12.1 Enhanced Proatherogenic Inflammation After Recombinant Human TSH Administration in Patients Monitored for Thyroid Cancer Remnant

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Enhanced proatherogenic inflammation after recombinant human TSH administration in patients monitored for thyroid cancer remnant

OBJECTIVE: To evaluate the effect of recombinant human TSH (rhTSH) on biomarkers of vascular endothelial cell and platelet activation in patients monitored for thyroid carcinoma remnant. METHODS: Circulating levels of soluble(s) intercellular adhesion molecule (sICAM)-1 and sE-selectin, as indices of vascular endothelial cell activation, of sP-selectin and sCD40 ligand (sCD40L), as indices of platelet activation, and of 8-iso-prostaglandin F(2alpha) (8-iso-PGF(2alpha)), as an index of lipid peroxidation, were evaluated in 20 patients (16 females, 48.0 +/- 13.6 years) at baseline and after intramuscular rhTSH injection (0.9 mg/day on two consecutive days). RESULTS: At baseline, serum TSH values were below normal whereas free T3 and free T4 were within the normal range. After rhTSH injection, serum TSH increased significantly but free T3 and free T4 remained unchanged. Concomitantly, plasma sICAM-1 concentrations increased significantly (from 155.9 +/- 39.1 to 183.6 +/- 38.1 ng/ml, P < 0.03), as did those of sE-selectin (from 74.8 +/- 15.4 to 91.4 +/- 12.2 ng/ml, P < 0.0006), sP-selectin (from 56.4 +/- 13.7 to 72.2 +/- 14.9 ng/ml, P < 0.002), sCD40L (from 2.1 +/- 0.9 to 2.8 +/- 1.1 ng/ml, P < 0.03) and total 8-iso-PGF(2alpha)(from 238.5 +/- 47.0 to 307.8 +/- 41.2 pg/l, P < 0.0001). Changes in circulating levels of sCD40L were directly correlated with changes in levels of plasma total 8-iso-PGF(2alpha) (r = 0.523, P < 0.02) and sP-selectin (r = 0.480, P < 0.03). CONCLUSIONS: Supraphysiological concentrations of rhTSH might exert proatherogenic effects by promoting activation of vascular endothelial cells and platelets probably through enhanced oxidative stress

COVID-19 pandemic: new rules of engagement in endocrine surgery

SARS-CoV-2 is sweeping across theworld triggering a nation-by-nationupscaling of emergency strategies totackle its outbreak1. The adoption ofstrict prevention and control measuresin addition to tactical reallocation ofhospital resources and manpower arerequired to respond to a surge in patientcare demand2. Guidance on priori-tization strategies to address surgicalpractice in these dire straits is required toreduce the burden on healthcare systemsand support institutions and providers3.Some guidance is available concerningthe management of patients needingsurgery for endocrine conditions duringthe COVID-19 pandemic4; patientswith the following endocrine conditionsrequiring hospitalization within 30 daysthat are included in the priority class ofthe waiting list are scheduled

Endocrine surgery during COVID-19 pandemic: do we need an update of indications in Italy?

The ongoing spread of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a significant threat to global health. As the coronavirus outbreak began spreading, hospitals were forced to relocate resources to treat the growing number of COVID-19 patients. As a consequence, doctors across the country canceled tens of thousands of nonurgent surgeries. However, recognizing that the COVID-19 situation may be highly variable and fluid in different communities across the country, elective surgery could be still allowed in some centers for patients included in the high-priority class. The majority of endocrine disorders requiring surgical treatment in patients identifiable as first-priority class, or needing hospitalization within 30 days, are generally represented by malignant thyroid tumors, hyperthyroidism, hyperparathyroidism, and some adrenal disorders. The need for urgent intervention is evaluated on a case-by-case basis according to the severity of the symptoms, the likelihood of progression, and global clinical judgment. On the basis of the above indications, during the last 4 weeks, we performed 18 planned surgical treatments in patients with thyroid cancer (total thyroidectomies, plus lymph node dissection if needed) or multinodular toxic goiter. In no case, postoperative ventilatory support was needed, and the average hospital stay was 3 days. The negative COVID-19 status for all the treated patients was appropriately evaluated beforehand. Nobody knows how long the current COVID-19 pandemic will be lasting. Certainly, we will be requested in the next future to incrementally offer surgical services for endocrine disorders that have been deferred for the COVID-19 pandemic

Improvement of Executive Function after Short-Term Administration of an Antioxidants Mix Containing Bacopa, Lycopene, Astaxanthin and Vitamin B12: The BLAtwelve Study

During the last few years increasing interest has been focused on antioxidants as potentially useful agents in the prevention of the onset and progression of cognitive dysfunction. In this randomized, double-blind, controlled, parallel arm study, the effects of daily consumption of an antioxidant mix on cognitive function in healthy older adults were evaluated. After a 1 week run-in period, 80 subjects aged 60 years or more, and with no evidence of cognitive dysfunction, were randomly allocated to a mix of four bioactive compounds (bacopa, lycopene, astaxanthin, and vitamin B12) or matched placebo, taken orally once a day for 8 weeks. The primary objective of the study was to evaluate the changes in trial making test (TMT) scores from baseline to 8 weeks of treatment, analyzed in the following hierarchical order: TMT-B, TMT-A, and TMT-B minus TMT-A. TMT-B increased in the control group (+3.46 s) and decreased in the active group (-17.63 s). The treatment difference was -21.01 s in favor of the active group (95% C.I. -26.80 to -15.2, p &lt; 0.0001). The decrease in TMT-A was significantly higher in the active group (-6.86 s) than in the control group (-0.37 s). TMT-B minus TMT-A increased in the control group (+3.84 s) and decreased in the active group (-10.46 s). The increase in letter fluency in the verbal fluency test (VFT) was also significantly higher in the active group and statistically significant (+5.28 vs. +1.07 words; p &lt; 0.001). Our findings provide encouraging evidence that regular dietary supplementation with bacopa, lycopene, astaxanthin, and vitamin B12 may be an effective dietary approach for counteracting cognitive changes associated with brain aging

Replacement therapy with levothyroxine modulates platelet activation in recent-onset post-thyroidectomy subclinical hypothyroidism

Background and aim Subclinical hypothyroidism has been linked to increased risk of atherosclerotic disease. Soluble CD40 ligand (sCD40L), mainly derived from activated platelets, and the lipid peroxidation product 8-iso-prostaglandin F2\u3b1(8-iso-PGF2\u3b1) are known to play a relevant pathophysiological role in atherogenesis. In this study, we analyzed the relationship between thyroid hormones and circulating levels of sCD40L and 8-iso-PGF2\u3b1in patient with recent-onset post-thyroidectomy subclinical hypothyroidism under replacement therapy. Methods and results Circulating levels of thyroid hormones, sCD40L, and 8-iso-PGF2\u3b1were assessed in 40 recently thyroidectomized patients (33 females, mean age 52.0 \ub1 11.7 years) at baseline (5\u20137 day after surgery) and after 2 months under replacement therapy with levothyroxine (LT-4). At baseline, circulating levels of thyroid hormones were indicative of a subclinical hypothyroidism (TSH 7.7 \ub1 3.9 \u3bcU/mL, FT3 1.8 \ub1 0.6 pg/mL, and FT3 8.9 \ub1 3.0 pg/mL). Circulating levels of sCD40L and 8-iso-PGF2\u3b1were directly correlated with each other (r = 0.360, p = 0.023) and with TSH levels (r = 0.322, p = 0.043 and r = 0.329 p = 0.038, respectively). After 2 months under the replacement therapy with LT-4 circulating levels of TSH (from 7.7 \ub1 3.9 to 2.7 \ub1 2.8 \u3bcU/mL, p < 0.0001), sCD40L (from 6.11 \ub1 2.41 to 2.43 \ub1 2.00 ng/mL, p < 0.0001) and 8-iso-PGF2\u3b1(from 45.33 \ub1 6.94 to 40.36 \ub1 6.20, p < 0.0001) significantly decreased. Changes in circulating levels of sCD40L and 8-iso-PGF2\u3b1were directly correlated with each other (r = 0.349 p = 0.028) and with changes in TSH levels (r = 0.367 p = 0.020 and r = 0.339 p = 0.032, respectively). Conclusion Our study suggests an influential role of TSH on proatherogenic activation of platelets, probably through enhanced lipid peroxidation. These findings could partially explain the increased susceptibility of patients with subclinical hypothyroidism to develop atherosclerotic disease