Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 13 de 13
Filter
1.
J Endocrinol Invest ; 46(11): 2327-2330, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37052872

ABSTRACT

PURPOSE: Screening programs that target healthy populations are an important tool for identifying unrecognized, asymptomatic disease. However, ultrasound screening for thyroid cancer has no obvious advantage in terms of cost-effectiveness in asymptomatic adults. There is far less consensus (and data) on the indications for screening in high-risk individuals. The aim of the study was to estimate the costs of ultrasound screening for individuals with first-degree family history of thyroid cancer. METHODS: We conducted a prospective cross-sectional study from January 1, 2009 through December 31, 2018 in the Thyroid Cancer Outpatient Clinic of a large teaching hospital in Rome, Italy. We estimated the costs of an ultrasound screening protocol using the micro-costing bottom-up method. RESULTS: For individuals without thyroid nodules, the screening examination had an estimated cost of €66.21 per screenee. For those found to have unsuspicious nodules, the estimated cost rose to €119.52 per screenee, owing to the addition of thyroid function tests. The estimated cost of screening for a subject with newly diagnosed nodules that were submitted to cytology was €259.89. The total cost of screening for the entire population of 1176 individuals was € 118,133.85. The total expenditure to confirm a single thyroid cancer diagnosis was €10,598.71. CONCLUSION: A sonographic screening implies a significant direct expenditure and is likely to detect a very large number of individuals with benign nodules (more than 45 asymptomatic individuals are diagnosed with a thyroid nodule for each newly detected cancer case), whose long-term follow-up will further increase healthcare costs.


Subject(s)
Thyroid Neoplasms , Thyroid Nodule , Adult , Humans , Thyroid Nodule/diagnostic imaging , Thyroid Nodule/genetics , Prospective Studies , Cross-Sectional Studies , Early Detection of Cancer , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/genetics , Ultrasonography
2.
J Endocrinol Invest ; 42(12): 1485-1490, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31203497

ABSTRACT

PURPOSE: The aim of the study was to describe the spontaneous TSH level variations and levothyroxine dose adjustments in athyreotic patients with differentiated thyroid cancer (DTC) in real-life practice. METHODS: Patients with DTC were retrospectively evaluated at a tertiary referral center between October 2006 and November 2013. Hormone measurements (TSH and FT4 serum levels), L-T4 prescription information (dose per kg per day) and other medications were recorded at 1 month and 3, 12, 24, 36 and 48 months after primary treatment (surgery ± radioiodine therapy). RESULTS: The cohort was composed of 452 patients; about 20% of patients with stable levothyroxine dose have clinically meaningful spontaneous TSH variations (defined as ΔTSH > 2 mcUI/mL) at yearly follow-up visit. Furthermore, about 25% of athyreotic DTC patients with stable dose have a ΔTSH > 1.5 mcUI/mL and about 40% a ΔTSH > 1 mcUI/mL during each follow-up visit. We further investigated whether this TSH variation would lead to subsequent dose changes. About 19.9-37.7% of DTC patients on stable LT4 dose on the previous visit had their levothyroxine dose reduced, while 7.8-14.9% increased due to TSH variations. We further evaluated the decision to change the dose in relation with the age-specific TSH range. Up to 77.2% of patients had their dose adjusted due to TSH falling below the age-specific range. CONCLUSIONS: Spontaneous serum TSH variations determine levothyroxine replacement therapy in athyreotic patients with DTC, requiring multiple dose changes.


Subject(s)
Thyroid Neoplasms/blood , Thyroidectomy , Thyrotropin/blood , Thyroxine/therapeutic use , Adult , Dose-Response Relationship, Drug , Female , Hormone Replacement Therapy , Humans , Iodine Radioisotopes/therapeutic use , Male , Middle Aged , Retrospective Studies , Thyroid Neoplasms/drug therapy , Thyroid Neoplasms/radiotherapy , Thyroid Neoplasms/surgery , Thyroxine/administration & dosage , Thyroxine/blood
3.
Eur Rev Med Pharmacol Sci ; 23(2): 749-754, 2019 Jan.
Article in English | MEDLINE | ID: mdl-30720183

ABSTRACT

OBJECTIVE: The aim of the present study was to assess the association among anxiety, depression, stress, social support and emotional abilities with adherence and healthcare spending in type 2 diabetic patients. PATIENTS AND METHODS: Sixty-four patients were enrolled and completed: Interpersonal Processes of Care (IPC), 20-item Toronto Alexithymia Scale (TAS-20), Rapid Stress Assessment Scale (RSAS), Morisky Medication Adherence Scale (MMAS-4), International Physical Activity Questionnaire (IPAQ)-Short Form and a socio-anamnestic questionnaire regarding also the healthcare spending. RESULTS: Mathematical linear regressions models were performed showing the predictive effects of: anxiety and social support scores (RSAS) on adherence levels (respectively p =. 019; p =. 016); adherence levels on anxiolytic use (p =.04); aggressiveness scores (RSAS) on the number of general check-ups (p =.031); TAS-20 and physician-patient communication (IPC) on the number of hospitalization days (respectively p=.001; p=.008); physician patient decision making (IPC) scores on physical activity (IPAQ) levels (p=.025); physical activity (IPAQ) on the number of medical examinations (p=.039). CONCLUSIONS: An association among psychosocial impairment, adherence and healthcare spending was found. Future studies should investigate the effect of a brief psychological intervention in increasing adherence levels and reducing the healthcare spending in this clinical population.


Subject(s)
Diabetes Mellitus, Type 2/psychology , Health Expenditures/statistics & numerical data , Medication Adherence/statistics & numerical data , Social Support , Aged , Aged, 80 and over , Anxiety/diagnosis , Anxiety/economics , Anxiety/epidemiology , Anxiety/psychology , Depression/diagnosis , Depression/economics , Depression/epidemiology , Depression/psychology , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/economics , Female , Humans , Male , Middle Aged , Psychometrics/statistics & numerical data , Self Report/statistics & numerical data , Stress, Psychological/diagnosis , Stress, Psychological/economics , Stress, Psychological/epidemiology , Stress, Psychological/psychology
4.
J Endocrinol Invest ; 42(1): 85-90, 2019 Jan.
Article in English | MEDLINE | ID: mdl-29667113

ABSTRACT

PURPOSE: Aim of this study was to evaluate the association between body mass index (BMI) and aggressive features of differentiated thyroid cancer (DTC) in a prospective cohort. METHODS: Patients with DTC were prospectively enrolled at a tertiary referral center and grouped according to their BMI. Aggressive clinic-pathological features were analyzed following the American Thyroid Association Initial Risk Stratification System score. RESULTS: The cohort was composed of 432 patients: 5 (1.2%) were underweight, 187 (43.3%) normal weight, 154 (35.6%) overweight, 68 (15.7%) grade 1 obese, 11 (2.5%) grade 2 obese and 7 (1.6%) grade 3 obese. No single feature of advanced thyroid cancer was more frequent in obese patients than in others. No significant correlation was found between BMI, primary tumor size (Spearman's ρ - 0.02; p = 0.71) and ATA Initial Risk Stratification System score (ρ 0.03; p = 0.49), after adjustment for age. According to the multivariate logistic regression analysis, male gender and pre-surgical diagnosis of cancer were significant predictors of cancer with high or intermediate-high recurrence risk according to the ATA system (OR 2.06 and 2.51, respectively), while older age at diagnosis was a protective factor (OR 0.98), and BMI was not a predictor. BMI was a predictor of microscopic extrathyroidal extension only (OR 1.06). CONCLUSIONS: Obesity was not associated with aggressive features in this prospective, European cohort of patients with DTC.


Subject(s)
Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/epidemiology , Obesity/diagnosis , Obesity/epidemiology , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/epidemiology , Adult , Body Mass Index , Cohort Studies , Female , Humans , Male , Middle Aged , Neoplasm Invasiveness/pathology , Prospective Studies
5.
Diabetes Res Clin Pract ; 104(1): e26-8, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24468098

ABSTRACT

Low high-density lipoprotein cholesterol (HDL-C) levels are associated with cardiovascular (CV) disease in type 2 diabetes (T2D). Unfortunately available drugs to increase HDL-C have failed to demonstrate a reduction in CV risk. We assessed the effect of improving glycemic control on HDL-C levels. A 6-month intervention resulted in significant improvement in HbA1c but not in HDL-C levels. However, when considering the subgroup of subjects with low levels of HDL-C at baseline, we found a significant and inverse relation between improvement in HbA1c and HDL-C levels.


Subject(s)
Blood Glucose/metabolism , Cholesterol, HDL/blood , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/drug therapy , Dyslipidemias/blood , Hypoglycemic Agents/therapeutic use , Adolescent , Adult , Aged , Diabetes Mellitus, Type 2/complications , Dyslipidemias/complications , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Young Adult
6.
Obesity (Silver Spring) ; 21(9): 1815-22, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23696329

ABSTRACT

OBJECTIVE: The effects of acquired obesity on lipid profile and lipoprotein composition in rare BMI-discordant monozygotic (MZ) twin pairs were studied. DESIGN AND METHODS: Abdominal fat distribution, liver fat (magnetic resonance imaging and spectroscopy), fasting serum lipid profile (ultracentrifugation, gradient gel-electrophoresis, and colorimetric enzymatic methods), and lifestyle factors (questionnaires and diaries) were assessed in 15 BMI-discordant (within-pair difference [Δ] in BMI >3 kg/m2) and nin concordant (ΔBMI <3 kg/m2) MZ twin pairs, identified from two nationwide cohorts of Finnish twins. RESULTS: Despite a strong similarity of MZ twins in lipid parameters (intra-class correlations 0.42-0.90, P < 0.05), concentrations of apolipoprotein B (ApoB), intermediate-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein 3a% (HDL3a%), and HDL3c% were higher (P < 0.05) and those of HDL cholesterol, HDL2-C, and HDL2b% were lower (P < 0.01) in the heavier co-twins of BMI-discordant pairs. The composition of lipoprotein particles was similar in the co-twins. When BMI-discordant pairs were further divided into liver fat-discordant and concordant (based on median for Δliver fat, 2.6%), the adverse lipid profile was only seen in those heavy co-twins who also had high liver fat. Conversely, BMI-discordant pairs concordant for liver fat did not differ significantly in lipid parameters. In multivariate analyses controlling for Δsubcutaneous, Δintra-abdominal fat, sex, Δsmoking and Δphysical activity, Δliver fat was the only independent variable explaining the variation in ΔApoB, Δtotal cholesterol, and ΔLDL-C concentration. CONCLUSIONS: Several pro-atherogenic changes in the amounts of lipids but not in the composition of lipoprotein particles were observed in acquired obesity. In particular, accumulation of liver fat was associated with lipid disturbances, independent of genetic effects.


Subject(s)
Abdominal Fat , Apolipoproteins B/blood , Cholesterol/blood , Fatty Liver/complications , Liver/metabolism , Obesity/complications , Twins, Monozygotic , Adult , Body Mass Index , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Exercise , Fatty Liver/blood , Fatty Liver/genetics , Fatty Liver/metabolism , Female , Finland , Humans , Male , Multivariate Analysis , Obesity/blood , Obesity/genetics , Obesity/metabolism , Subcutaneous Fat , Young Adult
7.
Nutr Metab Cardiovasc Dis ; 23(6): 505-10, 2013 Jun.
Article in English | MEDLINE | ID: mdl-22402064

ABSTRACT

BACKGROUND AND AIMS: Several studies have reported that the ectonucleotide pyrophosphatase phosphodiesterase 1 (ENPP1) K121Q polymorphism (rs1044498) interacts with increased adiposity in affecting glucose homeostasis and insulin sensitivity. Conversely, one would expect that the amelioration of glucose homeostasis observed after weight loss is modulated by the ENPP1 K121Q polymorphism. The aim of our study was to test such hypothesis, in non-diabetic overweight-obese individuals. METHODS AND RESULTS: Two hundred eleven non-diabetic overweight-obese individuals were studied. Body mass index (BMI), fasting glucose, homeostasis model assessment of insulin resistance (HOMA-IR index) and lipid levels were obtained before and after 6-week lifestyle intervention (LI; diet and exercise) and their changes calculated as baseline minus 6-week values. LI decreased BMI, glucose, HOMA-IR and triglyceride levels (p < 0.001 for all). No difference across genotype groups (160 KK and 51 KQ or QQ - named as XQ - individuals) was observed in these changes. In a multivariate model, BMI changes predicted fasting glucose changes (ß = 0.139 mmol/L (2.50 mg/dl) for 1 unit BMI change, p = 0.005). This correlation was not significant among KK individuals (ß = 0.082; p = 0.15), while much steeper and highly significant among XQ individuals (ß = 0.336; p = 0.00008) (p-value for Q121-by-weight loss interaction = 0.047). CONCLUSION: Individuals carrying the ENPP1 Q121 variant are highly responsive to the effect of weight loss on fasting glucose. This reinforces the previously suggested hypothesis that the Q121 variant interacts with adiposity in modulating glucose homeostasis.


Subject(s)
Adiposity , Blood Glucose/analysis , Phosphoric Diester Hydrolases/genetics , Polymorphism, Genetic , Pyrophosphatases/genetics , Weight Loss , Adult , Body Mass Index , Cholesterol, HDL/blood , Diabetes Mellitus , Diet , Exercise , Fasting , Female , Genotype , Homeostasis , Humans , Insulin Resistance , Life Style , Male , Middle Aged , Multivariate Analysis , Obesity/blood , Obesity/genetics , Overweight/blood , Overweight/genetics , Phosphoric Diester Hydrolases/metabolism , Pyrophosphatases/metabolism , Triglycerides/blood
9.
Horm Metab Res ; 43(1): 22-5, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20886414

ABSTRACT

Levothyroxine (L-T4)-based suppression of thyrotropin (TSH) secretion is widely used to prevent the growth of benign thyroid nodules, although the effectiveness of this approach has been demonstrated only in a subset of patients. In this study, we analyzed the in vivo effects of L-T4-mediated TSH suppression on elements of insulin/IGF-1-dependent growth-regulating pathways in tissues from patients with benign thyroid nodules. Nodular and non-nodular tissue specimens were collected from 63 patients undergoing thyroidectomy. 32 had received preoperative TSH suppressive therapy with TSH levels consistently below 0.5 mU/l (L-T4 group). TSH suppression had not been used in the other 31, and their TSH levels were normal (0.8-4 mU/l (control group). Quantitative RT-PCR was used to measure mRNA levels for TSH receptor, IGF1, IGF-1 receptor, insulin receptor, insulin receptor substrate 1 in nodular and non-nodular tissues from the 2 groups. Akt and phosphorylated Akt protein levels were detected by Western blot. Mean levels of mRNA for all genes tested were similar in the 2 groups, in both nodular and non-nodular tissues. The 2 groups were also similar in terms of phosphorylated Akt protein levels (measured by densitometric scan in 10 randomly selected nodules from each group). This is the first demonstration based on the study of human thyroid tissues that TSH suppression does not affect the expression of components of the insulin/IGF-1-dependent signaling pathways regulating thyrocyte growth. This may explain the lack of effectiveness of TSH-suppressive therapy in a substantial percentage of benign thyroid nodules.


Subject(s)
Goiter, Nodular/genetics , Goiter, Nodular/metabolism , Proto-Oncogene Proteins c-akt/metabolism , Receptors, Growth Factor/genetics , Thyrotropin/metabolism , Adult , Aged , Down-Regulation , Female , Gene Expression , Goiter, Nodular/drug therapy , Goiter, Nodular/surgery , Humans , Male , Middle Aged , Phosphorylation , Proto-Oncogene Proteins c-akt/genetics , Receptors, Growth Factor/metabolism , Signal Transduction , Thyroidectomy , Thyroxine/therapeutic use
10.
BMJ Case Rep ; 20112011 Jan 25.
Article in English | MEDLINE | ID: mdl-22715266

ABSTRACT

It is not unusual for doctors working in the emergency department (ED) to diagnose a benign syndrome of transient global amnesia (TGA). It is rare that the TGA patient is in danger of life because of a 'forgotten' acute aortic dissection (AAD). The present article deals with one of such rare cases of association between TGA and AAD, which presented laboratory findings never reported before. A practical diagnostic algorithm has also been drafted to help ED physicians facing such a puzzling situation.


Subject(s)
Aortic Aneurysm/diagnosis , Aortic Dissection/diagnosis , Algorithms , Amnesia, Transient Global/etiology , Aortic Dissection/complications , Aortic Aneurysm/complications , Emergencies , Emergency Service, Hospital , Humans , Male , Middle Aged
11.
J Endocrinol Invest ; 33(1): 2-6, 2010 Jan.
Article in English | MEDLINE | ID: mdl-19794300

ABSTRACT

BACKGROUND: Agents capable of increasing radioiodine concentration by stimulating the sodium/iodide symporter (NIS) expression have been extensively investigated for the treatment of certain well-differentiated breast cancers. AIM: In this study, we analyzed the regulation of the NIS and lactoperoxidase (LPO) gene expression in 4 different human breast cancer cell lines, representative of different histotypes of breast cancer. METHODS: MCF-7, T-47D, MDA-MB231, and HCC-1937 (the latter carrying the BRCA-1 mutation) were exposed to different stimulators and the levels of NIS and LPO mRNA measured by a quantitative RT-PCR. RESULTS: All-trans-Retinoic Acid (RA), Dexamethasone (DEX), Trichostatin A (TSA), and Sodium Butyrate (NaB) induced the expression of NIS mRNA in MCF-7 and T-47D cell lines, whereas HCC-1937 and MBA-MB231 were slightly responsive only to the histone-deacetylase inhibitors TSA and NaB. Minor stimulatory effects were detected on LPO mRNA in MCF-7 and T-47D treated with TSA and NaB or RA only in MCF-7, while no effect was detectable in the other two cell lines. CONCLUSIONS: These data indicate that retinoic acid, alone or in combination with DEX, as well as HDAC-inhibitors are very promising agents for a radioiodine- based therapy in a large spectrum of breast cancers, including neoplasms from both basal and ductal cells, especially for the well-differentiated estrogen-dependent tumors. Other molecules or other drug combinations should be tested to extend the same strategy to the less differentiated and more aggressive tumor cells, including those carrying the BRCA mutation.


Subject(s)
Breast Neoplasms/metabolism , Lactoperoxidase/genetics , Symporters/genetics , Butyrates/pharmacology , Cell Line, Tumor , Dexamethasone/pharmacology , Histone Deacetylase Inhibitors/pharmacology , Humans , Hydroxamic Acids/pharmacology , Lactoperoxidase/biosynthesis , RNA, Messenger/metabolism , Symporters/biosynthesis , Tretinoin/pharmacology
13.
Arterioscler Thromb Vasc Biol ; 21(10): E34-7, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11597949

ABSTRACT

Clinical trials with vitamin E have yielded contrasting results. In these trials, the amount of vitamin E given was different, and the compliance was not assessed in all studies. In addition, the modality of intake, ie, in relation to food, was not specified in any trial. Vitamin E is lipophilic, and its absorption is expected to be increased by food. We studied the bioavailability of vitamin E in relation to food intake and the effect on the lipid peroxide-scavenging activity of plasma and on 7beta-hydroxycholesterol and 7-ketocholesterol (oxysterols) as markers of oxidant stress. Twenty healthy Italian subjects were randomly assigned to take vitamin E at 300 mg/d on an empty stomach (group A) or during dinner (group B) for 15 days. Plasma vitamin E markedly increased in group B (84%) compared with group A (29%). The lipid peroxide-scavenging activity of plasma increased significantly in group B (14%, P=0.005) but did not change in group A. All subjects showed very low levels of plasma oxysterols, which were not affected by vitamin E supplementation in either group. This study shows that plasma concentration of vitamin E and plasma antioxidant activity in response to oral supplementation are markedly affected by food intake. Healthy Italian subjects show very low levels of cholesterol oxidation products; these low levels are possibly related to the Mediterranean diet. To obtain maximal absorption, vitamin E must be given at meals. These data should be taken into account in clinical trials with vitamin E.


Subject(s)
Hydroxycholesterols/blood , Ketocholesterols/blood , Lipid Peroxides/blood , Oxidative Stress , Vitamin E/administration & dosage , Adult , Arteriosclerosis/drug therapy , Biomarkers/blood , Eating , Female , Humans , Male , Vitamin E/blood
SELECTION OF CITATIONS
SEARCH DETAIL
...