Low doses of liquorice can induce hypertension encephalopathy.

Prolonged ingestion of liquorice is a well-known cause of hypertension due to hypermineralocorticoidism. We describe 2 cases of hypertension encephalopathy (in addition to the classical symptoms of hypertension, hypokalemia and suppression of the renin-aldosterone system) which resulted in pseudohyperaldosteronism syndrome due to the regular daily intake of low doses of liquorice. Glycyrrhizic acid, a component of liquorice, produces both hypermineralocorticism and the onset of encephalopathy through the inhibition of 11beta-hydroxysteroid dehydrogenase. Hypertension encephalopathy due to the daily intake of low doses of liquorice, however, has not been previously documented. It is proposed that some people could be susceptible to low doses of glycyrrhizic acid because of a 11beta-hydroxysteroid dehydrogenase deficiency.

Solitary nodular disease and multinodular goiter: a retrospective study on suppressive versus replacement levothyroxine therapy.

The aim of the present study was to ascertain whether patients affected by solitary nodular disease of the thyroid or multinodular goiter had a different clinical outcome when treated with suppressive levo-thyroxine (L-T4) therapy rather than replacement L-T4 therapy. We evaluated, by a retrospective analysis, 36 patients who had received TSH-suppressive L-T4 therapy according to TSH value and 55 who had received replacement L-T4 therapy. Fine needle aspiration cytology and thyroid scan after 131I were evaluated before L-T4 administration, while echographic monitoring of number and dimensions of nodules was recorded prior to and during L-T4 treatment. No difference in duration of L-T4 treatment (about 3 years) was registered between the TSH-suppressive therapy group and replacement therapy group. L-T4 administration in a TSH-suppressive or replacement manner did not induce a numerical or volumetric significant decrease of the main nodule or of the total nodule volume. Our data show that chronic TSH-suppressive therapy does not seem to be better than replacement therapy. Moreover, TSH-suppressive therapy presented a higher risk of adverse events than replacement therapy, thus requiring a more careful check with a higher cost of care.