Insulinooporność w ciąży powikłanej cukrzycą typu 1. Czy wiemy na jej temat dostatecznie dużo?

Insulin resistance (IR) is defined clinically as the inability of a known quantity of exogenous or endogenous insulin to increase glucose uptake and utilization. In recent years the increasing role of IR in the pathogenesis of type 1 diabetes mellitus (T1DM) related complications has been taken into account. The aim of this article is to discuss the possible role of IR in pregnancy complicated by T1DM. At the moment, there is no doubt that IR is not only frequently observed in T1DM patients, but also is a separate risk factor of several complications in non- pregnant patients. The role of IR in pregnancy complicated by T1DM has not been widely studied yet. However, data from the studies on different populations showed that IR may predispose to such conditions as miscarriage, preeclampsia and macrosomia. Interestingly, all of these are more frequently diagnosed in women with T1DM in comparison to healthy subjects. The literature on the role of IR in human pregnancy is relatively rich. However, despite its significance in pathophysiology of T1DM and its complications in general population, there is a lack of understanding of how it affects maternal and fetal health in pregnancy complicated by this disease. Nonetheless, based on the available literature, IR may be proposed as an additional factor modifying pregnancy outcome in woman with T1DM. Therefore, measures that might reduce IR such as good glycemic control and control of weight gain should be recommended for every woman with T1DM, optimally when planning but also throughout the pregnancy.Insulinooporność definiuje się jako zmniejszenie wrażliwości tkanek obwodowych na insulinę zarówno endogenną jak i egzogenną. W ostatnich latach podnosi się rolę insulinooporności w patogenezie powikłań cukrzycy typu 1. Insulinooporność jest nie tylko częstym zjawiskiem u pacjentów z cukrzycą typu 1 ale również stanowi izolowany czynnik ryzyka szeregu powikłań w populacji kobiet nie będących w ciąży oraz mężczyzn. Rola insulinooporności w ciąży powikłanej cukrzycą typu 1 nie była dotychczas szeroko zbadana. Dane z badań przeprowadzonych w innych populacjach ciężarnych pokazują iż insulinooporność zwiększa ryzyko takich powikłań jak poronienia, stan przedrzucawkowy i makrosomia. Co istotne, wszystkie te powikłania spotyka się istotnie częściej u pacjentek z cukrzycą typu 1. Mimo braku badań dotyczących roli insulinoopornośći w ciąży powikłanej cukrzycą typu 1, na podstawie danych z innych populacji ciężarnych, insulinnoporność może być uznana za dodatkowy czynnik ryzyka powikłań. Stąd też działania, które potencjalnie mogą doprowadzić do zmniejszenia insulinoopornośći takie jak kontrola glikemii oraz kontrola przyrostu masy ciała powinny być zalecane pacjentkom zarówno w okresie planowania ciąży jak i w trakcie jej trwania

Influence of cigarette smoking on thyroid gland — an update

Wyniki wielu badań dowodzą, że palenie papierosów wywiera istotny wpływ na gruczoł tarczowy. Wykazano, że nikotynizm modyfikuje parametry hormonalne tarczycy, w szczególności prowadzi do obniżenia stężenia TSH. Sugeruje się, że może również powodować nieznaczny wzrost stężenia wolnych hormonów tarczycy. Ponadto, palenie papierosów odgrywa istotną rolę w procesach autoimmunologicznych związanych z gruczołem tarczowym. Dowiedziono, że nikotynizm wywiera negatywny wpływ na przebieg choroby Gravesa i Basedowa oraz orbitopatii Gravesa i Basedowa. Palenie papierosów nie tylko zwiększa ryzyko rozwoju powyższych schorzeń, ale zmniejsza również skuteczność terapii i zwiększa ryzyko nawrotu. Wpływ palenia papierosów na chorobę Hashimoto nie jest tak jednoznacznie dowiedziony, jak w chorobie Gravesa i Basedowa. Sugeruje się, że palenie papierosów może negatywnie korelować z mianem przeciwciał przeciwko tyreoglobulinie oraz tyreoperoksydazie, zmniejszając w konsekwencji ryzyko rozwoju hipotyreozy. Palenie papierosów zwiększa ryzyko wystąpienia wola guzkowego szczególnie na obszarach niedoboru jodu. Interesująco przedstawiają się również wyniki badań nad wpływem palenia papierosów na ryzyko wystąpienia raka tarczycy. Wiele z nich dowodzi, że u palaczy ryzyko raka zróżnicowanego tarczycy jest mniejsze. Ponadto zarówno bierne, jak i czynne palenie papierosów przez kobiety ciężarne modyfikuje funkcję gruczołu tarczowego zarówno matki, jak i płodu. W pracy przedstawiono aktualny stan wiedzy dotyczący wpływu palenia papierosów na homeostazę hormonalną, procesy autoimmunologiczne oraz choroby tarczycy. W opinii autorów prezentowane wyniki badań wymagają rozważnej interpretacji, a niektóre z nich mają stosunkowo słabą siłę dowodu naukowego. Wpływ palenia papierosów na patofizjologię tarczycy powinien być przedmiotem dalszych badań. (Endokrynol Pol 2014; 65 (1): 54–62)Many studies have shown that cigarette smoking exerts multiple effects on the thyroid gland. Smoking seems to induce changes in thyroid function tests, like decrease in TSH and increase in thyroid hormones. However, these alterations are usually mild. In addition, tobacco smoking may also play a role in thyroid autoimmunity. Many studies have confirmed a significant influence of smoking on Graves’ hyperthyroidism and particularly on Graves’ orbitopathy. Here, smoking may increase the risk of disease development, may reduce the effectiveness of treatment, and eventually induce relapse. The role of smoking in Hashimoto’s thyroiditis is not as well established as in Graves’ disease. Nonetheless, lower prevalence of thyroglobulin antibodies, thyroperoxidase antibiodies and hypothyroidism were found in smokers. These findings contrast with a study that reported increased risk of hypothyroidism in smokers with Hashimoto’s thyroiditis. Moreover, cigarette smoking increases the incidence of multinodular goitre, especially in iodine-deficient areas. Some studies have examined cigarette smoking in relation to the risk of thyroid cancer. Interestingly, many of them have shown that smoking may reduce the risk of differentiated thyroid cancer. Furthermore, both active and passive smoking during pregnancy might modify maternal and foetal thyroid function. This review evaluates the current data concerning the influence of cigarette smoking on thyroid gland, including hormonal changes, autoimmunity and selected diseases. These findings, however, in our opinion, should be carefully evaluated and some of them are not totally evidence-based. Further studies are required to explain the effects of smoking upon thyroid pathophysiology. (Endokrynol Pol 2014; 65 (1): 54–62

ThyPROpl — The Polish version of the thyroid-specific quality of life questionnaire ThyPRO

  Wstęp: Choroby tarczycy mają znaczący wpływ na jakość życia pacjentów. ThyPRO jest kwestionariuszem oceny jakości życia przeznaczonym dla pacjentów z łagodnymi chorobami tarczycy. Kwestionariusz poddano walidacji i standaryzacji. Celem pracy było stworzenie polskiej wersji kwestionariusza ThyPRO. Materiał i metody: Kwestionariusz ThyPROpl przetłumaczono zgodnie ze standardową metodologią tłumaczenia kwestionariuszy samooceny jakości życia dokonywanej przez pacjentów. Początkowo dwóch niezależnych badaczy przetłumaczyło wersję angielską kwestionariusza na język polski. Wstępną, polską wersję kwestionariusza opracowano na bazie konsensusu pomiędzy tłumaczami oraz konsultantem. Trzeci tłumacz, który nie znał wersji oryginalnej kwestionariusza, na podstawie polskiej wersji przygotował wersję angielską, która również była oceniona przez konsultanta. Następnie tłumaczenie to poddano analizie przez zewnętrznego eksperta, którego językiem ojczystym jest język angielski oraz przez twórcę ThyPRO, którzy wprowadzili dodatkowe poprawki. Ostatecznie, pięcioro pacjentów zostało poproszonych o odpowiedź na pytania zawarte w ThyPROpl i zgodnie z ich sugestiami kolejne poprawki były wprowadzone celem udoskonalenia tłumaczenia. Wyniki: ThyPROpl jest polską wersją ThyPRO poddaną językowej walidacji. Wnioski: Autorzy rekomendują ThyPROpl do oceny jakości życia u polskich pacjentów z łagodnymi chorobami tarczycy. ThyPRO aktualnie występuje w 13 wersjach językowych. (Endokrynol Pol 2015; 66 (4): 367–380)    Introduction: Thyroid disorders have a significant impact on patients’ quality of life. ThyPRO is a thyroid-specific quality of life (QoL) questionnaire applicable to patients with benign thyroid disorders. There is substantial evidence for its clinical validity and reliability in patients with benign thyroid disorders. Our aim was to develop a validated Polish version of this questionnaire (ThyPROpl). Material and methods: ThyPROpl was translated and validated according to standard methodology for translation of patient-reported outcomes (PRO). Firstly, two independent translations from English to Polish were performed by two translators native in Polish, and a consensus version was reached in collaboration with an in-country consultant. A third translator prepared a back–translation from Polish to English, which likewise was reviewed by the in-country consultant. The backwards translation was reviewed by a PRO translation expert native in English (Health Research Associates HRA) and by the developer of ThyPRO, who provided additional revisions. Finally, ThyPROpl was tested among five patients with thyroid disorders with cognitive interview techniques, and new changes and clarifications needed for its full understanding were made. Results: ThyPROpl is a linguistically validated version of the original ThyPRO questionnaire. Conclusions: We recommend ThyPROpl for the evaluation of QoL among Polish patients with benign thyroid disorders. ThyPRO has now been translated into 13 languages. (Endokrynol Pol 2015; 66 (4): 367–380)

Autoimmune disorders and thyroid function in patients with rheumatoid arthritis after biological treatment

Rheumatoid arthritis (RA) and autoimmune diseases of the thyroid gland (AITD) often occur together. As autoimmune diseases, they share common pathological pathways, reflecting the fact that the treatment of the underlying disease can influence the course of thyroid disorders. The pharmacotherapy of RA is based on the supply of disease-modifying anti-inflammatory drugs with an increasing focus on biologics. This article aims to review the available literature describing the effects of biological treatments on thyroid function. The use of biological drugs may have the potential benefit of regulating the level of anti-thyroid antibodies. On the other hand, tumour necrosis factor-alpha (TNF-a) inhibitors are not indifferent to thyroid function and may increase the incidence of subacute thyroiditis. The coexistence of AITD and RA prompts consideration of the need for routine thyroid screening in RA patients and for RA screening in patients with thyroid disease who report joint problems

Decreased expression of survivin 2B in human pituitary adenomas. A preliminary study

Introduction. We aimed to investigate survivin and its splice variants DEx3 and 2B expressions in pituitary adenomas and normal pituitary glands using immunohistochemistry. Material and methods. The study group consisted of eight pituitary adenomas: five of non-functional tumors, two of GH-secreting tumors, and one PRL-secreting tumor. Eight healthy pituitary tissue samples obtained after autopsy served as controls. Results. Survivin expression was found in 87.5% of the study group and 100% of the controls. A positive staining of survivin 2B was found in 62.5% of pituitary adenomas and 100% of controls. Survivin DEx3 was recognized in 25% of pituitary adenomas and 12.5% of normal pituitary glands. There was significantly lower immunoreactivity of survivin 2B in pituitary adenomas when compared with normal pituitary glands (p = 0.0498). Conclusions: Survivin and its splice variants might be involved to some extent in benign tumor growth of pituitary adenomas. However, survivin cannot be regarded as a candidate for targeted therapy or molecular biomarker of pituitary adenomas

Selected thyreology problems during the COVID-19 pandemic. Hypothyroidism and hyperthyroidism — did anything change?

On March 11, 2020, the World Health Organisation (WHO) observed the scale of epidemic risk and declared the state of the COVID-19 pandemic. Most countries, including Poland, implemented national and local emergency management plans to deal with the imminent threat of SARS-CoV-2 infection, one of the most serious in this century, according to many experts. In the era of pandemic, during which an epidemiological regime and social distancing are constantly recommended, and routine medical care and planned surgical procedures have been postponed or significantly reduced, patients and their physicians have to struggle on a daily basis with difficult access to diagnostic and therapeutic procedures. This is a great challenge for both groups. The aim of this study is to assess the current state of knowledge about thyreological diseases during the COVID-19 pandemic and to provide indications for the introduced therapeutic changes on the basis of recent scientific literature published up to December 2020 and searches of the PubMed, Google Scholar, EMBASE, and Web of Science databases, which searched for keywords related to SARS-CoV-2 and its influence on thyreology problems. The main focus was on diagnostic and therapeutic differences in the era of the COVID-19 pandemic, bearing in mind the most common endocrinopathies, i.e. hypothyroidism and hyperthyroidism, as well as advantages and disadvantages and possibilities of using telemedicine in the common practice of a specialist physician

Effect of restoration of euthyroidism on visfatin concentrations and body composition in women

Dysregulation of thyroid function has known impact on body metabolism, however, data regarding metabolic outcome after restoration of thyroid function is limited. Therefore, the aim of the study was to investigate the effect of restoration of euthyroidism on serum visfatin, and its associations with insulin resistance and body composition. This is an observational study with consecutive enrollment. Forty-nine hyperthyroid (median age of 34 years) and 44 hypothyroid women (median age of 46 years) completed the study. Laboratory parameters and body composition analysis were assessed before and after the therapy. In the hyperthyroid group, visfatin concentrations increased (P \u3c 0.0001), while glucose concentrations decreased (P \u3c 0.0001). Total body mass and fat mass in the trunk and limbs significantly increased during the treatment. In the hypothyroid group, significant weight loss resulted from decrease of fat and muscle masses in trunk and limbs. Visfatin serum concentrations positively correlated with total fat mass (r = 0.19, P = 0.01) and insulin concentrations (r = 0.17, P = 0.018). In conclusion, restoration of thyroid function is not associated with beneficial changes in body composition, especially among hyperthyroid females

Determination of neuron-specific enolase in patients with midgut-type tumour treated with somatostatin analogues

Introduction: The biochemical diagnosis of neuroendocrine tumours (NETs) uses assays of specific and nonspecific markers. Nonspecific markers include, among others, neuron-specific enolase (NSE). The aim of this study was to evaluate NSE in patients with midgut type tumours treated with somatostatin analogues. Material and methods: The study group of patients with NETs of the small intestine included 41 patients. Grade G1 was found in 19 cases, while G2 was seen in the remaining 22 cases. Liver metastases were found in all patients studied. The examined group of patients was treated with somatostatin analogues receiving octreotide LAR at a dose of 30 mg. The control of biochemical parameters was performed every 3 months and imaging examinations every 6 months. The Immuno-Biological Laboratories kit was used for determination of NSE concentration, where reference values were 12.5–25 ng/mL. Results: In the G1 group of patients, the median value of NSE concentration was 134.67 ng/mL, while in the G2 group, the value was 234.55 ng/mL and was significantly higher than in the G1 group (p = 0.003). In the determination of NSE concentration values according to the degree of liver involvement, in the group of patients with 10% liver involvement, the median value of NSE concentration was 143.21 ng/mL, while in the group with 25% liver involvement, the value was 251.82 ng/mL (p < 0.001). In the analysis of NSE concentration assessment in patients with disease progression, the median value was 234.65 ng/mL compared to the group with disease stabilization, where the median NSE value was significantly lower and amounted to 136.27 ng/mL (p < 0.001). Conclusions: In our study, we observed that NSE concentration values were significantly higher among patients with NET midgut type tumour with histological grade G2 and in patients with 25% liver involvement and progression of the disease process

Circulating Visfatin in Hypothyroidism Is Associated with Free Thyroid Hormones and Antithyroperoxidase Antibodies

We hypothesized that regulation of visfatin in hypothyroidism might be altered by coexisting chronic autoimmune thyroiditis. This is a prospective case-control study of 118 subjects. The autoimmune study group (AIT) consisted of 39 patients newly diagnosed with hypothyroidism in a course of chronic autoimmune thyroiditis. The nonautoimmune study group (TT) consisted of 40 patients thyroidectomized due to the differentiated thyroid cancer staged pT1. The control group comprised 39 healthy volunteers adjusted for age, sex, and BMI with normal thyroid function and negative thyroid antibodies. Exclusion criteria consisted of other autoimmune diseases, active neoplastic disease, diabetes mellitus, and infection, which were reported to alter visfatin level. Fasting blood samples were taken for visfatin, TSH, free thyroxine (FT4), free triiodothyronine (FT3), antithyroperoxidase antibodies (TPOAb), antithyroglobulin antibodies (TgAb), glucose, and insulin levels. The highest visfatin serum concentration was in AIT group, and healthy controls had visfatin level higher than TT (p=0.0001). Simple linear regression analysis revealed that visfatin serum concentration was significantly associated with autoimmunity (β=0.1014; p=0.003), FT4 (β=0.05412; p=0.048), FT3 (β=0.05242; p=0.038), and TPOAb (β=0.0002; p=0.0025), and the relationships were further confirmed in the multivariate regression analysis

Titin and dystrophin serum concentration changes in patients affected by thyroid disorders

Introduction: It is well established that thyroid hormones significantly affect skeletal muscle function, causing symptoms like myalgia and muscle weakness. Hypothyroid patients present increased levels of creatine kinase (CK), indicating muscle destruction. Lately, we proposed new serum markers of muscle disturbances in thyroid disorders: titin (TTN) and dystrophin (DMD). The aim of this study is to determine the association between thyroid status, muscle metabolism, and serum levels of TTN and DMD in patients affected by hypoand hyperthyroidism, before and after the treatment. Material and methods: In the study 56 subjects were enrolled. The studied group consisted of 16 patients with newly diagnosed overt hypothyroidism and 20 patients with hyperthyroidism. Twenty healthy controls were also included in the study. Body composition, thyroid hormones, and biochemical markers of muscle deterioration levels were evaluated before and after restoration of euthyroidism. Results: Dystrophin and TTN levels were noticeably lower in the hypothyroid group and hyperthyroid group in comparison with controls, at the border of statistical significance. Along with the thyroid hormones and CK normalisation, DMD levels increased in the hypothyroid group, with no significant lowering of TTN levels. However, TTN concentrations and the fT3/fT4 ratio became significantly lower than in controls. Hyperthyroid patients experienced no significant changes in TTN and DMD. Conclusions: The presented data indicate that TTN and DMD are potential new markers of musculoskeletal deterioration in thyroid disorders. In addition, the shift in TTN and DMD serum concentrations after the treatment of hypothyroidism accompanied by decreased fT3/fT4 ratio suggest the influence of the chosen therapeutic approach on muscle metabolism