FGF21 Is Released During Increased Lipogenesis State Following Rapid-Onset Radioiodine-Induced Hypothyroidism.

Background: FGF21 pharmacological treatment reverses fatty liver and lowers serum triglyceride concentration but FGF21 serum level is increased in hepatic steatosis. FGF21 secretion is induced by thyroid hormones in vitro. Purpose: To determine the influence of thyroid hormones and metabolic changes secondary to thyroid dysfunction on FGF21 secretion in humans. Materials and Methods: This was a case-control study. 82 hyperthyroid and 15 hypothyroid patients were recruited together with 25 healthy controls. Of those with hyperthyroidism, 56 received radioiodine treatment and 42 of them achieved hypothyroidism and then euthyroidism within one year following therapy. Radioiodine-induced hypothyroidism developed abruptly within a six week interval between clinic visits. FGF21 serum levels were determined with an ELISA method. Results: Serum FGF21 levels did not differ in hyper- and hypothyroid patients in comparison to controls [median 103.25 (interquartile range, 60.90-189.48) and 86.10 (54.05-251.02) vs 85.20 (58.00-116.80) pg/mL P=0.200 and 0.503, respectively]. In hyperthyroid patients treated with radioiodine, serum FGF21 levels increased significantly in rapid-onset hypothyroidism in comparison to the hyperthyroid and euthyroid phase [median 160.55 (interquartile range, 92.48 - 259.35) vs 119.55 (67.78-192.32) and 104.43 (55.93-231.93) pg/mL, P=0.034 and 0.033, respectively]. The rising serum FGF21 level correlated positively with serum triglycerides (Spearman coefficient rs=0.36, P=0.017) and inversely with serum SHBG (rs=-0.41, P=0.007), but did not correlate with thyroid hormone levels. Conclusions: There was a transient increase in FGF21 serum level during rapid-onset hypothyroidism following radioiodine treatment. There was no association between FGF21 serum level and thyroid hormones. In radioiodine-induced hypothyroidism, the rising serum FGF21 concentration correlated positively with rising serum triglycerides and negatively with falling SHBG, reflecting increased hepatic lipogenesis.

Orbital decompression for thyroid eye disease: surgical treatment outcomes in endocrinological assessment.

INTRODUCTION: Surgical orbital decompression involves removal of one or more of the orbital bony walls in order to gain space for overgrown muscles and adipose tissue, which results in a reduction in pressure on the eye. This observational study aims to perform an endocrinological assessment of the surgical treatment outcomes of thyroid eye disease (TED) patients before and after orbital decompression. MATERIAL AND METHODS: This retrospective study included 51 TED patients (84 orbits) who underwent endoscopic orbital decompression (EOD) or balanced orbital decompression. The effect of surgical treatment was evaluated via the clinical activity score (CAS), and modified NOSPECS and EUGOGO classification. RESULTS: Before orbital decompression, the average CAS index was 3.83 ± 1.86 points, whereas the modified NOSPECS score was 3.31 ± 0.97 points. After surgical intervention, the values were as follows: 2.07 ± 1.84 points for CAS and 2.5 ± 0.97 points for modified NOSPECS. The EUGOGO classification before surgery showed that Graves' orbitopathy (GO) was mild, moderate to severe, and sight-threatening in 1%, 25%, and 74% of the orbits, respectively. After surgery, GO was determined to be mild, moderate to severe, and sight-threatening in 24%, 57%, and 19% of the orbits, respectively. Statistical analysis was performed using the R 3.6.2 statistical environment. Inference about the statistical reliability of the parameter was made by calculating the mean and the 95% credibility interval (CI). CONCLUSIONS: The severity of TED decreased after orbital decompression. The CAS, and modified NOSPECS and EUGOGO classification showed a statistically reliable postoperative reduction. The drop in activity of the disease after orbital surgery requires careful follow-up.

Iodine supplementation during pregnancy of hypothyroid women treated with L-thyroxine neither influences neonatal TSH nor prevents decrease in maternal free thyroid hormone concentrations in second and third trimesters.

INTRODUCTION: Pregnant women require about 250 µg of iodine daily. Hypothyroid women treated with L-thyroxine do not utilise iodine, and metabolism of L-thyroxine tablets is an additional source of iodine for their foetuses. The aim of the study was to evaluate the influence of iodine supplementation in hypothyroid pregnant women treated with L-thyroxine on neonate TSH concentration and maternal thyroid parameters. MATERIAL AND METHODS: Ninety-two pregnant women with primary hypothyroidism on adequate thyroid hormone replacement were voluntarily divided into two groups: "thyroxine" (n = 38) treated with L-thyroxine only, and "thyroxine + iodine" (n = 54) treated additionally with 150 µg/day of iodine since 10th gestational week. Primary outcomes were the maternal thyroid function tests (TSH, fT4, fT3) and neonatal TSH concentrations at the 3-4th day of life. Urinary iodine concentration was measured at first and third trimester to compare iodine status in both groups. RESULTS: Iodine supplementation significantly increased median urinary ioduria in the third trimester (from 95.15 µg/L to 151.50 µg/L), but did not prevent the decrease of maternal fT4 and fT3 concentrations in the second and third trimester. Median neonate TSH concentration in both groups was within normal range, but was 33% higher in the "thyroxine + iodine" than in the "thyroxine" group (1.91 mU/L vs. 1.34 mU/L). Moreover, 8.77% of newborns in the "thyroxine + iodine" group had TSH > 5 mIU/L. CONCLUSIONS: We did not find evidence for a positive influence of iodine supplementation on thyroid function of either hypothyroid pregnant women sufficiently treated with L-thyroxine or their neonates. (Endokrynol Pol 2016; 67 (4): 367-374).

Gestational diabetes insipidus. Case Report.

Gestational diabetes insipidus is a very rare complication. However, undiagnosed and untreated may lead to serious complications in both mother and fetus. In this study, a case of 34-year-old female patient with diabetes insipidus associated with pregnancy was reported. We discussed process of diagnosis and treatment with particular emphasis on the monitoring of water-electrolyte imbalance during labor.

Increased size and vascularisation, plus decreased echogenicity, of foetal thyroid in two-dimensional ultrasonography caused by maternal Graves' disease.

Foetal ultrasonography monitoring is a valuable tool in assessing foetal thyroid function when pregnancy is complicated by maternal Graves' disease with accompanying high levels of TSH receptor antibodies, or when antithyroid drug therapy is instituted. Among several ultrasonographic signs of foetal thyroid disorder such as abnormalities in bone maturation and heart rhythm, cardiac failure, hydrops, intrauterine growth restriction and polyhydramnios, goitre is the most sensitive one. Here we report three cases of pregnant women with Graves' disease accompanied by very high serum levels of TSH receptor antibodies. In all three cases, as documented by foetal or neonatal serum TSH and thyroid hormones measurements, foetal thyroid dysfunction occurred. The only ultrasonographic sign of foetal involvement was a goitre with decreased echogenicity and increased vascularisation, central or peripheral. This is the first report demonstrating that a foetal thyroid gland when affected by transplacental passage of maternal TSH receptor stimulating antibodies can present exactly the same characteristic ultrasound pattern of Graves' disease as in adults.

[Management of thyroid diseases during pregnancy]. / Postepowanie w chorobach tarczycy u kobiet w ciazy.

The management of thyroid disorders during pregnancy is one of the most frequently disputed problems in modern endocrinology. It is widely known that thyroid dysfunction may result in subfertility, and, if inadequately treated during pregnancy, may cause obstetrical complications and influence fetal development. The 2007 Endocrine Society Practice Guideline endorsed with the participation of the Latino America Thyroid Association, the American Thyroid Association, the Asia and Oceania Thyroid Association and the European Thyroid Association, greatly contributed towards uniformity of the management of thyroid disorders during pregnancy and postpartum. Despite the tremendous progress in knowledge on the mutual influence of pregnancy and thyroid in health and disease, there are still important areas of uncertainty. There have been at least a few important studies published in the last 3 years, which influenced the thyroidal care of the expecting mother. It should also be remembered that guidelines may not always be universally applied in all populations with different ethnical, socio-economical, nutritional (including iodine intake) background or exposed to different iodine prophylaxis models. The Task Force for development of guidelines for thyroid dysfunction management in pregnant women was established in 2008. The expert group has recognized the following tasks: development of the coherent model of the management of thyroid dysfunction in pregnant women, identification of the group of women at risk of thyroid dysfunction, who may require endocrine care in the preconception period, during pregnancy and postpartum - that is in other words, the development of Polish recommendations for targeted thyroid disorder case finding during pregnancy, and the development of Polish trimester-specific reference values of thyroid hormones. Comprehensive Polish guidelines developed by the Task Force are to systematize the management of the thyroid disorders in pregnant women in Poland.

Iodine status of pregnant women from central Poland ten years after introduction of iodine prophylaxis programme.

INTRODUCTION: Until 1997, Poland was one of the European countries suffering from mild/moderate iodine deficiency. In 1997, a national iodine prophylaxis programme was implemented based on mandatory iodisation of household salt with 30 ± 10 mg KI/kg salt, obligatory iodisation of neonatal formula with 10 µg KI/100 mL and voluntary supplementation of pregnant and breast-feeding women with additional 100-150 µg of iodine. Our aim in this study was to evaluate the iodine status of pregnant women ten years after iodine prophylaxis was introduced. MATERIAL AND METHODS: A cross-sectional study was undertaken in 100 healthy pregnant women between the fifth and the 38th week of gestation with normal thyroid function, singleton pregnancy, normal course of gestation, without drugs known to influence thyroid function except iodine. Serum TSH, fT(4), fT(3), thyroglobulin (TG), anti-peroxidase antibodies (TPO-Ab), anti-thyroglobulin antibodies (TGAb) and urinary iodine concentration (UIC) were determined. Thyroid volume and structure were evaluated by ultrasonography. RESULTS: Fifty nine per cent of studied pregnant women had a diet rich with iodine carriers and 35% obtained iodine supplements. Twenty eight per cent appeared to have a goitre: 11 diffuse and 17 a nodular one, median goitre volume was 18.7 mL (range 6.8-29.0 mL). Median UIC was 112.6 µg/L (range 36.3-290.3 µg/L), only 28% of women had UIC ≥ 150 µg/L. Median UIC was significantly higher in the group receiving iodine supplements than in the group without iodine supplements: 146.9 µg/L v. 97.3 µg/L respectively, p 〈 0.001. Serum TSH, fT(3) and fT(3)/fT(4) molar ratio increased significantly during pregnancy while fT(4) declined. Median serum TG was normal: 18.3 ng/mL (range 0.4-300.0 ng/mL) and did not differ between trimesters. Neonatal TSH performed on the third day of life as a neonatal screening test for hypothyroidism was normal in each case: median value was 1.49 mIU/L (range 0.01-7.2 mIU/L). Less than 3% (2 out of 68) of results were 〉 5 mIU/L. CONCLUSION: Iodine supplements with 150 µg of iodine should be prescribed for each healthy pregnant woman according to the assumptions of Polish iodine prophylaxis programme to obtain adequate iodine supply. (Pol J Endocrinol 2010; 61 (6): 646-651).

[Thyrotropin reference range--should it be changed?]. / Norma TSH--czy nalezy ja zmienic?

Current thyrotropin (TSH) reference range established by sensitive assays is from 0.2-0.4 mj.m./l to 4.0-4.5 mj.m./l. Serum TSH reference range was performed using specimens from healthy volunteers without history of thyroid disease but the values distribution is not concordant with Gaussian curve and is skewed toward upper values. It is claimed that upper reference limit for TSH should be declined because of possible incorporation of individuals with unrecognized chronic lymphocytic thyroiditis into initial study. American National Academy of Clinical Biochemistry recommends to examine only euthyroid healthy volunteers without personal or family history of thyroid dysfunction, visible or palpable goiter, with no detectable thyroid antibodies measured by sensitive immunoassays and without any medication except estrogen. Many authors observed that even in such rigorously selected population the upper limit of TSH does not decrease significantly. The other possible factors which may influence TSH values are ethnic features, age, iodine intake, time of phlebotomy or assay sensitivity and specificity. Furthermore there are no epidemiological data showing adverse consequences of serum TSH between 3.0 mj.m./l and 5.0 mj.m./l. And because of it current upper limit for TSH should remain unchanged. However one must realize that many people with TSH values between 3.0 mj.m./l and 5.0 mj.m./l have unrecognized chronic lymphocytic thyroiditis and should be followed because of possible future hypothyroidism. The special care is needed for pregnant women or those planning to be pregnant.

[Thyroidectomy as the last chance treatment for life threatening thyrotoxicosis. Case report]. / Strumektomia jako zabieg ratujacy zycie w ciezkiej nadczynnosci tarczycy. Opis przypadku.

The case of 54-year old woman with severe Graves thyrotoxicosis and antithyroid drugs intolerance is presented. She was admitted to Endocrinology Department and therapy with propranolol, lithium, glucocorticoids, iodine contrast media was instituted. Then ablative dose of radioiodine was given; all these appeared to be ineffective. To avoid thyrotoxic storm thyroidectomy was undertaken. Surgical procedure was uneventful and successful. Surgical intervention should be considered in severe life-threatening cases of thyrotoxicosis.