Neurobiol 2019; 56:8277-8295. [DOI: 10.1007/s12035-019-01645-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/10/2019] [Indexed: 12/12/2022]
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17
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Maciel RMB, Camacho CP, Assumpção LVM, Bufalo NE, Carvalho AL, de Carvalho GA, Castroneves LA, de Castro FM, Ceolin L, Cerutti JM, Corbo R, Ferraz TMBL, Ferreira CV, França MIC, Galvão HCR, Germano-Neto F, Graf H, Jorge AAL, Kunii IS, Lauria MW, Leal VLG, Lindsey SC, Lourenço DM, Maciel LMZ, Magalhães PKR, Martins JRM, Martins-Costa MC, Mazeto GMFS, Impellizzeri AI, Nogueira CR, Palmero EI, Pessoa CHCN, Prada B, Siqueira DR, Sousa MSA, Toledo RA, Valente FOF, Vaisman F, Ward LS, Weber SS, Weiss RV, Yang JH, Dias-da-Silva MR, Hoff AO, Toledo SPA, Maia AL. Genotype and phenotype landscape of MEN2 in 554 medullary thyroid cancer patients: the BrasMEN study. Endocr Connect 2019; 8:289-298. [PMID: 30763276 PMCID: PMC6410763 DOI: 10.1530/ec-18-0506] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/13/2019] [Indexed: 12/26/2022]
Abstract
Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant genetic disease caused by RET gene germline mutations that is characterized by medullary thyroid carcinoma (MTC) associated with other endocrine tumors. Several reports have demonstrated that the RET mutation profile may vary according to the geographical area. In this study, we collected clinical and molecular data from 554 patients with surgically confirmed MTC from 176 families with MEN2 in 18 different Brazilian centers to compare the type and prevalence of RET mutations with those from other countries. The most frequent mutations, classified by the number of families affected, occur in codon 634, exon 11 (76 families), followed by codon 918, exon 16 (34 families: 26 with M918T and 8 with M918V) and codon 804, exon 14 (22 families: 15 with V804M and 7 with V804L). When compared with other major published series from Europe, there are several similarities and some differences. While the mutations in codons C618, C620, C630, E768 and S891 present a similar prevalence, some mutations have a lower prevalence in Brazil, and others are found mainly in Brazil (G533C and M918V). These results reflect the singular proportion of European, Amerindian and African ancestries in the Brazilian mosaic genome.
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Affiliation(s)
- Rui M B Maciel
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Correspondence should be addressed to R M B Maciel or S C Lindsey: or
| | - Cleber P Camacho
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Lígia V M Assumpção
- Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, São Paulo, Brazil
| | - Natassia E Bufalo
- Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, São Paulo, Brazil
| | | | - Gisah A de Carvalho
- Faculdade de Medicina, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Luciana A Castroneves
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Lucieli Ceolin
- Hospital de Clínicas de Porto Alegre and Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Janete M Cerutti
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Rossana Corbo
- Instituto Nacional do Câncer, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Carla V Ferreira
- Hospital de Clínicas de Porto Alegre and Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - M Inez C França
- Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Hospital Santa Rita de Cássia, Vitória, Espírito Santo, Brazil
| | | | - Fausto Germano-Neto
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Hans Graf
- Faculdade de Medicina, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Alexander A L Jorge
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ilda S Kunii
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Márcio W Lauria
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vera L G Leal
- Instituto Estadual de Diabetes e Endocrinologia, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Susan C Lindsey
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Correspondence should be addressed to R M B Maciel or S C Lindsey: or
| | - Delmar M Lourenço
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, São Paulo, Brazil
| | - Léa M Z Maciel
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Patrícia K R Magalhães
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - João R M Martins
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - M Cecília Martins-Costa
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
- Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Gláucia M F S Mazeto
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Anelise I Impellizzeri
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Célia R Nogueira
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Edenir I Palmero
- Hospital de Câncer de Barretos, Barretos, São Paulo, Brazil
- Faculdade de Ciências da Saúde de Barretos Dr. Paulo Prata, Barretos, São Paulo, Brazil
| | | | - Bibiana Prada
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Débora R Siqueira
- Hospital de Clínicas de Porto Alegre and Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Sharmila A Sousa
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Escola Fiocruz de Governo, Fundação Oswaldo Cruz and Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Rodrigo A Toledo
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Vall d’Hebron Institute of Oncology (VHIO), CIBERONC, Barcelona, Spain
| | - Flávia O F Valente
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Fernanda Vaisman
- Instituto Nacional do Câncer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura S Ward
- Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, São Paulo, Brazil
| | - Shana S Weber
- Hospital de Clínicas de Porto Alegre and Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rita V Weiss
- Instituto Estadual de Diabetes e Endocrinologia, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ji H Yang
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Magnus R Dias-da-Silva
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Ana O Hoff
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, São Paulo, Brazil
| | - Sergio P A Toledo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ana L Maia
- Hospital de Clínicas de Porto Alegre and Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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18
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Martins-Costa MC, Lindsey SC, Cunha LL, Carreiro-Filho FP, Cortez AP, Holanda ME, Farias JWMD, Lima SB, Ferreira LAA, Maia Filho PC, Camacho CP, Furuzawa GK, Kunii IS, Dias-da-Silva MR, Martins JRM, Maciel RMB. A pioneering RET genetic screening study in the State of Ceará, Brazil, evaluating patients with medullary thyroid cancer and at-risk relatives: experience with 247 individuals. Arch Endocrinol Metab 2019; 62:623-635. [PMID: 30624503 PMCID: PMC10118677 DOI: 10.20945/2359-3997000000088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Initial diagnosis of medullary thyroid carcinoma (MTC) is frequently associated with advanced stages and a poor prognosis. Thus, the need for earlier diagnoses and detection in relatives at risk for the disease has led to increased use of RET genetic screening. SUBJECTS AND METHODS We performed RET screening in 247 subjects who were referred to the Brazilian Research Consortium for Multiple Endocrine Neoplasia (BRASMEN) Center in the State of Ceará. Direct genetic sequencing was used to analyze exons 8, 10, 11, and 13-16 in MTC index cases and specific exons in at risk relatives. Afterward, clinical follow-up was offered to all the patients with MTC and their affected relatives. RESULTS RET screening was performed in 60 MTC index patients and 187 at-risk family members. At the initial clinical assessment of the index patients, 54 (90%) were diagnosed with apparently sporadic disease and 6 (10%) diagnosed with hereditary disease. After RET screening, we found that 31 (52%) index patients had sporadic disease, and 29 (48%) had hereditary disease. Regarding at-risk relatives, 73/187 were mutation carriers. Mutations in RET codon 804 and the rare p.M918V mutation were the most prevalent. CONCLUSIONS Performing RET screening in Ceará allowed us to identify a different mutation profile in this region compared with other areas. RET screening also enabled the diagnosis of a significant number of hereditary MTC patients who were initially classified as sporadic disease patients and benefited their relatives, who were unaware of the risks and the consequences of bearing a RET mutation.
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Affiliation(s)
- Maria Cecília Martins-Costa
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil.,Centro de Endocrinologia e Metabologia, Hospital Geral de Fortaleza (HGF), Fortaleza, CE, Brasil.,Departamento de Medicina, Universidade de Fortaleza (UNIFOR), Fortaleza, CE, Brasil
| | - Susan C Lindsey
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Lucas L Cunha
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | | | - André P Cortez
- Santa Casa de Misericórdia de Fortaleza, Fortaleza, CE, Brasil.,Hospital Geral Dr. César Cals, Fortaleza, CE, Brasil
| | | | - J Wilson M de Farias
- Departamento de Cirurgia de Cabeça e Pescoço, Hospital Geral de Fortaleza, Fortaleza, CE, Brasil.,Santa Casa de Misericórdia de Fortaleza, Fortaleza, CE, Brasil
| | - Sérgio B Lima
- Santa Casa de Misericórdia de Fortaleza, Fortaleza, CE, Brasil
| | - Luís A Albano Ferreira
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil.,Hospital Infantil Albert Sabin, Fortaleza, CE, Brasil
| | | | - Cléber P Camacho
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Gilberto K Furuzawa
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Ilda S Kunii
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Magnus R Dias-da-Silva
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - João R M Martins
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil.,Divisão de Biologia Molecular, Departamento de Bioquímica, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Rui M B Maciel
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
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19
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Janovsky CCPS, Bittencourt MS, Novais MAPD, Maciel RMB, Biscolla RPM, Zucchi P. Thyroid cancer burden and economic impact on the Brazilian public health system. Arch Endocrinol Metab 2018; 62:537-544. [PMID: 30462807 PMCID: PMC10118657 DOI: 10.20945/2359-3997000000074] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/02/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Recent data indicates an increasing incidence of thyroid cancer not accompanied by a proportional increase in mortality, suggesting overdiagnosis, which may represent a big public health problem, particularly where resources are scarce. This article aims to describe and evaluate the procedures related to investigation of thyroid nodules and treatment and follow-up of thyroid cancer and the costs for the Brazilian public health system between 2008 and 2015. MATERIALS AND METHODS Data on procedures related to investigation of thyroid nodules and treatment/follow-up of thyroid cancer between 2008 and 2015 in Brazil were collected from the Department of Informatics of the Brazilian Unified Health System (Datasus) website. RESULTS A statistically significant increase in the use of procedures related to thyroid nodules investigation and thyroid cancer treatment and follow-up was observed in Brazil, though a reduction was noted for procedures related to the treatment of more aggressive thyroid cancer, such as total thyroidectomy with neck dissection and higher radioiodine activities such as 200 and 250 milicuries (mCi). The procedures related to thyroid nodules investigation costs increased by 91% for thyroid ultrasound (p = 0.0003) and 128% in thyroid nodule biopsy (p < 0.001). Costs related to treatment and follow-up related-procedures increased by 120%. CONCLUSION The increase in the incidence of thyroid cancer in Brazil is directly associated with an increased use of diagnostic tools for thyroid nodules, which leads to an upsurge in thyroid cancer treatment and followup-related procedures. These data suggest that substantial resources are being used for diagnosis, treatment and follow-up of a potentially indolent condition.
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Affiliation(s)
- Carolina Castro Porto Silva Janovsky
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP Brasil.,Centro de Medicina Preventiva, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Marcio Sommer Bittencourt
- Centro de Medicina Preventiva, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Núcleo de Pesquisa Clínica e Epidemiológica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP Brasil
| | - Maykon Anderson Pires de Novais
- Divisão de Economia da Saúde, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rui M B Maciel
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP Brasil
| | - Rosa Paula M Biscolla
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP Brasil
| | - Paola Zucchi
- Divisão de Economia da Saúde, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Ramos LS, Kizys MML, Kunii IS, Spinola-Castro AM, Nesi-França S, Guerra RA, Camacho CP, Martins JRM, Maciel RMB, Dias-da-Silva MR, Chiamolera MI. Assessing the clinical and molecular diagnosis of inherited forms of impaired sensitivity to thyroid hormone from a single tertiary center. Endocrine 2018; 62:628-638. [PMID: 30027432 DOI: 10.1007/s12020-018-1673-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/19/2018] [Accepted: 07/02/2018] [Indexed: 01/09/2023]
Abstract
AIM Resistance to thyroid hormone (RTH), characterized by persistent hyperthyroxinemia with non-suppressed thyrotropin (TSH), is mostly caused by mutations in thyroid hormone receptor beta gene (THRB). Two differential diagnoses should be considered due to similar clinical and laboratory findings: TSH-producing pituitary adenoma (TPA) and Familial Dysalbuminemic Hyperthyroxinemia (FDH). The aim of this study is to describe our single tertiary center experience in the molecular diagnosis of RTH in Brazilian patients, analyzing their clinical and laboratory characteristics and the most common differential diagnosis. SUBJECTS AND METHODS We enrolled 30 subjects with clinical and laboratory features of RTH. Patient´s evaluations included clinical examination, thyroid hormone profile and imaging tests. Sequencing analysis for THRB hot spot region was conducted on all patients, and those without mutations in beta isoform of the thyroid hormone receptor (TRβ) (non-TR-RTH) were investigated for albumin gene (ALB) mutation. RESULTS Seventeen patients presented mutations in TRβ (RTHβ); six were non-TR-RTH, three had a diagnosis of FDH with a mutation in ALB, and four were diagnosed with TPA. Two characteristics were different to what is commonly described in the literature: higher serum TSH levels in RTHβ patients when compared to the non-TR-RTH group, but this difference did not extend to free T4 (FT4) level; also the percentage of non-TR-RTH was higher than what was reported in other series. CONCLUSION In the present series, most cases were RTHβ with higher levels of TSH. We described three novel mutations in THRB (p.M313V, p.R320G and p.R438P) and the first patients with FDH molecular diagnosis (p.R242H) documented in Brazil.
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Affiliation(s)
- Luciano S Ramos
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Thyroid Diseases Unit, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marina M L Kizys
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ilda S Kunii
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Angela M Spinola-Castro
- Division of Pediatric Endocrinology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Suzana Nesi-França
- Division of Pediatric Endocrinology, Department of Pediatrics, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Ricardo A Guerra
- Endocrinology Unit, Hospital do Servidor Público Municipal (HSPM), São Paulo, Brazil
| | - Cleber P Camacho
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Thyroid Diseases Unit, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - João R M Martins
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Thyroid Diseases Unit, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Rui M B Maciel
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Thyroid Diseases Unit, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Magnus R Dias-da-Silva
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Thyroid Diseases Unit, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria I Chiamolera
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
- Thyroid Diseases Unit, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
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Maglione AV, Taranto P, Hamermesz B, Souza JS, Cafarchio EM, Ogihara CA, Maciel RMB, Giannocco G, Sato MA. Impact of swimming exercise on inflammation in medullary areas of sympathetic outflow control in spontaneously hypertensive rats. Metab Brain Dis 2018; 33:1649-1660. [PMID: 29946957 DOI: 10.1007/s11011-018-0273-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/26/2017] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
Abstract
Exercise reduces sympathetic activity (SA), arterial pressure and heart rate in spontaneously hypertensive rats (SHR). Exercise increases oxidative stress (OS) and inflammation is implicated in the generation of reactive oxygen species (ROS) and progression of hypertension. To unravel these effects of exercise and considering that SA is driven by medullary areas, we hypothesized that swimming exercise (SW) affects the gene expression (g.e.) of proteins involved in inflammation and OS in the commissural Nucleus of the Solitary Tract (cNTS) and Rostral ventrolateral medulla (RVLM), which control the sympathetic outflow in SHR. We used male SHR and Wistar rats (14-16wks-old) which were maintained sedentary (SED) or submitted to SW (1 h/day, 5 days/wk./6wks). The g.e. of cycloxygenase-2 (COX-2), interleukin 6 (IL-6), interleukin 10 (IL-10), AT-1 receptor (AT-1r), neuroglobin (Ngb) and cytoglobin (Ctb) in cNTS and RVLM was carried out by qPCR. We observed that COX-2 g.e. increased in SW-SHR in cNTS and RVLM compared to SED-SHR. The IL-6 g.e. reduced in RVLM in SW-SHR, whereas IL-10 g.e. increased in SW-SHR in comparison to SED-SHR. The AT-1r g.e. decreased in SW-SHR in cNTS and RVLM compared to SED-SHR. The Ngb and Ctb g.e. in cNTS neurons increased in SHR and Wistar rats submitted to SW compared to SED, but only Ctb g.e. increased in RVLM in SW-SHR and Wistar in comparison to SED. Therefore, the SW altered the g.e. in cNTS and RVLM for reducing the inflammation and ROS formation, which is increased particularly in SHR, consequently decreasing the OS.
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Affiliation(s)
- Andrea V Maglione
- Department of Morphology and Physiology, Faculdade de Medicina do ABC, 2000 Lauro Gomes Ave., Vila Sacadura Cabral, Santo Andre, SP, 09060-870, Brazil
| | - Patrícia Taranto
- Department of Morphology and Physiology, Faculdade de Medicina do ABC, 2000 Lauro Gomes Ave., Vila Sacadura Cabral, Santo Andre, SP, 09060-870, Brazil
| | - Bruno Hamermesz
- Department of Morphology and Physiology, Faculdade de Medicina do ABC, 2000 Lauro Gomes Ave., Vila Sacadura Cabral, Santo Andre, SP, 09060-870, Brazil
| | - Janaina S Souza
- Department of Medicine, Federal Univesity of Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo M Cafarchio
- Department of Morphology and Physiology, Faculdade de Medicina do ABC, 2000 Lauro Gomes Ave., Vila Sacadura Cabral, Santo Andre, SP, 09060-870, Brazil
| | - Cristiana A Ogihara
- Department of Morphology and Physiology, Faculdade de Medicina do ABC, 2000 Lauro Gomes Ave., Vila Sacadura Cabral, Santo Andre, SP, 09060-870, Brazil
| | - Rui M B Maciel
- Department of Medicine, Federal Univesity of Sao Paulo, Sao Paulo, SP, Brazil
| | - Gisele Giannocco
- Department of Medicine, Federal Univesity of Sao Paulo, Sao Paulo, SP, Brazil
| | - Monica A Sato
- Department of Morphology and Physiology, Faculdade de Medicina do ABC, 2000 Lauro Gomes Ave., Vila Sacadura Cabral, Santo Andre, SP, 09060-870, Brazil.
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Maciel RMB, Bim LV, Camacho CP, Cerutti JM. Penetrance of phaeochromocytoma in RET G533C carriers differs between South America and Europe. Endocr Relat Cancer 2018; 25:L49-L51. [PMID: 30012587 DOI: 10.1530/erc-17-0349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Received: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Rui M B Maciel
- Division of EndocrinologyDepartment of Medicine, Universidade Federal de São Paulo Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Larissa V Bim
- Division of GeneticsDepartment of Morphology and Genetics, Universidade Federal de São Paulo Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Cleber P Camacho
- Division of EndocrinologyDepartment of Medicine, Universidade Federal de São Paulo Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Janete M Cerutti
- Division of GeneticsDepartment of Morphology and Genetics, Universidade Federal de São Paulo Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
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Kizys MML, Louzada RA, Mitne-Neto M, Jara JR, Furuzawa GK, de Carvalho DP, Dias-da-Silva MR, Nesi-França S, Dupuy C, Maciel RMB. DUOX2 Mutations Are Associated With Congenital Hypothyroidism With Ectopic Thyroid Gland. J Clin Endocrinol Metab 2017; 102:4060-4071. [PMID: 28666341 DOI: 10.1210/jc.2017-00832] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 04/07/2017] [Accepted: 06/22/2017] [Indexed: 12/11/2022]
Abstract
CONTEXT Thyroid dysgenesis (TD) is the leading cause of congenital hypothyroidism (CH). The etiology of TD remains unknown in ∼90% of cases, the most common form being thyroid ectopia (TE) (48% to 61%). OBJECTIVE To search for candidate genes in hypothyroid children with TE. DESIGN, SETTING, AND PARTICIPANTS We followed a cohort of 268 children with TD and performed whole-exome sequencing (WES) in three children with CH with TE (CHTE) and compared them with 18 thyroid-healthy controls. We then screened an additional 41 children with CHTE by Sanger sequencing and correlated the WES and Sanger molecular findings with in vitro functional analysis. MAIN OUTCOME MEASURES Genotyping, mutation prediction analysis, and in vitro functional analysis. RESULTS We identified seven variants in the DUOX2 gene, namely G201E, L264CfsX57, P609S, M650T, E810X, M822V, and E1017G, and eight known variations. All children carrying DUOX2 variations had high thyroid-stimulating hormone levels at neonatal diagnosis. All mutations were localized in the N-terminal segment, and three of them led to effects on cell surface targeting and reactive oxygen species generation. The DUOX2 mutants also altered the interaction with the maturation factor DUOXA2 and the formation of a stable DUOX2/DUOXA2 complex at the cell surface, thereby impairing functional enzymatic activity. We observed no mutations in the classic genes related to TD or in the DUOX1 gene. CONCLUSION Our findings suggest that, in addition to thyroid hormonogenesis, the DUOX2 N-terminal domain may play a role in thyroid development.
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Affiliation(s)
- Marina M L Kizys
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Ruy A Louzada
- UMR 8200 CNRS, Villejuif, 94800, France
- Institut Gustave Roussy, Villejuif, 94800, France
- Université Paris-Saclay, Orsay, 91405, France
- Laboratory of Endocrine Physiology Doris Rosenthal, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Miguel Mitne-Neto
- Fleury Group, São Paulo 04344-070, Brazil
- Human Genome and Stem Cell Research Center, Biosciences Institute, Universidade de São Paulo, São Paulo 05508-900, Brazil
| | - Jessica R Jara
- Department of Pediatrics, Universidade Federal do Paraná, Curitiba 80060-240, Brazil
| | - Gilberto K Furuzawa
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Denise P de Carvalho
- Laboratory of Endocrine Physiology Doris Rosenthal, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Magnus R Dias-da-Silva
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Suzana Nesi-França
- Department of Pediatrics, Universidade Federal do Paraná, Curitiba 80060-240, Brazil
| | - Corinne Dupuy
- UMR 8200 CNRS, Villejuif, 94800, France
- Institut Gustave Roussy, Villejuif, 94800, France
- Université Paris-Saclay, Orsay, 91405, France
| | - Rui M B Maciel
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
- Fleury Group, São Paulo 04344-070, Brazil
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Yang JH, Maciel RMB, Nakabashi CCD, Janovsky CCPS, Padovani RP, Macellaro D, Camacho CP, Osawa A, Wagner J, Biscolla RPM. Clinical utility of 18F-FDG PET/CT in the follow-up of a large cohort of patients with high-risk differentiated thyroid carcinoma. Arch Endocrinol Metab 2017; 61:416-425. [PMID: 28977157 PMCID: PMC10522253 DOI: 10.1590/2359-3997000000285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the clinical utility of 18F-FDG PET/CT in patients with high-risk DTC. SUBJECTS AND METHODS Single-center retrospective study with 74 patients with high-risk differentiated thyroid cancer (DTC), classified in 4 groups. Group 1: patients with positive sTg or TgAb, subdivided in Group 1A: negative RxWBS and no foci of metastases identified at conventional image (n = 9); Group 1B: RxWBS not compatible with suspicious foci at conventional image or not proportional to sTg level (n = 13); Group 2: patients with histological findings of aggressive DTC variants (n = 21) and Group 3: patients with positive RxWBS (n = 31). RESULTS 18F-FDG PET/CT identified undifferentiated lesions and helped restage the disease in groups 1B and 2. The scan helped guide clinical judgment in 9/13 (69%) patients of group 1B, 10/21 (48%) patients of group 2 and 2/31 (6%) patients of group 3. There was no clinical benefit associated with group 1A. 18F-FDG PET/CT was associated with progressive disease. CONCLUSION 18F-FDG PET/CT is a useful tool in the follow-up of patients with high-risk DTC, mainly in the group of RxWBS not compatible with suspicious foci at conventional image or not proportional to sTg level and in those with aggressive DTC variants. Additionally, this study showed that 18F-FDG PET/CT was associated with progression and helped display undifferentiated lesions guiding clinical assessments regarding surgeries or expectant treatments.
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Affiliation(s)
- Ji H. Yang
- Divisão de EndocrinologiaDepartamento de Medicina, Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilCentro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Rui M. B. Maciel
- Divisão de EndocrinologiaDepartamento de Medicina, Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilCentro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Claudia C. D. Nakabashi
- Divisão de EndocrinologiaDepartamento de Medicina, Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilCentro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Carolina C. P. S. Janovsky
- Divisão de EndocrinologiaDepartamento de Medicina, Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilCentro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Rosalia P. Padovani
- Divisão de EndocrinologiaDepartamento de Medicina, Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilCentro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Danielle Macellaro
- Divisão de EndocrinologiaDepartamento de Medicina, Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilCentro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Cléber P. Camacho
- Divisão de EndocrinologiaDepartamento de Medicina, Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilCentro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Akemi Osawa
- Departamento de ImagemHospital Israelita Albert EinsteinSão PauloSPBrazilDepartamento de Imagem, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Jairo Wagner
- Departamento de ImagemHospital Israelita Albert EinsteinSão PauloSPBrazilDepartamento de Imagem, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Rosa Paula M. Biscolla
- Divisão de EndocrinologiaDepartamento de Medicina, Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilCentro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Rodrigues KC, Toledo RA, Coutinho FL, Nunes AB, Maciel RMB, Hoff AO, Tavares MC, Toledo SPA, Lourenço DM. Assessment of Depression, Anxiety, Quality of Life, and Coping in Long-Standing Multiple Endocrine Neoplasia Type 2 Patients. Thyroid 2017; 27:693-706. [PMID: 28276947 DOI: 10.1089/thy.2016.0148] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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] [Indexed: 12/18/2022]
Abstract
BACKGROUND Data on psychological harm in multiple endocrine neoplasia type 2 (MEN2) are scarce. OBJECTIVES The aim of this study was to assess anxiety, depression, quality of life, and coping in long-standing MEN2 patients. PATIENTS AND METHODS Patients were 43 adults (age ≥18 years) with clinical and genetic diagnosis of MEN2 and long-term follow-up (10.6 ± 8.2 years; range 1-33 years). This was a cross-sectional study with qualitative and quantitative psychological assessment using semi-directed interviews and HADS, EORTC QLQ C30, and MINI-MAC scales. Adopting clinical criteria from 2015 ATA Guidelines on MEN2, biochemical cure (39%; 16/41), persistence/recurrence (61%; 25/41), and stable chronic disease (22/41) of medullary thyroid carcinoma (MTC) were scored. Pheochromocytoma affected 19 (44%) patients, with previous adrenalectomy in 17 of them. RESULTS Overall, anxiety (42%; mean score 11 ± 2.9; range 8-18; anxiety is defined as a score ≥8) and depression (26%; mean score 11 ± 3.8; range 8-20; depression is defined as a score ≥8) symptoms were frequent. Patients who transmitted RET mutations to a child had higher scores for weakness-discouragement/anxious preoccupation and lower scores for cognitive, emotional, and physical functioning (p < 0.05). Feelings of guilt were present in 35% of patients with mutation-positive children. Lower mean score values for depression and anxiety and higher scores for role, cognitive, and emotional functioning were noticed in 33 patients who were well-informed about their disease (p < 0.05). Fighting spirit was more frequently found in patients with multiple surgical procedures (p = 0.019) and controlled chronic adrenal insufficiency (p = 0.024). Patients with MEN2-related stress-inducing factors had lower scores for fighting spirit and cognitive functioning and higher scores for insomnia and dyspnea (p < 0.05). Eleven patients required sustained psychotherapeutic treatment. Mean global health status was relatively good in MEN2 cases (68.1 ± 22.3), and the cured group had higher physical functioning (p = 0.021). CONCLUSIONS Psychological distress is likely chronic in MEN2 patients. This study identified diverse MEN2-related factors (degree of information on disease, mutation-positive children, number of surgeries, comorbidities, stress-inducing factors, and cure) interfering positively or negatively with the results of the psychometrics scales. The active investigation of these factors and the applied psychological assessment protocol are useful to identify MEN2 patients requiring psychological assistance.
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Affiliation(s)
- Karine C Rodrigues
- 1 Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo, Brazil
- 2 Endocrine Oncology Division, Institute of Cancer of the State of São Paulo, University of São Paulo School of Medicine , São Paulo, Brazil
| | - Rodrigo A Toledo
- 1 Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo, Brazil
| | - Flavia L Coutinho
- 1 Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo, Brazil
| | - Adriana B Nunes
- 3 Department of Endocrinology, Federal University of Rio Grande do Norte (UFRN) , Natal, Brazil
| | - Rui M B Maciel
- 4 Translational and Molecular Endocrinology Laboratory, Endocrinology Division, Federal University of Sao Paulo (UNIFESP) , São Paulo, Brazil
| | - Ana O Hoff
- 2 Endocrine Oncology Division, Institute of Cancer of the State of São Paulo, University of São Paulo School of Medicine , São Paulo, Brazil
| | - Marcos C Tavares
- 5 Head and Neck Surgery Division, Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo, Brazil
| | - Sergio P A Toledo
- 1 Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo, Brazil
- 4 Translational and Molecular Endocrinology Laboratory, Endocrinology Division, Federal University of Sao Paulo (UNIFESP) , São Paulo, Brazil
| | - Delmar M Lourenço
- 1 Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo, Brazil
- 2 Endocrine Oncology Division, Institute of Cancer of the State of São Paulo, University of São Paulo School of Medicine , São Paulo, Brazil
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Cunha LL, Lindsey SC, França MIC, Sarika L, Papathoma A, Kunii IS, Cerutti JM, Dias-da-Silva MR, Alevizaki M, Maciel RMB. Evidence for the founder effect of RET533 as the common Greek and Brazilian ancestor spreading multiple endocrine neoplasia 2A. Eur J Endocrinol 2017; 176:515-519. [PMID: 28137737 DOI: 10.1530/eje-16-1021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Received: 12/13/2016] [Accepted: 01/30/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVES About one-quarter of patients with medullary thyroid cancer (MTC) have inherited disease due to mutations in the RET gene. A rare mutation in exon 8 (G533C) of RET, previously described in a large Brazilian family with MEN2A, also appeared to be clustering in Greece, whereas it was rarely reported in other ethnic groups. The aim of this study was to identify a possible common ancestry between these carriers. PATIENTS AND METHODS Twelve RET G533C mutation carriers, four randomly selected from the Brazilian cohort and eight from apparently unrelated Greek families, were studied for a possible common ancestral origin. RET flanking microsatellite markers at chromosome 10q (D10S197, D10S196, D10S1652 and D10S537) were used. RESULTS Genomic DNA analysis using these markers showed that many of these apparently unrelated individuals shared a common haplotype indicating a common ancestral origin. CONCLUSION Our data suggest that Brazilian and Greek patients with MTC carrying the G533C mutation in exon 8 of RET gene originate from a common ancestor. Due to historical reasons, we speculate that the more plausible explanation for the origin of this mutation is in Greece.
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Affiliation(s)
| | | | | | - Leda Sarika
- Endocrine UnitDepartment of Medical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Papathoma
- Endocrine UnitDepartment of Medical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Janete M Cerutti
- Morphology and GeneticsEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Maria Alevizaki
- Endocrine UnitDepartment of Medical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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28
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Martins-Costa MC, Maciel RMB, Kasamatsu TS, Nakabashi CCD, Camacho CP, Crispim F, Ikejiri ES, Mamone MCO, Andreoni DM, Biscolla RPM. Clinical impact of thyroglobulin (Tg) and Tg autoantibody (TgAb) measurements in needle washouts of neck lymph node biopsies in the management of patients with papillary thyroid carcinoma. Arch Endocrinol Metab 2017; 61:108-114. [PMID: 28225995 PMCID: PMC10118871 DOI: 10.1590/2359-3997000000241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/26/2016] [Indexed: 11/22/2022]
Abstract
Objectives The presence of thyroglobulin (Tg) in needle washouts of fine needle aspiration biopsy (Tg-FNAB) in neck lymph nodes (LNs) suspected of metastasis has become a cornerstone in the follow-up of patients with papillary thyroid carcinoma (PTC). However, there are limited data regarding the measurement of anti-Tg antibodies in these washouts (TgAb-FNAB), and it is not clear whether these antibodies interfere with the assessment of Tg-FNAB or whether there are other factors that would more consistently justify the finding of low Tg-FNAB in metastatic LNs. Materials and methods We investigated 232 FNAB samples obtained from suspicious neck LNs of 144 PTC patients. These samples were divided according to the patient's serum TgAb status: sTgAb- (n = 203 samples) and sTgAb+ (n = 29). The TgAb-FNAB levels were measured using two different assays. Tg-FNAB was also measured using two assays when low levels (< 10 ng/mL) were identified in the first assay of the metastatic LNs from the sTgAb+ samples. Results The TgAb-FNAB results were negative in both assays in all samples. Low levels of Tg-FNAB were identified in 11/16 of the metastatic LNs of the sTgAb+ patients and 16/63 of the sTgAb- patients (p < 0.05) using assay 1. The measurement of the Tg-FNAB levels using assay 2 indicated additional metastases in 5 LNs of the sTgAb+ patients. Conclusions Factors other than the presence of TgAb-FNAB may contribute to the higher number of metastatic LNs with undetectable Tg-FNAB in the sTgAb+ group. In addition, the measurement of Tg-FNAB using different assays was useful to enhance the diagnosis of metastatic LNs, particularly when cytological and Tg-FNAB results are discordant.
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Affiliation(s)
- M Cecilia Martins-Costa
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Departamento de Medicina, Universidade de Fortaleza (Unifor), Fortaleza, CE, Brasil
| | - Rui M B Maciel
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Teresa S Kasamatsu
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil
| | - Claudia C D Nakabashi
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Cleber P Camacho
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil
| | - Felipe Crispim
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil
| | - Elza S Ikejiri
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil
| | - M Conceição O Mamone
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil
| | - Danielle M Andreoni
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil
| | - Rosa Paula M Biscolla
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
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29
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Martins-Costa MC, Cunha LL, Lindsey SC, Camacho CP, Dotto RP, Furuzawa GK, Sousa MSA, Kasamatsu TS, Kunii IS, Martins MM, Machado AL, Martins JRM, Dias-da-Silva MR, Maciel RMB. M918V RET mutation causes familial medullary thyroid carcinoma: study of 8 affected kindreds. Endocr Relat Cancer 2016; 23:909-920. [PMID: 27807060 DOI: 10.1530/erc-16-0141] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 10/05/2016] [Accepted: 10/07/2016] [Indexed: 12/13/2022]
Abstract
Germline mutations in codon 918 of exon 16 of the RET gene (M918T) are classically associated with multiple endocrine neoplasia type 2B (MEN 2B) with highly aggressive medullary thyroid cancer (MTC), pheochromocytoma and a unique phenotype. The objectives of this study are to describe the rare M918V RET mutation discovered in 8 MTC kindreds from Brazil lacking the MEN 2B phenotype classically observed in M918T patients and to investigate the presence of a founder effect for this germline mutation. Eight apparently sporadic MTC cases were diagnosed with the germline M918V RET mutation. Subsequently, their relatives underwent clinical and genetic assessment (n = 113), and M918V was found in 42 of them. Until today, 20/50 M918V carriers underwent thyroidectomy and all presented MTC/C-cell hyperplasia; the remainder carriers are on clinical follow-up. None of the M918V carriers presented clinical features of MEN 2B. Their clinical presentation was heterogeneous, and the age at tumor diagnosis ranged from 24 to 59 years. Lymph node metastases were present in 12/20 patients, and presumable distant metastases in 2/20; in contrast, we observed a carrier of up to 87 years of age without evidence of MTC. Ethnographic fieldwork and haplotype analyses suggested that the founder mutation first settled in that area fifteen generations ago and originated from Portugal. Our study is the first to demonstrate the RET M918V mutation co-segregating in 8 familial MTC kindreds with validated evidence of a founder effect. We suggest that M918V MTC should be clinically considered an American Thyroid Association (ATA) moderate-risk category.
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Affiliation(s)
- M Cecília Martins-Costa
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Center for Endocrinology and MetabologyHospital Geral de Fortaleza, Fortaleza, CE, Brazil
- Department of MedicineUniversidade de Fortaleza, Fortaleza, CE, Brazil
| | - Lucas L Cunha
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Susan C Lindsey
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Cleber P Camacho
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Renata P Dotto
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Gilberto K Furuzawa
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - M Sharmila A Sousa
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Teresa S Kasamatsu
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ilda S Kunii
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Márcio M Martins
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alberto L Machado
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Fleury Medicine and HealthSão Paulo, SP, Brazil
| | - João R M Martins
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Magnus R Dias-da-Silva
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rui M B Maciel
- Department of MedicineThyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Fleury Medicine and HealthSão Paulo, SP, Brazil
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30
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Chaker L, Baumgartner C, den Elzen WPJ, Collet TH, Ikram MA, Blum MR, Dehghan A, Drechsler C, Luben RN, Portegies MLP, Iervasi G, Medici M, Stott DJ, Dullaart RP, Ford I, Bremner A, Newman AB, Wanner C, Sgarbi JA, Dörr M, Longstreth WT, Psaty BM, Ferrucci L, Maciel RMB, Westendorp RG, Jukema JW, Ceresini G, Imaizumi M, Hofman A, Bakker SJL, Franklyn JA, Khaw KT, Bauer DC, Walsh JP, Razvi S, Gussekloo J, Völzke H, Franco OH, Cappola AR, Rodondi N, Peeters RP. Thyroid Function Within the Reference Range and the Risk of Stroke: An Individual Participant Data Analysis. J Clin Endocrinol Metab 2016; 101:4270-4282. [PMID: 27603906 PMCID: PMC5095234 DOI: 10.1210/jc.2016-2255] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT The currently applied reference ranges for thyroid function are under debate. Despite evidence that thyroid function within the reference range is related with several cardiovascular disorders, its association with the risk of stroke has not been evaluated previously. DESIGN AND SETTING We identified studies through a systematic literature search and the Thyroid Studies Collaboration, a collaboration of prospective cohort studies. Studies measuring baseline TSH, free T4, and stroke outcomes were included, and we collected individual participant data from each study, including thyroid function measurements and incident all stroke (combined fatal and nonfatal) and fatal stroke. The applied reference range for TSH levels was between 0.45 and 4.49 mIU/L. RESULTS We collected individual participant data on 43 598 adults with TSH within the reference range from 17 cohorts, with a median follow-up of 11.6 years (interquartile range 5.1-13.9), including 449 908 person-years. Age- and sex-adjusted pooled hazard ratio for TSH was 0.78 (95% confidence interval [CI] 0.65-0.95 across the reference range of TSH) for all stroke and 0.83 (95% CI 0.62-1.09) for fatal stroke. For the free T4 analyses, the hazard ratio was 1.08 (95% CI 0.99-1.15 per SD increase) for all stroke and 1.10 (95% CI 1.04-1.19) for fatal stroke. This was independent of cardiovascular risk factors including systolic blood pressure, total cholesterol, smoking, and prevalent diabetes. CONCLUSION Higher levels of TSH within the reference range may decrease the risk of stroke, highlighting the need for further research focusing on the clinical consequences associated with differences within the reference range of thyroid function.
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Affiliation(s)
- Layal Chaker
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Christine Baumgartner
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Wendy P J den Elzen
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Tinh-Hai Collet
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - M Arfan Ikram
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Manuel R Blum
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Abbas Dehghan
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Christiane Drechsler
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Robert N Luben
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Marileen L P Portegies
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Giorgio Iervasi
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Marco Medici
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - David J Stott
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Robin P Dullaart
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Ian Ford
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Alexandra Bremner
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Anne B Newman
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Christoph Wanner
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - José A Sgarbi
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Marcus Dörr
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - W T Longstreth
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Bruce M Psaty
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Luigi Ferrucci
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Rui M B Maciel
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Rudi G Westendorp
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - J Wouter Jukema
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Graziano Ceresini
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Misa Imaizumi
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Albert Hofman
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Stephan J L Bakker
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Jayne A Franklyn
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Kay-Tee Khaw
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Douglas C Bauer
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - John P Walsh
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Salman Razvi
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Jacobijn Gussekloo
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Henry Völzke
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Oscar H Franco
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Anne R Cappola
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Nicolas Rodondi
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
| | - Robin P Peeters
- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
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- Departments of Internal Medicine (R.P.P., L.C., M.M.) and Epidemiology (R.P.P., O.H.F., A.D., A.H., A.I., L.C., M.L.P.P.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; Rotterdam Thyroid Center (R.P.P., L.C., M.M.) and Department of Radiology and Neurology (M.A.I.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (N.R., C.B., M.R.B.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Departments of Clinical Chemistry and Laboratory Medicine (W.P.J.d.E.), Public Health and Primary Care (J.G.), and Cardiology (W.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Departments of Medicine and Epidemiology and Biostatistics (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Epidemiology (A.H.), Harvard T. H. Chan School of Public Health, Boston, Massachusetts 02115; Department of Endocrinology (S.R.), Gateshead Health Foundation National Health Service Trust, Gateshead, SE18 4QH, United Kingdom; Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Schools of Medicine and Pharmacology (J.P.W.) and Population Health (A.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; National Council Research Institute of Clinical Physiology (G.I.), 56124 Pisa, Italy; Robertson Centre for Biostatistics (I.F.) and Institute of Cardiovascular and Medical Sciences (D.J.S.), Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, United Kingdom; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.J.L.B., R.P.D.), University Medical Center, University of Groningen, 9700 AB Groningen, The Netherlands; Department of Medicine (C.W., C.D.), Division of Nephrology, University Hospital of Würzburg, and Comprehensive Heart Failure Centre (C.W., C.D.), 97070 Würzburg, Germany; Department of Clinical Studies (M.I.), Radiation Effects Research Foundation, Nagasaki 850-8555, Japan; Department of Clinical and Experimental Medicine (G.C.), University of Parma, 143100 Parma, Italy; National Institute on Aging (L.F.), Baltimore, Maryland 21225; Institute for Community Medicine (H.V.), Clinical-Epidemiological Research/Study of Health in Pomerania, University Medicine, German Centre of Cardiovascular Research, Partner Site, Department of Internal Medicine (M.D.), and University Medicine (M.D.), German Centre of Cardiovascular Research, Partner Site, 17487 Greifswald, Germany; Departments of Neurology and Epidemiology (W.T.L.), and Cardiovascular Health Research Unit (W.T.L.), Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington 98108; Group Health Research Institute (B.M.P.), Group Health Cooperative, Seattle, Washington 98101; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 05508-900 São Paulo, Brazil; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Brazil; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; Interuniversity Cardiology Institute of The Netherlands (W.J.), 3508 GA Utrecht, The Netherlands; School of Clinical and Experimental Medicine (J.A.F.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Public Health and Center for Healthy Ageing (R.G.W.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2400 Copenhagen, Denmark
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Xavier ACW, Maciel RMB, Vieira JGH, Dias-da-Silva MR, Martins JRM. Insights into the posttranslational structural heterogeneity of thyroglobulin and its role in the development, diagnosis, and management of benign and malignant thyroid diseases. Arch Endocrinol Metab 2016; 60:66-75. [PMID: 26909485 PMCID: PMC10118920 DOI: 10.1590/2359-3997000000103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/11/2015] [Indexed: 11/22/2022]
Abstract
Thyroglobulin (Tg) is the major glycoprotein produced by the thyroid gland, where it serves as a template for thyroid hormone synthesis and as an intraglandular store of iodine. Measurement of Tg levels in serum is of great practical importance in the follow-up of differentiated thyroid carcinoma (DTC), a setting in which elevated levels after total thyroidectomy are indicative of residual or recurrent disease. The most recent methods for serum Tg measurement are monoclonal antibody-based and are highly sensitive. However, major challenges remain regarding the interpretation of the results obtained with these immunometric methods, particularly in patients with endogenous antithyroglobulin antibodies or in the presence of heterophile antibodies, which may produce falsely low or high Tg values, respectively. The increased prevalence of antithyroglobulin antibodies in patients with DTC, as compared with the general population, raises the very pertinent possibility that tumor Tg may be more immunogenic. This inference makes sense, as the tumor microenvironment (tumor cells plus normal host cells) is characterized by several changes that could induce posttranslational modification of many proteins, including Tg. Attempts to understand the structure of Tg have been made for several decades, but findings have generally been incomplete due to technical hindrances to analysis of such a large protein (660 kDa). This review article will explore the complex structure of Tg and the potential role of its marked heterogeneity in our understanding of normal thyroid biology and neoplastic processes.
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Affiliation(s)
- Ana Carolina W Xavier
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rui M B Maciel
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - José Gilberto H Vieira
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Magnus R Dias-da-Silva
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João R M Martins
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Toledo RA, Loureço DM, Camacho C, Lindsey S, Cerutti J, Maciel RMB, Toledo SPA. RET Y791F: alone or accompanied? Arch Endocrinol Metab 2016; 59:476-7. [PMID: 26537412 DOI: 10.1590/2359-3997000000060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/21/2015] [Indexed: 11/22/2022]
Affiliation(s)
- Rodrigo A Toledo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Delmar M Loureço
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | | | - Susan Lindsey
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Janete Cerutti
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Rui M B Maciel
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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33
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Alves TG, Kasamatsu TS, Yang JH, Meneghetti MCZ, Mendes A, Kunii IS, Lindsey SC, Camacho CP, Dias da Silva MR, Maciel RMB, Vieira JGH, Martins JRM. Macrocalcitonin Is a Novel Pitfall in the Routine of Serum Calcitonin Immunoassay. J Clin Endocrinol Metab 2016; 101:653-8. [PMID: 26647152 DOI: 10.1210/jc.2015-3137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 02/11/2023]
Abstract
CONTEXT Calcitonin (CT) is a sensitive marker of medullary thyroid carcinoma (MTC) and is used for primary diagnosis and follow-up after thyroidectomy. However, persistently elevated CT is observed even after complete surgical removal without evidence of a recurrent or persistent tumor. OBJECTIVE To investigate the presence of assay interference in the serum CT of MTC patients who are apparently without a structural disease. PATIENTS AND METHODS We studied three index MTC cases for CT assay interference and 14 patients with metastatic MTC. The CT level was measured using an immunofluorometric assay. Screening for assay interference was performed by determination of CT levels before and after serum treatment with polyethylene glycol. Additionally, samples were analyzed by chromatography on ultra-performance liquid chromatography and protein A-Sepharose. RESULTS Patients with biochemical and structural disease showed CT mean recovery of 84.1% after polyethylene glycol treatment, whereas patients suspected of interference showed recovery from 2-7%. The elution profile on UPLC showed that the immunometric CT from these three patients behaved like a high molecular mass aggregate (>300 kDa). Additionally, when these samples were applied to the protein A-Sepharose, CT immunoreactivity was retained on the column and was only released after lowering the pH. CONCLUSIONS For the first time, our results show the presence of a novel pitfall in the CT immunoassay: "macrocalcitonin." Its etiology, frequency, and meaning remain to be defined, but its recognition is of interest and can help clinicians avoid unnecessary diagnostic investigations and treatment during the follow-up of MTC.
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Affiliation(s)
- Thalita G Alves
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Teresa S Kasamatsu
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Ji H Yang
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Maria Cecília Z Meneghetti
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Aline Mendes
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Ilda S Kunii
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Susan C Lindsey
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Cléber P Camacho
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Magnus R Dias da Silva
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Rui M B Maciel
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - José Gilberto H Vieira
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - João Roberto M Martins
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
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Nascimento FP, Cardoso MG, Lindsey SC, Kunii IS, Valente FOF, Kizys MML, Delcelo R, Camacho CP, Maciel RMB, Dias-Da-Silva MR. Analysis of somatic mutations in BRAF, CDKN2A/p16 and PI3KCA in patients with medullary thyroid carcinoma. Mol Med Rep 2015; 13:1653-60. [PMID: 26718898 DOI: 10.3892/mmr.2015.4731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 10/14/2015] [Indexed: 11/06/2022] Open
Abstract
Medullary thyroid carcinoma (MTC), a neuroendocrine tumor originating from thyroid parafollicular cells, has been demonstrated to be associated with mutations in RET, HRAS, KRAS and NRAS. However, the role of other genes involved in the oncogenesis of neural crest tumors remains to be fully investigated in MTC. The current study aimed to investigate the presence of somatic mutations in BRAF, CDKN2A and PI3KCA in MTC, and to investigate the correlation with disease progression. DNA was isolated from paraffin‑embedded tumors and blood samples from patients with MTC, and the hotspot somatic mutations were sequenced. A total of 2 novel HRAS mutations, p.Asp33Asn and p.His94Tyr, and polymorphisms within the 3' untranslated region (UTR) of CDKN2A (rs11515 and rs3088440) were identified, however, no mutations were observed in other genes. It was suggested that somatic point mutations in BRAF, CDKN2A and PI3KCA do not participate in the oncogenesis of MTC. Further studies are required in order to clarify the contribution of the polymorphisms identified in the 3'UTR of CDKN2A in MTC.
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Affiliation(s)
- Fabrício P Nascimento
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo 04039‑032, Brazil
| | - Mirian G Cardoso
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo 04039‑032, Brazil
| | - Susan C Lindsey
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo 04039‑032, Brazil
| | - Ilda S Kunii
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo 04039‑032, Brazil
| | - Flávia O F Valente
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo 04039‑032, Brazil
| | - Marina M L Kizys
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo 04039‑032, Brazil
| | - Rosana Delcelo
- Department of Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo 04039‑032, Brazil
| | - Cléber P Camacho
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo 04039‑032, Brazil
| | - Rui M B Maciel
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo 04039‑032, Brazil
| | - Magnus R Dias-Da-Silva
- Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo 04039‑032, Brazil
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Maciel RMB. Thyroid ultrasound: beyond the diagnosis of thyroid nodules. Arch Endocrinol Metab 2015; 59:479-81. [PMID: 26677085 DOI: 10.1590/2359-3997000000145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 11/21/2022]
Affiliation(s)
- Rui M B Maciel
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Yang JH, Lindsey SC, Camacho CP, Valente FOF, Germano-Neto F, Machado AL, Mamone MCOC, Brodskyn F, Biscolla RPM, Tuttle RM, Dias-da-Silva MR, Maciel RMB. Integration of a postoperative calcitonin measurement into an anatomical staging system improves initial risk stratification in medullary thyroid cancer. Clin Endocrinol (Oxf) 2015; 83:938-42. [PMID: 25376110 DOI: 10.1111/cen.12657] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 07/04/2014] [Revised: 08/19/2014] [Accepted: 10/30/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Staging systems applied to medullary thyroid cancer (MTC) rely on initial clinical and pathological features and do not consider the response to treatment. To determine whether MTC staging can be improved by incorporating the first postoperative calcitonin measurement. PATIENTS AND MEASUREMENTS Eighty-five patients being monitored for MTC (median follow-up 5 years) were retrospectively classified according to both the American Joint Committee on Cancer (AJCC) and the proposed combined risk stratification system (low, intermediate and high risk), which incorporates the first postoperative calcitonin measurement, using the outcomes no evidence of disease (NED), biochemical evidence of disease, structurally identifiable disease and death. RESULTS Ninety per cent of AJCC I patients were classified as NED at final follow-up. When we added a postoperative calcitonin measurement, 95% low-risk patients were classified as NED at final follow-up. AJCC stages I and IV were associated, respectively, with no occurrence and a high rate (63%) of structurally identifiable disease. Stages II and III yielded similar predictions of structurally identifiable disease, 13% and 14%, respectively. When we included the postoperative calcitonin level, the patients with structural evidence of disease included none from the low-risk group, 10% from the intermediate group and 63% from the high-risk group. The proportion of variance explained analysis (PVE) was better for the combined risk stratification system (54%) than for the AJCC system alone (32%). CONCLUSION Including the first postoperative calcitonin measurement with the anatomical staging system can better predict the clinical outcome of patients with MTC and refine the follow-up of these patients.
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Affiliation(s)
- Ji H Yang
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Susan C Lindsey
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Cléber P Camacho
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Flávia O F Valente
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Fausto Germano-Neto
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alberto L Machado
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Maria Conceição O C Mamone
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Fábio Brodskyn
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rosa Paula M Biscolla
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Magnus R Dias-da-Silva
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rui M B Maciel
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Santarosa VA, Orlandi DM, Fiorin LB, Kasamatsu TS, Furuzawa GK, Kunii IS, Padovani RP, Marone MMS, Castiglioni ML, Vieira JGH, Maciel RMB, Dias-da-Silva MR, Martins JRM. Low iodine diet does not improve the efficacy of radioiodine for the treatment of Graves’ disease. Arch Endocrinol Metab 2015; 59:501-6. [DOI: 10.1590/2359-3997000000082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/18/2015] [Indexed: 11/22/2022]
Affiliation(s)
| | | | | | | | | | | | - Rosália P. Padovani
- Universidade Federal de São Paulo, Brasil; Irmandade Santa Casa de Misericórdia de São Paulo, Brasil
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Toledo RA, Maciel RMB, Erlic Z, Lourenço DM, Cerutti JM, Eng C, Neumann HP, Toledo SP. RET Y791F Variant Does Not Increase the Risk for Medullary Thyroid Carcinoma. Thyroid 2015; 25:973-4. [PMID: 25950813 DOI: 10.1089/thy.2015.0168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 12/30/2022]
Affiliation(s)
- Rodrigo A Toledo
- 1 Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo, Brazil
| | - Rui M B Maciel
- 2 Division of Endocrinology, Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo , Brazil
| | - Zoran Erlic
- 3 Department of Hepatology and Gastroenterology, Interdisciplinary Centre of Metabolism: Endocrinology, Diabetes, and Metabolism, Charité-Universitätsmedizin Berlin , Berlin, Germany
| | - Delmar M Lourenço
- 1 Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo, Brazil
| | - Janete M Cerutti
- 4 Division of Genetics, Genetic Bases of Thyroid Tumors Laboratory, Department of Morphology and Genetics, Federal University of São Paulo , Brazil
| | - Charis Eng
- 5 Genomic Medicine Institute , Lerner Research Institute and Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hartmut P Neumann
- 6 Section for Preventive Medicine, Department of Nephrology and General Medicine, University Medical Centre , Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Sergio P Toledo
- 1 Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das Clínicas, University of São Paulo School of Medicine , São Paulo, Brazil
- 2 Division of Endocrinology, Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo , Brazil
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Åsvold BO, Vatten LJ, Bjøro T, Bauer DC, Bremner A, Cappola AR, Ceresini G, den Elzen WPJ, Ferrucci L, Franco OH, Franklyn JA, Gussekloo J, Iervasi G, Imaizumi M, Kearney PM, Khaw KT, Maciel RMB, Newman AB, Peeters RP, Psaty BM, Razvi S, Sgarbi JA, Stott DJ, Trompet S, Vanderpump MPJ, Völzke H, Walsh JP, Westendorp RGJ, Rodondi N. Thyroid function within the normal range and risk of coronary heart disease: an individual participant data analysis of 14 cohorts. JAMA Intern Med 2015; 175:1037-47. [PMID: 25893284 PMCID: PMC4732559 DOI: 10.1001/jamainternmed.2015.0930] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 01/02/2023]
Abstract
IMPORTANCE Some experts suggest that serum thyrotropin levels in the upper part of the current reference range should be considered abnormal, an approach that would reclassify many individuals as having mild hypothyroidism. Health hazards associated with such thyrotropin levels are poorly documented, but conflicting evidence suggests that thyrotropin levels in the upper part of the reference range may be associated with an increased risk of coronary heart disease (CHD). OBJECTIVE To assess the association between differences in thyroid function within the reference range and CHD risk. DESIGN, SETTING, AND PARTICIPANTS Individual participant data analysis of 14 cohorts with baseline examinations between July 1972 and April 2002 and with median follow-up ranging from 3.3 to 20.0 years. Participants included 55,412 individuals with serum thyrotropin levels of 0.45 to 4.49 mIU/L and no previously known thyroid or cardiovascular disease at baseline. EXPOSURES Thyroid function as expressed by serum thyrotropin levels at baseline. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) of CHD mortality and CHD events according to thyrotropin levels after adjustment for age, sex, and smoking status. RESULTS Among 55,412 individuals, 1813 people (3.3%) died of CHD during 643,183 person-years of follow-up. In 10 cohorts with information on both nonfatal and fatal CHD events, 4666 of 48,875 individuals (9.5%) experienced a first-time CHD event during 533,408 person-years of follow-up. For each 1-mIU/L higher thyrotropin level, the HR was 0.97 (95% CI, 0.90-1.04) for CHD mortality and 1.00 (95% CI, 0.97-1.03) for a first-time CHD event. Similarly, in analyses by categories of thyrotropin, the HRs of CHD mortality (0.94 [95% CI, 0.74-1.20]) and CHD events (0.97 [95% CI, 0.83-1.13]) were similar among participants with the highest (3.50-4.49 mIU/L) compared with the lowest (0.45-1.49 mIU/L) thyrotropin levels. Subgroup analyses by sex and age group yielded similar results. CONCLUSIONS AND RELEVANCE Thyrotropin levels within the reference range are not associated with risk of CHD events or CHD mortality. This finding suggests that differences in thyroid function within the population reference range do not influence the risk of CHD. Increased CHD risk does not appear to be a reason for lowering the upper thyrotropin reference limit.
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Affiliation(s)
- Bjørn O Åsvold
- Department of Public Health, Norwegian University of Science and Technology, Trondheim2Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lars J Vatten
- Department of Public Health, Norwegian University of Science and Technology, Trondheim3Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts
| | - Trine Bjøro
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway5Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Douglas C Bauer
- Department of Medicine, University of California, San Francisco7Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Alexandra Bremner
- School of Population Health, The University of Western Australia, Crawley
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Geriatric Endocrine Unit, University Hospital of Parma, Parma, Italy
| | - Wendy P J den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jayne A Franklyn
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Giorgio Iervasi
- National Council Research Institute of Clinical Physiology/Tuscany Region G. Monasterio Foundation, Pisa, Italy
| | - Misa Imaizumi
- Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Rui M B Maciel
- Division of Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Anne B Newman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robin P Peeters
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands21Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle23Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Salman Razvi
- Department of Endocrinology, Gateshead Health Foundation National Health Service Trust, Gateshead, England
| | - José A Sgarbi
- Division of Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil25Division of Endocrinology, Faculdade de Medicina de Marília, Marília, Brazil
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands28Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Henry Völzke
- Institute for Community Medicine, Study of Health in Pomerania/Clinical-Epidemiological Research and German Centre of Cardiovascular Research, University of Greifswald, Greifswald, Germany
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia32School of Medicine and Pharmacology, The University of Western Australia, Crawley
| | - Rudi G J Westendorp
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands33Netherlands Consortium for Healthy Aging, Leiden, the Netherlands34Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, University of Bern, Bern, Switzerland
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Chaker L, Baumgartner C, den Elzen WPJ, Ikram MA, Blum MR, Collet TH, Bakker SJL, Dehghan A, Drechsler C, Luben RN, Hofman A, Portegies MLP, Medici M, Iervasi G, Stott DJ, Ford I, Bremner A, Wanner C, Ferrucci L, Newman AB, Dullaart RP, Sgarbi JA, Ceresini G, Maciel RMB, Westendorp RG, Jukema JW, Imaizumi M, Franklyn JA, Bauer DC, Walsh JP, Razvi S, Khaw KT, Cappola AR, Völzke H, Franco OH, Gussekloo J, Rodondi N, Peeters RP. Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke: An Individual Participant Data Analysis. J Clin Endocrinol Metab 2015; 100:2181-91. [PMID: 25856213 PMCID: PMC4454799 DOI: 10.1210/jc.2015-1438] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The objective was to determine the risk of stroke associated with subclinical hypothyroidism. DATA SOURCES AND STUDY SELECTION Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished studies were identified through the Thyroid Studies Collaboration. We collected individual participant data on thyroid function and stroke outcome. Euthyroidism was defined as TSH levels of 0.45-4.49 mIU/L, and subclinical hypothyroidism was defined as TSH levels of 4.5-19.9 mIU/L with normal T4 levels. DATA EXTRACTION AND SYNTHESIS We collected individual participant data on 47 573 adults (3451 subclinical hypothyroidism) from 17 cohorts and followed up from 1972-2014 (489 192 person-years). Age- and sex-adjusted pooled hazard ratios (HRs) for participants with subclinical hypothyroidism compared to euthyroidism were 1.05 (95% confidence interval [CI], 0.91-1.21) for stroke events (combined fatal and nonfatal stroke) and 1.07 (95% CI, 0.80-1.42) for fatal stroke. Stratified by age, the HR for stroke events was 3.32 (95% CI, 1.25-8.80) for individuals aged 18-49 years. There was an increased risk of fatal stroke in the age groups 18-49 and 50-64 years, with a HR of 4.22 (95% CI, 1.08-16.55) and 2.86 (95% CI, 1.31-6.26), respectively (p trend 0.04). We found no increased risk for those 65-79 years old (HR, 1.00; 95% CI, 0.86-1.18) or ≥ 80 years old (HR, 1.31; 95% CI, 0.79-2.18). There was a pattern of increased risk of fatal stroke with higher TSH concentrations. CONCLUSIONS Although no overall effect of subclinical hypothyroidism on stroke could be demonstrated, an increased risk in subjects younger than 65 years and those with higher TSH concentrations was observed.
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Affiliation(s)
- Layal Chaker
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Christine Baumgartner
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Wendy P J den Elzen
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - M Arfan Ikram
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Manuel R Blum
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Tinh-Hai Collet
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Stephan J L Bakker
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Abbas Dehghan
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Christiane Drechsler
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Robert N Luben
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Albert Hofman
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Marileen L P Portegies
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Marco Medici
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Giorgio Iervasi
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - David J Stott
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Ian Ford
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Alexandra Bremner
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Christoph Wanner
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Luigi Ferrucci
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Anne B Newman
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Robin P Dullaart
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - José A Sgarbi
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Graziano Ceresini
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Rui M B Maciel
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Rudi G Westendorp
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - J Wouter Jukema
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Misa Imaizumi
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Jayne A Franklyn
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Douglas C Bauer
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - John P Walsh
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Salman Razvi
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Kay-Tee Khaw
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Anne R Cappola
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Henry Völzke
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Oscar H Franco
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Jacobijn Gussekloo
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Nicolas Rodondi
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
| | - Robin P Peeters
- Department of Internal Medicine (L.C., M.M., R.P.P.), and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology (L.C., M.A.I., A.D., A.H., M.L.P.P., O.H.F.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of General Internal Medicine (C.B., M.R.B., N.R.), Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Departments of Epidemiology, Public Health, and Primary Care (W.P.J.d.E., J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Radiology (M.A.I.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Neurology (M.A.I., M.L.P.P.), Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; Department of Internal Medicine (S.J.L.B., R.P.D.), University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Medicine (C.D., C.W.), Division of Nephrology, University Hospital of Würzburg, Germany Comprehensive Heart Failure Centre, D-97080 Würzburg, Germany; Department of Public Health and Primary Care (R.N.L., K.-T.K.), University of Cambridge, Cambridge CB2 1TN, United Kingdom; National Council Research Institute of Clinical Physiology (G.I.), Pisa 56124, Italy; Institute of Cardiovascular and Medical Sciences, Faculty of Medicine (D.J.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Population Health (A.B.), University of Western Australia, Crawley, Perth 6009, Western Australia, Australia; National Institute on Aging (L.F.), Baltimore, Maryland 20892; Department of Epidemiology (A.B.N.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Division of Endocrinology (J.A.S.), Faculdade de Medicina de Marília, Marília, Sao Paulo 17519, Brazil; Di
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Toledo RA, Hatakana R, Lourenço DM, Lindsey SC, Camacho CP, Almeida M, Lima JV, Sekiya T, Garralda E, Naslavsky MS, Yamamoto GL, Lazar M, Meirelles O, Sobreira TJP, Lebrao ML, Duarte YAO, Blangero J, Zatz M, Cerutti JM, Maciel RMB, Toledo SPA. Comprehensive assessment of the disputed RET Y791F variant shows no association with medullary thyroid carcinoma susceptibility. Endocr Relat Cancer 2015; 22:65-76. [PMID: 25425582 PMCID: PMC4289937 DOI: 10.1530/erc-14-0491] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Accurate interpretation of germline mutations of the rearranged during transfection (RET) proto-oncogene is vital for the proper recommendation of preventive thyroidectomy in medullary thyroid carcinoma (MTC)-prone carriers. To gain information regarding the most disputed variant of RET, ATA-A Y791F, we sequenced blood DNA samples from a cohort of 2904 cancer-free elderly individuals (1261 via Sanger sequencing and 1643 via whole-exome/genome sequencing). We also accessed the exome sequences of an additional 8069 individuals from non-cancer-related laboratories and public databanks as well as genetic results from the Catalogue of Somatic Mutations in Cancer (COSMIC) project. The mean allelic frequency observed in the controls was 0.0031, with higher occurrences in Central European populations (0.006/0.008). The prevalence of RET Y791F in the control databases was extremely high compared with the 40 known RET pathogenic mutations (P=0.00003), while no somatic occurrence has been reported in tumours. In this study, we report new, unrelated Brazilian individuals with germline RET Y791F-only: two tumour-free elderly controls; two individuals with sporadic MTC whose Y791F-carrying relatives did not show any evidence of tumours; and a 74-year-old phaeochromocytoma patient without MTC. Furthermore, we showed that the co-occurrence of Y791F with the strong RET C634Y mutation explains the aggressive MTC phenotypes observed in a large affected family that was initially reported as Y791F-only. Our literature review revealed that limited analyses have led to the misclassification of RET Y791F as a probable pathogenic variant and, consequently, to the occurrence of unnecessary thyroidectomies. The current study will have a substantial clinical influence, as it reveals, in a comprehensive manner, that RET Y791F only shows no association with MTC susceptibility.
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Affiliation(s)
- Rodrigo A Toledo
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Roxanne Hatakana
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Delmar M Lourenço
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Susan C Lindsey
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Cleber P Camacho
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Marcio Almeida
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - José V Lima
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Tomoko Sekiya
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Elena Garralda
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Michel S Naslavsky
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Guilherme L Yamamoto
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Monize Lazar
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Osorio Meirelles
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Tiago J P Sobreira
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Maria Lucia Lebrao
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Yeda A O Duarte
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - John Blangero
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Mayana Zatz
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Janete M Cerutti
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Rui M B Maciel
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA
| | - Sergio P A Toledo
- Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNational Institute on Aging, Bethesda, Maryland, USA Endocrine Genetics Unit (Laboratório de Investigação Médica/LIM-25) of Hospital das ClínicasUniversity of São Paulo School of Medicine, São Paulo, São Paulo 05403-010, BrazilNursing SchoolSchool of Public HealthHuman Genome Research CenterUniversity of São Paulo, São Paulo, São Paulo, BrazilDivision of GeneticsGenetic Bases of Thyroid Tumors Laboratory, Department of Morphology and GeneticsDivision of EndocrinologyLaboratory of Molecular and Translational Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, São Paulo, BrazilBrazilian National Laboratory of BiosciencesCampinas, São Paulo, BrazilCentro Integral Oncológico Clara CampalHospital Universitário Sanchinarro, Madrid, SpainDepartment of GeneticsTexas Biomedical Research Institute, AT&T Genomic Computing Center, San Antonio, Texas, USAEndocrinology DivisionSanta Casa Hospital, São Paulo, São Paulo, BrazilLaboratory of Epidemiology and Population SciencesNat
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Barbieri RB, Bufalo NE, Secolin R, Assumpção LVM, Maciel RMB, Cerutti JM, Ward LS. Polymorphisms of cell cycle control genes influence the development of sporadic medullary thyroid carcinoma. Eur J Endocrinol 2014; 171:761-7. [PMID: 25565272 DOI: 10.1530/eje-14-0461] [Citation(s) in RCA: 15] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of key cell cycle regulation genes such as, CDKN1B, CDKN2A, CDKN2B, and CDKN2C in sporadic medullary thyroid carcinoma (s-MTC) is still largely unknown. METHODS In order to evaluate the influence of inherited polymorphisms of these genes on the pathogenesis of s-MTC, we used TaqMan SNP genotyping to examine 45 s-MTC patients carefully matched with 98 controls. RESULTS A multivariate logistic regression analysis demonstrated that CDKN1B and CDKN2A genes were related to s-MTC susceptibility. The rs2066827*GT+GG CDKN1B genotype was more frequent in s-MTC patients (62.22%) than in controls (40.21%), increasing the susceptibility to s-MTC (OR=2.47; 95% CI=1.048-5.833; P=0.038). By contrast, the rs11515*CG+GG of CDKN2A gene was more frequent in the controls (32.65%) than in patients (15.56%), reducing the risk for s-MTC (OR=0.174; 95% CI=0.048-0.627; P=0.0075). A stepwise regression analysis indicated that two genotypes together could explain 11% of the total s-MTC risk. In addition, a relationship was found between disease progression and the presence of alterations in the CDKN1A (rs1801270), CDKN2C (rs12885), and CDKN2B (rs1063192) genes. WT rs1801270 CDKN1A patients presented extrathyroidal tumor extension more frequently (92%) than polymorphic CDKN1A rs1801270 patients (50%; P=0.0376). Patients with the WT CDKN2C gene (rs12885) presented larger tumors (2.9±1.8 cm) than polymorphic patients (1.5±0.7 cm; P=0.0324). On the other hand, patients with the polymorphic CDKN2B gene (rs1063192) presented distant metastases (36.3%; P=0.0261). CONCLUSION In summary, we demonstrated that CDKN1B and CDKN2A genes are associated with susceptibility, whereas the inherited genetic profile of CDKN1A, CDKN2B, and CDKN2C is associated with aggressive features of tumors. This study suggests that profiling cell cycle genes may help define the risk and characterize s-MTC aggressiveness.
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Affiliation(s)
- R B Barbieri
- University of Campinas (FCM - Unicamp)126, Tessalia Vieira de Camargo, Street. Cidade Universitaria Zeferino Vaz, Campinas - São Paulo, 13083-887 BrazilFederal University of Sao Paulo (Unifesp)669, Pedro Toledo Street, São Paulo-SP 04039-032, Brazil
| | - N E Bufalo
- University of Campinas (FCM - Unicamp)126, Tessalia Vieira de Camargo, Street. Cidade Universitaria Zeferino Vaz, Campinas - São Paulo, 13083-887 BrazilFederal University of Sao Paulo (Unifesp)669, Pedro Toledo Street, São Paulo-SP 04039-032, Brazil
| | - R Secolin
- University of Campinas (FCM - Unicamp)126, Tessalia Vieira de Camargo, Street. Cidade Universitaria Zeferino Vaz, Campinas - São Paulo, 13083-887 BrazilFederal University of Sao Paulo (Unifesp)669, Pedro Toledo Street, São Paulo-SP 04039-032, Brazil
| | - L V M Assumpção
- University of Campinas (FCM - Unicamp)126, Tessalia Vieira de Camargo, Street. Cidade Universitaria Zeferino Vaz, Campinas - São Paulo, 13083-887 BrazilFederal University of Sao Paulo (Unifesp)669, Pedro Toledo Street, São Paulo-SP 04039-032, Brazil
| | - R M B Maciel
- University of Campinas (FCM - Unicamp)126, Tessalia Vieira de Camargo, Street. Cidade Universitaria Zeferino Vaz, Campinas - São Paulo, 13083-887 BrazilFederal University of Sao Paulo (Unifesp)669, Pedro Toledo Street, São Paulo-SP 04039-032, Brazil
| | - J M Cerutti
- University of Campinas (FCM - Unicamp)126, Tessalia Vieira de Camargo, Street. Cidade Universitaria Zeferino Vaz, Campinas - São Paulo, 13083-887 BrazilFederal University of Sao Paulo (Unifesp)669, Pedro Toledo Street, São Paulo-SP 04039-032, Brazil
| | - L S Ward
- University of Campinas (FCM - Unicamp)126, Tessalia Vieira de Camargo, Street. Cidade Universitaria Zeferino Vaz, Campinas - São Paulo, 13083-887 BrazilFederal University of Sao Paulo (Unifesp)669, Pedro Toledo Street, São Paulo-SP 04039-032, Brazil
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Rolim ALR, Lindsey SC, Kunii IS, Crispim F, Moisés RCMS, Maciel RMB, Dias-da-Silva MR. The insulin-sensitivity sulphonylurea receptor variant is associated with thyrotoxic paralysis. J Mol Endocrinol 2014; 53:295-301. [PMID: 25143473 DOI: 10.1530/jme-14-0083] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thyrotoxicosis is the most common cause of the acquired flaccid muscle paralysis in adults called thyrotoxic periodic paralysis (TPP) and is characterised by transient hypokalaemia and hypophosphataemia under high thyroid hormone levels that is frequently precipitated by carbohydrate load. The sulphonylurea receptor 1 (SUR1 (ABCC8)) is an essential regulatory subunit of the β-cell ATP-sensitive K(+) channel that controls insulin secretion after feeding. Additionally, the SUR1 Ala1369Ser variant appears to be associated with insulin sensitivity. We examined the ABCC8 gene at the single nucleotide level using PCR-restriction fragment length polymorphism (RFLP) analysis to determine its allelic variant frequency and calculated the frequency of the Ala1369Ser C-allele variant in a cohort of 36 Brazilian TPP patients in comparison with 32 controls presenting with thyrotoxicosis without paralysis (TWP). We verified that the frequency of the alanine 1369 C-allele was significantly higher in TPP patients than in TWP patients (61.1 vs 34.4%, odds ratio (OR)=3.42, P=0.039) and was significantly more common than the minor allele frequency observed in the general population from the 1000 Genomes database (61.1 vs 29.0%, OR=4.87, P<0.005). Additionally, the C-allele frequency was similar between TWP patients and the general population (34.4 vs 29%, OR=1.42, P=0.325). We have demonstrated that SUR1 alanine 1369 variant is associated with allelic susceptibility to TPP. We suggest that the hyperinsulinaemia that is observed in TPP may be linked to the ATP-sensitive K(+)/SUR1 alanine variant and, therefore, contribute to the major feedforward precipitating factors in the pathophysiology of TPP.
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Affiliation(s)
- Ana Luiza R Rolim
- Laboratory of Molecular and Translational EndocrinologyDepartment of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 11° andar, 04039-032 São Paulo, SP, Brazil
| | - Susan C Lindsey
- Laboratory of Molecular and Translational EndocrinologyDepartment of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 11° andar, 04039-032 São Paulo, SP, Brazil
| | - Ilda S Kunii
- Laboratory of Molecular and Translational EndocrinologyDepartment of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 11° andar, 04039-032 São Paulo, SP, Brazil
| | - Felipe Crispim
- Laboratory of Molecular and Translational EndocrinologyDepartment of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 11° andar, 04039-032 São Paulo, SP, Brazil
| | - Regina Célia M S Moisés
- Laboratory of Molecular and Translational EndocrinologyDepartment of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 11° andar, 04039-032 São Paulo, SP, Brazil
| | - Rui M B Maciel
- Laboratory of Molecular and Translational EndocrinologyDepartment of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 11° andar, 04039-032 São Paulo, SP, Brazil
| | - Magnus R Dias-da-Silva
- Laboratory of Molecular and Translational EndocrinologyDepartment of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 11° andar, 04039-032 São Paulo, SP, Brazil
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Collet TH, Bauer DC, Cappola AR, Asvold BO, Weiler S, Vittinghoff E, Gussekloo J, Bremner A, den Elzen WPJ, Maciel RMB, Vanderpump MPJ, Cornuz J, Dörr M, Wallaschofski H, Newman AB, Sgarbi JA, Razvi S, Völzke H, Walsh JP, Aujesky D, Rodondi N. Thyroid antibody status, subclinical hypothyroidism, and the risk of coronary heart disease: an individual participant data analysis. J Clin Endocrinol Metab 2014; 99:3353-62. [PMID: 24915118 PMCID: PMC4154087 DOI: 10.1210/jc.2014-1250] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT Subclinical hypothyroidism has been associated with increased risk of coronary heart disease (CHD), particularly with thyrotropin levels of 10.0 mIU/L or greater. The measurement of thyroid antibodies helps predict the progression to overt hypothyroidism, but it is unclear whether thyroid autoimmunity independently affects CHD risk. OBJECTIVE The objective of the study was to compare the CHD risk of subclinical hypothyroidism with and without thyroid peroxidase antibodies (TPOAbs). DATA SOURCES AND STUDY SELECTION A MEDLINE and EMBASE search from 1950 to 2011 was conducted for prospective cohorts, reporting baseline thyroid function, antibodies, and CHD outcomes. DATA EXTRACTION Individual data of 38 274 participants from six cohorts for CHD mortality followed up for 460 333 person-years and 33 394 participants from four cohorts for CHD events. DATA SYNTHESIS Among 38 274 adults (median age 55 y, 63% women), 1691 (4.4%) had subclinical hypothyroidism, of whom 775 (45.8%) had positive TPOAbs. During follow-up, 1436 participants died of CHD and 3285 had CHD events. Compared with euthyroid individuals, age- and gender-adjusted risks of CHD mortality in subclinical hypothyroidism were similar among individuals with and without TPOAbs [hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.87-1.53 vs HR 1.26, CI 1.01-1.58, P for interaction = .62], as were risks of CHD events (HR 1.16, CI 0.87-1.56 vs HR 1.26, CI 1.02-1.56, P for interaction = .65). Risks of CHD mortality and events increased with higher thyrotropin, but within each stratum, risks did not differ by TPOAb status. CONCLUSIONS CHD risk associated with subclinical hypothyroidism did not differ by TPOAb status, suggesting that biomarkers of thyroid autoimmunity do not add independent prognostic information for CHD outcomes.
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Affiliation(s)
- Tinh-Hai Collet
- Service of Endocrinology, Diabetes, and Metabolism (T.-H.C.), University Hospital of 1011 Lausanne, Switzerland; Department of Ambulatory Care and Community Medicine (T.-H.C., J.C.), University of Lausanne, 1011 Lausanne, Switzerland; Departments of Epidemiology and Biostatistics (D.C.B., E.V.) and Medicine (D.C.B.), University of California, San Francisco, San Francisco, California 94143; Division of Endocrinology, Diabetes, and Metabolism (A.R.C.), Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104; Department of Public Health (B.O.Å.), Norwegian University of Science and Technology, N-7491 Trondheim, Norway; Department of Endocrinology (B.O.Å.), St Olavs Hospital, Trondheim University Hospital, N-7006 Trondheim, Norway; Department of General Internal Medicine (S.W., D.A., N.R.), Inselspital, University of Bern, 3000 Bern, Switzerland; Department of Clinical Pharmacology and Toxicology (S.W.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of Public Health and Primary Care (J.G., W.P.J.d.E.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; School of Population Health (A.B.) and School of Medicine and Pharmacology (J.P.W.), The University of Western Australia, Crawley, and Department of Endocrinology and Diabetes (J.P.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Division of Endocrinology (R.M.B.M., J.A.S.), Department of Medicine, Federal University of Sao Paulo, 04023-900 São Paulo, Brazil; Department of Endocrinology (M.P.J.V.), Royal Free Hospital, London NW3 2PF, United Kingdom; Clinic for Internal Medicine B (M.D.) and Institute of Clinical Chemistry and Laboratory Medicine (H.W.), University Medicine Greifswald, and Institute for Community Medicine (H.V.), Study of Health in Pomerania/Clinical-Epidemiological Research, University of Greifswald, D-17487 Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.D.,
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Zapata M, Kunii IS, Paninka RM, Simões DMN, Castillo VA, Reche A, Maciel RMB, Dias da Silva MR. Molecular cloning of ion channels in Felis catus that are related to periodic paralyses in man: a contribution to the understanding of the genetic susceptibility to feline neck ventroflexion and paralysis. Biol Open 2014; 3:785-93. [PMID: 25063199 PMCID: PMC4163655 DOI: 10.1242/bio.20148003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/20/2022] Open
Abstract
Neck ventroflexion in cats has different causes; however, the most common is the hypokalemia associated with flaccid paralysis secondary to chronic renal failure. In humans, the most common causes of acute flaccid paralysis are hypokalemia precipitated by thyrotoxicosis and familial forms linked to mutations in sodium, potassium, and calcium channel genes. Here, we describe the sequencing and analysis of skeletal muscle ion channels in Felis catus that could be related to periodic paralyses in humans, contributing to the understanding of the genetic susceptibility to feline neck ventroflexion and paralysis. We studied genomic DNA from eleven cats, including five animals that were hyperthyroid with hypokalemia, although only one presented with muscle weakness, and six healthy control domestic cats. We identified the ion channel ortholog genes KCNJ2, KCNJ12, KCNJ14, CACNA1S and SCN4A in the Felis catus genome, together with several polymorphic variants. Upon comparative alignment with other genomes, we found that Felis catus provides evidence for a high genomic conservation of ion channel sequences. Although we hypothesized that neck ventroflexion in cats could be associated with a thyrotoxic or familial periodic paralysis channel mutation, we did not identify any previously detected human channel mutation in the hyperthyroid cat presenting hypokalemia. However, based on the small number of affected cats in this study, we cannot yet rule out this molecular mechanism. Notwithstanding, hyperthyroidism should still be considered as a differential diagnosis in hypokalemic feline paralysis.
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Affiliation(s)
- Marlyn Zapata
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039032, SP, Brazil
| | - Ilda S Kunii
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039032, SP, Brazil
| | - Rolf M Paninka
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039032, SP, Brazil
| | - Denise M N Simões
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039032, SP, Brazil
| | - Víctor A Castillo
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039032, SP, Brazil
| | - Archivaldo Reche
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039032, SP, Brazil
| | - Rui M B Maciel
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039032, SP, Brazil
| | - Magnus R Dias da Silva
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039032, SP, Brazil
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Araujo AN, Moraes L, França MIC, Hakonarson H, Li J, Pellegrino R, Maciel RMB, Cerutti JM. Genome-wide copy number analysis in a family with p.G533C RET mutation and medullary thyroid carcinoma identified regions potentially associated with a higher predisposition to lymph node metastasis. J Clin Endocrinol Metab 2014; 99:E1104-12. [PMID: 24601688 DOI: 10.1210/jc.2013-2993] [Citation(s) in RCA: 7] [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] [Indexed: 02/13/2023]
Abstract
CONTEXT Our group described a p.G533C RET gene mutation in a large family with multiple endocrine neoplasia type 2 syndrome. Clinical heterogeneity, primarily associated with the presence of lymph node metastases, was observed among the p.G533C carriers. OBJECTIVE The aim of this study was to use single-nucleotide polymorphism-array technology to identify copy number variations (CNVs), which are present in the constitutional DNA and associated with the established clinical and pathological features of aggressive medullary thyroid carcinoma (MTC), primarily the presence of lymph node metastasis. DESIGN Fifteen p.G533C carriers with MTC were chosen for the initial screening. The subjects were divided into two groups according the presence (n = 8) or absence (n = 7) of lymph node metastasis. Peripheral blood DNA was independently hybridized using a genome-wide single-nucleotide polymorphism Array 6.0 platform. The results were analyzed using both Genotyping Console and PennCNV software. To identify the possible candidate regions associated with the presence of lymph node metastasis, cases (metastatic MTC) were compared with controls (nonmetastatic MTC). The identified CNVs were validated by quantitative PCR in an extended cohort (n = 32). RESULTS Using two different algorithms, we identified nine CNV regions that may contribute to susceptibility to lymph node metastasis. The validation step confirmed that a CNV loss impacting the FMN2 gene was potentially associated with a greater predisposition to lymph node metastasis in this family (P = .0179). Finally, we sought to investigate whether the development of lymph node metastasis might not depend on a single CNV but rather a combination of various CNVs. These analyses defined a CNV pattern related to a more aggressive phenotype in this family, with CNV deletions being enriched in the metastatic group (P = .0057). CONCLUSION Although hereditable specific RET mutations are important to determine cancer risk, germline CNVs in disease-affected individuals may predispose them to MTC aggressiveness.
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Affiliation(s)
- Aline N Araujo
- Genetic Bases of Thyroid Tumors Laboratory (A.N.A., L.M., J.M.C.), Division of Genetics, Department of Morphology and Genetics, Universidade Federal de São Paulo, and Laboratory of Molecular and Translational Endocrinology (M.I.C.F., R.M.B.M.), Division of Endocrinology, Department of Medicine, Universidade Federal de São Paulo, São Paulo SP 04039-032, Brazil; Center for Applied Genomics (H.H., J.L., R.P.), The Children's Hospital of Philadelphia, Research Institute; and Department of Pediatrics (H.H.), The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
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Kizys MML, Nesi-França S, Cardoso MG, Harada MY, Melo MCC, Chiamolera MI, Dias-da-Silva MR, Maciel RMB. The absence of mutations in homeobox candidate genes HOXA3, HOXB3, HOXD3 and PITX2 in familial and sporadic thyroid hemiagenesis. J Pediatr Endocrinol Metab 2014; 27:317-22. [PMID: 24127533 DOI: 10.1515/jpem-2013-0289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/09/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The molecular mechanisms leading to the formation of the two thyroid symmetrical lobes, which are impaired in thyroid hemiagenesis (TH), are little known. OBJECTIVE The aim of this work was to search for mutations in thyroid developmental candidate genes HOXA3, HOXB3, HOXD3 and PITX2. METHODS Total DNA from peripheral blood was extracted and then the entire coding region of all these genes was amplified by polymerase chain reaction and direct sequencing. RESULTS Herein we describe familial cases of TH in two generations (proband and his father), in addition to other two sporadic cases. We have found polymorphisms in the HOXB3 (rs2229304), HOXD3 (rs34729309, rs1051929, c.543-199G>T and c.543-34G>A; and a new synonymous variant, NP_008829.3:p.314;C>G) and PITX2 (c.45+76C>T) genes, but no deleterious mutations. CONCLUSION These results suggest the existence of other left-right thyroid asymmetry candidate genes in humans such as classical Mendelian mutation-causing disease, as well as other etiopathogenic mechanisms such as epigenetic modifications, especially for sporadic hemiagenesis.
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Signorini PS, França MIC, Camacho CP, Lindsey SC, Valente FOF, Kasamatsu TS, Machado AL, Salim CP, Delcelo R, Hoff AO, Cerutti JM, Dias-da-Silva MR, Maciel RMB. A ten-year clinical update of a large RET p.Gly533Cys kindred with medullary thyroid carcinoma emphasizes the need for an individualized assessment of affected relatives. Clin Endocrinol (Oxf) 2014; 80:235-45. [PMID: 23745650 DOI: 10.1111/cen.12264] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Received: 12/27/2012] [Revised: 01/21/2013] [Accepted: 06/04/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Reviewing the clinical outcomes of a large kindred with a RET p.Gly533Cys mutation, 10 years after the first description of this kindred, has provided an important set of clinical data for healthcare decision-making. DESIGN AND PATIENTS We identified 728 RET533 Brazilian relatives, spread out over 7 generations. We performed clinical examination, biochemical and imaging analyses in the proband and in 103 carriers. MEASUREMENT AND RESULTS The proband has been followed without evidence of structural disease in the last 10 years but with elevated calcitonin. The clinical and surgical features of 60 thyroidectomized RET533 relatives were also described. Forty-six patients had MTC (21-72 years), and 11 patients had C-cell hyperplasia (CCH) (5-42 years). Twelve MTC patients with lymph node metastases had a tumour size of 0·7-2·8 cm. Calcitonin level and CEA were correlated with disease stage, and none of the patients presented with an altered PTH or metanephrine. A 63-year-old woman developed pheochromocytoma and breast cancer. Two other RET533 relatives developed lung squamous cell carcinoma and melanoma. CONCLUSIONS A vast clinical variability in RET533 presentation was observed, ranging from only an elevated calcitonin level (3%) to local metastatic disease (25%). Many individuals were cured (42%) and the majority had controlled chronic disease (56%), reinforcing the need for individualized ongoing risk stratification assessment. The importance of this update relies on the fact that it allows us to delineate the natural history of RET 533 MEN2A 10 years after its first description.
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Affiliation(s)
- Priscila S Signorini
- Department of Medicine, Laboratory of Molecular and Translational Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Damião MJ, Giannocco G, Grespan R, Silva EL, Duarte JS, Maciel RMB, Yamada AN, Bersani-Amado CA, Cuman RKN. Ginger Essential Oil Ameliorates Cisplatin-Induced Nephrotoxicity in Mice. TROP J PHARM RES 2014. [DOI: 10.4314/tjpr.v12i6.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Valente FOF, Dias da Silva MR, Camacho CP, Kunii IS, Bastos AU, da Fonseca CCN, Simião HPC, Tamanaha R, Maciel RMB, Cerutti JM. Comprehensive analysis of RET gene should be performed in patients with multiple endocrine neoplasia type 2 (MEN 2) syndrome and no apparent genotype-phenotype correlation: an appraisal of p.Y791F and p.C634Y RET mutations in five unrelated Brazilian families. J Endocrinol Invest 2013; 36:975-81. [PMID: 23723040 DOI: 10.3275/8997] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND We previously identified a four-generation family with medullary thyroid cancer (MTC) and a germline p.Y791F RET mutation whose cancer lacked a strong genotype-phenotype correlation. The entire gene coding region of the RET gene should be sequenced when genotype-phenotype discrepancies are observed in patients with multiple endocrine neoplasia type 2 (MEN 2), even if a RET hotspot mutation has been identified. METHODS A new genetic test was performed in the index case of this family with the p.Y791F RET germline mutation. The entire coding region of the RET gene was investigated by direct sequencing of PCR products. Once a mutation was identified, the target exon was sequenced in all at-risk relatives. RESULTS An additional p.C634Y germline mutation in the RET gene was identified in the reported family. The double mutation occurred in cis and segregated with the phenotype. Through the Brazilian Genetic Screening Program developed at our institution, we additionally report the combination of these two mutations (p.C634Y/p.Y791F) in the RET gene in four other unrelated families. The overall penetrance of MTC and pheochromocytoma in patients with the p.C634Y/p.Y791F mutations was 79% and 13%, respectively. CONCLUSION Our data emphasises that a comprehensive analysis of the RET gene may reveal multiple germline mutations in MEN 2 patients who exhibit an atypical clinical course of the disease.
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Affiliation(s)
- F O F Valente
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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