ACTA ENDOCRINOLOGICA (BUC)

We report the case of a 24 years old male, diagnosed with severe pancytopenia, possibly myelodysplastic syndrome with ringed sideroblasts associated with immune thrombocytopenia, who presented with hyperthyroidism due to Graves’ disease. Standard antithyroid drugs were postponed for fear of exacerbation of cytopenia. Instead, steroid and immunoglobulin therapy gradually induced euthyroidism which was followed by correction of the hematological abnormalities. We review in this paper literature reports that discuss the association of thyrotoxicosis with pancytopenia, with reversibility of both the hematological and endocrine autoimmune picture after immunosuppressive treatment.

Context. Tumors associated with thyroid gland are relatively rare. Papillary thyroid cancer (PTC) represents the most\r\nfrequent thyroid neoplasm, and it has almost in all of the cases favorable prognosis. In the largest number of the cases, PTC remains within the thyroid gland or it gives the\r\nlymphogenic metastasis in the cervical lymph nodes and, extremely rare, it results in hematogenic metastasis.\r\nObjective. To present a case of a patient who had a distant secondary deposit in pelvic bone and sacral bone as a first sign of the PTC.\r\nSubjects and Methods. A 56 year old male was presented in this report.\r\nResults. After intensive hip pain, patient was diagnosed with osteolytic lesion in sacral and left pelvic bone. After aspiration biopsy, macroscopic analysis and imunohistochemistry, diagnosis of PTC was set. Patient has undergone total thyroidectomy, two doses of radioiodine\r\nwere applied and secondary deposit palliative radiotherapy as well.\r\nConclusions. The total thyroidectomy is the first line therapy in the PTC patients for primary tumors, while the therapy for the secondary deposits requires surgical\r\nprocedures combined with other means of treatment.

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Context. Vitamin D plays a crucial role in calcium metabolism through parathormone-dependent process. Deficiency of this important nutrient may be associated with hypocalcemia after thyroidectomy. Objective. To evaluate the role of vitamin D in predicting hypocalcemia following total thyroidectomy. Subjects and Methods. One hundred and fifty patients who underwent total thyroidectomy for benign or malignant thyroid disease were included in this prospective study. The association between preoperative vitamin D status and the development of hypocalcemia were investigated. Results. Biochemical and symptomatic hypocalcemia were found in 28 (18.7%) and 22 (14.7%) patients, respectively. Preoperative vit D level was found significantly lower in patients with biochemical (p = 0.006) and clinical (p < 0.001) hypocalcemia in comparison to normocalcemic patients. The patients who had <10 ng/mL vit D level (severe deficiency) developed significantly more biochemical and clinical hypocalcemia than the patients with serum vit D level higher than 10 ng/mL (p = 0.030 and p < 0.001, respectively). Conclusions. Although postthyroidectomy hypocalcemia is multifactorial, vit D deficiency, particularly severe form, is significantly associated with the development of biochemical and clinical hypocalcemia. Vit D supplementation can prevent this unwanted complication in such patients.

Iodine deficiency in a geographical area can be quantified, not only by urinary iodine\r\nexcretion, but also through the incidence of elevated TSH levels measured in newborns. We\r\nmeasured the TSH level in 3015 newborns, in a partial screening realized in Mures County\r\nduring the years 2001&#8211;2006. The law for the universal salt iodization with increased KIO3\r\nlevel (34 ? 8.5 mg/kg) was adopted in Romania in 2002, and implemented in practice\r\nstarting with December 2003. We compared TSH levels of 2,454 children born in the years\r\n2001-2003, before the universal salt iodization, with those of 561 children born in 2004-\r\n2006 after the implementation of the law of universal salt iodization. An elevated TSH\r\nlevels (over 10 mUI/L, according to the WHO criteria) was revealed in 8.23 %( 199/2,454)\r\nnewborns during 2001-2003, as compared to 9.62% (54/561) subjects born during 2004-\r\n2006 (p=NS). Based on both criteria and results, Mures County is a region with a\r\nmoderately mild iodine deficiency. However, the mean value of TSH levels (over 12\r\nmUI/L) obtained during 2001-2003, (19.81 ? 2.63 mUI/L, X ? SD, n= 145) significantly\r\ndecreased in the second period (15.63 ?7.35 mUI/L, n=34) (p= 0.02), i.e. a medium decrease\r\nwith 4.18 mUI/L. While the moderate increase of TSH levels (10-12 mUI/L) is an indicator\r\nof iodine deficiency, higher concentrations (>20 mUI/L) usually indicate the coexistence of\r\na hypothyroidism due to the low iodine supply. We observed an important decrease of the\r\nhypothyroidism induced by iodine deficiency: when during the first period its incidence was\r\n2.49%, in the second one it decreased to 1.46% (p=ns). In conclusion, after increasing the\r\niodine-content by universal salt iodization, the incidence of elevated TSH level (and the\r\ncorresponding hypothyroidism) did not decrease in newborns, but the mean value of higher\r\nthan normal TSH presented a statistically significant decrease, reflecting the improvement\r\nin iodine supplementation.

Background. Thyroid-associated ophthalmopathy (TAO), one of the most common orbital diseases in adults, seriously reduces patients’ quality of life. Although human tear proteomics identified many abnormal expressed proteins and proposed several pathogeneses of TAO, most of these studies focused on the active stage or mixed types in TAO. In this study we identified significantly changed proteins and preliminary revealed the potential signalling pathways and mechanisms of TAO with the late, inactive stage. Patients and Methods. Tears from TAO patients (n=6) with a CAS score < 3 and 6 control healthy subject were collected. The pooled tears were further fractionated using high pH reversed-phase chromatography, then submitted to LC-MS/MS and subsequent bioinformatic analysis. Results. Proteomic profiling identified 107 significantly changed proteins between the inactive stage of TAO patients and healthy cases. Among these proteins, 62 were upregulated, and 45 were downregulated in TAO cases compared to healthy individuals. Enrichment analysis revealed that the immune system, cell cycle, metabolism (carbohydrate metabolism and metabolism of cofactors and vitamins), protein synthesis and degradation might play a vital role in the progress of inactive TAO. The present investigation represents the first proteomic tear study of TAO patients in the inactive stage. Conclusion. The results shed light on the differences between inactive TAO patients and healthy cases, thus enabling us to understand better the molecular mechanisms and potential targets for the treatment of inactive TAO.

Background. Paget Disease (PD) is usually asymptomatic and discovered incidentally, it is known that it is exhibited low to high grade increased F-18 FDG uptake. Aim. In this study, we investigated the distinguishability of FDG PET/CT in incidental PD cases from other bone diseases and at different stages of the disease. Patients and Methods. In this cross-sectional, descriptive study, “Paget” identification associated with PET/ CT reports was found in 69 of 18,119 studies (~3.8%). Of the 45 patients (33 males and 12 females) eligible for inclusion in the study, 35.6% had monostotic and 64.4% had polyostotic disease (p>0.5). There was no statistically significant difference in biochemical parameters between groups. Results. According to the radiological appearance of the patients, 36 were in the mixed stage and 9 were in the blastic stage. Only the difference in ALP and creatinine values between the groups was statistically significant. SUVmax, SUVmean and HU values were found to be statistically significantly higher in pagetoid bones compared to control bone lesions. For SUVmax for PD bone lesion we found the 2.55 cutoff point with a sensitivity of 91% and a specificity of 84%. Conclusion. The specific radiological appearance of bone lesions and the evaluation of metabolic activity compared to normal bone seem to help differentiate PD from other lesions. Prospective studies are needed in the differentiation of FDG's disease stage and treatment response evaluation. The ability to differentiate between benign and malignant FDG avid bone lesions in oncological patients’ enables appropriate patient management, including avoiding unnecessary additional invasive procedures such as bone biopsy.