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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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Ceolin C, Scala A, Dall'Agnol M, Ziliotto C, Delbarba A, Facondo P, Citron A, Vescovi B, Pasqualini S, Giannini S, Camozzi V, Cappelli C, Bertocco A, De Rui M, Coin A, Sergi G, Ferlin A, Garolla A. Bone health and body composition in transgender adults before gender-affirming hormonal therapy: data from the COMET study. J Endocrinol Invest 2024; 47:401-410. [PMID: 37450195 PMCID: PMC10859333 DOI: 10.1007/s40618-023-02156-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Preliminary data suggested that bone mineral density (BMD) in transgender adults before initiating gender-affirming hormone therapy (GAHT) is lower when compared to cisgender controls. In this study, we analyzed bone metabolism in a sample of transgender adults before GAHT, and its possible correlation with biochemical profile, body composition and lifestyle habits (i.e., tobacco smoke and physical activity). METHODS Medical data, smoking habits, phospho-calcic and hormonal blood tests and densitometric parameters were collected in a sample of 125 transgender adults, 78 Assigned Females At Birth (AFAB) and 47 Assigned Males At Birth (AMAB) before GAHT initiation and 146 cisgender controls (57 females and 89 males) matched by sex assigned at birth and age. 55 transgender and 46 cisgender controls also underwent a complete body composition evaluation and assessment of physical activity using the International Physical Activity Questionnaire (IPAQ). RESULTS 14.3% of transgender and 6.2% of cisgender sample, respectively, had z-score values < -2 (p = 0.04). We observed only lower vitamin D values in transgender sample regarding biochemical/hormonal profile. AFAB transgender people had more total fat mass, while AMAB transgender individuals had reduced total lean mass as compared to cisgender people (53.94 ± 7.74 vs 58.38 ± 6.91, p < 0.05). AFAB transgender adults were more likely to be active smokers and tend to spend more time indoor. Fat Mass Index (FMI) was correlated with lumbar and femur BMD both in transgender individuals, while no correlations were found between lean mass parameters and BMD in AMAB transgender people. CONCLUSIONS Body composition and lifestyle factors could contribute to low BMD in transgender adults before GAHT.
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Affiliation(s)
- C Ceolin
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy.
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy.
| | - A Scala
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
| | - M Dall'Agnol
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - C Ziliotto
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - A Delbarba
- Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - P Facondo
- Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - A Citron
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - B Vescovi
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - S Pasqualini
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - S Giannini
- Clinica Medica 1, Department of Medicine, University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
| | - V Camozzi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
| | - C Cappelli
- Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - A Bertocco
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - M De Rui
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - A Coin
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - G Sergi
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
| | - A Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
| | - A Garolla
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
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Caretta N, Facondo P, Mereu S, Delbarba A, Crepaldi MC, Vedovato M, Avogaro A, Ferlin A. Cardiometabolic indices predict hypogonadism in male patients with type 2 diabetes. J Endocrinol Invest 2023; 46:599-608. [PMID: 36282472 PMCID: PMC9938038 DOI: 10.1007/s40618-022-01941-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/13/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate in men with type 2 diabetes the association of cardiometabolic indices [Visceral Adiposity Index (VAI), Triglyceride Glucose Index (TyG), and lipid accumulation product (LAP)] with total testosterone (TT) levels, and their predictive cut-off values in identifying hypogonadism. METHODS 265 consecutive men aged 40-70 years with type 2 diabetes performed an andrological evaluation; metabolic parameters and TT were determined. Receiver operating characteristic (ROC) curves were used to identify cut-off values of cardiometabolic indices in predicting low testosterone (TT < 12 nmol/l). RESULTS VAI, TyG, and LAP were negatively associated with TT levels. The prevalence of hypogonadism in men in the fourth quartiles of VAI, TyG, and LAP was ~ 70.0-75.0% compared to ~ 10.0-17.0% in men in the first quartiles (p < 0.001). The sensitivity and specificity of the three cardiometabolic indices in predicting TT < 12 nmol/l were significantly higher concerning BMI, waist circumference, lipid profile and HbA1c. Cut off values of VAI ≥ 3.985, TyG ≥ 4.925, and LAP ≥ 51.645 predict hypogonadism with good sensitivity and specificity. CONCLUSION This is the first study evaluating the association of VAI, TyG, and LAP with hypogonadism in men with type 2 diabetes. Alterations in these indices should direct the patients to andrological evaluation.
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Affiliation(s)
- N Caretta
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padua, Italy
| | - P Facondo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - S Mereu
- Department of Medicine, University of Padova, Padua, Italy
| | - A Delbarba
- Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy
| | - M C Crepaldi
- Department of Medicine, Division of Metabolic Diseases, University of Padova, Padua, Italy
| | - M Vedovato
- Department of Medicine, Division of Metabolic Diseases, University of Padova, Padua, Italy
| | - A Avogaro
- Department of Medicine, Division of Metabolic Diseases, University of Padova, Padua, Italy
| | - A Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padua, Italy.
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Vena W, Carrone F, Delbarba A, Akpojiyovbi O, Pezzaioli LC, Facondo P, Cappelli C, Leonardi L, Balzarini L, Farina D, Pizzocaro A, Lania AG, Mazziotti G, Ferlin A. Body composition, trabecular bone score and vertebral fractures in subjects with Klinefelter syndrome. J Endocrinol Invest 2023; 46:297-304. [PMID: 36030302 DOI: 10.1007/s40618-022-01901-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/10/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Klinefelter syndrome (KS) frequently causes skeletal fragility characterized by profound alterations in bone microstructure with increased risk of fractures. Increased body fat mass associated with decreased body lean mass are frequent features of KS with possible detrimental effects on skeletal health. In this cross-sectional study, we evaluated the associations between body composition parameters, vertebral fractures (VFs) and trabecular bone score (TBS) in adult subjects with KS. METHODS Seventy-one adult males (median age 41 years, range 18-64) with 47, XXY KS were consecutively enrolled by two Endocrinology and Andrology Units (IRCCS Humanitas Research Hospital in Milan and ASST Spedali Civili in Brescia). Dual-energy X-ray absorptiometry (DXA) was performed to assess bone mineral density (BMD) at lumbar spine, femoral neck and total hip, TBS and body composition. Prevalence of VFs was assessed by quantitative morphometry on lateral spine X-rays. RESULTS VFs were detected in 14 patients (19.7%), without significant association with low BMD (p = 0.912). In univariate logistic regression analysis, VFs were significantly associated with truncal/leg fat ratio (OR 2.32 per tertile; 95% CI 1.05-5.15; p = 0.038), whereas impaired TBS (detected in 23.4% of subjects) was associated with older age at study entry (p = 0.001) and at diagnosis of disease (p = 0.015), body mass index (BMI; p = 0.001), waist circumference (p = 0.007), fat mass index (FMI; p < 0.001), FMI/lean mass index (LMI) ratio (p = 0.001). Prevalence of VFs was not significantly different between subjects with impaired TBS as compared to those with normal TBS (26.7 vs. 18.4%; p = 0.485). Skeletal end-points were not significantly associated with duration of testosterone replacement therapy and serum testosterone and 25hydroxyvitamin D values. CONCLUSION Body composition might influence bone quality and risk of VFs in subjects with KS.
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Affiliation(s)
- W Vena
- Endocrinology, Diabetology and Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
- Diabetes Center, Humanitas Gavazzeni Institute, via M. Gavazzeni 21, 24100, Bergamo, Italy
| | - F Carrone
- Endocrinology, Diabetology and Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - A Delbarba
- Department of Medicine, Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy
| | - O Akpojiyovbi
- Endocrinology, Diabetology and Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - L C Pezzaioli
- Department of Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - P Facondo
- Department of Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - C Cappelli
- Department of Medicine, Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy
- Department of Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - L Leonardi
- Department of Radiology, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - L Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - D Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - A Pizzocaro
- Endocrinology, Diabetology and Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy.
| | - A G Lania
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - G Mazziotti
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, 20089, Rozzano, MI, Italy
| | - A Ferlin
- Department of Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padua, 35128, Padua, 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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