The relationship between iodine intake and serum thyroglobulin in the general population.

The relationship is shown between a concentration of urinary iodine and serum thyroglobulin in population studies carried out on a general population that was randomly selected from the registry of the General Health Insurance Company (individuals aged 6-98 years, 1751 males, 2420 females). The individuals were divided into subgroups with a urinary iodine concentration of <50, 50-99, 100-199, 200-299 and >/=300 microg/l. The mean and median of thyroglobulin were calculated in these subgroups. Tg concentrations were dependent on gender (males

Plasma adrenomedullin and subclinical cardiorenal syndrome in patients with type 2 diabetes mellitus.

OBJECTIVE: To evaluate whether plasma adrenomedullin is involved in the previously reported significant inverse correlation between left ventricular (LV) end-diastolic pressure (peak velocity of early transmitral flow/peak velocity of early diastolic mitral annular motion ratio [E/E' ]) and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus, mild-to-moderate renal function impairment and LV relaxation impairment (E'≤7.1 cm/s). METHODS: Plasma adrenomedullin concentration, E/E' and eGFR were assessed in 82 patients with type 2 diabetes. RESULTS: Plasma adrenomedullin concentration was positively correlated with eGFR in patients with or without LV relaxation impairment, and inversely correlated with E/E' in patients with LV relaxation impairment. Multivariate linear regression analysis supported a role for plasma adrenomedullin in the association between E/E' and eGFR. CONCLUSION: These results support the hypothesis that adrenomedullin modulates the interaction between the heart and kidneys in early subclinical cardiorenal syndrome in patients with type 2 diabetes mellitus.

Prevalence of obesity and metabolic syndrome in adult population of selected regions of the Czech Republic. Relation to eating habits and smoking.

Prevalence of the metabolic syndrome is around 25% in Europe but its occurrence grows in both genders with increasing age and weight. Lifestyle factors may contribute to the risk of developing metabolic syndrome. The objective of this study was to determine the relationship between metabolic syndrome and eating habits as well as length of sleep and smoking. Participants (519 women and 286 men aged 18-65 years) were chosen by random selection and questioned about their eating habits, sleep length and smoking. This information was combined with anthropometric and clinical parameters of metabolic syndrome. The female group was divided into two subgroups depending on climacteric stage (before and after menopause). Metabolic syndrome prevalence does not differ between regions in neither female (29.9%) nor male (32.5%) group. Body mass index ≥25 was detected in 50.4% of all women and 65.7% of men; 23.5% of all women and 21.7% men had body mass index ≥30. In conclusion, metabolic syndrome prevalence was proved to depend on eating habits and family heredity. Positive correlation between the above mentioned factors demonstrated itself in the total sample but not in individual regions. Metabolic syndrome prevalence in Czech adults is comparable with neighbouring countries. No significant interregional differences in metabolic syndrome prevalence within the Czech Republic were detected. In conclusion, relationship between eating habits and metabolic syndrome was confirmed.

Effect of long-term treatment on subjective problems of patients with common thyroid gland disorders in the Czech Republic.

In this study, a total of 364 patients of the Endocrinology outpatient clinic who had undergone thyreopathy treatment of various lengths were investigated. The objective of the study was to find out the consequences of thyroid gland disorder on a person's life, and whether the treatment length has any effect on subjective problems of patients. Common problems reported by patients were evaluated; the final number of such "common problems" in the final stage of the research was 56. In order to achieve better orientation in the processing of results, the patient-described types of disorders were classified according to the patients' own opinions into the following groups: eufunctional thyroid gland, inflammation, hypothyroidism, hyperthyroidism, tumour and surgery. The fact is that in the first year of treatment, almost half of all patients with a thyroid gland disorder experienced some problems caused by the disease. It is not a favourable finding that in the upcoming years, i.e. from 2 to 10 years, the number of those with problems will increase to as much as 61%. The period of treatment between 11 and 15 years means a decrease in the occurrence of problems to 50%, but with the number of patients with problems increasing, their number becomes even higher than that in the period of 2 to 10 years. Influence of aging processes should be also taken into account.

The impact of early diastolic myocardial relaxation on the other parameters of diastolic function and association of tissue Doppler parameters of diastolic function with diabetes compensation and duration in type 2 diabetic patients.

This study assessed the impact of tissue Doppler derived myocardial early diastolic relaxation velocity (E(m)) on the other parameters of diastolic function (preload dependent transmitral early diastolic velocity [E], tissue Doppler derived myocardial late diastolic velocity [A(m)], preload dependent transmitral late diastolic velocity [A]) and evaluated the correlation of these parameters with selected clinical variables in type 2 diabetic patients. Using tissue Doppler echocardiography, 82 type 2 diabetic patients were evaluated, divided into two equal groups of E(m) < 7.5 cm/s or > or = 7.5 cm/s. Patients with E(m) < 7.5 cm/s had significantly lower E/A and E(m)/A(m), and higher E/E(m) values. Multilinear regression showed a negative correlation between E(m) and glycated haemoglobin (Hb(A1c)) and duration of diabetes, a negative correlation of E(m)/A(m) with age, duration of diabetes and Hb(A1c), and a positive correlation of E/E(m) with age, duration of diabetes and use of diuretics. The E/A ratio only correlated negatively with age. It is concluded that E(m) is a reliable parameter of diastolic function, and that the tissue Doppler parameters of diastolic function are associated with diabetes compensation and diabetes duration.

[Influence of iodine saturation on thyreopathy incidence in selected regions of the Czech Republic]. / Vliv saturace jódem na výskyt tyreopatií ve vybraných regionech u dospelé populace Ceské republiky.

Thyreopathy--a disorder of thyroid gland--is, together with diabetes, one of the most common endocrine diseases and, similarly to other endocrinopathies, higher prevalence is seen in women than in men. When eliminating iodine deficiency, it should to be taken into account that the mean ioduria in the general population reaches 100-200 microg/l, just 1.3% of the population does not reach ioduria of 50 microg/l and the prevalence of goitre in school children declines below 5%. The 1991 and 1997 period was a period of slight iodine deficiency (ioduria < 100 microg/I) and was followed, between 1998 and 2006, by a period of optimum iodine saturation (ioduria > 100 microg/l). Median ioduria observed over one year follow up differed in different age groups, highest values were seen in the 18-35 age group and declined with age. Median iodinuria depended on the year of follow up, age and gender (p < 0.0000). Thyroid gland hypofunction was more frequent in women and ioduria levels > 100 microg/I, thyroid gland hyperfunction was also more frequent in women but with ioduria levels < 100 microg/l. Hypofunction, subclinical hypofunction, hyperfunction and subclinical hyperfunction were more frequent in women. Of unexplained laboratory findings, isolated hypothyroxinemia was more frequent in women and isolated hyperthyroxinemia was more frequent in men. Euthyreosis was more frequent in men than women.

[Iodine deficiency in the world and in the Czech Republic--current status and perspectives]. / Jodový deficit ve svete i v Ceské Republice--soucasný stav a perspektivy.

Iodopenia is importance world-wide problem--the cause of spectrum of iodine deficiency disorders (IDD). The "simple" way for its compensation is iodine supplementation--preferably by iodinization of salt: in the Czech Republic prevalence of IDD was very high in the past. The complex program for compensation of iodine deficiency realized in the CR includes improvement of salt iodization, supplementation of pregnant and lactating women, fortification of products for babies' nutrition and increasing use of iodinized salt in general population incl. food industry. Thus CR is country with compensated iodine deficiency according to criteria WHO, UNICEF, ICCIDD. In future, however, systematic interest should be focused on optimalization of iodine saturation, esp. in pregnant women and evaluation of possible risk of supranormal iodine intake (impairment of thyroid function, activation of thyroid autoimmunity). Taking in account, the changes of nutrition and life style systematic monitoring of quality of iodine supplementation seems to be essential.

Relationship between pituitary-thyroid axis hormones and anthropometric parameters in Czech adult population.

Although the relationships between thyroid function and anthropometric parameters were studied in patients with thyroid disorders and in morbidly obese subjects, such data in normal healthy population are scarce. In our study, relationships between factors of body composition, fat distribution and age with hormones of the pituitary-thyroid axis were evaluated in a large, randomly selected sample of normal adult Czech population comprising of 1012 men and 1625 women. Our results exhibited weak, but significant relationships between body composition, body fat distribution and the parameters of pituitary-thyroid axis. Some of these associations were gender-specific. As shown by backward stepwise regression model, body fat distribution evaluated by centrality index (subscapular/triceps skinfold ratio) was negatively associated with free triiodothyronine (fT3) serum levels only in women, while a positive correlation of fT3 with BMI was specific for men. BMI was inversely related to free thyroxine (fT4) concentrations in women but not in men. The centrality index (CI) was positively related to TSH levels in both genders. The fT3/fT4 ratio, reflecting deiodinase activity, was inversely related to age and positively related to BMI in both genders, while the highly significant negative correlation between CI and fT3/fT4 ratio was specific for women.

Anti-Helicobacter Pylori, anti-thyroid peroxidase, anti-thyroglobulin and anti-gastric parietal cells antibodies in Czech population.

Autoimmune thyropathies are frequently linked to many infections, such as Helicobacter pylori, which are also supposed to play a role in their pathogenesis. The aim of this study was to evaluate the relationships between thyroid and gastric autoimmunity and H. pylori infection on a large sample of Czech population (n=1621) by monitoring the autoantibodies against thyroglobulin (anti-Tg) and thyroid peroxidase (anti-TPO) and gastric parietal cell (anti-GPC, representing thyrogastric syndrome) in correlation with antibodies against Helicobacter pylori (anti-H. pylori) of classes IgG and IgA. The interrelation between autoantibodies and H. pylori antibodies was assessed by H. pylori seropositivity. In H. pylori seropositive persons as compared to seronegative irrespective of age and sex, a higher occurrence of anti-TPO (10.4 % vs. 5.8 %, p=0.001) and anti-GPC (6.1 % vs. 1.7 %, p<0.001) was found. Differences in anti-TPO occurrence were significant in both men (7.0 % vs. 3.3 %, p=0.03) and women (12.7 % vs. 8.0 %, p=0.02), differences in anti-GPC occurrence were significant only in women (7.2 % vs. 1.7 %, p<0.001). Results of this study support the idea of a connection between infection of H. pylori and the occurrence of anti-TPO autoantibodies representing thyroid autoimmunity and gastric parietal cells autoantibodies representing the thyrogastric syndrome.

TRH test in patients with diabetes mellitus type 1 and/or autoimmune thyroiditis. Changes in the pituitary-thyroid axis, reverse T3, prolactin and growth hormone levels.

The response of the pituitary- thyroid axis, reverse triiodothyronine (rT3), prolactin, and growth hormone (GH) levels following TRH stimulus (Relefact TRH 200 microg 2 amp. i.v.) was examined in patients with autoimmune diabetes type 1 (DM1, n=30), with autoimmune thyroiditis (AT, n=25), and with concurrent DM1 and AT (n=22) to evaluate the influence of DM1 and AT of autoimmune pathogenesis on the above-mentioned hormonal parameters. Statistical analysis (ANOVA) showed that: a) the response of TSH did not differ from control groups (C); b) free triiodothyronine (fT3), free thyroxine (fT4) and their ratio in DM1, DM1+AT and C rose in 120 and 180 min, while a similar increase was not seen in AT (p<0.000001); c) rT3 was not present in any group, with rT3 levels higher in AT (p<0.00002) and lower in DM1 (p<0.02); d) the response of GH had a paradoxical character in some patients in all groups, most often in DM1 (52 %, DM1 vs C, p <0.01). The characteristic response difference was not in the peak GH level, but the delayed return to basal levels in DM1 (p<0.0001) and an abrupt one in AT (p<0.0001). The major findings in DM1 were the differences in GH response, while significant impairment of pituitary-thyroid axis and PRL response to TRH was absent. AT was associated with impairment of TRH stimulated fT3, fT4, fT3/fT4 response and changes in rT3 levels, in spite of preserved TRH-stimulated TSH secretion. GH response in AT patients was also altered.

[Subclinical thyroid diseases]. / Subklinické tyreopatie.

Subclinical thyroids disease (STD) is recently defined term in clinical thyroidology, which includes mainly functional disorders. Basic diagnostic signs are: normal values of thyroid hormones (fT4, fT3) and elevated TSH level (subclinical hypothyroidism) or suppresed TSH level (subclinical hyperthyroidism). In a category of STD may be included subclinical autoimunne thyroiditis (elevated level of thyroid antigens antibodies and/or hypoechogenity in sonographic screen, increased volume of the thyroid without clinical symptoms and/or autoimminity) and microscopic lesions of papillary thyroid carcinoma. Subclinical hypothyroidism may be dangerous for tendency to development of manifest hypothyroidism and for risk of disorders of lipid profile and development of atherosclerosis and its organ complication (esp. myocardial infarction). Subclinical hyperthyroidism is a risk factor of cardiac arythmias and probably can increase a risk of cardiovascular mortality) as well for osteoporosis (esp. in peri- and post-climacteric women), and last but not least for degenerative diseases of brain (?). Indication of treatment of STD is a matter of controversies. Recomendations of experts, varied from "no therapy, monitoring only" to "treat always". Treatment of risk groups (esp. pregnant women) is probably nowadays a most rationale recommendations since results of sofisticated prospective studies will be available.

[Polyglandular activation of autoimmnunity as a manifestation of subclinical endocrinopathies]. / Polyglandulární aktivace autoimunity jako projev subklinických endokrinopatií.

BACKGROUND: Autoimmune thyropathies belong to the most frequently occurring autoimmune endocrinopathies. Autoimmune thyropathies occur either independently or linked to known polyglandular syndromes of type I-III. METHODS AND RESULTS: During the last decade, we observed a group of patients with autoimmune thyroiditis, in which autoimmune endocrinopathies were mutually associated and named the symptoms of this group "polyglandular activation of autoimmunity". The frequency of the occurrence of autoantibodies against other endocrine organs in this group was determined and the most frequent was the occurrence of the autoantibodies against steroid producing cells - anti-ovary 28 %, anti-adrenal 23 %, anti-testes 12 %. Considering the most frequent occurrence of autoantibodies against steroid producing cells, attention has been paid namely to patients with autoimmune thyroiditis and a concurrent occurrence of anti-adrenal autoantibodies. In the foreground of the clinical picture of these patients were dysregulations on the metabolic and circulation levels together with symptoms of discomfort (subfebrile condition, arthralgia and fatigue). Heavy fatigue of these patients was linked to the changes of levels and mutual ratio of melatonin and serotonin and regarding autoantibodies, mainly autoantibodies against steroid producing cells, namely against the particular cells of the layers of adrenal cortex played a role. CONCLUSIONS: The presence of autoantibodies influenced also the functional response, namely the ACTH/cortisol ratio. Autoantibodies detected were not anti-21-hydroxylase autoantibodies, typical for autoimmune polyglandular syndrome II, but antibodies against antigens of other molecular weight.

[Diabetes mellitus in adult patients with type I diabetes shows immunological, functional and clinical differences depending on the presence of autoimmune thyroiditis]. / Diabetes mellitus dospelých diabetiku 1. typu v závislosti na prítomné autoimunitní tyroiditide vykazuje imunologické, funkcní a klinické odlisnosti.

BACKGROUND: Autoimmune diabetes is usually accompanied by other autoimmune endocrinopathies, most often by autoimmune thyroiditis (AIT), but it is not clear whether diabetes in these patients differs from diabetes without AIT. METHODS AND RESULTS: Eleven-year follow-up of 47 young adult Type 1 diabetic patients with respect to the presence of AIT (group I - positive antibodies against microsomal peroxidase, antiTPO, and tyreoglobulin, antiTgl, group II - only positive antiTPO, group III - without AIT) showed: a) cessation of endogenous insulin secretion (Cpeptide <0.03 nmol/l) in 100 % of patients with AIT (in group I between year 2 and 9, in group II between year 3 and 11, p<0.05), while in group III without AIT only in 55 % of patients (I,II vs. II, p<0.001); b) higher prevalence of antiGAD values > 5 U/ml in group I when compared to patients without AIT (I vs III, p<0.05); c) tendency toward higher doses of insulin needed for diabetes compensation in patients without AIT; d) the highest prevalence of organ-specific and systemic autoantibodies in group I with the most distinct manifestations of AIT, and the lowest prevalence in group III without AIT (statistically significant). CONCLUSIONS: Autoimmune diabetes in adults with AIT compared to diabetes occurring isolated showed differences in the area of autoimmunity against islets of Langerhans, Langerhans islets' function and in the clinical course of the disease.

[Evaluation of results of iodine prophylaxis in Czech Republic]. / Hodnocení výsledku jodové profylaxe v ceské republice.

BACKGROUND: Improvement of system of iodine prophylaxis in Czech Republic resulted in compensation of iodine deficiency. Effects of increased iodine intake on the status of thyroid gland (volume, function, autoimmune disorders) should be determined. The aim of the study was to evaluate those effects in an epidemiological survey. METHODS AND RESULTS: A randomly selected sample of adult population (18-65 years old) from 3 regions was investigated using the same methods at the interval of 5 years. A significant increase of ioduria was proved with the marked increase of prevalence of high category (over 300 ug of I per 100 mL of urine). Volume of the thyroid gland decreased significantly in women, not in men. No significant changes of TSH were observed, however FT4 level slightly, but significantly increased. CONCLUSIONS: Repeated epidemiological survey of the randomly selected sample of adult population in 3 regions verified the effectiveness of improved iodine prophylaxis with not unequivocally positive increase of high (supraphysiological) category of ioduria. Decrease of thyroid volume was proved in women only, a tendency of mild (clinically not important) increase of thyroid function was also observed.

[Prevalence of C-reactive protein levels in adult population in two regions in the czech republic and their relation to body composition]. / Prevalence hladin C-reaktivního proteinu u dospelé populace dvou regionu Ceské republiky a jejich vztah k telesnému slození.

UNLABELLED: Increased concentration of high sensitivity C-reactive protein (hsCRP) is the new predictor of myocardial infarction, brain strokes, damage peripheral veins and sudden death. The aim of the study was to give an overview of current prevalence of individual risky concentrations of hsCRP in the adult population in two regions in the Czech Republic and to find a relationship to the indicators of fat tissue quantity. METHODS: test involved a representative sample of 516 adults aged 18 to 65 years (191 men and 322 women), with permanent residence in the Jablonec nad Nisou a Príbram regions. Period of testing: spring of 2004 and 2005. HsCRP was determined using the latex immunoprecipitation method with turbidimetric measurement on Cobas Integra 400 plus analyzer. The risk of cardiovascular disease (CVD) was set according to the scale derived by the American Heart Association. Body fat was measured with TANITA BF 410 MA, Omron and a calliper on 4 places on the body. Waist circumference was measured half-way between the anthropometric landmarks of the iliocristale and the lower angle of the ribs. Body mass index (BMI) was calculated using Quetelet formula: weight/height2. Statistical processing was done with Statgraphics Plus, version 7.1, using categorical data analysis with the chi2 statistic and Spearman's correlation analysis. RESULTS: 20.2% of cases with high CVD risk were identified in the whole sample of adults. Levels of hsCRP exceeding 10 mg/l (infectious disease indicator) at the time of the test were found in 3.9% cases (5.6% in the Jablonec region, 2.3% in the Príbram region). There were no significant regional differences for individual CVD risk categories; however, there was statistically significant difference between the two regions in terms of average hsCRP levels (with higher levels in the Jablonec region). Gender had a statistically significant impact on hsCRP levels: high CVD risk was recorded in 14.8% men and in 23.3% women. Levels of CRP indicating inflammatory disease were more frequent in women (4.7%) than in men (2.6%). The frequency of risk levels of hsCRP in adults significantly grows with age. Spearman's correlation analysis showed the closest relationship between hsCRP and body fat weight (r(S) = 0.5124). A statistically important positive CRP levels relationship was shown both in subcutaneous fat and visceral fat. CONCLUSION: One fifth of the adult population in two regions of the Czech Republic have at the present time levels of hsCRP which indicate a high cardiovascular risk. The risk is higher in women than in men and it doubles starting at 50 years of age and over. Positive correlation between hsCRP levels and body fat indicators was conformed both for visceral and subcutaneous fat.

[The meaning of the combination of fibrinogen, micro/macroalbuminuria and atheromatosis in the carotid bloodstream for the evaluation of the abnormal finding of the stress myocardial SPECT in the asymptomatic 2nd type diabetic patients]. / Význam kombinace zmen fibrinogenu, mikro/makroalbuminurie a ateromatózy v karotickém recisti pro posouzení rizika abnormálního nálezu zátezového SPECT myokardu u asymptomatických diabetiku 2. typu.

OBJECTIVES: Stress perfusion myocardial scintigraphy (SPECT) is useful in silent ischemia detection in the group of the asymptomatic type 2. diabetic patients. In our paper we present the combinations of the parameters predictive for stress myocardial SPECT result. METHODS: We selected parameters (fibrinogen, micro/macroalbuminuria, ateroma in carotid artery bed) that were significantly associated with stress myocardial SPECT result. We analyzed the combinations of these parameters change and evaluated their significance for stress myocardial SPECT result prediction. RESULTS: We evaluated 121 type 2. diabetic patients without patological ECG changes and with normal left ventricle ejection fraction. Thirty one (26%) had abnormal and 90 (74%) equivocal or normal stress myocardial SPECT result. The combination of ateroma presence in carotid bed and fibrinogen in upper tertile was found in 20 patients. Fifteen of them (75%) had the abnormal SPECT result. The combinations of the ateroma absence, negative micro/macroalbuminuria and fibrinogen in the middle or lower tertile were present almost in the half of all the examined diabetic patients. Such combinations were connected with normal or equivocal SPECT result in 93-96% cases. CONCLUSION: Micro/macroalbuminuria, fibrinogen and ateroma in carotid bed found by sonography are significantly associated with stress myocardial SPECT result. Combinations of these parameters changes lead to the futher stratification that enables the rationale approach in the stress examination indication.

[The volumes of the thyroid gland in adults aged 18-65 years in the Czech Republic--determination of the norms]. / Volumy stítné zlázy u dospelé populace ve veku 18-65 let v Ceské republice--stanovení norem.

OBJECTIVE: In the areas with moderate iodine deficit the sonographic examination of thyroid gland is a precious method of precise determination of its volume. The objective of the work was the sonographic examination of males and females aged 18-65 years and to determine the norms of the volumes of thyroid gland. METHODS AND RESULTS: In total, by random sampling, there were sonographically examined 3 416 adults in 11 areas of the Czech Republic; there was chosen a set of 971 females and 681 males whose iodinuria level in first morning urine sample was equal or higher than 100 microg/l. This set was divided according to sex and into the age categories in 5-year interval. The measurement of 3 dimensions of the thyroid gland was determined by Medison-Kretz SA 600 sonographic device with the use of 7.5 MHz linear probe for the depth and width measurement and 3.5 MHz probe was used for the lengths measurement. The volume was determined for each lobe individually using Brunn's formula: V (ml) = 0.479 x length x depth x width. Our results imply the age-related increase of the volume of thyroid gland at both sexes (F-ratio = 1.99, p < 0.0001). At men and women the volume of thyroid gland fluently increases to the 30th year equally, from 30 years to 55 years it increases more rapidly in men while in women there is observed a moderate plateau. Further increase of the volume of thyroid gland is equally fluent from the age of 55 years. CONCLUSION: We managed to determine first own norms of the volumes of thyroid gland for men and women aged 18-65 years in the Czech Republic in five-year age categories. In terms of practical use we recommend 90th percentile as a limit for the evaluation of upper limit of thyroid gland and the 10th percentile for the evaluation of lower limit of the volume of thyroid gland.