Hypothyroidism in coronary heart disease and its relation to selected risk factors

Otto Mayer Jr1, Jaroslav Šimon1, Jan Filipovský1, Markéta Plášková2, Richard Pikner11Center of Preventive Cardiology, 2nd Department of Internal Medicine, Charles University, Medical Faculty, Plze , Czech Republic; 2Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech RepublicIntroduction: Hypothyroidism (HT) has been found a predictor of cardiovascular diseases. We aimed to ascertain the prevalence of HT in patients with manifest coronary heart disease (CHD), and to establish its association with conventional risk factors.Methods: 410 patients, 6–24 months after hospitalization for acute coronary syndrome, and/or revascularization, were included into the cross-sectional study.Results: The prevalence of thyroid dysfunction was found in males and females as follows: overt HT, ie, thyroid stimulating hormone (TSH) > 3.65 mIU/L and free thyroxine (fT4) < 9 pmol/L and/or L-thyroxine substitution, in 2.6% and 8.4%, respectively; subclinical HT (TSH >3.65, fT4 9–23 and no substitution) in 4.3% and 15.0%, respectively. Higher prevalence of HT was found in females with hypercholesterolemia, and in males and females with concomitant positive thyroid peroxydase antibodies. Hypothyroid subjects had higher total homocysteine in both genders and von Willebrand factor in males only. Hypothyroid females had higher total  and LDL cholesterol, and were more often treated for diabetes.Conclusions: HT was found highly prevalent in patient with clinical coronary heart disease, mainly in females, and was associated with several cardiovascular risk factors.Keywords: hypothyroidism, coronary heart disease, cholesterol, homocysteine, diabete

Algorithm for the use of biochemical markers of bone turnover in the diagnosis, assessment and follow-up of treatment for osteoporosis

Introduction Increased biochemical bone turnover markers (BTMs) measured in serum are associated with bone loss, increased fracture risk and poor treatment adherence, but their role in clinical practice is presently unclear. The aim of this consensus group report is to provide guidance to clinicians on how to use BTMs in patient evaluation in postmenopausal osteoporosis, in fracture risk prediction and in the monitoring of treatment efficacy and adherence to osteoporosis medication. Methods A working group with clinical scientists and osteoporosis specialists was invited by the Scientific Advisory Board of European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Results Serum bone formation marker PINP and resorption marker βCTX-I are the preferred markers for evaluating bone turnover in the clinical setting due to their specificity to bone, performance in clinical studies, wide use and relatively low analytical variability. BTMs cannot be used to diagnose osteoporosis because of low sensitivity and specificity, but can be of value in patient evaluation where high values may indicate the need to investigate some causes of secondary osteoporosis. Assessing serum levels of βCTX-I and PINP can improve fracture prediction slightly, with a gradient of risk of about 1.2 per SD increase in the bone marker in addition to clinical risk factors and bone mineral density. For an individual patient, BTMs are not useful in projecting bone loss or treatment efficacy, but it is recommended that serum PINP and βCTX-I be used to monitor adherence to oral bisphosphonate treatment. Suppression of the BTMs greater than the least significant change or to levels in the lower half of the reference interval in young and healthy premenopausal women is closely related to treatment adherence. Conclusion In conclusion, the currently available evidence indicates that the principal clinical utility of BTMs is for monitoring oral bisphosphonate therapy

Analysis of the cytosol of thyroid gland and its contribution in the differential diagnosis of nodular lesions

Thyroid nodules represent the most frequent endocrine lession in our population and it is neccessary to differentiate malignant lessions from them. The aim of the study was to validate determination of selected angiogenic, proliferative, and appptotic markers in cytosol tissue extracts. We analysed 166 tissue samples (85 goitres, benign adenomas and 10 malignat tumours in which VEGF, bFGF, Endostatin, Thymidinkinase ans TPS were determined. Main limitation of cytosolic analysis is tissue sample volume, that must be about 1cm3 and interindividual variability caused by tissue sample heterogeneity. Best way is to compare normal with pathological tissue samples from one patient. We fund significant differences amog histological groups in VEGF, bFGF, Endostatin and maily Tymidinkinase and TPS. These differences are not sufficiently huge to distinguish goitres and benign lessions . We also did not find any correlation between cytosolic markers and iminuhistochemistry markers . Cytosol analysis is not able to measure local expression and its differences in anylysed tissue, but it is able to quantitatively determine mean levels of selected markers

Practical Considerations for the Clinical Application of Bone Turnover Markers in Osteoporosis.

peer reviewedBone turnover markers (BTMs) are released during the bone remodelling cycle and are measurable in blood or urine, reflecting bone remodelling rate. They have been useful in elucidating the pharmacodynamics and effectiveness of osteoporosis medication in clinical trials and are increasingly used in routine clinical management of osteoporosis, especially for monitoring therapy, in addition to their use in other metabolic bone disease such as Paget's disease of bone and osteomalacia. Serum β isomerised C-terminal telopeptide of type I collagen and pro-collagen I N-terminal propeptide have been designated as reference BTMs for use in osteoporosis. In addition, bone-specific isoenzyme of alkaline phosphatase (B-ALP) secreted by osteoblasts and tartrate-resistant acid phosphatase 5b (TRACP-5b) secreted by osteoclasts are also found to be specific markers of bone formation and resorption, respectively. The concentrations of the latter enzymes in blood measured by immunoassay provide reliable measures of bone turnover even in the presence of renal failure. B-ALP is recommended for use in the assessment of renal bone disease of chronic kidney disease, and TRACP-5b shows promise as a marker of bone resorption in that condition. BTMs in blood do not suffer from biological variation to the same extent as the older BTMs that were measured in urine. Appropriate patient preparation and sample handling are important in obtaining accurate measures of BTMs for clinical use. Reference change values and treatment targets have been determined for the reference BTMs for their use in monitoring osteoporosis treatment. Further ongoing studies will enhance their clinical applications

Clinical Biochemistry

Učebnice Clinical Biochemistry ve svých 39 kapitolách pokrývá všechna důležitá témata moderní klinické biochemie. Od preanalytických vlivů na laboratorní vyšetření přes analytické a klinické vlastnosti metod, kontrolu kvality v klinické laboratoři, automatizaci po jednotlivé indikace a interpretace laboratorních testů v diagnostice a sledování různých onemocnění. Cílem je dovést čtenáře k propojení všech aspektů ovlivňujících laboratorní výsledek a jejich kritickému zhodnocení při péči o pacienta. Text je určen především pro pregraduální studenty všeobecného lékařství, avšak jako referenční příručku ji využijí i začínající lékaři všech oborů. Clinical Biochemistry textbook covers in its 39 chapters all important topics of modern clinical biochemistry. From preanalytical influences to laboratory results through analytical and clinical properties of laboratory methods, quality control in Clinical laboratory, automation to indication and interpretation of laboratory tests in diagnosis and follow up of a plenty of diseases. The goal of this publication is to lead a reader to intersection of all aspects that influence laboratory results and to its critical evaluation in taking care about a patient. The text is designed to pregradual students of general medicine. However, also young medical doctors of all medical specializations can use the textbook as a reference guide

Clinical Biochemistry

Učebnice Clinical Biochemistry ve svých 39 kapitolách pokrývá všechna důležitá témata moderní klinické biochemie. Od preanalytických vlivů na laboratorní vyšetření přes analytické a klinické vlastnosti metod, kontrolu kvality v klinické laboratoři, automatizaci po jednotlivé indikace a interpretace laboratorních testů v diagnostice a sledování různých onemocnění. Cílem je dovést čtenáře k propojení všech aspektů ovlivňujících laboratorní výsledek a jejich kritickému zhodnocení při péči o pacienta. Text je určen především pro pregraduální studenty všeobecného lékařství, avšak jako referenční příručku ji využijí i začínající lékaři všech oborů. Clinical Biochemistry textbook covers in its 39 chapters all important topics of modern clinical biochemistry. From preanalytical influences to laboratory results through analytical and clinical properties of laboratory methods, quality control in Clinical laboratory, automation to indication and interpretation of laboratory tests in diagnosis and follow up of a plenty of diseases. The goal of this publication is to lead a reader to intersection of all aspects that influence laboratory results and to its critical evaluation in taking care about a patient. The text is designed to pregradual students of general medicine. However, also young medical doctors of all medical specializations can use the textbook as a reference guide