Gestational diabetes and thyroid autoimmunity.

Background. About 10% of pregnancies are complicated by previously unknown impairment of glucose metabolism, which is defined as gestational diabetes. There are little data available on prevalence of thyroid disorders in patients affected by gestational diabetes, and about their postgestational thyroid function and autoimmunity. We therefore investigated pancreatic and thyroid autoimmunity in gestational diabetic patients and in women who had had a previous gestational diabetic pregnancy. Methods. We investigated 126 pregnant women at the time of a 100-g oral glucose tolerance test: 91 were classified as gestational diabetics, and 35 were negative (controls). We also studied 69 women who had delivered a baby 18-120 months prior to this investigation and who were classified at that time gestational diabetics (38 women) or normally pregnant (31 women; controls). Results. Our data show no differences for both thyroid function and prevalence of autoimmune disorders during pregnancy; however, a significant increase in thyroid autoimmunity was seen in women previously affected by gestational diabetes. This increased prevalence of thyroid autoimmunity was not associated with the development of impaired glucose metabolism after pregnancy. Conclusions. Our data suggest that maternal hyperglycemia is a risk factor for the development of thyroid autoimmunity, a conclusion that should now be confirmed in a larger cohort of patients.

A TSHR-LH/CGR chimera that measures functional thyroid-stimulating autoantibodies (TSAb) can predict remission or recurrence in Graves' patients undergoing antithyroid drug (ATD) treatment.

CONTEXT: A functional thyroid-stimulating autoantibodies (TSAb) assay using a thyroid-stimulating hormone receptor chimera (Mc4) appears to be clinically more useful than the commonly used assay, a binding assay that measures all the antibodies binding to the thyroid-stimulating hormone receptor without functional discrimination, in diagnosing patient with Graves' disease (GD). OBJECTIVE: The objective of the study was to investigate whether an Mc4 assay can predict relapse/remission of hyperthyroidism after antithyroid drug (ATD) treatment in patients with GD. DESIGN: An Mc4 assay was used to prospectively track TSAb activity in GD patients treated with ATD over a 5-yr period. SETTING AND PATIENTS: GD patients from the Chieti University participated in this study. INTERVENTIONS: Interventions included the assessment of patients' sera using the Mc4 assay, the Mc4-derivative assay (Thyretain), and a human monoclonal thyroid-stimulating hormone receptor antibody, M22 assay. MAIN OUTCOME MEASURES: The Mc4 assay, a sensitive index of remission and recurrence, was used in this study. RESULTS: The TSAb levels significantly decreased only in the remitting group as evidenced by Mc4 assay values at the end of ATD (0.96 ± 1.47, 10.9 ± 26.6. and 24.7 ± 37.5 arbitrary units for the remitting, relapsing, and unsuspended therapy groups, respectively). Additional prognostic help was obtained by thyroid volume measurements at the end of treatment. Although not statistically significant, the Mc4 assay has a trend toward improved positive predictive value (95.4 vs. 84.2 or 87.5%), specificity (96.4 vs. 86.4 and 90.9%), and accuracy (87.3 vs. 83.3 and 80.9%) comparing the Mc4, Thyretain, and M22 assays, respectively. Thyretain has a trend toward improved negative predictive value (82.6 vs. 81.8 and 76.9%) and sensitivity (80 vs. 77.8 and 70%) comparing Thyretain, Mc4, and M22 assays, respectively. CONCLUSION: The Mc4 assay is a clinically useful index of remission and relapse in patients with GD. Larger studies are required to confirm these findings.

Walking training in postmenopause: effects on both spontaneous physical activity and training-induced body adaptations.

OBJECTIVE: Because physical exercise has been widely used for primary and secondary preventions of cardiometabolic diseases arising with menopause, the aim of our study was to determine whether participation in aerobic physical exercise is linked to the modification of spontaneous physical activity and whether this compensation affects aerobic training-related body adaptations. METHODS: Both before and after a 13-week walking training program, 34 postmenopausal women (mean ± SD age, 55.89 ± 3.57 y) were analyzed for lipids, adipokines, glucose, and insulin plasma levels, as well as for body measures, heart rate and blood pressure at rest, maximal aerobic capacity, total daily energy expenditure, mean intensity of daily physical activities, and time and energy spent on physical activities with an intensity of more than three metabolic equivalents. RESULTS: Aerobic training induced significant reductions in body mass, body mass index, heart rate, systolic blood pressure, basal cardiac double product, plasma glucose, leptin, and resistin. Aerobic fitness, the reserve of the cardiac double product, and the quantitative insulin sensitivity index were significantly improved. Cluster analysis of the variations in the total daily energy expenditure, the mean intensity of daily physical activities, and the time and energy spent on physical activities with an intensity of more than three metabolic equivalents identified two subgroups: one showed reduced spontaneous physical activity (GROUP-), whereas the other did not (GROUP+). The subgroups differed significantly only for plasma lipid variation. GROUP+ showed significantly reduced low-density lipoprotein cholesterol and total cholesterol, whereas GROUP- did not show significantly modified plasma lipids. CONCLUSIONS: In postmenopause, participation in a program of aerobic physical exercise can result in a reduction of spontaneous physical activity, which inhibits the positive effects of the aerobic exercise on plasma lipids and lipoproteins.