ACTA ENDOCRINOLOGICA (BUC)

Endemic goiter occurred in different degrees throughout 2/3 of Romania, mainly in the Carpathian area. The prophylaxis of iodine deficiency disorders (IDD) using salt iodization was introduced in 1956 with potassium iodate, KIO3, 15-25 mg/1kg salt, but only in 23 districts. In 2002 a new legislation introduced the mandatory use of the iodized salt in a higher concentration in households of all 41 districts and also in the baking industry. The study aims to evaluate the effects of iodine legislation changes upon the urinary iodine excretion (UIC) in schoolchildren (study group A) and pregnant women (study group B). Urine samples were collected from 3737 schoolchildren aged 6-14 years of 14 districts and from 1283 pregnant women of 11 districts in the years 2004-2005. In two areas - Bistrita Nasaud and Bucharest - the number of schoolchildren was larger, i.e. 465 and 1617 respectively. UIC was determined in spot urine samples by Sandell Kolthoff?s method. The results show in schoolchildren an increase of the median UIC in 9 out of 14 districts up to 90 ? 61.1 ?g/L (range 12.5-300 ?g/L). Six of these districts are in the Carpathian area. However, in pregnant women in 2004, UIC still showed low levels of 55 ? 48.78 ?g/L (range 12.5-280 ?g/L) in all 11 studied districts and in Bucharest, close to the UIC obtained in the year 2001. In conclusion, this study revealed an increase of median values of UIC in schoolchildren after universal salt iodization program. The persistence of iodine deficiency in pregnant women in the studied districts is an emergency problem that has to be solved as soon as possible. This fact involves the necessity of a large monitoring program in the next years, in all districts in urban and rural areas and in all known pockets of endemia.

The incidence of type 2 diabetes is continuously growing worldwide, with enormous costs for individuals as well as for society. In the last decades, bariatric surgery has emerged as a possible solution for ameliorating metabolic control or even obtaining diabetes remission. Observational trials and metaanalyses demonstrate consistent improvement of type 2 diabetes following various bariatric procedures, but they are generally uncontrolled or they use historic controls as comparators. In recent years, several randomized trials studying the effectiveness of bariatric surgery in type 2 diabetes have been conducted and they all show substantial benefits, with the observation that the majority are shortterm trials. With the increased popularity of diabetes surgery, concerns about its immediate and long-time safety have also grown. The most frequent peri-operative are ulcers or stenosis, obstruction, venous thrombosis, pulmonary embolism and other pulmonary complications, with a mortality of less than 1%. Gastro-intestinal diseases, nutritional deficiencies and psychiatric disorders are the most important longterm problems to be addressed. The uncertainty regarding the long-term effects of bariatric surgery, together with its potential for morbidity and mortality, underline the necessity of large, long-term, randomized clinical trials comparing the best medical therapy with bariatric surgery in patients with type 2 diabetes.

Aims. To investigate the effect of sulphonylurea (SU) treatment on all-cause and cardiovascular mortality as compared with metformin (MET), when used in combination with insulin (INS) in type 2 diabetes. Methods. All type 2 diabetes patients aged ≥40 years were included at their first prescription of INS+MET or INS+SU, during 2001-2008. They were considered at risk until death or December 31st, 2011. Mortality rates were calculated per 1000 person-years. Crude and adjusted rate ratios (RR) were calculated using time dependent analysis with INS+MET as reference. Results. There were 7122 patients (60.8% women) included in the analysis, with a mean age at baseline of 62.0±9.9 years. During the 11 years of study, patients on INS+MET contributed 13620 person-years and 330 deaths (mortality rate 24, CI95% 22-27), while those on INS+SU contributed 8720 person-years and 393 deaths (mortality rate 45, CI95% 41-50). Adjusted all-cause mortality RR were: SU 1.6 (CI95% 1.21-2.11, p<0.001), glimepiride 1.18 (CI95% 0.73-1.91, p=0.51), gliclazide 1.78 (CI95% 1.07-2.95, p=0.024), glibenclamide 1.66 (CI95% 0.71-3.88, p=0.23), glipizide 1.24 (CI95% 0.68-2.27, p=0.49), and gliquidonum 2.32 (CI95% 1.54-3.50, p=0.001). Conclusions. When combined with insulin as dual therapy, patients treated with SU were at increased mortality risk as compared with insulin + MET.

Introduction. Hypoparathyroidism is a rare endocrine disorder, leading to complications affecting the kidneys, the eyes, the cerebrum (Fahr’s syndrome, epilepsy, parkinsonism, cognitive impairment), and the heart. Case report. We present the case of a 24-year old male that presented to our clinic for generalized tonicclonic seizures increasing in frequency for the last year or so. Furthermore, he was diagnosed with subcapsular cataract of both eyes and had intraocular lens implant surgery 12 years ago. CT scan performed at admission showed calcium deposits on the dentate nuclei, basal ganglia, thalamus, cerebellum and bilateral subcortical fronto-parietal white matter compatible with Fahr’s disease. The results of the laboratory tests were normal except for hypocalcemia, hyperphosphoremia and low intact parathormone (iPTH). The patient was diagnosed with primary hypoparathyroidism which led to Fahr’s syndrome. The patient was prescribed oral medication including calcium carbonate, calcidiol, magnesium orotate and levetiracetam. The follow-up after three months revealed a seizure free status and normalization of magnesium, calcium, and phosphorus levels. Conclusion. Fahr’s syndrome can be a cause of epileptic seizures and should be considered in the clinical approach to an epileptic patient, especially in children, teenagers, and young adults.

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.

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.

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.