[The incidence of hypothyroidism symptoms and risk factors for cardiovascular events in subclinical hypothyroidism]. / Czestosc wystepowania objawów niedoczynnosci tarczycy oraz czynników ryzyka sercowo-naczyniowego w subklinicznej niedoczynnosci tarczycy.

UNLABELLED: The clinical significance of subclinical hypothyroidism (SH) has not been determined. There are different opinions with regard to symptoms and clinical consequences of SH as well as effectiveness of treatment. Aim of study was the analysis of incidence of hypothyroidism symptoms and selected cardiovascular risk factors in patients with SH in comparison to euthyroid individuals and the evaluation of the effect of treatment of SH on the above parameters. MATERIALS AND METHODS: Fifty patients were included in the study: 25 with SH, 25 in euthyreosis (C). The incidence of hypothyroidism symptoms and metabolic syndrome (MS), as well as total cholesterol (TCH), LDL, HDL triglycerides (TGL), glucose levels, values of systolic (SBP) and diastolic (DBP) blood pressure and the relationship between these factors and laboratory indexes of SH intensity were analyzed. Moreover, the risk of cardiovascular mortality (RCM) with the application of the HeartSCORE Risk Chart was evaluated. After a period of six months a similar analysis in the SH group was conducted; all the patients were administered L-thyroxin (mean dose +/- SD: 67.5 +/- 32.1 microg). RESULTS: The mean number of hypothyroidism symptoms was higher in SH than in C group (SH: 8.4 +/- 3.2 vs. C: 1.7 +/- 1.5, p < 0.0005). Normalization of TSH observed in 17 patients resulted in a decrease in the mean number of symptoms (9.1 +/- 2.8 vs. 5.9 +/- 2.9, p < 0.0001). There were not differences between groups in the incidence of the MS and MS components and also the RCM. However only in SH group a positive correlations between TSH and BMI, TSH and age, age and TCH and LDL levels and SBP DBP values and also between TSH and the RCM were noted. Normalization of TSH level resulted in a decrease in the RCM (p = 0.055). CONCLUSIONS: Treatment of SH might bring potential benefits; it might lessen symptoms and reduce the risk of cardiovascular mortality.

[Effect of subclinical hypothyroidism treatment on selected cardiovascular parameters]. / Wplyw leczenia subklinicznej niedoczynnosci tarczycy na wybrane parametry ukladu sercowo-naczyniowego.

UNLABELLED: The impact of subclinical hypothyroidism (SH) on the cardiovascular system has not been well determined. Due to contradictory views on clinical consequences of SH there is no clear opinion on the indications for treatment of this disorder. The aim of study was to analyse the L-thyroxin therapy effect on normalization of cardiac irregularities in patients with SH observed in physical, electrocardiographic (at rest and 24-hour) and echocardiographic examinations. MATERIALS AND METHODS: 25 patients with SH and 25 in euthyreosis --C were included in the study, mean age +/- SD: SH- 43 +/- 17.4; C--51 +/- 17.2; NS. The frequency of irregularities in the physical, echocardiographic, electrocardiographic (at rest and 24-hour) examinations in both examined groups were compared. The effectiveness of a six-month treatment of SH as well as the impact of normalization of the TSH on results of the above tests were also analyzed. RESULTS: It was observed that SH does not significantly affect results of the physical examination. However, normalization of the TSH decreased differences between the SH and C groups with regard to the frequency of irregularities in rest electrocardiographic examination (SH: 60% vs. C: 24%, p < 0.01). It also reduced the total number of irregularities observed in echocardiographic examination (p < 0.01). The changes included mainly an improvement of systolic and diastolic functions of the left ventricle. Moreover, less intensive supraventricular and ventricular arrhythmia in 24-hour electrocardiographic examination in some patients as well as an average positive correlation (R = 0.420, p < 0.05) between the number of irregularities in this examination and the TSH level were also observed. CONCLUSIONS: Normalization of the TSH level after a six-month treatment period contributes to positive changes with regard to essential cardiac parameters in some patients.

Usefulness of PTH measurements in FNAB washouts in the identification of pathological parathyroids--analysis of the factors that influence the effectiveness of this method.

INTRODUCTION: The aim of this investigation was to assess the usefulness of the measurement of PTH concentration in the material obtained during FNAB (PTH-FNAB) in the identification of pathological parathyroids in patients with frequently coexisting thyroid abnormalities (nodular goitre, chronic thyroiditis, previous thyroidectomy). Additionally, the influence of the size of goitre, parathyroid localisation and size on the results of PTH-FNAB measurement was examined. MATERIAL AND METHODS: Fifty patients with primary hyperparathyroidism and sonographically detected focal lesion that was suggestive of parathyroid gland were included in this study. PTH-FNAB results were correlated with the outcome of routine cytological examination and biochemical indices of hyperparathyroidism, SPECT-CT (33 patients) and histopathological examination (20 patients). RESULTS: Positive PTH-FNAB was observed in 80% of patients, and in more than 70% of persons with non-diagnostic smears or smears 'contaminated' with thyroid follicular cells. In the group of operated patients, sensitivity of PTH-FNAB (95.0%) was higher than SPECTCT (64.3%, p < 0.05). Presence of nodular goitre and/or chronic thyroiditis exerts a two times stronger negative effect on percentage of negative results of SPECT-CT than of PTH-FNAB. On the other hand, lower frequency of positive PTH-FNAB but not SPECT-CT was observed when the thickness of the thyroid was ≥ 20 mm (50% v. 87.5%, p < 0.05) and when the thickness of a lesion suspected of parathyroid pathology was ≤ 5 mm (66.7% v. 93.3%, p < 0.05). CONCLUSIONS: In patients with thyroid abnormalities, PTH-FNAB measurements show advantages over routine biopsy and SPECT-CT in the identification of typically located pathological parathyroids.

Long-term impact of vertical banded gastroplasty (VBG) on plasma concentration of leptin, soluble leptin receptor, ghrelin, omentin-1, obestatin, and retinol binding protein 4 (RBP4) in patients with severe obesity.

Restrictive type bariatric surgery is an effective therapeutic approach that decreases overall mortality in patients with severe obesity. Several new cytokines, including adipocytokines that control energy metabolism, have been discovered recently, but their role in obesity is not fully recognized. The aim of the study was to evaluate the influence of vertical banded gastroplasty (VBG), one of restrictive type bariatric surgery, on peripheral blood concentrations of some adipocytokines and hormones involved in the control of food intake and energy turnover. The studied group comprised 12 females and 2 males aged from 31 to 59years (46.6±7.4) with simple obesity (BMI: 44.9±7.2) and metabolic syndrome. The patients were examined both before and 3, 6, 12, 24months after bariatric surgery (eight patients were also checked after 36 and six patients after 48months). Measurements of peripheral blood concentration of glucose, insulin, leptin, soluble leptin receptor, obestatin, ghrelin, omentin-1, and retinol binding protein 4 (RBP4) by ELISA method have been performed. After the surgery body weight, BMI and waist circumference significantly decreased. Positive changes considering the components of metabolic syndrome have been noted. Namely glucose, insulin and triglycerides' levels decreased, accompanied by the significantly lower HOMA index. Conversely, HDL cholesterol concentrations increased. Furthermore, peripheral blood concentration of leptin decreased, but the blood levels of soluble leptin receptor and ghrelin gradually increased. The positive correlations between leptin and body weight and BMI were noted as well as between the RBP4 and total cholesterol and LDL cholesterol levels. We did not observe significant differences in levels of obestatin, omentin-1 and RBP4 after surgery. In conclusion, VBG is an effective type of bariatric surgery. Fast decrease of body weight in morbidly obese patients treated by restrictive bariatric surgery leads to significant changes in peripheral blood levels of some adipokines and hormones controlling energy turnover and appetite (leptin and soluble leptin receptor) as well as ghrelin but not omentin-1, obestatin or retinol binding protein (RBP-4).

Impact of vertical banded gastroplasty on body weight, insulin resistance, adipocytokine, inflammation and metabolic syndrome markers in morbidly obese patients.

INTRODUCTION: Diet, exercise, and pharmacological therapy have been shown to be unsatisfactory treatments for severe obesity in the long term. Bariatric surgery is the most effective means to achieve weight loss in morbidly obese subjects. The aim of this study was to evaluate the action of a number of adipocytokines, as well as the metabolic syndrome parameters of obese patients, before and after vertical banded gastroplasty (VBG). MATERIAL AND METHODS: The test subjects comprised eight males and 20 females (total 28 patients) aged from 20 to 59 years (43.7 ± 10.0) with simple obesity and the presence of metabolic syndrome, both before and 3, 6, 12, and 24 months after bariatric surgery (six patients were also checked after 36 and 48 months). RESULTS: After surgical treatment (at 24 months), the values of body weight, BMI, waist circumference, blood pressure (RR-S, RR-D), HOMA-IR and blood concentrations of CRP, TG, IRI, AUC-IRI, and AUC-GLU gradually decreased. We did not observe any significant differences of fasting glucose, leptin, total cholesterol and LDL-cholesterol concentrations before or after surgery. The blood levels of HDL, adiponectin, resistin, and ghrelin gradually increased after treatment. CONCLUSIONS: The significant decrease of body weight after vertical banded gastroplasty, as well as improvement of the main metabolic syndrome parameters and some adipocytokine blood levels, indicate the use of bariatric surgery as a valuable method of treating morbidly obese patients.

Systemic blood osteopontin, endostatin, and E-selectin concentrations after vertical banding surgery in severely obese adults.

BACKGROUND: Obesity is associated with endothelial dysfunction and increased inflammation as well as with expansion of the capillary bed in regional adipose deposits, and a balance between these factors is involved in angiogenesis. Osteopontin (OPN) is a proinflammatory cytokine involved in regulating immune processes and mediating chronic inflammation. Its level is usually elevated in the plasma and adipose tissue of obese subjects. E-selectin, an adhesion molecule which is released by dysfunctional endothelial cells, is believed to be a marker of an early atherosclerotic process. Endostatin (END), an angiogenesis inhibitor, is present in the blood of obese subjects. The most effective treatment to achieve weight loss in morbidly obese subjects is bariatric surgery. The aim of the study was to evaluate and compare the circulating concentrations of OPN, E-selectin and END as well as the insulin resistance (HOMA-IR) of severely obese patients with metabolic syndrome before and after vertical banded gastroplasty (VBG). MATERIAL AND METHODS: The test cohorts comprised eight males and 20 females (total 28 patients) aged from 20 to 59 years with simple obesity and the presence of metabolic syndrome, both before and 3, 6, 12, 24 months after bariatric surgery (six patients were also checked after 36 and four after 48 months). RESULTS: Bariatric surgery significantly reduced (over 24 months) body weight, BMI, waist circumference, HOMA-IR and blood concentrations of CRP. Plasma OPN gradually increased after VBG and E-selectin in systemic blood decreased. We did not observe any differences in END concentrations from 12 to 48 months after surgery. CONCLUSION: VBG improves metabolic syndrome parameters, decreases E-selectin and gradually increases OST blood concentrations but it does not have any significant influence on END levels.

Resistin increases with obesity and atherosclerotic risk factors in patients with myocardial infarction.

The objective of the study was to assess the relation of resistin to the anthropometric parameters, metabolic risk factors, and C-reactive protein (CRP) in men with myocardial infarction. Subjects were 40 obese (age, 53.6 +/- 7.39 years; body mass index, > or =30 kg/m2) and 40 lean (age, 54.4 +/- 6.62 years; body mass index, <25 kg/m2) men with first acute myocardial infarction. Waist and hip circumferences, CRP, uric acid, fasting glucose, lipid profile, and blood resistin concentration were measured. In obese patients, triglycerides, fasting glucose, and CRP were significantly higher whereas high-density lipoprotein cholesterol was lower than in lean patients. The range of blood resistin concentration was 6.0 to 70.5 ng/mL: 27.84 +/- 12.15 ng/mL in obese subjects and 17.35 +/- 11.08 ng/mL in lean subjects (P < .0001). Significant positive correlation was revealed between blood resistin concentration and each of the analyzed anthropometric parameter and with fasting glucose, low-density lipoprotein cholesterol, and CRP, whereas negative relation was observed between resistin and high-density lipoprotein cholesterol. As revealed by univariate logistic regression analysis, risk of blood resistin concentration being greater than the median value (19.75 ng/mL) was increased by obesity, high-density lipoprotein cholesterol <40 mg/dL, hypertension, and CRP. In multivariate model, independent variables associated with higher median of resistin were obesity and CRP. Obesity increased 5.5-fold the probability of blood resistin concentration being greater than 19.75 ng/mL, whereas each 1-mg/dL increase in CRP increased this probability by 13%. In patients with acute myocardial infarction, obesity is positively related to blood resistin concentration. Resistin is likely to play a major role in the atherogenesis and its complications, and this action seems to be mostly related to the inflammatory reaction.

[Anti-cytokine and anti-lymphocyte monoclonal antibodies in the treatment of thyroid associated ophthalmopathy]. / Zastosowanie przeciwcial monoklonalnych przeciwcytokinowych i przeciwlimfocytarnych w leczeniu orbitopatii tarczycowej.

Graves' ophthalmopathy or thyroid associated ophthalmopathy (TAO) is an autoimmune disease of the orbit involving both the retroorbital connective tissue and the extraocular muscles, but its pathogenesis is still incompletely understood. Examination of retroorbital tissues in the initial inflammatory phase of TAO reveals an accumulation of hydrophilic glycosaminoglycans, increased fat volume, marked T and B lymphocytic infiltration, and presence of many pro-inflammatory cytokines and growth factors. Peripheral blood levels of pro-inflammatory cytokines released from T and B lymphocytes (IFN-gamma, IL-1beta, IL-2, slL-2R TNF-alpha, IL-6, IL-6R) and antibodies of TSH receptor (TRAb) secreted from B lymphocytes are markers of the immune system activity. Updated the efficacy of the new anti-cytokine and anti-lymphocyte treatment of the Graves' ophthalmopathy has been revived. We described the first positive results of anti-B lymphocyte (anti-CD20; rituximab) and anti-TNF-alpha monoclonal antibodies (infliximab; etanercept) administration as new therapeutic options in the treatment of patients with active TAO. A randomized prospective study are needed to determine whether rituximab, infliximab or etanercept prove sufficiently effective in reducing the inflammatory symptoms of TAO, and whether they can be administered safely for a prolonged period without side effects.

Relation of C-reactive protein to obesity, adipose tissue hormones and cardiovascular risk factors in men treated with early percutaneous intervention in course of acute myocardial infarction.

UNLABELLED: Adipose tissue appears to be a key regulator of CRP levels. C-reactive protein (CRP), a marker of systemic inflammation, predicts the occurrence of diabetes, the metabolic syndrome and atherosclerotic diseases. Adipokines, the proteins produced by adipocytes are additional factors thought to be involved in the chronic, subclinical inflammatory state of adiposity. AIM: The aim of the study was to assess the impact of obesity on the blood CRP levels and the relation of CRP to coronary risk factors and adipokines in men with acute myocardial infarction (AMI). METHODS: The study was performed in 37 obese (BMI> or =30) and 33 lean patients (BMI<25) with first AMI treated with percutaneous coronary intervention within the initial 6 hours of AMI. Clinical data, anthropometric measurements, biochemical parameters and blood adipokines concentration were analyzed. RESULTS: Values of the following parameters were significantly higher in obese than in lean patients: CRP, fasting glucose, glucose at admission, leptin and resistin, whereas HDL-cholesterol and adiponectin levels were lower. In univariate regression analysis CRP was related to obesity, HDL-cholesterol, fasting glucose, glucose at admission and adipokines but only glucose at admission and resistin were the independent positive factors and adiponectin an independent negative factor associated with CRP levels (R2= 51.1%). CONCLUSIONS: In the early stage of AMI inflammation is more pronounced in obese than in lean patients. The pleiotropic association between CRP and obesity, adipokines and cardiovascular risk factors might prove it to be an important link between inflammatory reaction and atherogenesis in which adipose tissue hormones are involved.

Monoclonal anti-TNFalpha antibody (infliximab) in the treatment of patient with thyroid associated ophthalmopathy.

TNFalpha (tumor necrosis factor alpha) plays a central role in the development of thyroid associated ophthalmopathy (TAO). We describe and document by ophthalmic (CAS and NO SPECS scales) and radiological (MRI) evaluation a positive effect of anti-TNFalpha antibody (infliximab) administration on active TAO in a 58 years old woman with Graves' disease. The single dose of infliximab administration resulted in a dramatic reduction of inflammation studies and improvement of visual function as measured by MRI and CAS and NO SPECS scales, without noticeable short-term side effects. A randomized prospective study is needed to determine whether infliximab proves to be sufficiently effective in reducing the inflammatory symptoms of TAO, and whether it can be administered safely for a prolonged period without side effects.

Obesity and adiponectin in acute myocardial infarction.

BACKGROUND: Low plasma concentration of adiponectin, a hormone-like peptide secreted by adipose tissue, is detected in obesity and in coronary artery disease. The aim of the study was to assess the impact of obesity on adiponectin and the relation of adiponectin to the anthropometric parameters and cardiovascular risk factors in men with acute myocardial infarction. METHODS: Two groups of patients with first acute myocardial infarction were analyzed: 40 obese and 40 non-obese men. Waist and hip circumferences and waist-to-hip ratio, C-reactive protein (CRP), uric acid, fasting glucose, lipid profile and adiponectin were measured. RESULTS: Mean level of adiponectin was significantly lower in obese than non-obese patients (6.80 mug/ml +/- 4.31 vs. 11.18 mug/ml +/- 7.19; p < 0.01). Adiponectin levels correlated negatively with all anthropometric measurements, the most significantly with waist circumference, with systolic blood pressure, fasting glucose, triglyceride levels, CRP, uric acid and positively with age and HDL-cholesterol. Adiponectin level was significantly associated with HDL-cholesterol, waist circumference and with trigliceryde levels and these independent variables explained 39% of the plasma adiponectin variability. CONCLUSIONS: In patients with acute myocardial infarction obesity is related to decreased adiponectin. Low adiponectin level is associated with atherogenic lipid profile and higher levels of inflammatory markers. (Cardiol J 2007; 14: 29-36).