Hashimoto's thyroiditis and autoimmune gastritis

The term "thyrogastric syndrome" defines the association between autoimmune thyroid disease and chronic autoimmune gastritis (CAG), and it was first described in the early 1960s. More recently, this association has been included in polyglandular autoimmune syndrome type IIIb, in which autoimmune thyroiditis represents the pivotal disorder. Hashimoto's thyroiditis (HT) is the most frequent autoimmune disease, and it has been reported to be associated with gastric disorders in 10-40% of patients while about 40% of patients with autoimmune gastritis also present HT. Some intriguing similarities have been described about the pathogenic mechanism of these two disorders, involving a complex interaction among genetic, embryological, immunologic, and environmental factors. CAG is characterized by a partial or total disappearance of parietal cells implying the impairment of both hydrochloric acid and intrinsic factor production. The clinical outcome of this gastric damage is the occurrence of a hypochlorhydric-dependent iron-deficient anemia, followed by pernicious anemia concomitant with the progression to a severe gastric atrophy. Malabsorption of levothyroxine may occur as well. We have briefly summarized in this minireview the most recent achievements on this peculiar association of diseases that, in the last years, have been increasingly diagnosed

Early detection of biochemically occult autonomous thyroid nodules

Objective: Autonomously functioning thyroid areas may be associated with subclinical or overt hyperthyroidism, but may exist even in the presence of normal TSH. This study was aimed at comparing the rate of autonomously functioning areas and their cardiac sequelae in patients with nodular goitre studied with the usual and a novel approach. Design and methods: In total 490 adult outpatients with thyroid nodular goitre, living in a mild iodine-deficient area, were selected in our referral centre for thyroid diseases from 2009 to 2014 on the basis of a suspicion of thyroid functional autonomy. They were divided in three groups according to a non-conventional approach (excessive response to thyroxine treatment: group 1) or conventional approach (low/normal TSH with clinical suspicion or low TSH: groups 2 and 3). All patients of the study with the suspicion of thyroid functional autonomy underwent thyroid scan with radioactive iodine (I131) uptake (RAIU). Results: The percentage of confirmed thyroid functional autonomy was 319/490, being significantly higher in group 3 than in groups 1 and 2 (81.5 vs 64.7 vs 52.6%; chi-square P < 0.0001). However, the diagnosis with non-conventional approach was made at a significant earlier age (P < 0.0001). Cardiac arrhythmias as well as atrial fibrillation were similarly detected by conventional and non-conventional approaches (chi-square test: P = 0.2537; P = 0.8425). Conclusions: The hyper-responsiveness to thyroxine treatment should induce the suspicion of thyroid functional autonomy at an early stage, allowing to detect autonomous functioning areas in apparently euthyroid patients

Liderazgo e Igualdad de género: un análisis en las áreas STEM

Las desigualdades entre hombres y mujeres ha sido siempre un problema estructural (es una construcción social) y transversal (afecta al conjunto de las mujeres, es decir a una mayoría de la población) para la sociedad. Es lo que se conoce como “brecha de género” y se refleja en varios sectores económicos de un país, pero, sobre todo, en los relacionados con las materias STEM (Science, Tecnology, Engeniere, Mathematics, por sus siglas en inglés), por lo que la poca representación femenina que existe dentro de este ámbito es digna de estudio. Con este trabajo se pretende poner de manifiesto la evolución que ha tenido lugar en esta área, con referencia a las condiciones en que las mujeres podían acceder a la formación académica antiguamente hasta llegar a la actualidad. Seguidamente se analizarán los diferentes factores que favorecen las desigualdades presentes dentro del mundo científico, especialmente en el entorno estudiantil español y el motivo de la poca participación de las mujeres en estas áreas.Además, el análisis teórico se complementa con una parte más práctica utilizando una encuesta a estudiantes de ciencias. Gracias a ella, trataremos de conocer la opinión y experiencia de los alumnos y alumnas que estudian alguna de estas áreas en nuestro país, para recopilar muestras que nos ayuden a sacar conclusiones actuales y contrastar el análisis previamente realizado de los factores que favorecen esta desigualdad.<br /

Plants as biomonitors for volcanic emissions

Biomonitoring techniques have been widely used in environmental studies to monitor anthropogenic pollutant. Recently such techniques have been applied also to ascertain the impact of contaminants naturally released by volcanic activity. In the present study a biomonitoring surveys has been performed in many different active volcanic systems: Mt. Etna and Vulcano (Italy), Nisyros (Greece), Nyiragongo (DRC), Masaya (Nicaragua), Gorely (Kamchatka, Russia). We sampled leaves of different species Betulla aethnensis, Pinus nigra, Populus tremula, Senecio aethnensis and Rumex aethnensis on Etna, Cistus creticus and salvifolius on Vulcano and Nisyros, Senecio ssp. on Nyiragongo, a Fern on Masaya and Salix arctica at Gorely. All samples were analyzed by ICP-MS and ICP-OES for 49 elements after acid digestion with a microwave oven (HNO3 + H2O2). Major constituents in leaves are K, Ca, Mg, Na, Si, Al and Fe ranging from about 10 3 to 105 ppm. Manganesium, Sr, Rb, Ba, Zn, B, Cu show also relatively high concentrations (100-103 ppm) while the remaining elements (As, Bi, Cd, Ce, Co, Cr, Cs, Ga, Li, Mo, Ni, Pb, Sb, Sc, Se, Th, Tl, U, V, Y and lanthanide series) display much lower values (10-4-101 ppm). Nearly all investigated elements show their highest concentrations in the samples collected closest to the main degassing vents (open craters, fumarolic fields). Increased concentrations are also found in the samples collected in the downwind direction where volcanic emissions are prevailingly dispersed. Leaves collected along radial transects from the active vents, highlight that the levels of metals decrease from one to two orders of magnitude with increasing distance from the source. The decrease is stronger for volatile elements, which are highly enriched in volcanic emissions, (As, Bi, Cd, Cs, Pb, Sb, Tl) than for more refractory elements (Al, Ba, Sc, Si, Sr, Th, U). The different species of plants show significant differences in the bioaccumulation processes for most of the analyzed elements, in particular lanthanides, which are systematically enriched in Rumex leaves. Needles of pine (non-deciduous tree) represent a good tool for biomonitoring investigation because they are important tracers of accumulation with time. The high concentrations of many toxic elements in the leaves allow us to consider some of these plants as highly tolerant species to the volcanic emissions, and suitable for biomonitoring researches further confirming their strong potential in tracing the impact and geographic distribution of these natural contaminants

Daily requirement of softgel thyroxine is independent from gastric juice pH

BackgroundSoftgel levothyroxine (LT4) preparation showed a better in vitro dissolution profile at increasing pH as compared to tablet LT4 preparation. Clinical studies suggested a better performance of softgel LT4 preparation in patients with gastric disorders but whether this finding is related to gastric juice pH variation in vivo is not known. MethodsTwenty-eight hypothyroid patients (24F/4M; median age=50 treated with tablet LT4 (median dose= 1.65 mu g/kg/day) and with stable thyroid stimulating hormone (TSH) values on target ( mU/l) have been shifted to softgel LT4 preparation. The dose of softgel LT4 has been titrated to obtain a similar individual serum TSH value. All subjects followed a specific treatment schedule, taking LT4 in fasting condition and then abstaining from eating or drinking for at least 1 hour. Owing to the presence of long-lasting dyspepsia or of already known gastric disorders, all patients underwent endoscopy, upon informed consent. Gastric juice has been collected during endoscopy to measure gastric pH. Then we plotted the dose of LT4 with the gastric pH obtained in vivo, before and after the switch tablet/softgel preparation in all patients. ResultsUpon the switch tablet/softgel preparation, the therapeutic LT4 dose was very slightly reduced (-6%) in the whole sample. However, the individual variations revealed the existence of two populations, one without any dose reduction (A) and the other showing a dose reduction &gt;20% (B). Upon matching with the actual gastric pH, patients with normal pH (A: n=17; 14F/3M, median 1.52) no showed a lower softgel LT4 requirement. Instead, among patients with reduced gastric acid production (B: n=11; 10F/1M, median pH 5.02) the vast majority (10/11; 91%, p&lt;0.0001) benefited from a lower dose of softgel LT4 (median = -23%, p&lt;0.0001). Interestingly, the dose of LT4 in tablet correlated with pH value (Spearman's rho =0.6409; p = 0.0002) while softgel dose was independent from gastric juice pH (Spearman's rho =1.952; p = 0.3194). ConclusionsThese findings provide evidence that softgel LT4 preparation is independent from the actual gastric pH in humans and may represent a significant therapeutic option in patients with increased LT4 requirement, owed to disorders impairing the gastric acidic output

Ulcerative Colitis as a Novel Cause of Increased Need for Levothyroxine

Background: Thyroxine absorption takes place at the small intestine level and several disorders affecting this intestinal tract lead to thyroxine malabsorption. An increased need for thyroxine has also been observed in gastric disorders due to variations in drug dissolution and/or in its ionization status. Ulcerative colitis (UC) is an inflammatory bowel disease that has been postulated as a potential cause of the increased need for thyroxine, but there is a lack of evidence on this topic. This study is aimed at measuring the thyroxine requirement in hypothyroid patients with UC.Patients and Methods: Among 8,573 patients with thyroid disorders consecutively seen in our referral center from 2010 to 2017, we identified 34 patients with a definite diagnosis of UC. Thirteen of them were hypothyroid (12 F/1 M; median age = 53 years), bearing UC during the remission phase and in need for thyroxine treatment, thus representing the study group. The dose of T4 required by UC patients has been compared to the one observed in 51 similarly treated age- and weight-matched patients, compliant with treatment and clearly devoid of any gastrointestinal and /or pharmacological interference.Results: To reach the target serum TSH, the dose of thyroxine had to be increased in twelve out of thirteen (92%) hypothyroid patients with ulcerative colitis. The median thyroxine dose required by UC patients was 1.54 μg/kg weight/day, that is 26% higher than the control patients, to reach a similar TSH (1.23 μg/kg weight/day; p = 0.0002). Since half of our study group consisted of patients aged over 60 years old, we analyzed the effect of age on the subdivision in two classes. Six out of seven (86%) adult patients (&lt;60 years) required more T4 than those in the respective control group (1.61 vs. 1.27 μg/kg weight/day; +27%; p &lt; 0.0001). An increased dose (+17%; p = 0.0026) but to a lesser extent, was also observed in all patients over 60 years, as compared to the control group.Conclusions: In almost all hypothyroid patients with UC, the therapeutic dose of thyroxine is increased. Therefore, ulcerative colitis, even during clinical remission, should be included among the gastrointestinal causes of an increased need for oral thyroxine