Epidemiološki trendi bolezni ščitnice, ki so povezane z jodom: primer Slovenije

The epidemiology of thyroid disorders is significantly associated with iodine supply. In 1999, Slovenia increased iodine content in kitchen salt from 10 mg to 25 mg of potassium iodide per kg of salt. According to the WHO criteria, Slovenia shifted from a mildly iodine-deficient country to a country with adequate iodine intake. Ten years after the increase in iodine intake, the incidence of diffuse goitre and thyroid autonomy decreased. Now patients with diffuse goitre and thyroid autonomy reach older age than the patients before the increase in iodine intake. In addition, patients with thyroid autonomy are less frequently hyperthyroid than ten years ago and iodine-induced hyperthyroidism is less severe. The incidence of highly malignant thyroid carcinoma has also dropped. However, the incidence of Hashimoto’s thyroiditis increased, most probably in genetically predisposed individuals. Over the last ten years, many animal and in vitro studies evaluated the effects of endocrine disrupting chemicals (EDC) on various aspects of the thyroid function. They mostly studied the effects of polychlorinated biphenyls (PCBs) and dioxins, brominated flame retardants, phthalates, bisphenol A, perfluorinated chemicals, and perchlorate. However, human studies on the effects of EDCs on the thyroid function are very scarce, especially the long-term ones. What they do suggest is that PCBs and dioxins interfere with the transport of thyroid hormones and adversely affect the thyroid function. Many authors agree that iodine deficiency predisposes the thyroid gland to harmful effects of EDCs. Therefore the effects of EDCs in iodine-deficient areas could be more severe than in areas with adequate iodine intake.Epidemiologija bolezni ščitnice je pomembno povezana z jodno preskrbo. V Sloveniji smo leta 1999 zvečali vsebnost joda v kuhinjski soli z 10 mg na 25 mg kalijevega jodida na kg soli. Glede na kriterije SZO smo se iz države z blagim pomanjkanjem joda spremenili v državo z ustreznim vnosom joda. Ugotovili smo, da se je v desetih letih po zvečanju jodne preskrbe zmanjšala pojavnost difuzne golše in avtonomnega tkiva v ščitnici. Bolniki z difuzno golšo in avtonomnim tkivom so sedaj starejši kot pred zvečanjem jodne preskrbe. Poleg tega so bolniki z avtonomnim tkivom redkeje hipertirotični kot pred desetimi leti, hipertiroza, ki je posledica čezmernega vnosa joda, pa je manj izražena. Zmanjšala se je pojavnost najbolj maligne oblike ščitničnega karcinoma. Povečala se je pojavnost Hashimotovega tiroiditisa, verjetno pri genetsko predisponiranih posameznikih. V zadnjem desetletju so v številnih raziskavah na živalih in v raziskavah in vitro ugotavljali vpliv kemijskih povzročiteljev hormonskih motenj (KPHM) na različne vidike ščitnične funkcije. Najpogosteje testirani KPHM so bili poliklorirani bifenili (PCB) in dioksini, bromirani zaviralci gorenja, ftalati, bisfenol A, perfluorirane kemikalije in perklorat. Vendar pa so raziskave o učinkih KPHM na delovanje ščitnice pri ljudeh, zlasti dolgoročne raziskave, zelo redke. Zdi se, da zlasti PCB in dioksini vplivajo na transport ščitničnih hormonov in negativno učinkujejo na delovanje ščitnice. Številni avtorji menijo, da pomanjkanje joda poveča dovzetnost ščitnice za škodljive učinke KPHM. Torej bi lahko bili škodljivi učinki KPMH na področjih pomanjkanja joda resnejši kot na področjih zadostnega vnosa joda

Hashimoto's Thyroiditis: From Genes to the Disease

Hashimoto’s thyroiditis (HT) is the most prevalent autoimmune thyroid disorder. Intrathyroidal lymphocytic infiltration is followed by a gradual destruction of the thyroid gland which may lead to subclinical or overt hypothyroidism. Biochemical markers of the disease are thyroid peroxidase and/or thyroglobulin autoantibodies in the serum which are present with a higher prevalence in females than in males and increase with age. Although exact mechanisms of aetiology and pathogenesis of the disorder are not completely understood, a strong genetic susceptibility to the disease has been confirmed predominantly by family and twin studies. Several genes were shown to be associated with the disease occurrence, progression, and severity. Genes for human leukocyte antigen, cytotoxic T lymphocyte antigen-4, protein tyrosine phosphatase nonreceptor-type 22, thyroglobulin, vitamin D receptor, and cytokines are considered to be of utmost importance. Amongst endogenous factors for the disease development, the attention is focused predominantly on female sex, pregnancy with postpartum period and fetal microchimerism. Environmental factors influencing HT development are iodine intake, drugs, infections and different chemicals. Disturbed self-tolerance accompanied by the increased antigen presentation is a prerequisite for the HT occurrence, whereas proper interaction of thyroid cells, antigen presenting cells, and T cells are necessary for the initiation of thyroid autoimmunity. Secreted cytokines lead predominantly to T-helper type 1 (Th1) response as well as to Th 17 response which has only recently been implicated. Final outcome of HT is thyroid destruction which is mostly a consequence of the apoptotic processes combined with T-cell mediated cytotoxicity

Phase transition and hysteresis in a rechargeable lithium battery

We represent a model which describes the evolution of a phase transition that occurs in some part of a rechargeable lithium battery during the process of charging/discharging. The model is capable to simulate the hysteretic behavior of the voltage - charge characteristics. During discharging of the battery, the interstitial lattice sites of a small crystalline host system are filled up with lithium atoms and these are released again during charging. We show within the context of a sharp interface model that two mechanical phenomena go along with a phase transition that appears in the host system during supply and removal of lithium. At first the lithium atoms need more space than it is available by the interstitial lattice sites, which leads to a maximal relative change of the crystal volume of about $6\%$. Furthermore there is an interface between two adjacent phases that has very large curvature of the order of magnitude 100 m, which evoke here a discontinuity of the normal component of the stress. In order to simulate the dynamics of the phase transitions and in particular the observed hysteresis we establish a new initial and boundary value problem for a nonlinear PDE system that can be reduced in some limiting case to an ODE system

Elimination of fan starting vibrations by introducing the DMAIC methodology

V diplomskem delu je predstavljena odprava zagonskih vibracij aksialnega ventilatorja z uvedbo DMAIC metode. Zaradi številnih reklamacij kupcev ter nepotrebnih dodelav v montažnem procesu predstavljajo vibracije velik problem. V teoretičnem delu so predstavljene osnove obravnavanega aksialnega ventilatorja. Podrobneje je opisana metodologija DMAIC ter nekatera orodja, ki so uporabljena v posameznih fazah. V praktičnem delu pa je predstavljen celoten potek projekta odprave zagonskih vibracij aksialnega ventilatorja. Glavni del predstavljajo testi hipotez, ki nam omogočajo definiranje izvirnih vzrokov za nastale vibracije. Na podlagi testov hipotez so definirane in uvedene najprimernejše izboljšave v procesu in na samem izdelku. V zaključku je prikazana primerjava starega in novega procesa s pomočjo kontrolnih kart ter sposobnosti procesa. Prikazana je tudi primerjava med začetnim, ciljnim in dejanskim stanjem reklamacij kupca in stroškov dodatnih ur.The diploma thesis presents the elimination of starting vibrations of an axial fan with the introduction of the DMAIC methodology. Vibrations are a big problem due to numerous customer complaints and unnecessary finishing touches in the assembly process. In the theoretical part, the basics of the considered axial fan are presented. The DMAIC methodology and some of the tools used in each phase are described in details. In the practical part, the entire course of the project of eliminating the starting vibrations of the axial fan is presented. The main part is the hypothesis tests, which allow us to define the root causes of the resulting vibrations. Based on the hypothesis tests, the most appropriate improvements in the process and on the product itself are defined and introduced. In the conclusion, a comparison of the old and the new process is shown with the help of control charts and process capability. A comparison between the initial, target and actual status of customer complaints and the cost of additional hours is shown

Razvoj nuklearne medicine v Sloveniji in Ljubljani. Pol stoletja nuklearne medicine pri Slovencih

Background. Nuclear medicine began to be developed in the USA after 1938 when radionuclides were introduced into medicine and in Europe after radionuclides began to be produced at the Harwell reactor (England, 1947). Slovenia began its first investigations in the 1950s. This article describes the development of nucleor medicine in Slovenia and Ljubljana. The first nuclear medicine interventions were performed in Slovenia at the Internal Clinic in Ljubljana in the period 1954-1959. ln 1954, Dr Jože Satler started using radioactive iodine for thyroid investigations. In the same year, Dr Bojan Varl, who is considered the pioneer of nuclear medicine in Slovenia, began systematically introducing nuclear medicine. The first radioisotope laboratories were established in January 1960 at the Institute of Oncology and at the Internal Clinic. Under the direction of Dr. Varl, the laboratory at the Internal Clinicdeveloped gradually and in 1973 became the Clinic for Nuclear Medicine with departments for in viva and in vi/ro diagnostics and for the treatment ofinpatients and outpatients at the thyroid department. The Clinic for NuclearMedicine beca me a teaching unit of the Medical Faculty and developed its own post-graduate programme- the first student enrolled in 1972. In the 1960s, radioisotope laboratories opened in the general hospitals of Slovenj Gradec and Celje, and in the I 970s also in Maribor. Izola and Šempeter pri Novi Gorici. Conclusions. Nowadays, nuclear medicine units are modernly equipped and the staff is trained in morphological, functional and laboratory diagnostics in c1inical medicine. They also work on the treatment of cancer, increased thyroid function and other diseases

Advances in understanding Li battery mechanisms using impedance spectroscopy

The use of impedance spectroscopy in the field of modern batteries is demonstrated on three systems: lithium ion batteries represented by lithium iron phosphate (LFP) and lithium cobalt oxide (LCO) electrodes, a porous carbon cathode in contact with polysulfides and a metallic lithium anode exhibiting dendritic growth. In all cases, systematic experiments are shown where the type and composition of electrochemical cell is varied in order to identify the main processes contributing to the impedance response. The experiments are upgraded with appropriate models, using mainly the transmission line approach. The approach allows establishment of clear correlations between the composition and morphology of electrodes on one hand and the measured impedance features on the other. As the transmission line models are based on the use of physically well-defined elements, the approach allows a quantitative description of the main processes (diffusion, reaction, migration across films and contacts) taking place in modern battery electrodes

Spectroscopical and Electrochemical Characterisation of a (3-Mercaptopropyl)trimethoxysilane - Based Protective Coating on Aluminium Alloy 2024

Coatings based on organic-inorganic hybrids may effectively improve the resistance of metals/alloys against corrosion. In this work the protection ability of a coating based on (3-mercaptopropyl)trimethoxysilane (MPTMS) deposited on the well-known aluminium AA 2024 alloy is studied. The hydrolysis and condensation reactions in the initial sol and the structure of thermally treated protective MPTMS coatings is studied using infrared absorbance spectroscopy. In addition, the structure of coatings is investigated using infrared reflection-absorption (IR RA) spectroscopy. Several physical properties of prepared coatings such as contact angles, surface energy and thickness are reported. The corrosion protection ability of once, twice and three times deposited MPTMS coatings is studied using potentiodynamic polarisation measurements. Finally, possible morphological changes at different potentials of interest are investigated using in situ electrochemical AFM. This work is licensed under a Creative Commons Attribution 4.0 International License

Ten-year follow-up of thyroid epidemiology in Slovenia after increase in salt iodization

Aim To assess iodine supply and follow thyroid epidemiology for ten years after an iodine increase from 10 to 25 mg of potassium iodide per kilogram of salt in 1999. Methods In 2002 and 2003, we determined the thyroid size by palpation and ultrasound and measured urinary iodine concentration (UIC) in 676 schoolchildren from 34 schools throughout Slovenia. From 1999 to 2009, we followed the incidence of diffuse and nodular goiter, thyroid autonomy, Graves’ disease, and Hashimoto’s thyroiditis among adults in the stable catchment area of the University Medical Centre Ljubljana with 1 000 000 inhabitants. Results In children, only 1% had a goiter grade 2 (visible and palpable thyroid gland), median thyroid volume was 5.8 mL, and median UIC was 148 μg/L. In adults, the incidence of diffuse goiter and thyroid autonomy decreased significantly (2009 vs 1999, rate ratio [RR], 0.16; 95% confidence interval [CI], 0.12-0.21 and RR, 0.73; 95% CI, 0.62- 0.86, respectively), with a lower incidence in younger participants in 2009 (P < 0.001). The incidence of multinodular goiter and solitary nodule increased (2009 vs 1999, RR, 1.55; 95% CI, 1.35-1.79 and RR, 1.72; 95% CI, 1.49-1.99, respectively). No long-term changes were observed for Graves’ disease (2009 vs 1999, RR, 0.95; 95% CI, 0.81-1.13), while the incidence of Hashimoto’s thyroiditis increased strongly (2009 vs 1999, RR, 1.86; 95% CI, 1.64-2.12). Conclusions The change from mildly deficient to sufficient iodine supply was associated with a marked change in the incidence of thyroid epidemiology – a significant decline in the incidence of diffuse goiter and thyroid autonomy and a marked increase in the incidence of Hashimoto’s thyroiditis

Five-year follow-up and clinical outcome in euthyroid patients with thyroid nodules

BACKGROUND: Thyroid nodule diagnosis has become increasingly frequent. Defining optimum surveillance intervals for patients with unsuspicious thyroid nodules remains a challenge. This was a single centre cohort study in which patients diagnosed with unsuspicious thyroid nodules in whom no treatment was indicated were invited for re-evaluation 5 years after the diagnosis. The primary end point of the study was to estimate the change in nodule size with thyroid ultrasound (US) and the secondary end point was to assess the need for clinical management 5 years after the diagnosis. PATIENTS AND METHODS: Baseline patient parameters and ultrasound characteristics of the nodules were retrospectively collected. At follow-up, thyroid ultrasound was performed. RESULTS: A hundred and eighteen (107 women / 11 men, aged 56.8 ± 13.4 years) patients were included in the study having 203 nodules at baseline, with mean largest nodule diameter 10.5 ± 7.4 mm. After 5 years, 58 (28.6%) nodules significantly increased in size, 27 (13.3%) decreased, and for 104 (51.2%) of nodules, no change in size was noted. Fourteen (6.9%) nodules disappeared. Additional 26 new nodules (mean largest diameter 7.7 ± 5.0 mm) in 16 patients were identified at follow-up. Regarding the clinical outcome, no new thyroid cancers were found. For 107 (90.7%) patients no further management was indicated. Five (4.2%) patients were referred to thyroidectomy because of the growth of the nodules. Two (1.7%) patients were treated for hyperthyroidism. Four (3.4%) patients did not complete the study. CONCLUSIONS: We report a single centre experience of the natural history of unsuspicious thyroid nodules. Our results showed that 71.4% of such nodules remained stable in size, decreased or even disappeared and that the vast majority of the patients remained clinically stable with no need for treatment 5 years after the diagnosis

Hypothyroidism is associated with higher testosterone levels in postmenopausal women with Hashimoto's thyroiditis

Introduction: There are few data about possible interaction of sex hormones and thyroid autoimmunity and function in women with Hashimoto’s thyroiditis (HT) after menopause. Therefore, our aim was to investigate sex hormone levels in euthyroid (EuHT) and hypothyroid (HypoHT) postmenopausal women with HT. Material and methods: We performed a prospective observational clinical study that included 55 women with HT (AllHT) and 18 healthy subjects (HS) after menopause matched by age, body mass index, follicle-stimulating hormone, and menopause duration. According to their thyrotropin (TSH) level, the AllHT patients were divided into two subgroups: EuHT with TSH in the range 0.35–5.5 mU/L and HypoHT with TSH above 5.5 mU/L. Total and free testosterone (T), sex hormone-binding globulin (SHBG), oestradiol (E2), and progesterone (P) were measured in all subjects. Values are presented as mean ± SD. The Mann-Whitney U test was used for comparison of values between the groups. Correlations were tested using Kendall’s tau test. Results: In the HypoHT group, significantly higher free T levels were found in comparison to the HS group (7.89 ± 3.55 pmol/L and 7.13 ± 3.03 pmol/L, p &lt; 0.05). Furthermore, in HypoHT, free T was significantly higher than in EuHT (7.19 ± 5.65 pmol/L, p &lt; 0.05). SHBG was significantly lower in HypoHT compared with HS (45.4 ± 17.4 nmol/L and 60.09 ± 19.51 nmol/L, p &lt; 0.05). No significant correlation was found between sex hormone levels and thyroglobulin and thyroid peroxidase antibodies. Conclusion: We report significantly higher free and total T levels in hypothyroid postmenopausal women with HT. To our knowledge, this is the first study of sex hormone levels in postmenopausal women with HT.