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Anelli V, Gatta E, Pirola I, Delbarba A, Rotondi M, Cappelli C. Thyroid impairment and male fertility: a narrative review of literature. Aging Male 2024; 27:2310303. [PMID: 38347677 DOI: 10.1080/13685538.2024.2310303] [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: 09/22/2023] [Accepted: 01/20/2024] [Indexed: 02/15/2024] Open
Abstract
PURPOSE To evaluate the effect of thyroid function on male fertility, focusing on hypo- and hyperthyroidism. METHODS A PubMed/MEDLINE, Web of Science, and Scopus research was performed. Original studies in English published online up to 31 May 2023 were selected and reviewed. The final reference list was defined based on the relevance of each paper to the scope of this review. RESULTS The available data in animals (31 studies) and human (26 studies) showed conflicting results. However, thyroid dysfunction altered erection and ejaculation both in animal models than in men. CONCLUSION Both hypothyroidism and hyperthyroidism seem to cause ejaculation and erectile dysfunction. Hence, Guidelines recommend against the systematic screening for thyroid disorders in the men in sub-fertile couples, but only in men with ejaculation and erectile dysfunction and/or altered semen parameters.
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Affiliation(s)
- Valentina Anelli
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Elisa Gatta
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Delbarba
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Mario Rotondi
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
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Gatta E, Maltese V, Cimino E, Cavadini M, Anelli V, Di Lodovico E, Piovani E, Zammarchi I, Gozzoli G, Agosti B, Pirola I, Delbarba A, Girelli A, Buoso C, Bambini F, Alfieri D, Bremi W, Facondo P, Lupo R, Bezzi F, Fredi M, Mazzola AM, Gandossi E, Saullo M, Marini F, Licini M, Pezzaioli LC, Pini L, Franceschini F, Ricci C, Cappelli C. Evaluation of a large set of patients with Autoimmune Polyglandular Syndrome from a single reference centre in context of different classifications. J Endocrinol Invest 2024; 47:857-864. [PMID: 37752372 DOI: 10.1007/s40618-023-02200-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To characterize patients with APS and to propose a new approach for their follow-up. Query ID="Q1" Text="Please check the given names and familynames." METHODS Monocentric observational retrospective study enrolling patients referred to the Outpatients clinic of the Units of Endocrinology, Diabetology, Gastroenterology, Rheumatology and Clinical Immunology of our Hospital for Autoimmune diseases. RESULTS Among 9852 patients, 1174 (11.9%) [869 (73.9%) female] were diagnosed with APS. In 254 subjects, the diagnosis was made at first clinical evaluation (Group 1), all the other patients were diagnosed with a mean latency of 11.3 ± 10.6 years (Group 2). Group 1 and 2 were comparable for age at diagnosis (35.7 ± 16.3 vs. 40.4 ± 16.6 yrs, p = .698), but different in male/female ratio (81/173 vs 226/696, p = .019). In Group 2, 50% of patients developed the syndrome within 8 years of follow-up. A significant difference was found after subdividing the first clinical manifestation into the different outpatient clinic to which they referred (8.7 ± 8.0 vs. 13.4 ± 11.6 vs. 19.8 ± 8.7 vs. 7.4 ± 8.1 for endocrine, diabetic, rheumatologic, and gastroenterological diseases, respectively, p < .001). CONCLUSIONS We described a large series of patients affected by APS according to splitters and lumpers. We propose a flowchart tailored for each specialist outpatient clinic taking care of the patients. Finally, we recommend regular reproductive system assessment due to the non-negligible risk of developing premature ovarian failure.
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Affiliation(s)
- E Gatta
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy
| | - V Maltese
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy
| | - E Cimino
- UOC Medicina Generale ad Indirizzo Metabolico e Diabetologico, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M Cavadini
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy
| | - V Anelli
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy
| | - E Di Lodovico
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell'Area Sanitaria-SUMAI, Trade Union Organisation, Brescia, Italy
| | - E Piovani
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - I Zammarchi
- Department of Clinical and Experimental Sciences, Gastroenterology Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - G Gozzoli
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - B Agosti
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell'Area Sanitaria-SUMAI, Trade Union Organisation, Brescia, Italy
| | - I Pirola
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy
| | - A Delbarba
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell'Area Sanitaria-SUMAI, Trade Union Organisation, Brescia, Italy
| | - A Girelli
- UOC Medicina Generale ad Indirizzo Metabolico e Diabetologico, ASST Spedali Civili of Brescia, Brescia, Italy
| | - C Buoso
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy
| | - F Bambini
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy
| | - D Alfieri
- Department of Clinical and Experimental Sciences, Gastroenterology Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - W Bremi
- Department of Clinical and Experimental Sciences, Gastroenterology Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - P Facondo
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy
| | - R Lupo
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - F Bezzi
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M Fredi
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - A M Mazzola
- Department of Clinical and Experimental Sciences, Gastroenterology Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - E Gandossi
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell'Area Sanitaria-SUMAI, Trade Union Organisation, Brescia, Italy
| | - M Saullo
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell'Area Sanitaria-SUMAI, Trade Union Organisation, Brescia, Italy
| | - F Marini
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell'Area Sanitaria-SUMAI, Trade Union Organisation, Brescia, Italy
| | - M Licini
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy
| | - L C Pezzaioli
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy
| | - L Pini
- Department of Clinical and Experimental Sciences, Respiratory Medicine Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - F Franceschini
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - C Ricci
- Department of Clinical and Experimental Sciences, Gastroenterology Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - C Cappelli
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili no 1, 25100, Brescia, Italy.
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Bambini F, Gatta E, D'Alessio R, Dondi F, Pignata G, Pirola I, Bertagna F, Cappelli C. Thyroid disease and autoimmunity in obese patients: a narrative review. Endokrynol Pol 2023; 74:VM/OJS/J/96255. [PMID: 37994585 DOI: 10.5603/ep.96255] [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: 06/28/2023] [Accepted: 08/18/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION The high prevalence of obesity and thyroid diseases worldwide justifies di per se their simultaneous coexistence. In recent decades, there has been a parallel and significant rise in obesity and thyroid diseases in industrialised countries, although the underlying mechanisms are complex and not well known. MATERIAL AND METHODS The authors accomplished a comprehensive literature search of original articles concerning obesity and thyroid status. Original papers exploring the association between these two morbidities in children and adults were included. RESULTS A total of 79 articles were included in the present analysis. A total of 12% of obese children (mean age 10.9 ± 1.4 years) showed a thyroid disease, and they were younger than healthy obese children (10.9 ± 1.2 vs. 11.0 ± 0.4 years, p < 0.001). Isolated hyperthyrotropinaemia was the most frequent finding in children (10.1%). Autoimmune thyroid disease was more frequent in puberal age. Thyroid antibodies and subclinical hypothyroidism were more frequent in obese that in non-obese patients (7% vs. 3%, p < 0.001; 10% vs. 6%, p < 0.001). Among obese adults, 62.2% displayed a thyroid disease; those affected were younger (35.3 ± 6.8 vs. 41.0 ± 1.9 years, p < 0.001), heavier [body mass index (BMI): 39.4 ± 6.3 vs. 36.1 ± 2.3 kg/m², p < 0.001], and more frequently female (13% vs. 8%, p < 0.001). The most frequent disease was overt hypothyroidism (29.9%). BMI appears to be correlated with TSH levels in obese adults. Overt hypothyroidism was significantly more frequent in obese patients (7% vs. 3%, p < 0.005), but no difference was found in thyroid antibodies (15% vs. 14%, p = 0.178). CONCLUSIONS An undeniable relationship between obesity and thyroid impairments exists. Isolated hyperthyrotropinaemia is frequently seen in obese children, often followed by spontaneous resolution. Subclinical hypothyroidism should never be treated in children or adults with the aim of reducing body weight.
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Affiliation(s)
- Francesca Bambini
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Elisa Gatta
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | | | - Francesco Dondi
- Nuclear Medicine, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | - Giusto Pignata
- Department of General Surgery 2, ASST Spedali Civili di Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy.
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Gatta E, Maltese V, Cavadini M, Anelli V, Bambini F, Buoso C, Facondo P, Pirola I, Delbarba A, Cappelli C. Interference or Noninterference Between Soy and Levothyroxine: That Is the Question. A Narrative Review of Literature. Endocr Pract 2023; 29:897-901. [PMID: 37633413 DOI: 10.1016/j.eprac.2023.08.009] [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: 06/14/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE To evaluate the effect of soy intake on levothyroxine (L-T4) absorption among different L-T4 formulations. METHODS A PubMed/MEDLINE, Web of Science, and Scopus research was performed. Case reports, case series, and original studies written in English and published online up to November 30, 2022, were selected and reviewed. The final reference list was defined based on the relevance of each study to the scope of this review. RESULTS Few data, mainly case reports, seemed to suggest a possible interference of soy products on L-T4 tablets absorption. However, the only prospective randomized cross-over study showed no differences in L-T4 absorption when L-T4 and soy isoflavones were assumed concomitantly. The very little data available on liquid L-T4 formulations did not allow for any conclusions to be made, even if a double-blind placebo-controlled trial showed no impaired L-T4 absorption. CONCLUSION The inference of soy products on L-T4 absorption, if present, seems to have little clinical impact. Considering this fact, the Hamlet-like question whether soy milk interferes with L-T4 absorption remains unanswered.
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Affiliation(s)
- Elisa Gatta
- Department of Clinical and Experimental Sciences, SSVD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Virginia Maltese
- Department of Clinical and Experimental Sciences, SSVD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Maria Cavadini
- Department of Clinical and Experimental Sciences, SSVD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Valentina Anelli
- Department of Clinical and Experimental Sciences, SSVD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Bambini
- Department of Clinical and Experimental Sciences, SSVD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Caterina Buoso
- Department of Clinical and Experimental Sciences, SSVD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Facondo
- Department of Clinical and Experimental Sciences, SSVD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSVD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Delbarba
- Department of Clinical and Experimental Sciences, SSVD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSVD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy.
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Gatta E, Anelli V, Cimino E, Di Lodovico E, Piovani E, Zammarchi I, Gozzoli G, Maltese V, Cavadini M, Agosti B, Delbarba A, Pirola I, Girelli A, Buoso C, Bambini F, Alfieri D, Bremi W, Facondo P, Lupo R, Bezzi F, Fredi M, Mazzola AM, Gandossi E, Saullo M, Marini F, Licini M, Pezzaioli LC, Pini L, Franceschini F, Ricci C, Cappelli C. Autoimmune polyglandular syndrome type 4: experience from a single reference center. Front Endocrinol (Lausanne) 2023; 14:1236878. [PMID: 37937054 PMCID: PMC10627240 DOI: 10.3389/fendo.2023.1236878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023] Open
Abstract
Purpose To characterize patients with APS type 4 among those affected by APS diagnosed and monitored at our local Reference Center for Autoimmune Polyglandular Syndromes. Methods Monocentric observational retrospective study enrolling patients affected by APS diagnosed and monitored in a Reference Center. Clinical records were retrieved and analyzed. Results 111 subjects (51 males) were affected by APS type 4, mean age at the onset was 23.1 ± 15.1 years. In 15 patients the diagnosis of APS was performed during the first clinical evaluation, in the other 96 after a latency of 11 years (range 1-46). The most frequent diseases were type I diabetes mellitus and celiac disease, equally distributed among sexes. Conclusions The prevalence of APS type 4 is 9:100,000 people. Type I diabetes mellitus was the leading indicator of APS type 4 in 78% subjects and in 9% permitted the diagnosis occurring as second manifestation of the syndrome. Our data, showing that 50% of patients developed APS type 4 within the first ten years, don't suggest any particular follow-up time and, more importantly, don't specify any particular disease. It is important to emphasize that 5% of women developed premature ovarian failure.
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Affiliation(s)
- Elisa Gatta
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Anelli
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Elena Cimino
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Elena Di Lodovico
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell’Area Sanitaria – SUMAI, Brescia, Italy
| | - Elda Piovani
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Irene Zammarchi
- Department of Clinical and Experimental Sciences, Gastroenterology Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giorgia Gozzoli
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Virginia Maltese
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Maria Cavadini
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Barbara Agosti
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell’Area Sanitaria – SUMAI, Brescia, Italy
| | - Andrea Delbarba
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell’Area Sanitaria – SUMAI, Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Angela Girelli
- UOC Medicina Generale ad indirizzo Metabolico e Diabetologico, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Caterina Buoso
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Bambini
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Daniele Alfieri
- Department of Clinical and Experimental Sciences, Gastroenterology Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Walter Bremi
- Department of Clinical and Experimental Sciences, Gastroenterology Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Paolo Facondo
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Roberto Lupo
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesco Bezzi
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Micaela Fredi
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Anna Maria Mazzola
- Department of Clinical and Experimental Sciences, Gastroenterology Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Elena Gandossi
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell’Area Sanitaria – SUMAI, Brescia, Italy
| | - Maura Saullo
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell’Area Sanitaria – SUMAI, Brescia, Italy
| | - Fiorella Marini
- Sindacato Unico Medicina Ambulatoriale Italiana e Professionalità dell’Area Sanitaria – SUMAI, Brescia, Italy
| | - Massimo Licini
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Letizia Chiara Pezzaioli
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Laura Pini
- Department of Clinical and Experimental Sciences, Respiratory Medicine Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Franco Franceschini
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Chiara Ricci
- Department of Clinical and Experimental Sciences, Gastroenterology Unit, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
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Pirola I, Rotondi M, Di Lodovico E, Pezzaioli LC, Agosti B, Castellano M, Ferlin A, Cappelli C. When and why patients drop out from benign thyroid nodules follow-up: a single centre experience. Endocrine 2023; 79:512-516. [PMID: 36434324 PMCID: PMC9988786 DOI: 10.1007/s12020-022-03256-9] [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: 07/19/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Drop-out in clinical long-term follow-up is a general problem that is potentially harmful to patients. No data about patients that drop out from thyroid ultrasound follow-up is available literature. The aim of the present retrospective study was to evaluate the characteristics of patients that dropped out from ultrasound thyroid nodule follow-up. PATIENTS AND METHODS We reviewed medical records of all consecutive patients who underwent a fine needle aspiration from January 2007 to March 2009 in our department. All the patients with benign nodule(s) were recommended annual ultrasounds; patients who had dropped out from follow-up were included and a telephone interview was obtained to evaluate the reasons for dropping out. RESULTS 289/966 (30%) of patients with benign nodules dropped out during follow-up; 94% of them within the first 5 years. Phone interviews were obtained from 201/289 (70%) of the patients. In the 57% of cases, the main declared reason for dropping out was nodular dimension stability during the first 2-3 years; 8.7% of them had forgotten about the appointment; 6.4% of subjects claimed to check only serum TSH, and 3.2% stated that they would undergo an ultrasound only if the nodule(s) were symptomatic. Finally, 10.7% patients continued follow-up in other centres. CONCLUSION we showed that a third of patients miss their thyroid ultrasound follow-ups, and that the major cause is the low perceived threat coming from the disease. As a certain amount of drop-out is inevitable, attempting to reinforce our patients' awareness regarding their own health state is mandatory. TRIAL REGISTRATION Trial registration: no. 4084.
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Affiliation(s)
- Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - Elena Di Lodovico
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Letizia Chiara Pezzaioli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Barbara Agosti
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Alberto Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy.
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Maltese V, Gatta E, Facondo P, Anelli V, Cavadini M, Buoso C, Bambini F, Delbarba A, Pirola I, Cappelli C. SIMULTANEOUS INTAKE OF LIQUID L-T4 FORMULATION AND IRON SALT: FACT OR FICTION? Acta Endocrinol (Buchar) 2023; 19:54-58. [PMID: 37601720 PMCID: PMC10439335 DOI: 10.4183/aeb.2023.54] [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] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Context Hypothyroidism and iron deficiency are among the most common pathologies in population. Therefore, there are a lot of patients assuming both iron salt supplements and levothyroxine therapy. Objective To evaluate the effect of iron salt intake on L-T4 absorption among different L-T4 formulations. Materials and methods A PubMed/MEDLINE, Web of Science, and Scopus research was performed. Original studies and reviews written in English and published online up to 21 December 2022 were selected and reviewed. The final reference list was defined based on the relevance of each paper to the scope of this review. Results The data show an impaired absorption of L-T4 in tablets formulation when taken concomitantly with iron salt supplements. These phenomena seem to be circumvented by new L-T4 formulations. Conclusion Liquid L-T4 formulations can be ingested with iron salts, with no impairment of absorption. More studies are necessary to confirm these data for soft-gel capsules L-T4.
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Affiliation(s)
- V. Maltese
- University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, SSD Endocrinologia, Department of Clinical and Experimental Sciences, Brescia, Italy
| | - E. Gatta
- University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, SSD Endocrinologia, Department of Clinical and Experimental Sciences, Brescia, Italy
| | - P. Facondo
- University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, SSD Endocrinologia, Department of Clinical and Experimental Sciences, Brescia, Italy
| | - V. Anelli
- University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, SSD Endocrinologia, Department of Clinical and Experimental Sciences, Brescia, Italy
| | - M. Cavadini
- University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, SSD Endocrinologia, Department of Clinical and Experimental Sciences, Brescia, Italy
| | - C. Buoso
- University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, SSD Endocrinologia, Department of Clinical and Experimental Sciences, Brescia, Italy
| | - F. Bambini
- University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, SSD Endocrinologia, Department of Clinical and Experimental Sciences, Brescia, Italy
| | - A. Delbarba
- University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, SSD Endocrinologia, Department of Clinical and Experimental Sciences, Brescia, Italy
| | - I. Pirola
- University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, SSD Endocrinologia, Department of Clinical and Experimental Sciences, Brescia, Italy
| | - C. Cappelli
- University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, SSD Endocrinologia, Department of Clinical and Experimental Sciences, Brescia, Italy
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Facondo P, Maltese V, Delbarba A, Pirola I, Rotondi M, Ferlin A, Cappelli C. Case Report: Hypothalamic Amenorrhea Following COVID-19 Infection and Review of Literatures. Front Endocrinol (Lausanne) 2022; 13:840749. [PMID: 35757408 PMCID: PMC9229338 DOI: 10.3389/fendo.2022.840749] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
SARS-CoV-2 infection, responsible for the coronavirus disease 2019 (COVID-19), can impair any organ system including endocrine glands. However, hypothalamic-pituitary dysfunctions following SARS-CoV-2 infection remain largely unexplored. We described a case of hypothalamic amenorrhea following SARS-CoV-2 infection in a 36-year-old healthy woman. The diagnostic workup excluded all the causes of secondary amenorrhea, in agreement to the current guidelines, whereas the gonadotropin increase in response to GnRH analogue tests was suggestive for hypothalamic impairment. Therefore, since our patient did not present any organic cause of hypothalamic-pituitary disorder, we hypothesized that her hypothalamic deficiency may have been a consequence of SARS-CoV-2 infection. This assumption, besides on the temporal consecutio, is strengthened by the fact that SARS-CoV-2 infection can impair the hypothalamic circuits, altering the endocrine axes, given that angiotensin-converting enzyme 2 receptors have also been observed in the hypothalamus. We reviewed the literature regarding hypothalamic-pituitary dysfunction in patients with SARS-CoV-2 infection. No study has previously described female hypogonadotropic hypogonadism with secondary amenorrhea following COVID-19. We suggest clinicians focusing greater attention on this possible endocrine disorder.
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Affiliation(s)
- Paolo Facondo
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Brescia, Brescia, Italy
| | - Virginia Maltese
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Brescia, Brescia, Italy
| | - Andrea Delbarba
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Brescia, Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Brescia, Brescia, Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Istituto Clinico Scientifico (ICS) Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Brescia, Brescia, Italy
- *Correspondence: Carlo Cappelli,
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Gatta E, Bambini F, Buoso C, Gava M, Maltese V, Anelli V, Delbarba A, Pirola I, Cappelli C. Liquid levothyroxine formulations in patients taking drugs interfering with L-T4 absorption. Front Endocrinol (Lausanne) 2022; 13:1080108. [PMID: 36561558 PMCID: PMC9764388 DOI: 10.3389/fendo.2022.1080108] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To describe the current knowledge on thyroid hormonal profile in patients on liquid L-T4 therapy and drugs known to interfere with L-T4 absorption. METHODS A PubMed/MEDLINE, Web of Science, and Scopus research was performed. Case reports, case series, original studies and reviews written in English and published online up to 31 August 2022 were selected and reviewed. The final reference list was defined based on the relevance of each paper to the scope of this review. RESULTS The available data showed that novel levothyroxine formulations circumvent gastric pH impairment due to multiple interfering drugs such as proton pump inhibitors, calcium or iron supplements, sevelamer, aluminum/magnesium hydroxide and sodium alginate. CONCLUSION New formulations can be taken simultaneously with drugs interfering with L-T4 absorption, in particular liquid formulations. Softgel capsules need more studies to support these data.
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Daffini L, Pirola I, Saccà G, Salvetti M, Cappelli C. Graves' disease treated by complementary medicine leading to thyroid storm: A case report. Caspian J Intern Med 2021; 12:S371-S375. [PMID: 34760085 PMCID: PMC8559635 DOI: 10.22088/cjim.12.0.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022]
Abstract
Background: Thyroid storm is a rare, life-threatening condition characterized by severe clinical manifestations of thyrotoxicosis and can be precipitated by several factors. We described a thyroid storm precipitated by a long-term treatment using homeopathic medicine containing iodine. Case presentation: A 55-year-old Italian woman was admitted to our Sub-Intensive Care Unit with the diagnosis of congestive heart failure and thyrotoxicosis. She has been diagnosed with Graves’ disease two years before; she refused conventional therapy and in the preceding six months had been using phytotherapeutic and homeopathic medicine. We found serum and urine iodine levels consistent with severe intoxication by iodine (serum iodine: 42100 mcg/L and urinary iodine: 4223 mcg/L, respectively). After a few hours, the patient went into cardiac arrest. She was subjected to invasive ventilation, dialyzed with continuous veno-venous hemofiltration and treated with vasoactive amines. Conclusion: The high level of iodemia manifested in our patient - around a thousand times greater than the normal range and itself associated with fatal outcomes - was caused by long-term homeopathic treatment. This long-term treatment has two consequences: first, iodine load-precipitated hyperthyroidism in thyroid storm, and secondly, it prevents us from treating patients with inorganic iodide.
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Affiliation(s)
- Linda Daffini
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | | | | | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Italy
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11
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Pirola I, Gandossi E, Rotondi M, Marini F, Cristiano A, Chiovato L, Castellano M, Ferlin A, Cappelli C. Incidence of De Quervain's thyroiditis during the COVID-19 pandemic in an area heavily affected by Sars-CoV-2 infection. Endocrine 2021; 74:215-218. [PMID: 34363586 PMCID: PMC8349140 DOI: 10.1007/s12020-021-02841-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the possible association between Covid-19 infection and subacute thyroiditis. METHODS We reviewed the medical and imaging records of patients referred to our Department's outpatient setting dedicated to 'thyroid emergency' (records with a 'bollino verde'-green sticker, classifed as urgent) from April 2020 to October 2020. This outpatient clinic is devoted to patients requiring evaluation for severe hypothyroidism, thyrotoxicosis and neck discomfort or pain. All patients with a newly-diagnosed subacute thyroiditis were selected. The data of all patients receiving a diagnosis of subacute thyroiditis was collected retrospectively, taking into account the same period of time (April-October) and starting from 2016. RESULTS During the COVID-19 outbreak in our region (April 2020 to October 2020) 396 patients attended the outpatient emergency clinic. Among them, 10 (2.5%) patients received a diagnosis of subacute thyroiditis. In a single patient, a 44-year-old man, a COVID-19 pulmonary infection had been diagnosed 7 weeks before the diagnosis of subacute thyroiditis. All of the remaining patients were and remain COVID-19 free as confirmed by telephone interview. The percentage of patients who received a diagnosis of subacute thyroiditis in the same period starting from 2016 was very similar (2.9%, 2.9%, 2.6% and 3.0% in 2016, 2017, 2018 and 2019, respectively). CONCLUSIONS Our data do not show an increase in the incidence of subacute thyroiditis in the Brescia area, a region with the highest prevalence of COVID-19 in Italy during the period of the pandemic outbreak.
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Affiliation(s)
- Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Elena Gandossi
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S., Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy
| | - Fiorella Marini
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Alessandra Cristiano
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S., Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy.
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Cappelli C, Pirola I, Gandossi E, Rotondi M, Casella C, Lombardi D, Agosti B, Ferlin A, Castellano M. Ultrasound of benign thyroid nodules: A 120 months follow-up study. Clin Endocrinol (Oxf) 2021; 94:866-871. [PMID: 33394535 DOI: 10.1111/cen.14408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Some evidence suggests that most benign nodules exhibit no significant size increase during 5 years of follow-up, although conflicting results have emerged. The aim of the present study is to evaluate the frequency and the magnitude of growth in benign nodules during 120 months of follow-up. DESIGN We reviewed the medical and imaging records of patients who were submitted to ultrasound-guided FNA of thyroid nodules at our hospital from January 2007 to March 2009. We selected only patients with benign nodules who underwent annual ultrasound evaluation in our Department. RESULTS Among 966 selected patients, 289 were lost during follow-up, meaning that the total number of patients analysed was 677 (474 women and 203 men), with a mean age of 45.6 (16-71) years. In 559/677 patients (82.7%), the size of the nodule remained stable during follow-up; 42 (6.2%) patients experienced spontaneous nodule shrinkage, and 75 (11.1%) patients showed nodule growth. Patients with or without nodule growth during follow-up were superimposable at baseline for age, gender, TSH values, number of patients on levothyroxine treatment and nodule characteristics. All baseline variables in predicting nodular growth were entered to an adjusted multivariate logistic regression model. None of the parameters taken into account was associated with nodular growth. CONCLUSIONS In conclusion, the majority of benign nodules remained stable over the period of monitoring. On the basis of our experience, we recommend ultrasound examination at a distance of 2 and 5 years following cytological evaluation, then every 4-5 years from then on.
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Affiliation(s)
- Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Elena Gandossi
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Claudio Casella
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Barbara Agosti
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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Pirola I, Di Lodovico E, Casella C, Pezzaioli L, Facondo P, Ferlin A, Lombardi D, Cappelli C. Thyroid scintigraphy in the era of fine-needle aspiration cytology. Clin Endocrinol (Oxf) 2020; 94:711-716. [PMID: 33350500 DOI: 10.1111/cen.14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate whether thyroid scintigraphy would alter the clinical management of patients referred for fine-needle aspiration cytology (FNA). METHODS We reviewed the medical and imaging records of patients referred to our Department between 2016 and 2019. All the patients had to take a serum thyrotropin test administered in our hospital at least two months before the FNA; where the TSH level was ≤1.5 mIU/L, the patients were subjected to a scan and subsequently to FNA, where indicated. We selected only healthy patients with no previous history of thyroid disease, who were not taking any drugs and who had a TSH level of ≤1.5 mIU/L. We excluded patients with multinodular goitre. RESULTS A total of 176 patients were analysed. A total of 67/176 patients (38%) showed a serum of TSH ≤ 0.27 mIU/L. Scintigraphy identified a hot nodule in 142 lesions (80.7%), a warm nodule in 8 lesions (4.5%) and a cold nodule in 26 lesions (14.8%). The ROC curve analysis indicated that a TSH value of ≤0.42 mIU/L identified patients with hyperfunctioning nodules with a sensitivity of 65% and a specificity of 77%. All patients with cold and warm nodules were submitted to FNA: 22/26 (85%) and 5/8 (63%) lesions showed suspected malignancy or were compatible with malignancy, respectively. CONCLUSION Speculating on our data, if we had subjected our patients to FNA as indicated by the 2015 ATA guidelines, we would have subjected 117 patients to cytology, from whom 83 had undetected hot nodules. Conversely, by adopting scintigraphy for all patients with TSH ≤ 1.5 mIU/L, 109 patients have avoided FNA. However, our study was performed in a region with a history of mild iodine deficiency. Therefore, we cannot claim that our observation is valid for patients born and living in areas with sufficient iodine uptake. We recommend thyroid scintigraphy for treating single thyroid nodules in euthyroid patients born and living in regions with an iodine deficiency, when TSH levels are below 1.5 mIU/L before FNA.
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Affiliation(s)
- Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Elena Di Lodovico
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Claudio Casella
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Letizia Pezzaioli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Facondo
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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Toniati P, Piva S, Cattalini M, Garrafa E, Regola F, Castelli F, Franceschini F, Airò P, Bazzani C, Beindorf EA, Berlendis M, Bezzi M, Bossini N, Castellano M, Cattaneo S, Cavazzana I, Contessi GB, Crippa M, Delbarba A, De Peri E, Faletti A, Filippini M, Filippini M, Frassi M, Gaggiotti M, Gorla R, Lanspa M, Lorenzotti S, Marino R, Maroldi R, Metra M, Matteelli A, Modina D, Moioli G, Montani G, Muiesan ML, Odolini S, Peli E, Pesenti S, Pezzoli MC, Pirola I, Pozzi A, Proto A, Rasulo FA, Renisi G, Ricci C, Rizzoni D, Romanelli G, Rossi M, Salvetti M, Scolari F, Signorini L, Taglietti M, Tomasoni G, Tomasoni LR, Turla F, Valsecchi A, Zani D, Zuccalà F, Zunica F, Focà E, Andreoli L, Latronico N. Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev 2020; 19:102568. [PMID: 32376398 PMCID: PMC7252115 DOI: 10.1016/j.autrev.2020.102568] [Citation(s) in RCA: 541] [Impact Index Per Article: 135.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
A hyperinflammatory syndrome (HIS) may cause a life-threatening acute respiratory distress syndrome (ARDS) in patients with COVID-19 pneumonia. A prospective series of 100 consecutive patients admitted to the Spedali Civili University Hospital in Brescia (Italy) between March 9th and March 20th with confirmed COVID-19 pneumonia and ARDS requiring ventilatory support was analyzed to determine whether intravenous administration of tocilizumab (TCZ), a monoclonal antibody that targets the interleukin 6 (IL-6) receptor, was associated with improved outcome. Tocilizumab was administered at a dosage of 8 mg/kg by two consecutive intravenous infusions 12 h apart. A third infusion was optional based on clinical response. The outcome measure was an improvement in acute respiratory failure assessed by means of the Brescia COVID Respiratory Severity Score (BCRSS 0 to 8, with higher scores indicating higher severity) at 24-72 h and 10 days after tocilizumab administration. Out of 100 treated patients (88 M, 12 F; median age: 62 years), 43 received TCZ in the intensive care unit (ICU), while 57 in the general ward as no ICU beds were available. Of these 57 patients, 37 (65%) improved and suspended noninvasive ventilation (NIV) (median BCRSS: 1 [IQR 0-2]), 7 (12%) patients remained stable in NIV, and 13 (23%) patients worsened (10 died, 3 were admitted to ICU). Of the 43 patients treated in the ICU, 32 (74%) improved (17 of them were taken off the ventilator and were discharged to the ward), 1 (2%) remained stable (BCRSS: 5) and 10 (24%) died (all of them had BCRSS≥7 before TCZ). Overall at 10 days, the respiratory condition was improved or stabilized in 77 (77%) patients, of whom 61 showed a significant clearing of diffuse bilateral opacities on chest x-ray and 15 were discharged from the hospital. Respiratory condition worsened in 23 (23%) patients, of whom 20 (20%) died. All the patients presented with lymphopenia and high levels of C-reactive protein (CRP), fibrinogen, ferritin and IL-6 indicating a HIS. During the 10-day follow-up, three cases of severe adverse events were recorded: two patients developed septic shock and died, one had gastrointestinal perforation requiring urgent surgery and was alive at day 10. In conclusion, our series showed that COVID-19 pneumonia with ARDS was characterized by HIS. The response to TCZ was rapid, sustained, and associated with significant clinical improvement.
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Affiliation(s)
- Paola Toniati
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Simone Piva
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Cattalini
- Pediatric Rheumatology, Children's Hospital, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emirena Garrafa
- Department of Laboratory Diagnostics, ASST Spedali Civili, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesca Regola
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Franco Franceschini
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Airò
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Chiara Bazzani
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Eva-Andrea Beindorf
- Division of Anesthesiology and Critical Care Medicine, Montichiari Hospital, ASST Spedali Civili, Brescia, Italy
| | | | - Michela Bezzi
- Division of Endoscopic Pneumology, ASST Spedali Civili, Brescia, Italy
| | - Nicola Bossini
- Division of Nephrology and Dialysis, ASST Spedali Civili, Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Internal Medicine and Endocrinology, ASST Spedali Civili, Brescia, Italy
| | - Sergio Cattaneo
- Division of Cardio-Thoracic Intensive Care, ASST Spedali Civili, Brescia, Italy
| | - Ilaria Cavazzana
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | | | - Massimo Crippa
- Division of Internal Medicine, Gardone Val Trompia Hospital, ASST Spedali Civili, Brescia, Italy
| | - Andrea Delbarba
- University Division of Internal Medicine and Endocrinology, ASST Spedali Civili, Brescia, Italy
| | - Elena De Peri
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Angela Faletti
- Division of Anesthesiology and Critical Care Medicine, Gardone Val Trompia Hospital, ASST Spedali Civili, Brescia, Italy
| | - Matteo Filippini
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Matteo Filippini
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Micol Frassi
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Mario Gaggiotti
- Division of Nephrology and Dialysis, ASST Spedali Civili, Brescia, Italy
| | - Roberto Gorla
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Michael Lanspa
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Silvia Lorenzotti
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Rosa Marino
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; University Division of Diagnostic Radiology, ASST Spedali Civili, Brescia, Italy
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Division of Cardiology, ASST Spedali Civili, Brescia, Italy
| | - Alberto Matteelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Denise Modina
- Division of Pneumology, ASST Spedali Civili, Brescia, Italy
| | - Giovanni Moioli
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Giovanni Montani
- Third Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Maria-Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Silvia Odolini
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Elena Peli
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Silvia Pesenti
- Division of Gastroenterology, ASST Spedali Civili, Brescia, Italy
| | - Maria-Chiara Pezzoli
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Ilenia Pirola
- University Division of Internal Medicine and Endocrinology, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Pozzi
- Division of Gastroenterology, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Proto
- Division of Internal Medicine, Gardone Val Trompia Hospital, ASST Spedali Civili, Brescia, Italy
| | - Francesco-Antonio Rasulo
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Renisi
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Chiara Ricci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Division of Gastroenterology, ASST Spedali Civili, Brescia, Italy
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Internal Medicine, Montichiari Hospital, ASST Spedali Civili, Brescia, Italy
| | - Giuseppe Romanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Geriatric Internal Medicine, Montichiari Hospital, ASST Spedali Civili, Brescia, Italy
| | - Mara Rossi
- Third Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Francesco Scolari
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Division of Nephrology and Dialysis, ASST Spedali Civili, Brescia, Italy
| | - Liana Signorini
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Marco Taglietti
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Gabriele Tomasoni
- First Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Lina-Rachele Tomasoni
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Fabio Turla
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Davide Zani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Zuccalà
- First Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Fiammetta Zunica
- Pediatric Rheumatology, Children's Hospital, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emanuele Focà
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Latronico
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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15
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Cappelli C, Pirola I, Gandossi E, Rotondi M, Lombardi D, Casella C, Marini F, Saullo M, Agosti B, Di Lodovico E, Chiovato L, Ferlin A, Castellano M. Could Serum TSH Levels Predict Malignancy in Euthyroid Patients Affected by Thyroid Nodules with Indeterminate Cytology? Int J Endocrinol 2020; 2020:7543930. [PMID: 32377187 PMCID: PMC7191401 DOI: 10.1155/2020/7543930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/09/2019] [Accepted: 03/30/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Serum TSH levels in the upper-normal range were reported to be associated with increased risk of thyroid malignancy. However, measurement of TSH levels is currently not recommended for assessing the risk of malignancy in patients with newly diagnosed thyroid nodules. OBJECTIVE To evaluate a possible relationship between the serum levels of TSH and the histological outcome of patients undergoing thyroidectomy for thyroid nodules with indeterminate cytology. MATERIALS AND METHODS We collected the clinical data of all patients who had performed ultrasound-guided FNA of thyroid nodules with cytological diagnosis of indeterminate lesions (TIR3A and TIR3B) and serum TSH levels within the normal range. All patients had been submitted to thyroid surgery (hemi or thyroidectomy, as appropriate), and histological diagnosis had been performed. RESULTS A histological diagnosis of thyroid malignancy was rendered in 74/378 (19.6%) nodules. Patients with histologically proven thyroid malignancy were characterized by higher serum levels of TSH as compared to patients with histologically proven benign nodules (3.03 ± 1.16 vs. 2.37 ± 1.19 mIU/L, p < 0.001). To further analyze the role of serum TSH in predicting thyroid cancer, patients were stratified in 4 groups according to quartiles of TSH concentrations. The prevalence of malignancy was 12.2% for the first quartile and 50.0% for the last quartile. ROC curve analysis identified that a serum TSH level of ≥2.7 mIU/L predicted thyroid malignancy with a sensitivity of 61% and a specificity of 65%. CONCLUSIONS TSH levels in the upper-normal range are associated with an increased risk of thyroid malignancy in patients affected by thyroid nodules with indeterminate cytology at FNA. The measurement of serum TSH levels represents an easily performed additional tool for decision-making in patients with indeterminate cytological findings.
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Affiliation(s)
- Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Elena Gandossi
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Claudio Casella
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Fiorella Marini
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Maura Saullo
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Barbara Agosti
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Elena Di Lodovico
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
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16
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Cappelli C, Franco F, Pirola I, Gandossi E, Marini F, Di Lodovico E, Casella C, Lombardi D, Cristiano A, Ferlin A, Castellano M. Radiofrequency ablation of functioning and non-functioning thyroid nodules: a single institution 12-month survey. J Endocrinol Invest 2020; 43:477-482. [PMID: 31654311 DOI: 10.1007/s40618-019-01132-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/27/2019] [Accepted: 10/16/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Radiofrequency (RF) treatment has played an increasing role in the management of benign thyroid nodules in recent years. The aim of this retrospective study was to evaluate the efficacy of RF treatment on volume reduction in functioning and non-functioning thyroid nodules. PATIENTS AND METHODS We reviewed the medical records of patients who had thyroid nodule RF ablation at our department between August 2017 and May 2018. Patients underwent a periodical follow-up with ultrasound examinations and thyroid function tests at 1, 3, 6 and 12 months from RF. Complications were assessed using the reporting standards of Interventional societies. RESULTS 43 patients were submitted to thyroid nodule RF ablation treatment. Patients were subdivided into two groups, those with functioning (17 patients) or non-functioning nodules. At baseline (i.e. pre-RF treatment), the two groups of patients were superimposable for gender, age, BMI, nodule volume and maximum nodule diameter. The volume reduction of all 43 nodules was 69.1 ± 17.3% (range 26.0-94.5%) with no difference between functioning and non-functioning lesions (72.9 ± 18.1% vs 66.7 ± 16.7%, p = 0.254). A total energy delivered per nodule was 16.5 ± 6.8 kJ, with no difference between functioning and non-functioning lesions (14.5 ± 7.2 kJ vs. 18.2 ± 6.3 kJ, p = 0.083, respectively). No major complications were observed. CONCLUSIONS Radiofrequency ablation is a clinically effective and safe outpatient treatment in patients with benign nodules. In particular, we showed that a single treatment is effective in restoring euthyroidism in patients with autonomously functioning thyroid nodules.
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Affiliation(s)
- C Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy.
| | - F Franco
- Department of Radiology, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - I Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - E Gandossi
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - F Marini
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - E Di Lodovico
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - C Casella
- 3rd Division of General Surgery, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - D Lombardi
- Department of Otorhinolaryngology, Spedali Civili di Brescia, 25123, Brescia, Italy
| | - A Cristiano
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - A Ferlin
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - M Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
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17
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Giacché M, Panarotto A, Tacchetti MC, Tosini R, Campana F, Mori L, Cappelli C, Pirola I, Lombardi D, Pezzola DC, Casella C, Castellano M. p.Ser891Ala RET gene mutations in medullary thyroid cancer: Phenotypical and genealogical characterization of 28 apparently unrelated kindreds and founder effect uncovering in Northern Italy. Hum Mutat 2019; 40:926-937. [PMID: 30927507 DOI: 10.1002/humu.23754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/16/2019] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 12/30/2022]
Abstract
Applying genetic screening in medullary thyroid cancer (MTC) patients we identified an unexpectedly high frequency of c.2671T>G, p.Ser891Ala RET mutation carriers. Our aim was to: (a) deeply characterize the clinical expression of this mutation, (b) identify the presence of a founder effect in our region. Genetic analysis was performed in 251 relatives from 28 Ser891Ala kindreds, among 108 p.Ser891Ala asymptomatic carriers, 64 were submitted to thyroidectomy: mean age for 10 subjects presenting C-cells hyperplasia was 30.2 ± 13.7 years, raising to 37.9 ± 10.3 in 14 subjects with micro-MTC and to 55.0 ± 14.7 years in 39 subjects with MTC. Age-related progression across histopathological groups CCH/microMTC and MTC were statistically significant: genetic screening in Ser891Ala families could be safely postponed at the age of 14. To investigate the hypothesis of a common ancestor for Ser891Ala mutation we genotyped for 18 polymorphic microsatellite markers encompassing RET locus all subjects belonging to Ser891Ala families and we identified a founder effect, estimating the age of a common ancestor, dating back to 1493 AD. Ethnographic data collected in historical archives support laboratory results; the high prevalence of this mutation in our region could suggest the hypothesis of a population study to realize a preventive intervention in a rare neoplastic disease.
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Affiliation(s)
- Mara Giacché
- Endocrine and Metabolic Disease Unit, Department of Medicine, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alessandra Panarotto
- Molecular Medicine Laboratory, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Rossella Tosini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Federica Campana
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Mori
- Molecular Medicine Laboratory, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Cappelli
- Endocrine and Metabolic Disease Unit, Department of Medicine, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ilenia Pirola
- Endocrine and Metabolic Disease Unit, Department of Medicine, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology, Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Diego Cesare Pezzola
- Department of Surgery, Surgery Division II, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Claudio Casella
- Department of Molecular and Translational Medicine, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Maurizio Castellano
- Endocrine and Metabolic Disease Unit, Department of Medicine, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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18
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Cappelli C, Pirola I, Gandossi E, Marini F, Cristiano A, Casella C, Lombardi D, Agosti B, Ferlin A, Castellano M. Ultrasound Microvascular Blood Flow Evaluation: A New Tool for the Management of Thyroid Nodule? Int J Endocrinol 2019; 2019:7874890. [PMID: 31019533 PMCID: PMC6452547 DOI: 10.1155/2019/7874890] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/25/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Toshiba Medical System has developed a new Doppler technique [Superb Microvascular Imaging (SMI)] that has improved microvascular flow imaging. SMI depicts perinodular and intranodular thyroid microvascular flow in higher detail compared to standard colour Doppler (CD) and power Doppler (PD) imaging. OBJECTIVE Assess the nodular microvascular architecture by SMI compared to CD and PD features in a series of thyroid nodules submitted to fine needle aspiration cytology, in order to evaluate the potential of SMI in detecting thyroid cancer. MATERIALS AND METHODS From April 2016 to July 2017, 254 patients with thyroid nodules, evaluated as at high risk for malignancy in agreement with AACE/ACE/AME guidelines, were submitted to cytology. All nodules were previously submitted to ultrasound grayscale, CD, PD, and SMI evaluation. Benign and malignant nodules were stratified in accordance to the number of vessels visualised by SMI: score 1 with a maximum of two blood vessels and score 2 with three or more vessels. RESULTS Score 1 was found in 59.6% of benign nodules and in 17.9% of malignant nodules, whereas score 2 was found in 40.4% and in 82.1%, respectively (sensitivity 81.7%; specificity 60.5%, p < 0.001). Variables significantly associated with malignancy in the univariate analysis were gender (OR, 0.18; 95% CI, 0.08-0.37; p < 0.001), vascularity (OR, 1.91; 95% CI, 1.65-3.89; p < 0.001), and SMI (OR, 6.72; 95% CI, 3.89-11.59; p < 0.001); multivariate logistic model confirmed SMI score 2 as an independent risk factor for malignancy (OR, 6.99; 95% CI, 3.46-12.09; p < 0.001). CONCLUSIONS This prospective pilot study showed that SMI can depict intranodular flow in higher detail compared to CDI and PDI, thus improving thyroid cancer detection.
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Affiliation(s)
- Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Elena Gandossi
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Fiorella Marini
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alessandra Cristiano
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Claudio Casella
- Department of Molecular and Translational Medicine, 3rd Division of General Surgery, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Barbara Agosti
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
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19
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Pirola I, Gandossi E, Brancato D, Marini F, Cristiano A, Delbarba A, Agosti B, Castellano M, Cappelli C. TSH evaluation in hypothyroid patients assuming liquid levothyroxine at breakfast or 30 min before breakfast. J Endocrinol Invest 2018; 41:1301-1306. [PMID: 29582344 DOI: 10.1007/s40618-018-0867-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 01/22/2018] [Accepted: 03/09/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare TSH levels of hypothyroid patients treated with liquid LT4 at breakfast or 30 min before breakfast. PATIENTS AND METHODS Subjects, aged 18-75 years old, were eligible if they presented hypothyroidism, due to Hashimoto's thyroiditis or after thyroidectomy for proven benign goiter. Seven hundred ninety-eight patients were recruited and enrolled in the study. Thirty-seven subjects withdrew from the trial. A total of 761 patients (mean age 46.2 ± 10.8 years) completed the study. The starting dose of LT4 was determined through clinical judgment, taking into account TSH levels, estimated residual thyroid function, age, body weight and comorbidities. All patients underwent TSH, fT4, and fT3 evaluation to verify achievement of euthyroidism with their initial fasting state assumption of LT4 after 8 weeks of therapy. If euthyroidism was not achieved, an appropriately adjusted LT4 dose was administered for 8 weeks, after which thyroid function parameters were checked again. If euthyroidism was achieved, the patients were asked to take LT4 at breakfast and hormone levels were checked again after 6 months. RESULTS At the end of the study period, no significant differences in serum TSH level were observed whether LT4 was ingested at breakfast or 30 min prior in a fasting state: 2.61 ± 1.79 vs. 2.54 ± 1.86 mIU/L, respectively (p = 0.455). CONCLUSIONS This study confirms in a large set of patients that a liquid LT4 formulation can be taken directly at breakfast and potentially improve therapeutic compliance.
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Affiliation(s)
- I Pirola
- Endocrine and Metabolic Unit, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2° Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, 25100, Brescia, Italy
| | - E Gandossi
- Endocrine and Metabolic Unit, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2° Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, 25100, Brescia, Italy
| | - D Brancato
- Department of Internal Medicine, Regional Reference Center for Diabetology, Hospital of Partinico, Palermo, Italy
| | - F Marini
- Endocrine and Metabolic Unit, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2° Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, 25100, Brescia, Italy
| | - A Cristiano
- Endocrine and Metabolic Unit, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2° Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, 25100, Brescia, Italy
| | - A Delbarba
- Endocrine and Metabolic Unit, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2° Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, 25100, Brescia, Italy
| | - B Agosti
- Endocrine and Metabolic Unit, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2° Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, 25100, Brescia, Italy
| | - M Castellano
- Endocrine and Metabolic Unit, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2° Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, 25100, Brescia, Italy
| | - C Cappelli
- Endocrine and Metabolic Unit, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2° Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, 25100, Brescia, Italy.
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Cappelli C, Castello R, Marini F, Paoletta A, Marchetti M, Saullo M, Cristiano A, Pirola I, Gandossi E, Ferlin A, Castellano M. Adherence to Levothyroxine Treatment Among Patients With Hypothyroidism: A Northeastern Italian Survey. Front Endocrinol (Lausanne) 2018; 9:699. [PMID: 30532737 PMCID: PMC6265311 DOI: 10.3389/fendo.2018.00699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 09/07/2018] [Accepted: 11/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background: A significant number of patients show sub-optimal adherence to levothyroxine (LT4) therapy, mainly because they have to postpone their breakfast by at least 30 min. The aim of this observational cross-sectional study was to assess the therapeutic compliance of patients on LT4 treatment and to verify the preference of a lifetime treatment in tablet or liquid form. Patients and Methods: Ambulatory care patients aged 18 years or older, affected by hypothyroidism and on LT4 treatment (in tablet or liquid form) were administered the eight-item Morisky Medication Adherence Scale (MMAS-8). The MMAS-8 questionnaire was supplemented with 3 further items to specifically evaluate preference between tablet and liquid forms of LT4 for lifetime treatment. Results: A total of 320 patients (272 female), median age 47.9 ± 15.6 years (range, 20-78 years), completed the MMAS-8 questionnaire. Eighty-seven percent of the participants were adhering to their treatment for both tablet and liquid LT4 formulations, although significant differences emerged. Patients on LT4 tablets forgot to take their medication more frequently (p < 0.001), felt hassled about sticking to their treatment plan (p < 0.001), and had difficulty remembering to take all their medication(s) (p < 0.001) than those on liquid LT4 treatment. Conclusions: Adherence to LT4 treatment was high for both tablet and liquid formulations. Taking LT4 at breakfast was the most convenient option for most patients.
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Affiliation(s)
- Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
- *Correspondence: Carlo Cappelli
| | - Roberto Castello
- General Medicine and Endocrinology, University Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Fiorella Marini
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Agostino Paoletta
- Endocrinology Outpatient Service, Azienda ULSS 6 Euganea, Cittadella, Italy
| | - Massimo Marchetti
- General Medicine and Endocrinology, Ospedale Bassano del Grappa, Bassano del Grappa, Italy
| | - Maura Saullo
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessandra Cristiano
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Elena Gandossi
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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Cappelli C, Pirola I, Agosti B, Tironi A, Gandossi E, Incardona P, Marini F, Guerini A, Castellano M. Complications after fine-needle aspiration cytology: a retrospective study of 7449 consecutive thyroid nodules. Br J Oral Maxillofac Surg 2017; 55:266-269. [DOI: 10.1016/j.bjoms.2016.11.321] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
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Cappelli C, Pirola I, Gandossi E, Casella C, Lombardi D, Agosti B, Marini F, Delbarba A, Castellano M. TSH Variability of Patients Affected by Differentiated Thyroid Cancer Treated with Levothyroxine Liquid Solution or Tablet Form. Int J Endocrinol 2017; 2017:7053959. [PMID: 28572820 PMCID: PMC5441121 DOI: 10.1155/2017/7053959] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/13/2017] [Accepted: 03/22/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recent guidelines from the American Thyroid Association (ATA) indicate that, in many patients affected by differentiated thyroid cancer (DTC), the serum TSH should be maintained between 0.1 and 0.5 mU/L. The purpose of this study was to evaluate the TSH variability of patients affected by DTC treated with liquid L-T4 formulation or in tablet form. PATIENTS AND METHODS Patients were eligible if (a) they were submitted to a total thyroidectomy and 131I remnant ablation for DTC in our institution and (b) they were classified low-risk patients according to ATA guidelines 2009. Patients were randomized (1 : 1) to receive treatment of hypothyroidism with liquid L-T4 or tablet form. The first check-up evaluation was made from 8 to 12 months after 131I remnant ablation. TSH values were established again after further 12 months. RESULTS A significant increase in TSH values (median) was observed in patients taking tablets [TSH (min-max): 0.28 (0.1-0.45) versus 0.34 (0.01-0.78) mIU/L, p = 0.041] as compared to those taking liquid formulation [TSH (min-max): 0.28 (0.1-0.47) versus 0.30 (0.1-0.55) mIU/L, p = 0.345]. CONCLUSIONS The use of L-T4 liquid formulation, as compared to that of tablets, resulted in a significantly higher number of DTC patients maintaining TSH values in range for the ATA risk score, reducing TSH variability over the time.
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Affiliation(s)
- Carlo Cappelli
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
- *Carlo Cappelli:
| | - Ilenia Pirola
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Elena Gandossi
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Claudio Casella
- Department of Molecular and Translational Medicine, 3rd Division of General Surgery, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Barbara Agosti
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Fiorella Marini
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Andrea Delbarba
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Maurizio Castellano
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
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Pirola I, Gandossi E, Agosti B, Delbarba A, Cappelli C. Wpływ suplementacji selenu na przywrócenie eutyreozy u chorych na subkliniczną niedoczynność tarczycy w wyniku autoimmunologicznego zapalenia tarczycy. Endokrynologia Polska 2016; 67:567-571. [DOI: 10.5603/ep.2016.0064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 06/09/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022]
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Cappelli C, Pirola I, Daffini L, Formenti A, Iacobello C, Cristiano A, Gandossi E, Agabiti Rosei E, Castellano M. A Double-Blind Placebo-Controlled Trial of Liquid Thyroxine Ingested at Breakfast: Results of the TICO Study. Thyroid 2016; 26:197-202. [PMID: 26586610 DOI: 10.1089/thy.2015.0422] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Levothyroxine (LT4) is the recommended treatment for millions of hypothyroid patients. Current guidelines recommend that LT4 tablets be taken in a fasting state, but inability to adhere to this often leads to poor therapy compliance. METHODS A randomized, double-blind, placebo-controlled, crossover trial was conducted in previously untreated hypothyroid patients randomly assigned to receive an oral solution of LT4 either at least 30 minutes before breakfast or directly at breakfast time. Each patient completed two six-week treatment periods, with different timing of active LT4 administration: placebo before breakfast and active LT4 at breakfast, or vice versa. At the end of each period, thyrotropin (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) were measured. The primary endpoint was to verify any difference in serum TSH levels whether consuming liquid LT4 at breakfast or 30 minutes prior to breakfast. RESULTS A total of 77 patients (64 females; median age 45.4 ± 3.7 years) completed the study. No statistically significant differences in serum TSH, fT4, or fT3 levels were observed whether LT4 was taken at breakfast or 30 minutes before, in a fasting state. No significant effect from the sequence of regimens, breakfast composition, and/or concomitantly administered drugs was observed on the dose of LT4 administered, or on the post-treatment serum TSH values. CONCLUSIONS The TICO study suggests that a liquid LT4 formulation can be ingested directly at breakfast, thus potentially improving therapeutic compliance. This observation is of considerable clinical relevance, since non-adherence to LT4 therapy requirements is more likely to cause variability in serum TSH concentrations.
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Affiliation(s)
- Carlo Cappelli
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Ilenia Pirola
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Linda Daffini
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Annamaria Formenti
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Carmelo Iacobello
- 2 Department of Molecular and Translational Medicine, University of Brescia , Brescia, Italy
| | - Alessandra Cristiano
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Elena Gandossi
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Enrico Agabiti Rosei
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Maurizio Castellano
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
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Cappelli C, Pirola I, Gandossi E, Cristiano A, Daffini L, Agosti B, Casella C, Castellano M. Thyroid Hormone Profile in Patients Ingesting Soft Gel Capsule or Liquid Levothyroxine Formulations with Breakfast. Int J Endocrinol 2016; 2016:9043450. [PMID: 27313613 PMCID: PMC4904100 DOI: 10.1155/2016/9043450] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 01/05/2023] Open
Abstract
Background. Recently, it has been shown that liquid L-T4 formulation can be ingested with breakfast. This study looked to extend these findings by investigating whether a soft gel capsule formulation of L-T4 could also be ingested at breakfast time. Methods. 60 patients (18-65 yrs), previously submitted to thyroidectomy for proven benign goitre in stable euthyroidism receiving liquid L-T4 therapy ingested with breakfast, were enrolled. TSH, fT4, and fT3 levels were assessed in all the patients who were switched from liquid L-T4 to a soft gel capsule formulation at the same dosage of L-T4. After 6 months, TSH, fT4, and fT3 levels were determined again. Results. There were no differences in TSH levels, but fT3 and fT4 levels during treatment with the soft gel capsule were significantly lower than those at enrolment with the liquid L-T4 formulation (TSH median (min-max): 1.9 (0.5-4.0) versus 2.2 (0.5-4.5) mIU/L, fT3: 2.5 (2.4-3.1) versus 2.7 (2.4-3.3) pg/mL, p < 0.05, and fT4: 9.9 (8.0-13) versus 10.6 (8.6-13.8) pg/mL, p < 0.0001). Conclusion. Both liquid and soft gel formulations of L-T4 can be taken with breakfast. However, liquid L-T4 would be the preferred formulation for patients in whom even small changes in fT4 and fT3 levels are to be avoided.
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Affiliation(s)
- Carlo Cappelli
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, University of Brescia, Spedali Civili di Brescia, 25123 Brescia, Italy
- *Carlo Cappelli:
| | - Ilenia Pirola
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, University of Brescia, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Elena Gandossi
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, University of Brescia, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alessandra Cristiano
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, University of Brescia, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Linda Daffini
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, University of Brescia, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Barbara Agosti
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, University of Brescia, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Claudio Casella
- Department of Molecular and Translational Medicine, 3rd Division of General Surgery, University of Brescia, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Maurizio Castellano
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, 2nd Medicina, University of Brescia, Spedali Civili di Brescia, 25123 Brescia, Italy
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Abstract
OBJECTIVE To evaluate the need and the magnitude of levothyroxine (LT4) increase in hypothyroid pregnant women on liquid compared to tablet formulations. METHODS Patients were recruited by searching our "thyroid patients" database. The selection criteria were as follows: a) pregnant women on treatment for hypothyroidism (both liquid and tablet LT4) who gave birth at our hospital between February 2012 and January 2014; b) thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels obtained at least 3 months before missed menstrual cycle, with a TSH value less than 2.5 mIU/L and c) TSH and FT4 obtained within 12 weeks of pregnancy, and each month subsequently. RESULTS During pregnancy, 8/31 (25.5%) of the women had to increase the dosage of LT4. Of these, 7/17 (41.2%) were on LT4 replacement therapy with tablets, and 1/14 (7.1%) with liquid formulation (p = 0.038). Daily LT4 was significantly increased in the liquid group only (52.9 ± 19.5 versus 67.5 ± 19.2 mcg/day (p = 0.013). A logistic regression analysis showed that the treatment with LT4 tablets was the only predictor of LT4 increase (OR: 0.44; 95% CI: 0.04-0.83; p = 0.031). CONCLUSION Pregnant women on optimal replacement therapy before pregnancy require an increase of LT4 dosage more often when on a tablet than liquid formulation.
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Affiliation(s)
- Carlo Cappelli
- a Department of Clinical and Experimental Sciences , Endocrine and Metabolic Unit, University of Brescia , Brescia , Italy and
| | - Roberto Negro
- b Division of Endocrinology , "V. Fazzi" Hospital , Lecce , Italy
| | - Ilenia Pirola
- a Department of Clinical and Experimental Sciences , Endocrine and Metabolic Unit, University of Brescia , Brescia , Italy and
| | - Elena Gandossi
- a Department of Clinical and Experimental Sciences , Endocrine and Metabolic Unit, University of Brescia , Brescia , Italy and
| | - Barbara Agosti
- a Department of Clinical and Experimental Sciences , Endocrine and Metabolic Unit, University of Brescia , Brescia , Italy and
| | - Maurizio Castellano
- a Department of Clinical and Experimental Sciences , Endocrine and Metabolic Unit, University of Brescia , Brescia , Italy and
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Affiliation(s)
- Anna Maria Formenti
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, Brescia, Italy
| | - Linda Daffini
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, Brescia, Italy
| | - Elena Gandossi
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, Brescia, Italy
| | - Alessandra Cristiano
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, Brescia, Italy
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Cappelli C, Pirola I, Gandossi E, Formenti A, Agosti B, Castellano M. Elastography Evaluation of Benign Thyroid Nodules in Patients Affected by Hashimoto's Thyroiditis. Int J Endocrinol 2015; 2015:367054. [PMID: 26273296 PMCID: PMC4530237 DOI: 10.1155/2015/367054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/25/2015] [Accepted: 06/28/2015] [Indexed: 11/30/2022] Open
Abstract
The aim of the present prospective study was to evaluate the predictive value of elastography in benign thyroid nodules of patients affected by Hashimoto's thyroiditis (HT). From January 2011 to January 2012, 242 nodules in patients affected by HT were submitted to fine needle aspiration cytology (FNAC). All of the patients underwent sonography and elastography performed before FNAC. 230 (95%) nodules were benign, 8 papillary cancers, and 4 follicular lesions. Score 1 was found in 79.1% of benign lesions (sensitivity 79.1%; specificity 66.7%; PPV 97.8%; NPV 14.3%; accuracy 78.5%; p < 0.05). In order to evaluate the outcome of thyroid ultrasound echogenicity in relation to elastography features of nodule(s), all the patients with benign nodules were stratified according to their hypoechoic pattern of thyroid (mild-moderate and severe). Following stratification score 1 was found in 84.2% of benign nodules (sensitivity 75.0%; specificity 88.9%; PPV 27.3%; NPV 98.4%; accuracy 88.2%; p < 0.0001) of patients with a mild-moderate ultrasound thyroid hypoechogenicity, whereas it was found in 60% of benign nodules (p = 0.715) of patients with a marked thyroid hypoechogenicity. Elastography appears to have limited value in detecting thyroid cancer in patients affected by Hashimoto's thyroiditis with severe hypoechoic thyroid tissue.
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Affiliation(s)
- Carlo Cappelli
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Piazzale Spedali Civili No. 1, 25100 Brescia, Italy
- *Carlo Cappelli:
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Piazzale Spedali Civili No. 1, 25100 Brescia, Italy
| | - Elena Gandossi
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Piazzale Spedali Civili No. 1, 25100 Brescia, Italy
| | - Annamaria Formenti
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Piazzale Spedali Civili No. 1, 25100 Brescia, Italy
| | - Barbara Agosti
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Piazzale Spedali Civili No. 1, 25100 Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Piazzale Spedali Civili No. 1, 25100 Brescia, Italy
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Cappelli C, Pirola I, Daffini L, Gandossi E, Agosti B, Castellano M. Thyroid hormonal profile in elderly patients treated with two different levothyroxine formulations: A single institute survey. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pirola I, Daffini L, Gandossi E, Lombardi D, Formenti A, Castellano M, Cappelli C. Comparison between liquid and tablet levothyroxine formulations in patients treated through enteral feeding tube. J Endocrinol Invest 2014; 37:583-7. [PMID: 24789541 DOI: 10.1007/s40618-014-0082-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/07/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The majority of clinicians suggest that enteral feedings should be held 1-2 h prior to and after L-T4 administration despite lack of data for continuous enteral nutrition. AIM The aim of this study was to: (1) compare the thyroid hormonal profile in patients submitted to L-T4 treatment in tablets or liquid formulation with an enteral feeding tube; (2) evaluate the nursing compliance with the two different formulations. SUBJECTS AND METHODS 20 euthyroid patients submitted to total laryngectomy and thyroidectomy consecutively started L-T4 treatment in tablets (Group T) or in liquid formulation (Group L) with enteral feeding tube the day after surgery. Tablets were crushed before administration and enteral feeding was stopped for 30 min before and after L-T4 treatment, whereas liquid formulation was placed into the nasoenteric tube immediately. A questionnaire about the preparation and administration of thyroxine replacement therapy was given to the nurses. RESULTS No difference of TSH, fT4 and fT3 before and after L-T4 treatment was observed among patients of Group L. A slightly serum TSH increase was observed in Group T, but not reaching statistical significance (2.50 ± 1.18 vs 2.94 ± 1.22 mUI/L), whereas no difference in fT4 and fT3 levels was found. Preparation and administration of liquid L-T4 was considered excellent by 12/13 nurses, whereas tablet formulation was considered poor by 10/13. CONCLUSIONS Our data showed that liquid L-T4 formulation can be administered directly through feeding tube with no need for an empty stomach, with a significant improvement in therapy preparation and administration by nurses.
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Affiliation(s)
- I Pirola
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, c/o 1^ Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n°1, Brescia, 25100, Italy
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Cappelli C, Pirola I, Gandossi E, Formenti AM, Agosti B, Castellano M. Ultrasound findings of subacute thyroiditis: a single institution retrospective review. Acta Radiol 2014; 55:429-33. [PMID: 23969266 DOI: 10.1177/0284185113498721] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND High resolution ultrasonography features have also been described as having a useful supporting role in the diagnosis of subacute granulomatous thyroiditis (ST), and images are generally characterized by heterogeneous hypoechoic areas of the affected tissue with lack of flow on color Doppler US. PURPOSE To determine the sonographic features of subacute granulomatous thyroiditis. MATERIAL AND METHODS We reviewed the medical records of patients referred at the Endocrine and Metabolic Unit of our Institution between January 2010 and December 2011. RESULTS A total of 7520 patients were evaluated in our department between January 2010 and December 2011. Among them, 22 (0.3%) patients had a diagnosis of ST (19 women and 3 men, 45.4 ± 9.7 year; range, 33-62 years). Ultrasound examination showed bilateral ST in 64% of patients. Thyroid volume was 13.2 ± 7.7 mL, without difference if ST was unilateral (13.2 ± 7.1 mL) or bilateral (13.9 ± 8.3 mL). On grayscale US, heterogeneous diffusely or focally marked hypoechoic areas, like "lava flow", were found in all the lesions. CONCLUSION Our data confirm the high sensitivity of US in the diagnosis of ST: diffuse hypoechoic and confluent areas with the characteristic features like "lava flow".
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Affiliation(s)
- C Cappelli
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Italy
| | - I Pirola
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Italy
| | - E Gandossi
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Italy
| | - AM Formenti
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Italy
| | - B Agosti
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Italy
| | - M Castellano
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, University of Brescia, Italy
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Cappelli C, Rotondi M, Pirola I, Agosti B, Formenti AM, De Cata P, Salvetti M, Chiovato L, Castellano M. Metformin-induced thyrotropin suppression is not associated with cardiac effects. Hormones (Athens) 2014; 13:252-8. [PMID: 24776625 DOI: 10.1007/bf03401339] [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: 01/28/2023]
Abstract
OBJECTIVE Metformin treatment may induce a decrease/suppression in serum TSH levels, mimicking sub-clinical hyperthyroidism (SHT). The aim of the present study was to retrospectively evaluate changes in several electrocardiographic indices in euthyroid subjects with diabetes who, after starting metformin treatment, developed a low serum TSH as compared to patients with SHT resulting from an underlying thyroid disease or TSH suppressive treatment with L-thyroxine. DESIGN Heart rate, P wave duration, P wave dispersion, QTmax, QTmin and QT-dispersion were assessed in 23 patients with diabetes treated with metformin before and after 6 months of TSH-suppression and in 31 control patients with SHT. RESULTS No significant changes in electrocardiographic parameters were observed from baseline to the TSH-suppression measurement. A significant difference in P wave duration (102.9 ± 7.4 vs. 92.1 ± 5.8 ms, p<0.001), P wave dispersion (13.1 ± 3.4 vs. 7.1 ± 3.5 ms, p<0.001), QTmax (399 ± 18 vs. 388 ± 16 ms, p=0.024), QTmin (341 ± 14 vs. 350 ± 17 ms, p=0.038) and QT dispersion (49.9 ± 9.6 vs. 30.9 ± 9.2 ms, p<0.001) were observed between the control group with SHT and the group of diabetic patients with low serum levels of TSH. CONCLUSIONS Our results show that the TSH-suppressive effect observed in patients taking metformin is not associated with peripheral markers of thyroid hormone excess, at least at the cardiac level.
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Affiliation(s)
- Carlo Cappelli
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia; Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Superiore Prevenzione e Sicurezza Lavoro Laboratory for Endocrine Disruptors, University of Pavia; Italy
| | - Ilenia Pirola
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia; Italy
| | | | - Ana Maria Formenti
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia; Italy
| | - Pasquales De Cata
- Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Superiore Prevenzione e Sicurezza Lavoro Laboratory for Endocrine Disruptors, University of Pavia; Italy
| | - Massimo Salvetti
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia; Italy
| | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Superiore Prevenzione e Sicurezza Lavoro Laboratory for Endocrine Disruptors, University of Pavia; Italy
| | - Maurizio Castellano
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia; Italy
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Pirola I, Formenti AM, Gandossi E, Mittempergher F, Casella C, Agosti B, Cappelli C. Oral liquid L-thyroxine (L-t4) may be better absorbed compared to L-T4 tablets following bariatric surgery. Obes Surg 2014; 23:1493-6. [PMID: 23824980 PMCID: PMC3726924 DOI: 10.1007/s11695-013-1015-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Drug malabsorption is a potential concern after bariatric surgery. We present four case reports of hypothyroid patients who were well replaced with thyroxine tablets to euthyroid thyrotropin (TSH) levels prior to Roux-en-Y gastric bypass surgery. These patients developed elevated TSH levels after the surgery, the TSH responded reversibly to switching from treatment with oral tablets to a liquid formulation.
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Affiliation(s)
- Ilenia Pirola
- Department of Clinical and Experimental Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, 1 Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n1, 25100 Brescia, Italy
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Abstract
OBJECTIVE Taking levothyroxine (L-T₄) with coffee or with water followed by coffee intake within a few minutes results in poor TSH response in many patients. T₄ is available in tablet form worldwide, but novel formulations in soft gel capsule or liquid form are now available. DESIGN We fortuitously identified a euthyroid patient who wrongly consumed liquid L-T₄ with coffee at breakfast; after changing the time of consumption to 30 min before breakfast, no change in TSH, free T₄ (fT₄), and free tri-iodothyronine (fT₃) concentrations was observed. Once the first patient was identified, additional stable euthyroid patients who consumed liquid L-T₄ with coffee were identified. METHODS Patients were recruited by searching our 'thyroid patients' database. All the patients on liquid L-T₄ treatment were contacted by phone to ask them whether they took L-T₄ at breakfast. We identified 54 patients who were submitted to TSH, fT₄, and fT₃ evaluation, with the indication that the same dosage of L-T₄ be consumed 30 min before breakfast. We determined their TSH, fT₄, and fT₃ concentrations after 3 and 6 months again. RESULTS no significant difference in thyroid hormone concentrations was observed in patients when they consumed L-T₄ at breakfast or when they consumed it 30 min before breakfast for 3 and 6 months (TSH: 2.5±1.1 vs 2.5±1.1 and 2.4±1.1 mIU/l respectively, fT₄: 12.4±2.4 vs 12.5±2.4 and 12.3±2.1 pg/ml respectively, and fT₃: 3.4±0.6 vs 3.4±0.6 and 3.3±0.5 pg/ml respectively). CONCLUSION Oral liquid L-T₄ formulations could diminish the problem of L-T₄ malabsorption caused by coffee when using traditional tablet formulations.
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Affiliation(s)
- Carlo Cappelli
- Endocrine and Metabolic Unit, Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 1^ Medicina Spedali Civili di Brescia, Piazzale Spedali Civili no. 1, 25100 Brescia, Italy
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Cappelli C, Pirola I, Gandossi E, Agosti B, Cimino E, Casella C, Formenti A, Castellano M. Real-time elastography: a useful tool for predicting malignancy in thyroid nodules with nondiagnostic cytologic findings. J Ultrasound Med 2012; 31:1777-1782. [PMID: 23091248 DOI: 10.7863/jum.2012.31.11.1777] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the predictive value of sonography and sonographic elastography in thyroid nodules with nondiagnostic cytologic findings. METHODS The study included 101 patients (74 female, mean age ± SD, 55 ± 11 years [range, 27-70 years]; and 27 male, mean age, 62 ± 9 years [range, 42-72 years]) who had at least 1 nodule with nondiagnostic cytologic findings at two different fine-needle aspiration cytologic evaluations and with an indication for hemi or total thyroidectomy for clinical suspicion of malignancy, nodule size, or the occurrence of a coexisting nodule with cytologic findings suspicious for malignancy. All of the patients underwent sonography and elastography 2 months after the second fine-needle aspiration and before surgery. The elastogram was matched with an elasticity color scale and classified as follows: score 1, nodules with high elasticity (soft); score 2, nodules with indeterminate elasticity; and score 3, nodules with low elasticity (hard). RESULTS A total of 135 nodules (93.7%) were hyperplastic; 15 (9.4%) were papillary carcinomas; and 9 (6.3%) were follicular adenomas. The association of scores 2 and 3 identified 12 of 15 thyroid cancers (sensitivity, 80.0%; specificity, 93.7%; positive predictive value, 57.1%; negative predictive value, 97.8%; and accuracy, 92.4%), whereas the association of conventional sonographic features plus scores 2 and 3 identified all of the cancers (specificity, 70.8%; positive predictive value, 26.3%; negative predictive value, 100%; and accuracy, 73.6%). CONCLUSIONS Our data suggest that elastography could be a promising tool in the management of nodules that are nondiagnostic at cytologic evaluation, reducing unnecessary surgery.
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Affiliation(s)
- Carlo Cappelli
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, Clinica Medica, University of Brescia, c/o 1 Medicina Spedali Civili di Brescia, 1 Piazzale Spedali Civili, 25100 Brescia, Italy.
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Cappelli C, Rotondi M, Pirola I, Agosti B, Formenti A, Zarra E, Valentini U, Leporati P, Chiovato L, Castellano M. Thyreotropin levels in diabetic patients on metformin treatment. Eur J Endocrinol 2012; 167:261-5. [PMID: 22645202 DOI: 10.1530/eje-12-0225] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A retrospective study to evaluate the changes in TSH concentrations in diabetic patients treated or not treated with metformin and/or L-thyroxine (L-T(4)). METHODS Three hundred and ninety three euthyroid diabetic patients were divided into three groups on the basis of metformin and/or L-T(4) treatment: Group (M-/L-), 119 subjects never treated with metformin and L-T(4); Group (M+/L-), 203 subjects who started metformin treatment at recruitment; and Group (M+/L+), 71 patients on L-T(4) who started metformin recruitment. RESULTS The effect of metformin on serum TSH concentrations was analyzed in relation to the basal value of TSH (below 2.5 mIU/L (Q1) or between 2.51 and 4.5 mIU/L (Q2)). In patients of group M+/L+, TSH significantly decreased independently from the basal level (Q1, from 1.450.53 to 1.011.12 mU/L (P=0.037); Q2, from 3.600.53 to 1.910.89 mU/L (P<0.0001)). In M+/L group, the decrease in TSH was significant only in those patients with a basal high-normal serum TSH (Q2: from 3.24±0.51 to 2.27±1.28 mU/l (P=0.004)); in M-/L- patients, no significant changes in TSH levels were observed. In patients of group M+/L showing high-normal basal TSH levels, a significant decrease in TSH was observed independently from the presence or absence of thyroid peroxidase antibodies (ABTPO; Q2 ABTPO +: from 3.38±0.48 to 1.87±1.08 mU/l (P<0.001); Q2 AbTPO -: from 3.21±0.52 to 2.34±1.31 mU/l (P<0.001)). CONCLUSIONS These data strengthen the known TSH-lowering effect of metformin in diabetic patients on L-T(4) treatment and shows a significant reduction of TSH also in euthyroid patients with higher baseline TSH levels independently from the presence of AbTPO.
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Affiliation(s)
- Carlo Cappelli
- Endocrine and Metabolic Unit, Department of Medical and Surgical Sciences, Clinica Medica, University of Brescia, c/o 1 Medicina Spedali Civili Piazzale Spedali Civili 1, 25100 Brescia, Italy.
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Cappelli C, Pirola I, Mittempergher F, De Martino E, Casella C, Agosti B, Nascimbeni R, Formenti A, Rosei EA, Castellano M. Morbid obesity in women is associated to a lower prevalence of thyroid nodules. Obes Surg 2012; 22:460-4. [PMID: 21491133 DOI: 10.1007/s11695-011-0410-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have recently showed functional and morphological changes of the thyroid gland in relation to obesity. To our knowledge, no data are available about the prevalence of thyroid nodules in female obese patients. The aim of this study was to investigate the prevalence of thyroid nodules in morbidly obese women. METHODS One hundred eight consecutive female obese patients were selected from those referred to our medical and surgery outpatients providing that following criteria were satisfied: (1) affected by morbid obesity (body mass index (BMI) >40 kg/m(2)); (2) no previous diagnosis of thyroid disease; (3) biochemically proven euthyroid state at the time of recruitment. Ninety-seven control subjects, constituted by normo-weight and/or slightly overweight (BMI ≤ 30 kg/m(2)) women, should satisfy the above criteria 2 and 3. All the subjects were submitted to ultrasound investigation. RESULTS The two groups of patients displayed no differences for age and fT4 levels. Obese patients clearly showed a lower prevalence of thyroid nodules [odds ratio 0.294, 95% confidence interval 0.206-0.382]. A single nodule was found in 23% of obese patients as compared to 65% of control subjects (p < 0.0001). No difference for age (year) was found between obese and non-obese subjects with nodules (40.5 ± 8.2 vs. 44.2 ± 8.9, respectively, p = 0.07). CONCLUSIONS Our data clearly show a significantly lower prevalence of thyroid nodules in morbidly obese patients. Further studies are needed to confirm and to understand this first observation.
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Affiliation(s)
- Carlo Cappelli
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia, Piazzale Spedali Civili n°1, 25100, Brescia, Italy.
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Cappelli C, Rotondi M, Pirola I, De Martino E, Gandossi E, Agosti B, Agabiti Rosei E, Chiovato L, Castellano M. Usefulness of repeated recombinant human thyrotropin-stimulated thyroglobulin test in the post-surgical follow-up of very low-risk patients with differentiated thyroid carcinoma. J Endocrinol Invest 2012; 35:459-63. [PMID: 22067268 DOI: 10.3275/8057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/17/2022]
Abstract
BACKGROUND The European Thyroid Association (ETA) and the American Thyroid Association (ATA) guidelines identify subgroups of patients affected by thyroid carcinoma in whom, due to a low risk of recurrence, radioiodine ablation is not indicated. These patients are referred to as "very low-risk" according to the ETA consensus and "low-risk" patients according to the ATA guidelines. The recommended post-surgical follow-up of these patients is based upon periodical measurements of serum thyroglobulin (Tg) on levothyroxine therapy and neck ultrasound (US). AIM To evaluate the usefulness of recombinant human (rh)-TSH Tg test and its repetition 2-3 yr afterwards in very low-risk patients. MATERIALS AND METHODS We consecutively enrolled 32 patients with undetectable anti-Tg antibodies. Basal serum Tg levels was undetectable in all patients. RESULTS Following rhTSH serum Tg remained undetectable in 23 (71.9%) patients (UP) and was >1.0 ng/ml in 9 (DP). US and whole body scan, revealed lymph node metastasis in 4/9 DP patients. A second rhTSH stimulation test (36.9±3.5 months later) was performed in all UP and in 5 DP patients without proven recurrences. All the UP and 4/5 formerly DP patients showed undetectable Tg stimulation. CONCLUSIONS Our results suggest that rhTSH Tg test may be helpful in very low-risk patients, given its ability to differentiate those who may be considered "free of disease" from those who require further investigation and treatment. Repeated rhTSH Tg tests may be indicated only in patients with detectable serum Tg at prior stimulation testing.
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Affiliation(s)
- C Cappelli
- Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia, Brescia, Italy.
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Giacché M, Panarotto A, Mori L, Daffini L, Tacchetti MC, Pirola I, Agabiti Rosei E, Castellano M. A novel menin gene deletional mutation in a little series of Italian patients affected by apparently sporadic multiple endocrine neoplasia type 1 syndrome. J Endocrinol Invest 2012; 35:124-8. [PMID: 22490989 DOI: 10.1007/bf03345419] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 12/14/2022]
Abstract
AIM To perform a genetic screening for the multiple endocrine neoplasia type 1 (MEN1) gene mutations in patients affected by an apparently sporadic form of the disease, referred to an internal medicine unit of a large general hospital. SUBJECTS AND METHODS In a group of 12 consecutive patients presenting clinical features of MEN type 1 syndrome, we performed a genetic screening for germline MEN1 gene mutations, including complete sequencing of the coding region (exons 2 to 10) and multiplex ligation-dependent probe amplification analysis for large deletion detection. RESULTS Among these patients affected by apparently sporadic MEN type 1 syndrome, a targeted clinical history could detect indirect support for a diagnosis of familial condition only in 2 cases. The genetic screening identified pathogenic germline MEN1 gene mutations in 3 patients (25%). A previously unknown 18 base-pair deletion within exon 3, c.564_581delCAATGGGGAGCAGACAGC, resulting in loss of 6 amino acids (pAsp189_Ala194del), was found in heterozygosis in a woman affected by primary hyperparathyroidism and multifocal pancreatic neoplasia. CONCLUSIONS Our results underscore the importance of performing genetic testing also in apparently sporadic MEN1 patients and extend the list of molecular variants leading to inactivation of the MEN1 gene.
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Affiliation(s)
- M Giacché
- Internal Medicine Division, Department of Medical and Surgical Sciences, University of Brescia – Spedali Civili of Brescia, Italy.
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Cappelli C, Pirola I, De Martino E, Gandossi E, Cimino E, Samoni F, Agosti B, Rosei EA, Casella C, Castellano M. Thyroglobulin measurement in fine-needle aspiration biopsy of metastatic lymph nodes after rhTSH stimulation. Head Neck 2011; 35:E21-3. [PMID: 21692135 DOI: 10.1002/hed.21796] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2011] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Thyroglobulin measurement in the washout of the needle used in fine-needle aspiration cytology (FNAC) has been proposed for the early detection of lymph node metastasis both in patients with or without serum thyroglobulin antibodies; however, up to now, there have been no reports that recombinant human thyrotropin (rhTSH) stimulation modifies thyroglobulin measurement in lymph node aspirates. METHODS We described, after rhTSH stimulation, the switching from undetectable to detectable levels of thyroglobulin in fine-needle aspiration fluid from a suspected metastatic lymph node in 2 patients. RESULTS We hypothesized that thyroglobulin levels in the lymph node increased after rhTSH stimulation. The excess thyroglobulin saturates all thyroglobulin antibody binding sites and becomes detectable, explaining why it was undetectable when TSH was suppressed. CONCLUSION On the basis of our experience, we suggest submitting to thyroglobulin measurement in the washout of the needle used in FNAC all patients with detectable serum thyroglobulin antibody after rhTSH stimulation.
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Affiliation(s)
- Carlo Cappelli
- Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia, Brescia, Italy.
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Pirola I, Cappelli C, Delbarba A, Scalvini T, Agosti B, Assanelli D, Bonetti A, Castellano M. Anabolic steroids purchased on the Internet as a cause of prolonged hypogonadotropic hypogonadism. Fertil Steril 2010; 94:2331.e1-3. [PMID: 20416868 DOI: 10.1016/j.fertnstert.2010.03.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 03/13/2010] [Accepted: 03/17/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To report a case of hypogonadotropic hypogonadism due to the chronic abuse of anabolic steroids purchased over the Internet. DESIGN Case report. SETTING Endocrinology unit of the University of Brescia. PATIENT(S) A 34-year-old man. INTERVENTION(S) A single dose (100 μg) of triptorelin (triptorelin test). MAIN OUTCOME MEASURE(S) Clinical symptoms, androgen normalization, levels of serum testosterone, follicle-stimulating hormone, and luteinizing hormone. RESULT(S) Within 1 month, the patient's serum testosterone was in the normal range, and he reported a return to normal energy and libido. CONCLUSION(S) The World Anti-Doping Code has proved to be a very powerful and effective tool in the harmonization of antidoping efforts worldwide, but it is insufficient to combat this illegal phenomenon. To tackle the serious side effects caused by doping we believe that it is necessary to increase monitoring and adopt severe sanctions, particularly with regard to Internet sites.
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Affiliation(s)
- Ilenia Pirola
- Internal Medicine and Endocrinology Unit, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy
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Cappelli C, Rotondi M, Pirola I, Agosti B, Gandossi E, Valentini U, De Martino E, Cimino A, Chiovato L, Agabiti-Rosei E, Castellano M. TSH-lowering effect of metformin in type 2 diabetic patients: differences between euthyroid, untreated hypothyroid, and euthyroid on L-T4 therapy patients. Diabetes Care 2009; 32:1589-90. [PMID: 19502536 PMCID: PMC2732148 DOI: 10.2337/dc09-0273] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the interplay between metformin treatment and thyroid function in type 2 diabetic patients. RESEARCH DESIGN AND METHODS The acute and long-term effects of metformin on thyroid axis hormones were assessed in diabetic patients with primary hypothyroidism who were either untreated or treated with levothyroxine (L-T4), as well as in diabetic patients with normal thyroid function. RESULTS No acute changes were found in 11 patients with treated hypothyroidism. After 1 year of metformin administration, a significant thyrotropin (TSH) decrease (P < 0.001) was observed in diabetic subjects with hypothyroidism who were either treated (n = 29; from 2.37 +/- 1.17 to 1.41 +/- 1.21 mIU/l) or untreated (n = 18; 4.5 +/- 0.37 vs. 2.93 +/- 1.48) with L-T4, but not in 54 euthyroid subjects. No significant change in free T4 (FT4) was observed in any group. CONCLUSIONS Metformin administration influences TSH without change of FT4 in patients with type 2 diabetes and concomitant hypothyroidism. The need for reevaluation of thyroid function in these patients within 6-12 months after starting metformin is indicated.
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Affiliation(s)
- Carlo Cappelli
- Internal Medicine and Endocrinology Unit, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
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Cappelli C, Rotondi M, Pirola I, De Martino E, Leporati P, Magri F, Rosei EA, Chiovato L, Castellano M. Prevalence of parathyroid cysts by neck ultrasound scan in unselected patients. J Endocrinol Invest 2009; 32:357-9. [PMID: 19636206 DOI: 10.1007/bf03345727] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Parathyroid cysts (PC) are a rare entity, representing only 0.5-1% of all parathyroid lesions and <1% of neck masses. Since its first description, in the second half of the 19th century, fewer than 300 cases have been reported. By reviewing the literature, it appears that the data available arose from surgical series, and the precise incidence of PC as detected by ultrasound (US) has not been described. The aim of this study was to review 5 yr of routine neck US, mainly performed for thyroid diseases, in order to estimate the prevalence of PC in a large series of patients. METHODS We reviewed our database of neck US investigations performed from 2003 to 2007: all data regarding patient's clinical history, US images, and fine needle aspiration cytology were retrospectively collected. RESULTS Among 6621 patients submitted to neck US investigation, a PC (mean diameter 36.4+/-14.2 mm; range 25-61 mm) was diagnosed in 5 cases. Serum PTH levels were high in all the patients (221+/-140.7 pg/ml; range 111-456 pg/ml), whereas serum calcium levels only in 3 subjects (10.8+/-1.4 mg/dl; range 9.2-12.9 mg/ml). CONCLUSION This is the first study evaluating the prevalence of PC in a large series of unselected patients by US. Our results demonstrate a much lower incidence (0.075%) of incidentally detected PC than previously reported.
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Affiliation(s)
- C Cappelli
- Internal Medicine and Endocrinology Unit, Department of Medical and Surgical Sciences, University of Brescia, c/o 2; Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n degrees 1, 25100 Brescia, Italy.
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Rotondi M, Cappelli C, Pirali B, Pirola I, Magri F, Fonte R, Castellano M, Rosei EA, Chiovato L. The effect of pregnancy on subsequent relapse from Graves' disease after a successful course of antithyroid drug therapy. J Clin Endocrinol Metab 2008; 93:3985-8. [PMID: 18664537 DOI: 10.1210/jc.2008-0966] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Pregnancy and the postpartum (PP) period are associated with profound changes of the immune system, which largely influence the clinical activity of autoimmune diseases. The aim of this study was to evaluate the effect of pregnancy and/or the PP period in driving a clinical relapse of hyperthyroidism in patients with Graves' disease (GD) who are in remission after antithyroid drug (ATD) treatment. Data were retrospectively collected from 150 female patients with GD, who were assigned to two groups according to the occurrence of a successful pregnancy after ATD withdrawal. RESULTS Relapsing Graves' hyperthyroidism was observed in 70 of 125 patients in group I (no pregnancy after ATD withdrawal) (56.0%) and 21 of 25 patients in group II (pregnancy after ATD withdrawal) (84.0%) (P < 0.05). Logistic regression analysis (dependent variable: relapse/nonrelapse; covariates: age, positive family history for autoimmune thyroid disease, duration of treatment with ATD, number pregnancies at diagnosis, number of pregnancies after ATD withdrawal) showed a significant effect only for the number of pregnancies after ATD withdrawal [4.257 (1.315-13.782)]. The effect was ascribed to the PP period rather than to pregnancy itself because in 20 of 21 patients of group II (95.2%), the relapse of Graves' hyperthyroidism occurred between 4 and 8 months after delivery. CONCLUSIONS The PP period is significantly associated with a relapse of hyperthyroidism in GD patients being in remission after ATD. We therefore recommend that patients with GD in remission after a course of ATD should have their thyroid function tested at 3 and 6 months after delivery.
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Affiliation(s)
- Mario Rotondi
- Fondazione Salvatore Maugeri Istituto di Ricovero e Cura a Carattere Scientifico Chair of Endocrinology, University of Pavia, Via S. Maugeri 10, I-27100, Pavia, Italy
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Cappelli C, Pelizzari G, Pirola I, Gandossi E, De Martino E, Delbarba A, Agosti B, Agabiti Rosei E, Castellano M. Modified percutaneous ethanol injection of parathyroid adenoma in primary hyperparathyroidism. QJM 2008; 101:657-62. [PMID: 18499732 DOI: 10.1093/qjmed/hcn062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Surgery is the treatment of choice for symptomatic primary hyperparathyroidism; unlikely few patients do not meet established surgical criteria or have comorbid conditions that prohibit surgery. In these subjects, medical therapy alone offers little hope for a sustained long normocalcemic period. However percutaneous ethanol injection (PEI) may represent an alternative therapeutic procedure. It is currently in use for the treatment of secondary or tertiary hyperparathyroidism, however, few studies or case reports suggest it for the treatment of primary hyperparathyroidism. Moreover, little information is available about the long-term follow-up, where incomplete necrosis or the spreading of ethanol in the surrounding tissues is often reported. We believe that many of the side effects could be correlated to procedure itself. Taking these experiences into account, we have reasoned that in order to limit these side effects, we had to modify the standard PEI procedure. We reported this preliminary experience describing our modified PEI procedure.
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Affiliation(s)
- C Cappelli
- Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia, 1, 25100 Brescia, Italy.
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Cappelli C, Tironi A, Marchetti GP, Pirola I, De Martino E, Delbarba A, Castellano M, Rosei EA. Aggressive thyroid carcinoma showing thymic-like differentiation (CASTLE): case report and review of the literature. Endocr J 2008; 55:685-90. [PMID: 18560200 DOI: 10.1507/endocrj.k07e-147] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Carcinoma showing thymic-like differentiation (CASTLE) is a rare tumour of the thyroid, which arises from ectopic thymic tissue or remnants of branchial pouches. A systematic review of English literature evidences less than thirty cases; from them, it clearly appears that CASTLE is considered an indolent slow-growing neoplasia even when lymph nodes metastasis are present. We describe a case of very aggressive CASTLE, which showed seeding along fine needle aspiration tract.
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Affiliation(s)
- Carlo Cappelli
- Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia, Italy
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47
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Cappelli C, Castellano M, Gandossi E, Pirola I, De Martino E, Delbarba A, Agabiti Rosei E. Spinal needle improves adequate thyroid nodule cytology. Clin Radiol 2008; 63:483-4. [PMID: 18325371 DOI: 10.1016/j.crad.2007.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 08/01/2007] [Indexed: 11/17/2022]
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De Martino E, Pirola I, Gandossi E, Delbarba A, Cappelli C. Thyroid nodular disease: an emerging problem. MINERVA ENDOCRINOL 2008; 33:15-25. [PMID: 18277376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
As a consequence of increasing application of ultrasound technology, the detection of asymptomatic thyroid nodules has generally increased. In fact, ultrasound epidemiological studies report that two third of subjects have at least a thyroid nodule, instead of 4-7% detected by clinicians. These evidences suggest the need of a rational approach to the thyroid nodule ''epidemia''. The question of whether clinically unapparent thyroid lesions should be assessed by cytology is still unresolved and, moreover, the clinical significance of nonpalpable (diameter <10 mm) thyroid carcinoma is still a matter of discussion. Aim of this work is to delineate a rational approach to thyroid nodules, taking in account literature data, the most recent guidelines and our clinical experience.
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Affiliation(s)
- E De Martino
- Dipartimento di Scienze Mediche e Chirurgiche, II Divisione di Medicina Interna ed Endocrinologia, Università degli Studi di Brescia, Spedali Civili Brescia, Italia
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49
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Cappelli C, Pirola I, De Martino E, Agosti B, Delbarba A, Castellano M, Rosei EA. The role of imaging in Graves’ disease: A cost-effectiveness analysis. Eur J Radiol 2008; 65:99-103. [PMID: 17459638 DOI: 10.1016/j.ejrad.2007.03.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 02/07/2007] [Accepted: 03/14/2007] [Indexed: 11/28/2022]
Abstract
According to many guidelines, scintigraphy remains the first suggested diagnostic procedure in hyperthyroid patients in spite of the widespread availability of ultrasounds. The aim of this study was to evaluate the cost-effectiveness of sonography versus scintigraphy in the management of Graves's disease, and to assess ultrasound features suggesting cancer in detecting thyroid nodules. Among 1470 hyperthyroid patients evaluated in our department from 2002 to 2005, 426 (29%) had Graves' disease: echographic and scintigraphic features were not suggestive of GD in 20/426 (4.8%) and 11/426 (2.6%) patients, respectively (p=0.763), even if one of the two procedures was almost always diagnostic. Ultrasound identified 68/426 (16%) patients with a concomitant solid lesion, while scintigraphy detected only 9/426 (2.1%) "cold" nodules (p<0.001). Thyroid cancer was diagnosed in 30/68 (47.7%) patients. Malignancy presented at ultrasound investigation blurred margins (26.7% versus 15.8%), microcalcifications (33.3% versus 28.9%) and an anteroposterior and transverse diameter ratio>or=1 (73.3% versus 71.1%); more frequently than benign nodules, but this was not statistically significant. The total cost to obtain a diagnosis by ultrasound was euro14645.34 (euro13312.5 for echography+euro1332.84 for scintigraphy in the 29 patients "negative" at echographic evaluation for GD) versus euro19922.71 by scintigraphy (euro19578.96 for scan+euro343.75 for ultrasounds in the 11 patients "negative" at scintigraphy). Our data show no difference in terms of diagnosis between sonography and scintigraphy. Indeed, scintigraphy was less sensitive in detecting nodules (often of malignant nature) than ultrasound, and, moreover, with a consequent increase of the direct cost of nodule management when scintigraphy is the first line procedure. In conclusion, according to our results, we suggest that ultrasounds with color-Doppler evaluation should be performed as first step in all hyperthyroid patients, and that scintigraphic examination should be limited only to the uncommon cases, where physician's observation, laboratory assays and/or ultrasounds are not diagnostic.
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Affiliation(s)
- C Cappelli
- Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia, Italy.
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Cappelli C, Castellano M, Pirola I, De Martino E, Gandossi E, Delbarba A, Salvi A, Rosei EA. Reduced thyroid volume and nodularity in dyslipidaemic patients on statin treatment. Clin Endocrinol (Oxf) 2008; 68:16-21. [PMID: 17666091 DOI: 10.1111/j.1365-2265.2007.02982.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Little information is available concerning the possible antiproliferative effects of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) on the thyroid gland. We have hypothesized that the antiproliferative effects of statins observed in thyroid cell lines in vitro may have a clinical counterpart that could be detected by investigating the prevalence and size of thyroid nodules in patients on long-term treatment with statins. METHODS We retrospectively evaluated 135 dyslipidaemic patients receiving statin therapy continuously for at least 5 years, and 137 controls. All the subjects were submitted to ultrasound investigation of the thyroid gland, to establish prevalence, number and volume of thyroid nodules. RESULTS Subjects treated with statins showed markedly lower prevalence of thyroid nodules (36.3%vs. 67.9%, P < 0.001), as well as reduced number and smaller total volume of lesions, as compared to the control group. A logistic regression analysis, taking into account age, sex, risk factors for the development of thyroid nodules and concomitant drug treatment, revealed that treatment with statins remained the only important predictor of the presence of thyroid nodules [odds ratio (OR) 0.312, 95% confidence interval (CI) 0.156-0.625, P < 0.001] besides risk factors. CONCLUSIONS Our data provide the first circumstantial evidence of an association between HMG-CoA reductase inhibitor treatment and reduced prevalence, number and volume of thyroid nodules. This finding may be explained by an antiproliferative and/or pro-apoptotic effect of long-term statin treatment on thyroid cells, in vivo.
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Affiliation(s)
- Carlo Cappelli
- Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University Medical School, Brescia, Italy.
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