ACTA ENDOCRINOLOGICA (BUC)

Background. Differentiated thyroid carcinoma (DTC) has witnessed an increase in incidence and although it is considered to have a slow grow potential and a 90% 10- year survival rate, local or distant metastases can be observed in 20%. It is essential to recognize other factors associated with malignancy and poor prognosis. Vitamin D and its deficiency has proven useful as a prognostic biomarker for many types of cancer, including thyroid cancer. Aim. Evaluate the relationship between vitamin D status in DTC and benign thyroid disorders patients and correlation between vitamin D and histopathological findings in DTC group. Methods. Study included 170 patients with confirmed DTC and 200 with benign thyroid pathology. Evaluation included 25-hydroxy vitamin D [25(OH)D], ultrasound and histopathologic features. Results. In DTC patients, mean value of vitamin D was significantly lower (17.86 ng/mL ± 9.31 DS versus 20.26 ng/mL ± 9.31 DS, p=0.029). Statistical analysis confirmed a negative correlation between vitamin D levels and tumor size (T) according to TNM classification (r=-0.176, p=0.02). Conclusions. Vitamin D level was significantly lower in the DTC group and 25(OH)D levels may be correlated with histopathology features like tumor size and aggressiveness according to TNM classification.

Aims: we wanted to check the importance of sunlight exposure and vitamin D supplementation in reverting secondary hyperparathyroidism at IIIrd age institutionalized patients.\r\nDesign: cross-sectional study of calcium and bone metabolism in a group of 123 institutionalized IIIrd age volunteers after winter period, followed by a prospective double blind placebo-controlled study of effects upon calcium and bone metabolism, serum 25OHD3, 1,25(OH)2D3 and PTH levels of daily sunlight exposure during the summer months, with or without vitamin D supplementation (2000 IU 25OH-D3 po, daily). The study was performed on volunteers from the Elderly Resting House of Copou,\r\nIasi, Romania. 25OH-D3 was measured by an inhouse RIA technique. 1,25(OH)2D3 was measured by HPLC, serum calcium by photocolorimetry, bone alkaline phosphatase by immunoenzymatic technique, whereas serum PTH and urinary deoxypyridinoline (DPD) were measured by IRMA. Data was compared using Student&#8217;s t test and correlation analysis (R2). Almost all volunteers (93.5%) had low 25OH-D3 values, but normal or even increased levels of the active hormone, 1,25(OH)2D3. High PTH was found in 41 cases (33.3%), of which three were primary hyperparathyroidism, whereas the others had low or low-normal calcium levels (secondary hyperparathyroidism). More than half of the cases had high DPD levels, suggesting high bone turnover. Bone turnover parameters were higher in females than in males (p<0.05). A positive correlation between PTH and urinary DPD was noticed (R2=0.351). We further supplemented the vitamin D intake in 42 volunteers with a daily dose of 2000 IU of 25-OHD3 for three months in the summer period, whereas other 42 volunteers received placebo (vitamin B). Normalization of 25-OHD3 levels was seen in both vitamin D and placebo-treated sun-exposed groups. A more significant increase in 25OHD3, and also of 1,25(OH)2D3 at the upper limit of normal was however observed in the vitamin D-treated group. Normalization of serum PTH, but not of turnover parameters was observed in both groups. Mild hypercalcemia and increase in serum creatinine were noticed in the vitamin D-treated group.\r\nConclusions: Secondary hyperparathyroidism might be of importance in high turnover bone loss at institutionalized IIIrd age patients. Women seem to be more at risk, possibly due to sex hormone depletion. PTH-induced 1&#945; hydroxylation in the elderly with undamaged kidney function partially compensates the paucity of vitamin D substrate, by normalizing active hormone levels. Mild sun exposure at institutionalized patients increases skin resources of vitamin D, normalizing 25OH-D3 levels and reverting secondary hyperparathyroidism. Oral vitamin D supplementation added to sunlight exposure should be done with caution, since it might be accompanied in certain patients by hypercalcemic or nephrotoxic effects at doses higher than 2000 IU/day.

Objectives. Chronic kidney disease is a progressive complication of diabetes mellitus (DM). This study aimed to analyse early renal changes in streptozotocin induced diabetic rats and demonstrate the effect of early treatment with insulin on kidney’s histology. Methods. 30 male-adult Sprague-Dawley rats were included in the study. Diabetes was induced in 24 of the rats by a single injection of 65 mg/kg streptozotocin dissolved in saline. 5 units/day NPH insulin injection was started to 10 rats as treatment group and 11 rats were followed untreated. 6 rats constituted the control group. Induction of diabetes failed in 3 animals and 3 untreated rats died during the study. After 21 days, all rats were sacrificed and their kidneys were removed to obtain histological sections to be evaluated by light microscopy. Results. Ten treated and 8 untreated diabetic rats and 6 healthy controls, totally 24 rats completed the study. There was a significant weight loss in treated and untreated diabetic groups and a weight gain in the control group (p<0.05). Final blood glucose levels were significantly higher in untreated diabetic group when compared to treated diabetic and control groups and higher in treated diabetic group when compared to control group. Histological analysis of kidney sections showed normal morphology in control group. Changes like increased mesangium, tubular atrophy and tubules with dilated lumen and irregular cell shapes were found in the untreated group whereas, glomerulus and mesangium showed similar morphology with control group with a few changes in tubules, in insulin-treated group. Conclusion. In DM, renal changes start at an early point and it is possible to prevent/delay those changes at this point with early intervention of insulin treatment.

Background. Osteoporosis has a high incidence after menopause, and at the same time the relationship between menopausal oestrogen deprivation and proinflammatory status is considered to be involved in postmenopausal bone turnover. Objective. The aim of this study was to evaluate the serum levels of IL-1β and of the TNFα in pre and postmenopausal women, as well as to investigate the relationship between these cytokines and bone mineral density. Design. A case-control study was performed during a period of 12 months. Subjects and Methods. The study included 150 women divided into 4 study groups. Serum levels of IL-1β and TNFα were determined using multiplex cytokine kits. BMD was measured by DXA at the level of the hip and lumbar spine. Results. Serum concentration of IL-1β is significantly higher in natural and surgically induced menopausal women, compared to women in the control group. Serum levels of TNFα in postmenopausal women and with surgically induced menopause are significantly higher than in fertile and premenopausal women. Serum levels of IL-1β are significantly higher in patients with osteopenia and osteoporosis compared to patients with normal BMD values. We found a negative correlation between serum levels of IL-1β, TNFα and BMD in pre and postmenopausal women, and in women with surgically induced menopause. Conclusions. Serum levels of IL- 1β and TNFα are significantly higher in menopausal women compared to fertile women. IL-1β is significantly higher in patients with osteopenia and osteoporosis than in women with normal BMD values, and IL-1β and TNFα associate negatively with BMD in pre and postmenopausal women, as well as in women with surgically induced menopause.

Objective. Medical Nutrition Therapy (MNT) is important in the treatment and regulation of diabetic patients. In this study, it was aimed to evaluate the effects of medical nutrition therapy on Pentraxin-3, hsCRP and body composition analysis in Type 2 diabetes patients (DM). Methods. This study included 160 individuals who were admitted and diagnosed with Type 2 DM. Laboratory, clinical, anthropometric and body composition parameters were obtained 3 months after baseline evaluation of the patients and the MNT was given by the dietitian. Results. After 3 months MNT, weight, body mass index, waist circumference, body fat weight, body fat ratio and visceral fat area (p<0.001), glucose (p<0.001), insulin (p=0.033), HOMA index (p=0.004), HbA1c (p<0.001), total cholesterol (p=0.001), LDL (p=0.008), ALT (p<0.001) and hsCRP (p<0.001) levels were significantly lower than they were before MNT. There wasn’t significant difference in triglyceride (p=0.509), HDL (p=0.079), Pentraxin-3 (p=0.706) levels and waist-to-hip ratio (p=0.802). The level of Framingham risk score after MNT was significantly lower (p<0.001). Conclusion. In this study, it was cocluded that MNT, applied to patients with Type 2 DM decreased cardiovascular risk and inflammation, contributed to the maintenance of glycemic control, and a significantly improved the body composition.

When the laboratory results are not compatible with the clinical features of the patient, the presence of assay interference should be considered. Patient and Methods. Here, we report a case of macro-thyroid stimulating hormone (macro-TSH) in a 31 yearold woman who had hypothyroidism due to thyroidectomy as well as discordant TSH levels with the clinical findings. Her TSH level was spuriously high with low levels of free T3 and T4 on levothyroxine treatment and she had only mild fatigue. To screen for the presence of interference, we performed TSH measurements in different platforms and serial dilution of the sample. Her rheumatoid factor was found to be negative. Results. The testing for heterophile blocking and non-specific anti TSH antibodies suggested lack of interference. We did further test for the clinical suspicion of interference and TSH decreased to 29.8 μIU/mL from 210.5 μIU/mL (recovery: 14.1%) after polyethylene glycol (PEG) precipitation indicating the existence of macro-TSH. After two months of increased dosage of levothyroxine, her TSH level was still very high (192.0 μIU/mL), but free T3 and free T4 increased to normal levels. PEG precipitation test was reperformed and TSH was decreased to 46.0 μIU/mL from 192.0 μIU/mL (recovery: 24.0 %). Her levothyroxine replacement dosage was not increased since free T3 and T4 levels were normal. Conclusions. If there is a suspicion for the discordant TSH level, the presence of macro-TSH by PEG precipitation should be investigated even though first step investigations for interference were found to be negative.

Context. Follicular thyroid carcinomas (FTC) represent 6-10 % of all thyroid carcinomas; the evolution of FTC is quite controversial, partly due to frequent changes of the histopathological definition (minimally invasive–MIFTC or widely invasive carcinoma–WIFTC) and treatment strategies adjustments. Objective. This research aims to examine the diagnostic procedure, therapeutic attitude and survival rates of patients with FTC, over a period of 16 years in the same institution, with a follow-up of at least 4 years, by analyzing correlations between histology subtype, treatments and the rate of recurrent disease. Subjects and methods. We have studied 5891 patients with thyroid carcinomas who have undergone surgical or oncological treatment within the institution, between 1st January 2000 – 31st December 2015; among them we found 133 patients (2.25%) with “pure” follicular thyroid carcinoma: 114 (86%) women and 19 (14%) men, with a female-male ratio of 6:1. The age of the patients ranged from 10 to 76 years, with an average of 47.8 years. Statistical analysis was done comparing differences among groups of MIFTC and WIFTC. Results. There was an unexpected high percentage of WIFTC and also an increased number of biochemically persistent and/or recurrent disease in patients with MIFTC. A stronger correlation was observed with the tumour dimensions, rather than with the histopathological subtype. Conclusions. This research observed that overall survival was associated with tumour size rather than histopathological subtype and there is an important need to perform further studies to assess the effectiveness of treatment strategies.

Context. In patients undergoing thyroidectomy for malignant disease, lower quality of life scores were observed in the early postoperative period compared to those undergoing thyroidectomy for benign causes. Objective. Thyroid gland diseases are commonly encountered in society. This study presents health-related quality of life differences in thyroidectomies performed for benign and malignant diseases and the factors affecting this. Design. Patients who underwent thyroidectomy for thyroid disease between January 2021 and January 2022 were evaluated prospectively. Subjects and Methods. The SF 36 questionnaire was applied and interpreted at the 1st and 6th months after thyroidectomy in patients over the age of 18 who did not have a history of previous thyroid surgery. Results. The study included a total of 228 patients. Among them, 171 (75%) were female (male/female: 57/171). Multinodular goiter in benign cases and papillary carcinoma in malignant cases were predominant (68.3% and 90.6%, respectively). SF-36 scores were found to be worse in the malignant group. Conclusion. In patients undergoing thyroidectomy for malignant disease, lower quality of life scores were observed in the early postoperative period compared to those undergoing thyroidectomy for benign causes.

Background. Lithium, a well known antimanic drug, has adverse effects on endocrine functions; but it is unknown in aged animals.\r\nAim. Untoward effects of lithium on thyroidal and extra-thyroidal thyroid hormones were investigated in adult and aged rats.\r\nMaterials and methods. Lithium was injected intraperitoneally at a dose of 2 mEq/kg\r\nbody weight daily to one group of rats for 10 days and the other for 25 days respectively. Thyroid and serum T3 and T4, and extrathyroidal liver and kidney T3and T4 levels were\r\nmeasured by ELISA. Pituitary and serum TSH-like substance was determined using a human-TSH immunoassay kit. Thyroperoxidase profile was measured spectrophotometrically.\r\nResults. Lithium decreased thyroid and serum T3 and T4 levels, and increased pituitary and serum TSH-like profiles after 10 and 25 days of treatments respectively in adult and aged rats. Thyroperoxidase activity was decreased in all the treatments of adult and aged rats. Liver\r\nand kidney T3 and T4 profiles were also decreased in lithium recipients. Lithium actions were severe after 10 days of treatment in adult rats and 25 days treatment in aged rats.\r\nConclusion. Lithium has untoward effects on thyroid and extra-thyroidal thyroid hormone synthesis irrespective of the age of rats.