Thyroid cancer in women of reproductive age: Key issues for the clinical team.

Women who are fertile experience a significant burden from thyroid cancer. In reality, delaying childbirth is the current trend in maternity. Women who have thyroid cancer may later want to get pregnant after it has been treated, which presents a multidisciplinary issue for their doctors. A variety of specialists are frequently involved in the treatment of thyroid cancer. This review aims to address the key elements of the strategy and places special emphasis on the significance of fertility in women with thyroid cancer diagnosis and remission. We will cover topics including the role of thyroid hormones in pregnancy and fertility.

Hypoglycemia Incidence and Factors Associated in a Cohort of Patients With Type 2 Diabetes Hospitalized in General Ward Treated With Basal Bolus Insulin Regimen Assessed by Continuous Glucose Monitoring.

INTRODUCTION: Continuous glucose monitoring (CGM) is a better tool to detect hyper and hypoglycemia than capillary point of care in insulin-treated patients during hospitalization. We evaluated the incidence of hypoglycemia in patients with type 2 diabetes (T2D) treated with basal bolus insulin regimen using CGM and factors associated with hypoglycemia. METHODS: Post hoc analysis of a prospective cohort study. Hypoglycemia was documented in terms of incidence rate and percentage of time <54 mg/dL (3.0 mmol/L) and <70 mg/dL (3.9 mmol/L). Factors evaluated included glycemic variability analyzed during the first 6 days of basal bolus therapy. RESULTS: A total of 34 hospitalized patients with T2D in general ward were included, with admission A1c of 9.26 ± 2.62% (76.8 ± 13 mmol/mol) and mean blood glucose of 254 ± 153 mg/dL. There were two events of hypoglycemia below 54 mg/dL (3.0 mmol/L) and 11 events below 70 mg/dL (3.9 mmol/L) with an incidence of hypoglycemic events of 0.059 and 0.323 per patient, respectively. From second to fifth day of treatment the percentage of time in range (140-180 mg/dL, 7.8-10.0 mmol/L) increased from 72.1% to 89.4%. Factors related to hypoglycemic events <70 mg/dL (3.9 mmol/L) were admission mean glucose (IRR 0.86, 95% CI 0.79, 0.95, P < .01), glycemic variability measured as CV (IRR 3.12, 95% CI 1.33, 7.61, P < .01) and SD, and duration of stay. CONCLUSIONS: Basal bolus insulin regimen is effective and the overall incidence of hypoglycemia detected by CGM is low in hospitalized patients with T2D. Increased glycemic variability as well as the decrease in mean glucose were associated with events <70 mg/dL (3.9 mmol/L).

Defining High Glycemic Variability in Type 1 Diabetes: Comparison of Multiple Indexes to Identify Patients at Risk of Hypoglycemia.

Background: International consensus on the use of continuous glucose monitoring (CGM) recommends coefficient of variation (CV) as the metric of choice to express glycemic variability (GV) with a cutoff of 36% to define unstable diabetes. Even though, CV is associated with hypoglycemia in type 2 diabetes patients, the evidence on the use of one particular measure of GV in type 1 diabetes (T1DM) patients as a predictor of hypoglycemia is limited. Methods: A cohort of T1DM ambulatory patients was evaluated using CGM. Number and incidence rate of events <54 and <70 mg/dL were calculated. Bivariate and multivariate analysis of different glycemic indexes and clinical variables were performed to identify those associated with hypoglycemia. Receiver operating characteristic (ROC) curve analysis for each of the glycemic indexes was performed to define the best index and its optimal cutoff threshold to discriminate patients with events of hypoglycemia. Results: Seventy-three patients were included. A total of 128 events <54 mg/dL were recorded in 34 patients, and 350 events <70 mg/dL were registered in 51 patients. CV was the only variable significantly associated with hypoglycemia <54 mg/dL in the multivariate analysis (adjusted relative risk [aRR] 1.44, 95% confidence interval [CI]: 1.10-1.88, P = 0.008). CV, HbA1c (glycated hemoglobin), and mean glucose were associated with events <70 mg/dL. ROC curve analysis showed that, among GV metrics, CV had the best performance to discriminate patients with events <54 mg/dL (area under the curve [AUC] 0.87, 95% CI: 0.79-0.95) and events <70 mg/dL (AUC 0.79, 95% CI: 0.68-0.90) with optimal cutoff thresholds values of 34% and 31%, respectively. Among glycemic risk (GR) indexes, low blood glucose index (LBGI) showed the best performance. Conclusions: This analysis shows that CV is the best GV index, and LBGI the best GR index, to identify patients at risk of clinically significant hypoglycemia and hypoglycemia alert events in T1DM patients.