Iodine status and thyroid function among Spanish schoolchildren aged 6-7 years: the Tirokid study.

I deficiency is still a worldwide public health problem, with children being especially vulnerable. No nationwide study had been conducted to assess the I status of Spanish children, and thus an observational, multicentre and cross-sectional study was conducted in Spain to assess the I status and thyroid function in schoolchildren aged 6-7 years. The median urinary I (UI) and thyroid-stimulating hormone (TSH) levels in whole blood were used to assess the I status and thyroid function, respectively. A FFQ was used to determine the consumption of I-rich foods. A total of 1981 schoolchildren (52 % male) were included. The median UI was 173 µg/l, and 17·9 % of children showed UI<100 µg/l. The median UI was higher in males (180·8 v. 153·6 µg/l; P<0·001). Iodised salt (IS) intake at home was 69·8 %. IS consumption and intakes of ≥2 glasses of milk or 1 cup of yogurt/d were associated with significantly higher median UI. Median TSH was 0·90 mU/l and was higher in females (0·98 v. 0·83; P<0·001). In total, 0·5 % of children had known hypothyroidism (derived from the questionnaire) and 7·6 % had TSH levels above reference values. Median TSH was higher in schoolchildren with family history of hypothyroidism. I intake was adequate in Spanish schoolchildren. However, no correlation was found between TSH and median UI in any geographical area. The prevalence of TSH above reference values was high and its association with thyroid autoimmunity should be determined. Further assessment of thyroid autoimmunity in Spanish schoolchildren is desirable.

Carga de la enfermedad atribuible al hipotiroidismo subclínico en la población española / Burden of illness attributable to subclinical hypothyroidism in the Spanish population

Introducción. El hipotiroidismo subclínico (HS) se ha asociado a enfermedades cardiovasculares, pero se desconoce la pérdida de salud que conlleva. Hemos evaluado la carga de enfermedad del HS en España. Pacientes y métodos. A partir de la prevalencia del HS en España obtenida de estudios internacionales, se llevó a cabo un modelo teórico que calculó los años de vida ajustados por discapacidad (AVAD), los años de vida perdidos (AVP), y las pérdidas de salud por discapacidad (AVD) asociados al HS. Las prevalencias de los factores de riesgo, el riesgo de mortalidad coronaria, y de episodios coronarios asociados al HS se obtuvieron de una revisión de la literatura. El análisis se llevó a cabo según la metodología de la Organización Mundial de la Salud, utilizando fuentes oficiales españolas (registro de altas hospitalarias: conjunto mínimo básico de datos [CMBD], registro de mortalidad hospitalaria, etc.). Resultados. En España hay aproximadamente 2.767.124 personas con HS (1.949.820 con niveles de TSH entre 4,5 y 6,9mUI/l [70,5%], 538.988 con TSH entre 7 y 9,9mUI/l [19,5%], y 278.317 con TSH entre 10 y 19,9mUI/l [10%]). Estas personas con HS podrían sufrir 12.608 episodios cardiacos y 1.388 muertes cardiacas anuales, lo que representa 30.550 AVAD (13.124 AVP y 17.426 AVD). El HS puede representar entre el 1,6 y el 7,3% de los AVAD cardiovasculares. Conclusión. El HS es una condición silente que determina una enorme carga de enfermedad. La valoración del HS, al menos en los pacientes pertenecientes a grupos de riesgo, podría ser coste-efectiva (AU)

Introduction. Subclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. Patients and methods. Based on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL) and Years Lost due to Disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic data set [MBDS], inpatient mortality records, etc. Results. In Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9mIU/l (70.5%), 538,988 with levels between 7 and 9.9mIU/l (19.5%), and 278,317 between 10 and 19.9mIU/l (10%). These subjects suffer approximately 12,608 cardiac events and 1,388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. Conclusion. SH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective (AU)

Burden of illness attributable to subclinical hypothyroidism in the Spanish population.

INTRODUCTION: Subclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. PATIENTS AND METHODS: Based on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL) and Years Lost due to Disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic data set [MBDS], inpatient mortality records, etc. RESULTS: In Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9mIU/l (70.5%), 538,988 with levels between 7 and 9.9mIU/l (19.5%), and 278,317 between 10 and 19.9mIU/l (10%). These subjects suffer approximately 12,608 cardiac events and 1,388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. CONCLUSION: SH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective.

Comments to SEOM clinical guidelines for the treatment of thyroid cancer

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[Medullar carcinoma of the thyroid gland: surgical treatment of mediastinal metastases]. / Carcinoma medular de tiroides: tratamiento quirúrgico de metástasis mediastínica.

Metastatic medullary carcinoma is related to very bad prognosis. Surgery, associated or not to radiotherapy, may be effective in controlling metastasis due to local invasion, as in mediastinal extension. We present a case of medullary carcinoma with mediastinal disease that was treated through mediastinal dissection following by complimentary radiotherapy. After three years of follow-up, the patient remains free of recurrence, although calcitonin levels have not become normal yet.

Carcinoma medular de tiroides: tratamiento quirúrgico de metástasis mediastínica / Medullar carcinoma of the thyroid gland: surgical treatment of mediastinal metastases

Las metástasis del carcinoma medular de tiroides comportan muy mal pronóstico. LA cirugía, asociada o no a radioterapia, puede ser efectiva en el control de las metástasis por invasión local, como en los ganglios mediastínicos. Presentamos un caso de carcinoma medular de tiroides con extesión mediastínica, que fue tratado mediante vaciamiento ganglionar mediastínico por esternotomía media y radioterapia complementaria. Tras tres años de seguimiento, permanece sin recidiva, aunque los niveles de calcitonina no se han normalizado totalmente (AU)

Acute liver injury and octreotide.

Octreotide is a synthetic analogue of somatostatin with therapeutic applications in a variety of endocrine and gastrointestinal disorders. We report a patient with acromegaly who developed acute hepatocellular liver injury after receiving two 0.1-mg doses of octreotide. The drug causality was confirmed by rechallenge. To our knowledge this is the second reported case in the literature.

Growth hormone response to acute growth hormone releasing hormone administration in uraemic patients on haemodialysis.

To examine the response of growth hormone (GH) to growth hormone releasing factor (GHRF) in patients on haemodialysis, we performed the acute GHRF test (50 micrograms administered intravenously as a bolus) in 10 uraemic male patients on haemodialysis and eight normal controls. Each patient was tested before and after a haemodialysis session (at 08.30 and 12.30). Controls were tested on the same time schedule. At 08.30, patients had significantly greater basal and peak GH values (2.5 +/- 0.6 and 27.8 +/- 5.5 micrograms/l) than controls (0.68 +/- and 11.5 +/- 4 micrograms/l). After the haemodialysis session, basal and peak values declined significantly (P less than 0.01) in the uraemic group (0.5 +/- 0.03 and 3.1 +/- 1.1 micrograms/l), whereas the controls did not show such a change in the 12.30 test. Basal and intratest glycaemic values were comparable both before and after haemodialysis. After dialysis test results did not change either with the use of glucose-free dialysate or with bicarbonate buffer. Uraemic patients display a greater GH response to GHRF injection than normal subjects, and this response decreases after haemodialysis. The degree of reduction has no relationship with either glycaemia or the dialysate buffer. We suggest that other GH secretion regulating factors are altered by the haemodialysis procedure.

Plasma somatostatin-like immunoreactivity during growth-hormone-releasing hormone therapy in non-growth-hormone-deficient children.

To date, the effects of long-term growth hormone (GH)-releasing hormone [GHRH(1-29)-NH2] treatment on the plasma concentrations of somatostatin-like immunoreactivity (SLI) remain undefined. In the present study, the effect of GHRH(1-29)-NH2 therapy on plasma SLI levels has been studied in 11 non-GH-deficient children. The pattern of administration was 5 micrograms/kg body weight, given subcutaneously once every day. There was no significant change in plasma SLI levels after bolus injection of GHRH(1-29)-NH2 before and during GHRH(1-29)-NH2 therapy. However, plasma SLI rose in basal plasma and nocturnal sleep after 3 months of GHRH(1-29)-NH2 therapy and remained the same during 6 months of treatment with GHRH(1-29)-NH2. The reason for this finding is uncertain, but an increase in SLI release from the enteroinsular axis is a possible explanation. The association of our findings with the role of the circulating SLI on nutrient homeostasis and the effects of GNRH on growth velocity is discussed.