Ghrelin in gestational diabetes: serum level and mRNA expression in fat and placental tissue.

OBJECTIVES: We studied the effect of an oral glucose load on circulating ghrelin, as well as ghrelin and ghrelin receptor (GHS-R1a) mRNA expression in subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) and placental tissue from pregnant women with gestational diabetes (GDM) and normal glucose tolerance (NGT). METHODS: Plasma total ghrelin levels were measured in 58 patients with GDM and 61 women with NGT by radioimmunoassay. Ghrelin and GHS-R1a mRNA expression was studied in 16 subjects with GDM and 20 healthy pregnant women at term, using RT-PCR. RESULTS: Basal ghrelin concentrations and the maximal decrease in ghrelin levels after glucose load did not differ in the women with GDM and NGT (399.1 [299.6-563.3] pg/ml vs. 400.9 [302.3-475.8] pg/ml and 127.6 [23.1-213.1] pg/ml vs. 101.7 [44.0-217.6] pg/ml, respectively). Ghrelin mRNA expression in placental tissue was significantly higher in the subjects with GDM than in the healthy pregnant women (0.06 [0.03-0.07] AU vs. 0.02 [0.015-0.03 AU], p=0.02), whereas GHS-R1a mRNA expression in all three tissues studied did not differ between the two groups. Multiple regression analysis revealed that ghrelin mRNA expression in SAT was significantly predicted by serum insulin (beta=0.62, p=0.01), explaining 42% of its variability. CONCLUSIONS: Ghrelin mRNA expression in placental tissue was higher in the GDM than in NGT subjects, whereas no association between circulating ghrelin and GDM was observed.

Circulating pro- and anti-inflammatory cytokines in Polish women with gestational diabetes.

In this study we measured serum concentrations of proinflammatory interleukin-6, interleukin-8, and interleukin-18 as well as anti-inflammatory interleukin-10 in 30 pregnant women with normal glucose tolerance, in 32 women with abnormal results of a 50-g glucose challenge test, and in 57 patients with gestational diabetes mellitus. Patients with gestational diabetes had significantly higher IL-6 (median 1.0 [0.7-1.5] vs. 0.7 [0.4-0.8] pg/ml, p=0.001), IL-8 (2.1 [1.1-4.2] pg/ml vs. 0.7 [0.4-0.9] pg/ml, p<0.0001), and IL-18 (249.3 [188.5-318.7] pg/ml vs. 186.7 [139.9-243.9] pg/ml, p=0.005) as well as lower IL-10 levels than healthy pregnant women (0.6 [0.5-1.5] pg/ml vs. 2.9 [1.8-3.2] pg/ml, p<0.0001). After adjusting for glucose, insulin, and BMI values, the differences in IL-8 and IL-18 became insignificant, whereas the differences in IL-6 and IL-10 levels remained highly significant (p<0.0001). The subjects with abnormal glucose challenge test results had higher IL-6 levels (0.9 [0.7-1.3] pg/ml, p=0.005) and similar levels of other cytokines as compared with the women with normal glucose tolerance. Our results suggest an impaired balance between circulating pro- and anti-inflammatory cytokines in patients with gestational diabetes; however, a significant contribution of maternal obesity to the increased levels of IL-8 and IL-18 should be underlined.

Iodine-induced hyperthyroidism--an epidemiological survey several years after institution of iodine prophylaxis in Poland.

In 1997, the obligatory model of iodine prophylaxis was introduced in Poland in order to correct the existing status of mild and/or moderate iodine deficiency. In order to monitor possible side-effects of increased iodine supply, studies on iodine-induced hyperthyroidism were initiated by establishing several regional registers of hyperthyroidism. In the present paper, the results of a two-year monitoring (2000-2001) have been summarized. There are no epidemiological data on hyperthyroidism prior to starting the iodine prophylaxis, but the obtained current data are comparable to observations in other countries, made after iodine supplementation. The incidence of iodine-induced hyperthyroidism did not exceed the acceptable level, thus confirming--together with previous observations on the effectiveness of iodine prophylaxis--the adequacy of applied dose of KI (30 microg/kg NaCl), used for salt iodization in Poland.

[Some parameters of hemostasis and fibrinolysis in diabetic patients]. / Niektóre parametry krzepniecia i fibrynolizy u chorych na cukrzyce.

The aim of our study was to estimate selected parameters of hemostasis and fibrinolysis in diabetic patients with vascular complications and obesity. The investigation was carried out in 23 type 1 diabetic subjects aged 17-56 ys, in 25 type 2 diabetic patients aged 41-69 ys and in 38 healthy persons: 16 "young"--aged 32.5 +/- 13.2 ys and 22 "old"--aged 56.2 +/- 9.4 ys. The following parameters were determined: glycaemia, HbA1c, blood level fibrinogen, euglobulin clot lysis time, plasminogen activator inhibitor (PAI-1) activity, microalbuminuria, triglyceride, total, HDL- and LDL-cholesterol concentration. Plasma fibrinogen level was elevated in type 2 diabetic subjects, and the highest concentrations were noted in patients with retinopathy or arterial hypertension, in overweight persons and--surprisingly--in type 1 diabetic subjects with nephropathy and coronary vascular disease (CVD). There were also positive correlations between fibrinogen level and systolic blood pressure (r = 0.3413, p < 0.02), diastolic blood pressure (r = 0.3809, p < 0.002) and microalbuminuria (r = 0.3552, p < 0.05). The mean euglobulin clot lysis time was prolonged in type II diabetics in comparison to the control group, especially in obese subjects. The highest activity of PAI-1 was found in overweight controls (28.87 +/- 6.24 Au/ml, p < 0.002). PAI-1 activity was also slightly increased in type 1 diabetic patients, especially with the symptoms of diabetic neuropathy, nephropathy or CHD, in comparison to the other groups. Our results seem to confirm the disturbed balance between coagulation and fibrinolysis--towards and increased risk of a prothrombotic state --in both--obese and diabetic patients--especially with advanced vascular complications.

Iodine prophylaxis in the aftermath of the Chernobyl accident in the area of Sejny in north-eastern Poland.

The aim of our study was the estimation of the effects, possible side-effects and immunological reactions after the mass iodine prophylaxis following the Chernobyl nuclear disaster. 1457 subjects, aged 6-55 yrs, filled in our questionnaires and in 1191 of them the titres of antithyroid antibodies (TA) including ATMA--Anti-Human Thyroid Membrane Antibodies and TGAb--Anti-Thyreoglobulin Antibodies were estimated. Our study revealed that the prophylaxis, recommended in Poland only for children and teenagers was widely used (more than 90%) and relatively safe. No serious side effects, especially in pregnant women consuming KI were reported. The frequency and mean titres of TA were similar in adults who took and did not take stable iodine. The incidence of TA could be connected with many different factors including iodine deficiency, endemy of goitre as well as iodine prophylaxis. The reason of this phenomenon may be explained in long-term population studies.

Incidence of thyroid autoantibodies in the endemic goiter.

The aim of our study was to investigate the incidence of thyroid autoantibodies (TA) in the endemic region of the north-eastern Poland. The mean titres of ATMA and TGAb were measured in 1508 randomly chosen persons aged 3 to 68 yrs. ATMA or TGAb were positive in 17% of the population studied. Frequency and mean titres of TA were observed to increase with age. Autoantibodies were more frequently noted in persons with parenchymatous goiter. There was no correlation between the incidence of autoantibodies and goiter enlargement, however, the highest percentage of TGA was noted in people with large thyroid (III). TA were also found in 10% of the subjects without goitre. Our results do not confirm the hypothesis that thyroid autoantibodies play a key role in the pathogenesis of endemic goiter.

[Epidemiology of thyroid diseases in the population of the Sejny community after the atomic catastrophe in Chernobyl]. / Epidemiologia chorób tarczycy na terenie gminy Sejny po katastrofie elektrowni atomowej w Czarnobylu.

The survey carried out in 1990 covering the population of Sejny community, sponsored by the Ministry of Health and Welfare, program MZXVII, demonstrated the occurrence of goiter in 33.6% of studied persons. Such an incidence can rightly be recognized as an endemy. Predominance of cases with small or moderate enlargement of the thyroid (OB and I), low percentage of nodules (18%), and 2.8 times more frequent occurrence of goiter in women allows o characterize the endemy as mild. The percentage of goiter in this population does not differ from that found in this area before the Chernobyl disaster. However a small increase in the incidence of thyroid enlargement in a group of boys of age between 17 and 19 years, and an increase in percentage of nodular goiter in whole population was noted. The questionnaire studies confirmed in addition a high effectiveness of mass iodine prophylaxis introduced after the atomic disaster, especially in the population of developmental age. However, because of the latency period concerning the possible effects, the results obtained will be verified in the course of long-term prospective studies.

[Epidemiologic examinations of goiter in the population of the Sejny community]. / Badania epidemiologiczne tarczycy na terenie gminy Sejny.

The study was aimed at the evaluation of incidence of goiter in the population of the community of Sejny. The survey comprising 1520 subjects revealed the presence of thyroid enlargement in 31.8% of the subjects studied, indicating the occurrence of a mild endemy. The facts speaking for this type of endemy are: predominance of cases with goiter of OB or I degree (83%), higher incidence of goiter in women than in men (3.3 times), occurrence of nodular goiter in 12% of cases with goiter, and sporadic appearance of hypothyroidism. Goiter endemy in the population of this area can be attributed to such goitrogenic factors as low level of iodine and high content of calcium in the water, tobacco smoking, and a habit of drinking tap water.

[Relationship between thyroid size and urinary concentration of iodine in the population of Bialystok]. / Wielkosc tarczycy i poziom jodu w moczu populacji miasta Bialystok.

The survey carried out in May 1991 in the city of Bialystok comprised 308 children of age between 8 and 14 years and 116 young adults. In each of the studied subjects the size of the thyroid was measured by ultrasonography and iodine concentration determined in a randomly voided sample of urine. Body weight and height of the subjects have also been measured. In about 50% of the subjects studied (58.4% of children, 38.5% of men and 58.4% of women) the presence of goiter accompanied by a low urinary iodine concentration (median--2.0 micrograms/ml) was found. A significant negative correlation between the thyroid size and urinary iodine concentration, and lack of relation between the former and TSH concentration, have been found. No relation was observed between the presence of goiter and the inadequate physical development in the children studied. Insignificantly elevated TSH levels without accompanying clinical symptoms of hypothyreosis were observed in 8.7% of children, 3.8% of women and 5.1% of men studied. Higher prevalence of goiter found as compared to the results previously obtained in the same area can be related on the one to the use of more precise methods and on the other to real worsening of the situation due to discontinuation of obligatory iodine prophylaxis in the country more than 10 years ago.

[Behavior of thyroid autoantibodies in persons inhabiting an endemic goiter area]. / Zachowanie sie przeciwcial przeciwtarczycowych u osób z terenu endemii wola.

The study was aimed at investigating the occurrence of thyroid autoantibodies (ATMA and TGA) in persons inhabiting the area of goiter endemy of mild degree. The survey comprised 1508 persons of age ranging from 3 to 68 years. The subjects studied have been divided into the groups taking into account age, sex, degree of thyroid enlargement (according to WHO, 1974), and the characteristics of the goiter. The occurrence of ATMA or TGA antibodies was demonstrated in 17% of the subjects. An increase in the incidence and titer of thyroid autoantibodies with age was observed. The occurrence of thyroid autoantibodies was observed more frequently in the subjects with parenchymatous goiter. No correlation was found between the incidence of the antibodies and goiter size. Thyroid autoantibodies have also been found in 10% of subjects without goiter. The results obtained do not indicate convincingly the role of the thyroid autoantibodies in the pathogenesis of endemic goiter.

Antithyroid autoantibodies in the examined population with iodine prophylaxis after the Chernobyl catastrophe.

The aim of the present study was the observation of the frequency of antithyroid autoantibodies in the population in low endemic goitre area after mass iodine prophylaxis after the Chernobyl catastrophe and the estimation of TSH and thyroid hormones secretion in this population. On the basis of the investigations carried out we could conclude that the frequency of antithyroid autoantibodies in the population with confirmed endemic goitre is comparable to the frequency of antithyroid autoantibodies in the healthy population. ATA occurrence in children after iodine prophylaxis could confirm the hypothesis that thyroglobulin immunity is higher after iodine intake. The lower T3 concentration observed in the group with antithyroid autoantibodies suggests that autoantibodies may be involved in the thyroid hormones synthesis or peripheral conversion of thyroid hormones.

[Results of studies on the effect of radiologic contamination after the Czernobyl catastrophe and prophylactic iodine on thyroid morphology and function of inhabitants of North-East Poland]. / Wyniki badania wplywu skazenia radiologicznego po katastrofie w Czarnobylu i profilaktyki jodowej na morfologie i czynnosc tarczycy na terenie pólnocno-wschodniego regionu Polski.

The results of the investigations of radioactive contamination after the Chernobyl catastrophe and subsequent iodine prophylaxis on the thyroid gland function and morphology in Northeast Poland. The aim of the study was to determine whether kalium iodine in one dose during radioactive contamination in Poland limited the radioactive dose in the thyroid gland and if significant disadvantageous side-effects in the intrathyroid and extrathyroid occurred. Additionally during the studies we tried to determine if radioactive iodine contamination which occurred in the region of the Medical Academy in Bialystok caused an increase in thyroid disease. It is interesting to note the different results obtained after radioactive contamination with the results from the investigations in this same territory in 1983-1985. In 1983-1985, before the Chernobyl catastrophe, 6,921 persons in Northeast Poland were investigated. In 1986-1988, immediately after the disaster 4,010 persons were investigated. The main study according to grant No MZ-XVII was carried out in three provinces: Bialystok, Suwalki and Olsztyn. In this investigation 10,011 persons born before April 26, 1986 and after January 1, 1936 participated, 5,789 townspeople and 4,222 villagers, 3,987 children up to 16 years of age it the time of the disaster 1,973 boys and 2,009 girls; 6,024 adults 2,509 men and 3,516 women were drawn from a register. Committed doses to the thyroid in the investigated region were one of the highest in Poland and depended on age group and were depended on time of prophylaxis non proportional. Iodine prophylaxis was provided mainly with one dose of Lugol solution about 90%, 95% children and 30% adults took iodine. The majority of the population (53.3%-74%) were given iodine in April. From May 1st to 5th 23.0-43.4% received iodine, but after May 5th very few persons. Iodine was well tolerated, but Lugol Solution was better tolerated than other kinds of iodine. Only 241 (4.4%) cases had side effects, mainly vomiting (143), symptoms such as stomach ache, diarrhea, dyspnoe, skinrash etc. in lesser numbers. 12% (29 persons) were seen by a physician. In the investigated population were 200 pregnant women aged 19-40 years of which the majority (177) delivered full term healthy babies. Only 1 interrupted pregnancy and 7 had spontaneous abortion. Changes in the thyroid were noticed by 187 persons (2.3%-11.7%) most of which were enlargement of the thyroid, but only a few were confirmed by a physician. In the studied population from 1989 to 1990 over 30% of the population had struma.(ABSTRACT TRUNCATED AT 400 WORDS)

[Thyroid hormones and thyrotropin in the population of patients with endemic goiter in the Kolno community]. / Hormony tarczycy oraz tyreotropina w populacji osób z wolem endemicznym na terenie gminy Kolno.

The studies comparing the actions of dried thyroid gland (Thyroideum-Polfa) with L-thyroxine sodium (L-T4) were carried out in 20 female patients with hypothyroidism, including 19 patients with the primary hypothyroidism and 1 patient with hypothyroidism secondary to pituitary deficiency. Administration of the dried thyroid gland did not normalize blood serum T4 an TSH in any patient. Normal serum T4 or even slightly increased was achieved in all patients treated with L-T4. Serum TSH was normalized in 17 patients with the primary hypothyroidism. The following conclusions have been drawn: 1. Dried thyroid gland (Thyroideum-Polfa) is ineffective in the treatment of hypothyroidism. 2. Serum TSH remains elevated despite normal serum T3 in cases of the primary hypothyroidism with decreased serum T4 levels. 3. Sodium salt of L-thyroxine should be used for the treatment of hypothyroidism. 1-Triiodothyronine sodium may be used as an adjuvant therapy.

[Incidence of simple goiter among the population of the Goldap community]. / Wystepowanie wola prostego u mieszkanców gminy Goldap.

The possibility of the occurrence of goiter endemia++ among the inhabitants of Goldap community in the Suwalki voivodeship has been investigated. The investigations embraced 2488 persons, i.e. 21% of the population of the studied community. The occurrence of goiter was revealed in 38% of the investigated persons, and this observation lead to the conclusion that goiter is endemic among the population of the Goldap community. Such features as high incidence of thyroid enlargement of low degree (OB and I), higher incidence of goiter in women than in men, absence of cases with hypothyroidism, and low incidence of nodular goiter, characterize the observed endemia++ as mild.