Human lymphocyte antigens (HLA) and Graves' disease in Turkey

To evaluate the association of HLA types with Turkish patients with Graves' disease, HLA typing, clinical findings, and thyroid antibodies were correlated. The HLA types, clinical findings (ophthalmopathy and age at onset), and thyroid stimulating hormone (TSH) receptor (TRAb) and antithyroid microsomal antibodies (MAb) were analyzed. Seventy Turkish patients with Graves' disease and 306 control subjects were assessed. Serological HLA typing was performed in HLA A, B, C, DR, and DQ loci. There was a significantly increased prevalence of HLA B8, B49, DR3, DR4, and DR10 in Graves' disease. The association of Graves' disease with HLA DR3 was found to be less strong than previously described. The HLA DR4 antigen may contribute to the predisposition of Graves' disease in Turkey. The results suggest that HLA B7, B13, DR7, DQw2, and DQw3 may confer a protective effect for Graves' disease in Turkey. Patients carrying HLA B12, B18, and B44 haplotypes had a tendency to develop the disease at a later age. The difference from the other studies may be the result of the selection of the controls; in part, of the variability in serological typing reagents; and, also, of the rather weak HLA associations with the disease.This study was presented in part at the Annual Meeting of the National Endocrinology and Diabetes Association, Bursa, Turkey, May 25–28, 1992.     

Influence of thyroid-stimulating hormone on 18F-fluorodeoxyglucose and 99mTc-methoxyisobutylisonitrile uptake in human poorly differentiated thyroid cancer cells in vitro

Objective  In poorly differentiated thyroid cancer originating from thyroid follicular cells, the ability to concentrate iodine is lost. This makes recurrence undetectable by ¹³¹I whole-body scan. In this situation, other radiopharmaceuticals, such as ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) and technetium-99m-methoxyisobutylisonitrile (^99mTc-MIBI), are used to evaluate recurrence or metastasis. Some reports suggest that ¹⁸F-FDG uptake is increased by thyroid-stimulating hormone (TSH) stimulation. This study aimed to determine the influence of TSH on ¹⁸F-FDG and ^99mTc-MIBI uptake in human poorly differentiated thyroid cancer cells in vitro. Materials and methods  The cells were stimulated with 1000 μU/ml of recombinant human thyroid-stimulating hormone (rhTSH) for 1 day, 3 days, and 5 days. Each cell was incubated with 0.5 MBq/ml-1 MBq/ml of ¹⁸F-FDG or 0.5 MBq/ml-1 MBq/ml of ^99mTc-MIBI for 1 h at 37°C. The uptake of each radiopharmaceutical in the cells was quantified as a percent of whole radioactivity per total viable cell number. The quantification of glucose transporter 1, 2, 3 and 4 mRNA expression was measured using RT-PCR. Results  TSH stimulation increased ¹⁸F-FDG uptake in a time-dependent manner. Following 5 days of rhTSH stimulation, ¹⁸F-FDG uptake was approximately 2.2 times that of the control. The increase in ¹⁸F-FDG uptake following rhTSH stimulation was correlated to the increase in GLUT4 mRNA level. The GLUT1 mRNA level was unchanged. An increased uptake of ^99mTc-MIBI was observed with a pattern similar to that of ¹⁸F-FDG. The ^99mTc-MIBI uptake was approximately 1.5 times that of the control 5 days later. Conclusions  These results suggest that TSH stimulates ¹⁸F-FDG and ^99mTc-MIBI uptake in poorly differentiated papillary thyroid cancer, and therefore ¹⁸F-FDG-PET or ^99mTc-MIBI scans under TSH stimulation may be more accurate than under suppression.     

Pituitary volume in patients with panic disorder

Panic patients have many functional deficiencies in the hypothalamic-pituitary-adrenal (HPA) axis. Previous studies have shown changed pituitary gland volume in some psychiatric disorders that have functional deficiencies in the HPA axis. However, to date no study has evaluated the pituitary gland volume in patients with panic disorder (PD). We investigated the pituitary gland volume in patients with PD (n = 27) and age- and sex-matched healthy controls (n = 27), using 1.5-T magnetic resonance imaging in this study. Analysis showed that patients with PD had significantly smaller pituitary volume compared to healthy subjects. Patients with agoraphobia especially had a significantly smaller pituitary volume than patients without agoraphobia. There was a significant relationship between the pituitary volume and both the severity of symptoms and the illness duration in the patient group. The results show that patients with PD have reduced pituitary volume, which may reflect the functional abnormalities seen in this disorder. These findings may help us better understand the pathology of PD.     

Alterations in hypothalamic-pituitary-adrenal/thyroid (HPA/HPT) axes correlated with the clinical manifestations of depression

The alterations of hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes are important neuroendocrine abnormalities in depression. We aimed to identify some potential associations between these alterations and the clinical manifestations of depression in a sample of Chinese origin. 565 depressed patients of Chinese Han region were collected and seven kinds of hormones in HPA and HPT axes were detected. A 17-item Hamilton Depression Rating Scale (HAMD-17) and a 14-item Hamilton Anxiety Rating Scale (HAMA-14) were used to evaluate the baseline condition of each patient. 519 patients were enrolled into analysis. The patients with dysfunction of HPA axis had susceptibility to agitation symptoms (HAMD9 item) and cognitive disorders (HAMD2, 3 and 9 items), while those with normal function of HPA axis had susceptibility to shallow sleep (HAMD5 item). The patients with dysfunction of HPT axis had susceptibility to difficulty in falling asleep (HAMD4 item), weight loss (HAMD16 item) and gastrointestinal symptoms (HAMD12 item). Besides, the patients with dysfunctions of both HPA and HPT axes showed remarkable retardation symptoms (HAMD8 item). These findings might provide some evidences for the clinical subgrouping and management individualization of depressed patients according to the neuroendocrine alterations.     

Clomiphene citrate alone,in combination with metformin or in combination with pioglitazone as first line therapy in induction of ovulation in infertile women with polycystic ovary syndrome,a randomized controlled trial

Study objectiveTo compare the efficacy of clomiphene citrate (CC) alone, combined CC and metformin and combined CC and pioglitazone as first line therapy for induction of ovulation and achievement of pregnancy in overweight and obese infertile women due to polycystic ovary syndrome (PCOS).DesignA randomized controlled trial.SettingThe infertility clinic of Ain Shams University maternity hospital.Materials and methods106 overweight and obese women complaining of infertility due to PCOS were randomly assigned to receive ovulation induction using CC, 100 mg daily for 5 days beginning on the third day of spontaneous or induced menses, either alone (Group 1) in combination with metformin, 850 mg twice daily, (Group 2) or in combination with pioglitazone, 30 mg daily, (Group 3). Folliculometry was started from cycle day 9 and repeated every 2 days. hCG (10000 IU) was given intramuscular when at least one follicle ?18 mm was formed. Serum β-hCG was measured 16 days after hCG injection to diagnose pregnancy.Main outcome measureBiochemical pregnancy rate.ResultsThere were no statistically significant differences between the three study groups regarding the biochemical pregnancy rates (7.4% (2/27), 11.1% (3/27) and 18.5% (5/27) for groups 1, 2 and 3, respectively) and the number of women who succeeded to have mature follicles (74.1% (20/27), 74.1% (20/27) and 81.5% (22/27) for groups 1, 2 and 3, respectively).ConclusionThere is no potential benefit from adding pioglitazone or metformin to CC while inducing ovulation in overweight and obese women complaining of infertility due to PCOS. Further larger extended trials are needed to assess using insulin sensitizers for longer duration which could give a better chance to evaluate the cumulative effect of these drugs.     

甲状腺功能与血脂关系的临床分析

目的研究不同甲状腺功能状态下血脂的特点及甲状腺功能与血脂的关系。方法收集甲亢、甲减、亚临床甲亢、亚临床甲减和正常甲功者共568例,分析各组血脂谱的差别,并应用相关及多重回归分析影响这些指标的因素。结果甲亢时TC、TG、HDL、LDL、ApoB降低;而甲减时TC、LDL、ApoB升高,HDL降低;亚临床甲减较亚临床甲亢对代谢影响更大,可出现TC、LDL、ApoB升高;而亚临床甲亢组上述指标均无明显变化。TSH对甲亢组TC、LDL、ApoB,甲减组TC和亚甲减组血脂谱影响较大。结论甲状腺功能状态与血脂等代谢指标相关,且TSH与血脂异常关系密切。     

Hypothyroidism and levothyroxine therapy following bariatric surgery: a systematic review,meta-analysis,network meta-analysis,and meta-regression

BackgroundMany health benefits of bariatric surgery are known and well-studied, but there is scarce data on the benefits of bariatric surgery on the thyroid function.ObjectiveWe aimed to make a meta-analysis regarding the impact of bariatric surgery on thyroid-stimulating hormone (TSH) levels, levothyroxine dose, and the status of subclinical hypothyroidism.SettingSystematic review and meta-analysis.MethodsPubMed, EMBASE, and Cochrane Library were searched up to December 2020 for relevant clinical studies. Random-effects model was used to pool results. Network meta-analysis was performed, incorporating direct and indirect comparisons among different types of bariatric surgery. Meta-regression analysis was performed to evaluate the impact of moderator variables on TSH levels and required levothyroxine dose after surgery. We followed the PRISMA guidelines for data selection and extraction. PROSPERO registry number: CRD42018105739.ResultsA total of 28 studies involving 1284 patients were included. There was a statistically significant decrease in TSH levels after bariatric surgery (mean difference = ?1.66 mU/L, 95%CI [?2.29, ?1.03], P < .0001). In meta-regression analysis, we found that the following moderator variables: length of follow-up, mean age, baseline TSH, and preoperative thyroid function, could explain 1%, 43%, 68%, and 88% of the between-study variance, respectively. Furthermore, subclinical hypothyroidism was completely resolved in 87% of patients following bariatric surgery. In addition, there was a statistically significant decrease of levothyroxine dose in frank hypothyroid patients following bariatric surgery (mean difference = ?13.20 mcg/d, 95%CI [?19.69, ?6.71]). In network meta-analysis, we found that discontinuing or decreasing levothyroxine dose was significant following Roux-en-Y gastric bypass, 1 anastomosis gastric bypass, and sleeve gastrectomy, (OR = 31.02, 95%CI [10.34, 93.08]), (OR = 41.73, 95%CI [2.04, 854.69]), (OR = 104.03, 95%CI [35.79, 302.38]), respectively.ConclusionsBased on our meta-analysis, bariatric surgery is associated with the resolution of subclinical hypothyroidism, a decrease in TSH levels, and a decrease in levothyroxine dose.     

怀孕对甲状腺微小乳头状癌进展影响的相关研究

目的探讨怀孕对甲状腺微小乳头状癌进展的影响。方法选择2000年1月～2013年12月12例孕期诊断为甲状腺微小乳头状癌的患者,同时选取20例非孕期的甲状腺微小乳头状癌的患者作为对照。随访期间监测肿瘤大小、Tg以及TSH的水平变化。结果孕期甲状腺微小乳头状癌患者的肿瘤大小由诊断时（6.2±2.1）mm增长至产后6个月的（9.2±4.4）mm,此时显著大于对照组肿瘤大小[（6.9±4.5）mm,P〈0.05]。甲状腺微小乳头状癌患者Tg水平在孕中期为（33.59±10.23）ng/ml,显著高于诊断时水平[（12.34±4.23）ng/ml,P〈0.05];TSH水平在孕中期为（0.3±0.1）μIU/ml,也显著高于诊断时水平[（3.5±1.2）μIU/ml,P〈0.05]。结论怀孕期间,甲状腺微小乳头状癌患者的肿瘤显著增大,Tg及TSH水平显著增高。因此,对甲状腺微小乳头状癌患者应该密切随访,尤其是在孕早期。