Endothelial-mediated coronary flow reserve in patients with mild thyroid hormone deficiency

ContextAlthough coronary flow reserve (CFR) is reduced in patients with subclinical hypothyroidism (SHypo), the endothelial response of coronary vasomotion has never been explored in this clinical setting.ObjectiveTo investigate the endothelial response of coronary flow in young and middle-aged patients with SHypo, without associated cardiovascular risk factors compared with healthy control subjects.Patients and methodsThe study population consisted of 20 women (mean age 38.4+12.1 years) with newly diagnosed, untreated and persistent SHypo due to Hashimoto's thyroiditis. A total of 15 volunteers served as controls. Age, gender, body surface area, glucose, insulin levels, heart rate, systolic, diastolic, and mean blood pressure were similar in patients and controls. Body mass index was significantly higher in SHypo patients. Total cholesterol and low-density lipoprotein cholesterol, despite not significant, tended to be higher, and high-density lipoprotein cholesterol to be lower in SHypo. Coronary blood flow velocities were recorded in patients at rest and after the cold pressor test (CPT), a stimulus that can be considered totally endothelium-dependent. CFR was calculated as the ratio of hyperemic-to-resting diastolic peak velocities.ResultsCoronary diastolic peak velocities at rest did not differ between the two groups but were significantly lower after CPT in patients with SHypo, thereby resulting in a lower CFR. The difference remained significant after adjusting resting and CPT velocities for the respective mean blood pressures. TSH was inversely correlated with CFR in the pooled population.ConclusionPatients with SHypo without associated cardiovascular risk factors have a coronary endothelial dysfunction that appears in response to a physiological stimulus (the CPT)

POORLY DIFFERENTIATED FOLLICULAR THYROID CARCINOMA: PROGNOSTIC FACTORS AND RELEVANCE OF HISTOLOGICAL CLASSIFICATION

Background. Poorly differentiated follicular carcinomas (PDFC) of the thyroid represent an heterogeneous but distinct group of tumors, clinically and histopathogenetically intermediate between follicular-derived well-differentiated and anaplastic carcinomas. The existence of this group of tumors was first proposed independently by Sakamoto et al. in 1983 and Carcangiu et al. in 1984 according to substantially different diagnostic criteria. Indeed, although the number of articles written on the subject of PD carcinoma has grown exponentially during the last decade, at the present the diagnostic criteria differ between various authors. Moreover, there is no clear definition of the histological, immunohistochemical and genetic characteristics of PDFC. Furthermore, although the majority of studies show the aggressiveness of PDFC with a high propensity for local recurrence and distant metastasis, there is no consensus regarding the prognostic indicators for these tumors. Objective: The work performed during my Doctorate thesis in France contributes to clarify the histological definition and to identify clinical, histological, immunohistochemical characteristics of PDFC. For this purpose, parallel clinical, histological and immunohistochemical investigations have been performed. Methods: Forty patients affected by PDFC were identified on the basis of a trabecular, insular, or solid (TIS) growth pattern, and their clinical outcome was correlated with histological architecture, cytological characteristics and expression of various markers of cell proliferation and differentiation such as cyclin A, B1, D1 and E, Ki67, TPO, galectin 3, Duox, VEGF, EGFR, P53. Results: The mean survival was 5.2 5 years. At 5 years,the survival rate was 63% and the metastasis-free survival rate was 57%. An older age at the time of diagnosis and a larger tumor size were associated with an increased risk of distant metastases and of cancer related death whereas a high expression of Duox was associated with a reduced risk of death. In these patients with PDFC, no histological features or marker expression was prognostic. Conclusion: this study confirmed that PDFC has a more aggressive behavior than well differentiated carcinoma (WDC); prognosis is related to indicators that are relevant in patients with WDC, advanced age and larger tumor size

Poorly differentiated follicular thyroid carcinoma (prognostic factors and relevance of histological classification)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Screening in von Hippel-Lindau disease: Concurrent pheochromocytomas, paragangliomas and spinal hemangioblastomas revealed by helical-CT, MIBG scintigraphy and MRI in an asymptomatic patient

Early detection of visceral as well as neurological abnormalities in von Hippel-Lindau (VHL) disease is highly recommended and usually accomplished by a combination of radiological and nuclear medicine techniques. We report a case of an asymptomatic 30-year-old male with VHL disease who was found to have concurrent bilateral pheochromocytomas, a carotid body tumor, sacral para-gangliomas and spinal hemangioblastomas during a screening performed by contrast-enhanced helical computed tomography, 131I-metaiodobenzylguanidine scintigraphy and magnetic resonance imaging. Despite their common embriogenetic origin from the neural crest, the concurrence of pheochromocytomas and para-gangliomas in VHL disease is rare. Although frequently asymptomatic, the occurrence of spinal hemangioblastomas in the clinical context of the screening has not been previously reported