L’inibizione tireotropinica da metformina non si associa a segni cardiologici di ipertiroidismo subclinico

Recenti dati di letteratura hanno evidenziato come metformina determini una riduzione/soppressione dei livelli sierici di tireotro- pina (TSH), simulando un ipertiroidismo subclinico il cui signifi- cato clinico rimane a oggi ancora assai controverso. Sebbene l’ipertiroidismo subclinico sia nella maggioranza dei casi una condizione clinica asintomatica, è altrettanto noto come esso si associ a un aumentato rischio di aritmie (più frequentemente la fibrillazione atriale) e ad alterazioni morfo-funzionali cardiache determinando un aumento di morbilità e mortalità cardiovasco- lare. Scopo del presente studio è stato quello di valutare retrospetti- vamente le alterazioni di differenti indici elettrocardiografici in pazienti diabetici eutiroidei che, dopo aver intrapreso terapia con metformina, hanno sviluppato riduzione/soppressione dei valori di TSH comparando i dati con quelli ottenuti in pazienti con iper- tiroidismo subclinico secondario a patologie tiroidee o a terapia soppressiva con L-tiroxina. I parametri elettrocardiografici (frequenza cardiaca, durata del- l’onda P, indice di dispersione dell’onda P, QT max, QT min, indice di dispersione dell’intervallo QT) sono stati valutati in 23 pazienti diabetici in terapia con metformina prima e dopo 6 mesi dall’instaurarsi della soppressione del TSH e in 31 con- trolli con ipertiroidismo subclinico. Nessuna modifica significa- tiva è stata osservata tra i parametri elettrocardiografici rilevati prima e dopo la riduzione del TSH. Al contrario, significative dif- ferenze nella durata dell’onda P (102,9 ± 7,4 vs 92,1 ± 5,8 ms, p < 0,001), dell’indice di dispersione dell’onda P (13,1 ± 3,4 vs 7,1 ± 3,5 ms, p < 0,001), del QT max (399 ± 18 vs 388 ± 16 ms, p = 0,024), del QT min (341 ± 14 vs 350 ± 17 ms, p = 0,038) e di quello dell’intervallo QT (49,9 ± 9,6 vs 30,9 ± 9,2 ms, p < 0,001) sono state rilevate tra i controlli con iperti- roidismo subclinico e il gruppo di pazienti diabetici con valori ridotti/soppressi di TSH. I risultati del nostro studio evidenzierebbero come l’effetto di riduzione/soppressione del TSH osservato in alcuni pazienti dia- betici in terapia con metformina non si associ a marker periferi- ci cardiaci da eccesso di ormoni tiroidei. L’alterazione del profilo tiroideo metformina-indotto sembrerebbe non indicativo di iper- tiroidismo subclinico, suggerendo quindi che non sussiste la necessità di sottoporre a stretti controlli della funzione tiroidea i pazienti diabetici in terapia con metformin

Oral liquid L-thyroxine (L-t4) may be better absorbed compared to L-T4 tablets following bariatric surgery.

Drug malabsorption is a potential concern after bariatric surgery. We present four case reports of hypothyroid patients who were well replaced with thyroxine tablets to euthyroid thyrotropin (TSH) levels prior to Roux-en-Y gastric bypass surgery. These patients developed elevated TSH levels after the surgery, the TSH responded reversibly to switching from treatment with oral tablets to a liquid formulation

Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

Background: Prone whole breast irradiation (WBI) leads to reduced heart and lung doses in breast cancer patients receiving adjuvant radiotherapy. In this feasibility trial, we investigated the prone position for whole breast + lymph node irradiation (WB + LNI). Methods: A new support device was developed for optimal target coverage, on which patients are positioned in a position resembling a phase from the crawl swimming technique (prone crawl position). Five left sided breast cancer patients were included and simulated in supine and prone position. For each patient, a treatment plan was made in prone and supine position for WB + LNI to the whole axilla and the unoperated part of the axilla. Patients served as their own controls for comparing dosimetry of target volumes and organs at risk (OAR) in prone versus in supine position. Results: Target volume coverage differed only slightly between prone and supine position. Doses were significantly reduced (P < 0.05) in prone position for ipsilateral lung (Dmean, D2, V5, V10, V20, V30), contralateral lung (Dmean, D2), contralateral breast (Dmean, D2 and for total axillary WB + LNI also V5), thyroid (Dmean, D2, V5, V10, V20, V30), oesophagus (Dmean and for partial axillary WB + LNI also D2 and V5), skin (D2 and for partial axillary WB + LNI V105 and V107). There were no significant differences for heart and humeral head doses. Conclusions: Prone crawl position in WB + LNI allows for good breast and nodal target coverage with better sparing of ipsilateral lung, thyroid, contralateral breast, contralateral lung and oesophagus when compared to supine position. There is no difference in heart and humeral head doses

Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): A Pituitary Society Statement

Introduction With the goal of generate uniform criteria among centers dealing with pituitary tumors and to enhance patient care, the Pituitary Society decided to generate criteria for developing Pituitary Tumors Centers of Excellence (PTCOE). Methods To develop that task, a group of ten experts served as a Task Force and through two years of iterative work an initial draft was elaborated. This draft was discussed, modified and finally approved by the Board of Directors of the Pituitary Society. Such document was presented and debated at a specific session of the Congress of the Pituitary Society, Orlando 2017, and suggestions were incorporated. Finally the document was distributed to a large group of global experts that introduced further modifications with final endorsement. Results After five years of iterative work a document with the ideal criteria for a PTCOE is presented. Conclusions Acknowledging that very few centers in the world, if any, likely fulfill the requirements here presented, the document may be a tool to guide improvements of care delivery to patients with pituitary disorders. All these criteria must be accommodated to the regulations and organization of Health of a given country

Counseling patients about sexual health when considering post-prostatectomy radiation treatment

Prostate cancer is the second most frequently diagnosed cancer in men in the United States. Many men with clinically localized prostate cancer survive for 15 years or more. Although early detection and successful definitive treatments are increasingly common, a debate regarding how aggressively to treat prostate cancer is ongoing because of the effect of aggressive treatment on the quality of life, including sexual functioning. We examined current research on the effect of post-prostatectomy radiation treatment on sexual functioning, and suggest a way in which patient desired outcomes might be taken into consideration while making decisions with regard to the timing of radiation therapy after prostatectomy