ACTA ENDOCRINOLOGICA (BUC)

Context. In medically treated Graves’ disease (GD) patients, prolonged low serum TSH levels represent an independent risk factor for relapse. The predictors of this prolonged TSH suppression are still debatable. Objectives. The primary endpoint of this study was to identify predictors of the time to TSH recovery (TTR), in GD patients, at diagnosis and during ATDs treatment. The secondary endpoint was to compare the TTR between patients with GD and autonomous hyperthyroidism. Subjects and Methods. We retrospectively analyzed 109 newly diagnosed hyperthyroid patients (90 with GD and 19 with autonomous hyperthyroidism), consecutively evaluated in a tertiary center. The main features recorded were: TSH and thyroid hormone levels at diagnosis and follow-up visits, the TTR and the mean dose of ATDs/day. Results. There was no significant difference regarding the TTR between patients with GD and autonomous hyperthyroidism. In GD patients, age at diagnosis, gender, goiter size, smoking status, thyroid antibody titers and ophtalmopathy presence did not seem to influence the TTR. GD patients with higher FT3, TT3 at diagnosis and higher TT3 at the first visit after ATDs administration (V1) needed longer TTR, after adjusting for the mean dose of ATDs/day. FT3 at diagnosis and TT3 at V1 are significant predictors for the TTR in GD patients. Conclusions. The time to TSH recovery was not significantly different between patients with GD and autonomous hyperthyroidism. In GD patients, the time to TSH recovery is longer in patients with more severe T3 hyperthyroidism at diagnosis and at the first visit after ATDs administration.

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In this study we aimed to assess amiodarone&#8217;s effects on thyroid hormones, C reactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor (TNF-&#945;) profile in amiodarone-induced thyrotoxicosis (AIT) and their relationship with arrhythmias. In 60 patients with AIT (29M/31F), aged 59.7 ? 1.5 years and 105 hyperthyroid patients (25M/80F), aged 59.4 ? 1 years, TSH, total T3, total T4, free T4 were measured by IRMA or microenzymatic immunoassay. In 11 AIT patients and 26 patients with common hyperthyroidism, without significant Graves&#8217; ophthalmopathy, CRP, IL-6 and TNF-&#945; were measured by chemiluminescent immunoassays. AIT patients showed significantly lower T3 levels (273.82 ? 18.76 ng/dL) as compared to common thyrotoxicosis (361.89 ? 13.47 ng/dL), p<0.001, while T4 and FT4 were similar. AIT patients showed similar CRP, IL-6 and TNF-&#945; levels to common hyperthyroidism (10.22 ? 3.03 mg/L vs. 6.31 ? 2.33 mg/L, p=0.11, for CRP, 17.46 ? 13.09 pg/mL vs. 6.46 ? 1.14 pg/mL, p=0.65, for IL-6, and 9.9 ? 1.76 pg/mL vs. 12.85 ? 2.22 pg/mL, p=0.22, for TNF-&#945;, respectively. Patients with arrhythmias (n=19) showed significantly higher CRP, IL-6 and TNF-&#945; levels as compared to patients without arrhythmias (n= 18): 10.81 ? 3.35 mg/L vs. 3.96 ? 1.08 mg/L, p=0.05, for CRP, 15.15 ? 7.52 pg/mL vs. 4.02 ? 0.74 pg/mL, p=0.007 for IL-6, and 15.16 ? 3.33 pg/mL vs. 9.2 ? 0.82 pg/mL, p=0.037 for TNF-&#945;. In conclusion, AIT showed a similar pattern of proinflammatory cytokines to common hyperthyroidism. Increased CRP, IL-6 and TNF-&#945; are found only in patients with thyrotoxicosis associated with atrial fibrillation or other arrhythmias.

Dual X-ray absorptiometry (DXA) is well known as the “gold standard” technique for the diagnosis of osteoporosis; therefore its “brightness” puts into shadow other valuable applications both in research and clinical practice. Whole body scan offers the opportunity to analyze the body composition, the oldest non bone densitometric application with valuable research data relevant for sarcopenia diagnosis, obesity and lipodystrophy diagnosis. Hip geometry analysis is also an older feature of DXA femur scan remained in the research area. The trabecular bone score (TBS) is the newest and most astonishing application using DXA scans: it brings bone quality data based on the image texture analysis of the spine DXA images with relevant impact on the fracture risk assessment independent of the bone density. Vertebral fracture assessment could be done in the same visit with bone densitometry using DXA rapid lateral spine scan: it is a borrowed application from plain radiology, as atypical femoral fracture (AFF) diagnosis and relies on the increased image quality of the DXA scans on recent equipments. At the same time, incidental findings on these images offer the opportunity to evaluate aortic calcifications useful for cardiovascular risk evaluation.

Context. Both human immunodeficiency virus (HIV) infection and hepatitis C virus (HCV) infection represent systemic diseases that may develop metabolic complications, thus HIV/HCV coinfection metabolic changes need to be depicted. Objective. We aimed to evaluate the body composition changes in patients with either HIV and HCV monoinfections or HIV/HCV coinfection. Methods. 123 young men divided into three groups: 41 with HIV/HCV coinfection, 42 with HIV-monoinfection, and 40 with HCV-monoinfection were evaluated for total and regional bone and soft tissue body composition assessments using a Dual-energy X-ray absorptiometry (DXA) and were compared with 40 healthy men with age and body mass index similar to the study groups. To detect sarcopenia, we calculated the appendicular limbs’ lean mass index (ALMI), for obesity, we used the percent of body fat, and for lipodystrophy, we calculated the trunk/limbs index. Results. HIV/HCV coinfection is associated with a significant higher bone demineralization in all regions of interest compared to HCV or HIV monoinfections and to controls. The prevalence of bone demineralization in HIV/ HCV patients was 31.7%, more frequently at lumbar spine. Fat mass and lean mass were significantly lower in HIV/ HCV-coinfected patients than in controls. Lipodystrophy was found in similar percentages in all three evaluated groups (80.4% in HIV/HCV, 92.5% in HIV, and 95% in the HCV group). Sarcopenia was higher in HIV/HCV group (43.9%) and important in HCV-monoinfection group (30%). Conclusions. HIV/HCV-coinfected patients had the highest prevalence of bone demineralization, fat mass, and lean mass loss, compared to controls and to HIV and HCV monoinfections.

Autoimmune diseases are a heterogeneous group that involves almost any tissue and organ, a patient could frequently present more than one autoimmune disease. Type 1 diabetes mellitus is frequently associated with other autoimmune diseases in polyglandular autoimmune syndrome. Aim of the study is to evaluate a phenotype of diabetic patients with autoimmune diseases. There is a retrospective study; we analyzed type 1 diabetes inpatients from our department in late 4 years based on clinical records. We state that type 1 diabetes mellitus diagnosis is established based on insulin treatment at onset or less than 1 year from onset. We analyzed the presence of the following autoimmune diseases: Graves&#8217; disease, Hashimoto thyroiditis, autoimmune hypothyroidism, Addison&#8217;s disease, vitiligo, psoriasis, systemic lupus erythematosus, pernicious anemia. We recorded 151 patients with type 1 diabetes mellitus: 91 (60.3%) women. Mean age was 38.4?15.8 years, mean span of type 1 DM was 12 years, mean age at the onset of DM was 26.5 years, and mean BMI was 23.4 kg /m2. Patients were insulin treated with 2 doses of insulin 11.3%, 3 doses of insulin 41.6%, 4 doses of insulin 45%, and insulin pump 2%. 41 patients (27.2%) associated other autoimmune diseases, most frequently being chronic thyroiditis. Type 1 DM preceded autoimmune disease in 60%. Patients that associated autoimmune disease have mean age at the onset of type 1 DM 29.1 years. Mean glycated hemoglobin among patients with autoimmune diseases was 10.1% vs. 9.9% among patients without autoimmune diseases (NS); mean insulin needs were respectively 0.78 u/kgc vs. 0.72 u/kgc (NS). In conclusion, type 1 DM is frequently associated with other autoimmune diseases, patients being mainly women. The most frequent association is Graves&#8217; disease. In over 50% of cases type 1 DM precedes autoimmune disease with several years. Even though more than half of patients were treated with multiple doses of insulin, glycated hemoglobin was high, slightly higher among patients with autoimmune diseases but the differences were not statistically significant.

Tuberculosis continues to be a universal health problem and recent studies showed an increased incidence of all forms of this disease. We report the case of a 81 year old female patient with a large left cervical tumour and cutaneous lesions that proved to be an unusual form of tuberculosis. The patient had a 2 years history of slowly increasing left cervical mass with no significant clinical manifestation. Medical assistance was requested mostly by the family, concerned about the large mass visible on the left side of the patient?s neck. Clinical and laboratory investigation revealed: a large left laterocervical tumour and the presence of erythematous, non pruriginous skin lesions. No significant changes were shown by routine blood tests. Thyroid function was in the normal range. Neck ultrasound revealed the presence of a 5/6 cm, well defined hypoechoic mass and the thyroid scan showed no accumulation of the radiotracer in the cervical tumour. Routine tuberculosis test was negative and the patient had no sign of pulmonary involvement. Histopathological examination after ablation of this tumour showed the presence of granulomatous lesions suggesting tuberculosis or sarcoidosis. The same aspect was seen after histopathological examination of the specimens from cutaneous biopsy. The diagnosis was certified by the PCR amplification of the DNA extracted from the skin lesions, which led to the identification of Mycobacterium tuberculosis. The cutaneous lesions were clearly improved after tuberculostatic treatment, supporting the hypothesis of a rare form of cutaneous tuberculosis.

Background. Psychiatric patients with schizophrenia present a higher risk for dyslipidemia than other categories. Aim. To evaluate the values of glucose, triglycerides, cholesterol and total lipids in patients with schizophrenia, who received typical or atypical antipsychotics. Demographic characteristics were also collected. Subjects and methods. This observational, retrospective cohort study included 54 inpatients diagnosed with schizophrenia who were observed during a period of one year. Glucose, triglycerides, cholesterol and total lipids were monitored after 6 and 12 months. We selected patients who were not on hypolipemiant treatment, for various reasons, in order to better evaluate the impact of antipsychotic medication. Results. The majority of patients were male (93% ). The mean age of the patients was of 38, and 87% of them were living in urban areas. Analyzing the mean values of glycemia, cholesterol, triglycerides and total lipids under different types of antipsychotics, higher values of these constants were observed in patients who received olanzapine and risperidone treatment, but with no significant correlations. Conclusion. Patients with schizophrenia naturally shown an increased risk for dyslipidemia, partially due to poor diet and sedentary lifestyle, and these conditions may be exacerbated by antipsychotic medication.