Radiotherapy in the treatment of Graves ophthalmopathy—to do it or not?

To the objective of this study is to evaluate the role and toxicity of radiotherapy in the treatment of Graves ophthalmopathy. In the years 2000–2003, 121 patients with malignant exophthalmos were treated with radiotherapy of the retrobulbar area to the total dose of 20 Gy in ten fractions with a 6 MeV photon beam. The treatment was performed by the team of the Clinic of Oncology of the Jagiellonian University Medical College in Cracow. The radiotherapy was preceded by intravenous steroid therapy: methylprednisolone acetate administered at the dose of 2 g/week for four consecutive weeks. The highest efficacy, expressed as improvement of all ocular symptoms, was observed for the combined treatment. Female and non-diabetic patients responded positively to the combined treatment. Radiotherapy combined with steroid therapy in the treatment of Graves ophthalmopathy seems to be an effective treatment for strictly defined indications. In the treatment of Graves–Basedow disease, radiotherapy is a well-tolerated treatment modality. Diabetes is a factor that worsens prognosis in Graves ophthalmopathy and female sex is a favourable factor for this condition

Endothelial dysfunction in Graves' disease

ABSTRACT Purpose: Graves' disease (GD) is an organ-specific autoimmune thyroid disease, characterized by hyperthyroidism due to excessive production of thyroid hormone induced by thyrotropin receptor-specific stimulatory autoantibodies. In this study, we determined serum levels of the soluble forms of ICAM-1, VCAM-1, vWF, IL-6, IL-12, IL-18, fibrinogen and CRP in patients with subclinical (SH) and overt hyperthyroidism (OH) caused by GD to elucidate a possible role of those parameters as markers of endothelium dysfunction (ED). Material/Methods: The study included 96 patients: 52 with GD and 44 euthyroid controls, divided into 3 groups according to their thyroid function tests: SH, OH and controls (CG). Results: The values of IL-6, IL-12 and IL-18 were significantly higher in GD than in CG patients (p < 0.0001, p < 0.0001; p < 0.00001, respectively). Significant difference of sVCAM-1 values were found in the patients with GD compared to CG (p < 0.0001). Patients with GD had significantly higher levels of PAI-1 (p < 0.00001), vWF (p < 0.0001), fibrinogen (p < 0.0001) in comparison to CG. In patients with OH, we observed statistically higher values of fibrinogen compared to SH group (p < 0.05). There were no significant differences in serum concentration of other study parameters in patients with SH compared to the OH. Conclusions: ED occurs during subclinical and overt hyperthyroidism causing decreased fibrinolytic activity, hypercoagulability and increased levels of IL-6, Il-12 and IL-18. These results support the notion that serum cytokines could be used as a marker of GD activity. Results of this study support the opinion that GD might require treatment as early as in the phase of SH

Body mass analysis in patients with Hashimoto thyroiditis

Introduction: Hashimoto thyroiditis (HT) is one of the most common autoimmune thyroid disorders and o the most common cause of hypothyroidism, but the relation between TSH and body mass is still unclear. Material and methods: The group studied consisted of 53 patients with HT in euthyreosis and 28 healthy individuals. All the patients underwent thyroid ultrasonography and body mass analysis with the use of a medical analyzer INBODY 200. Blood samples were also analyzed for TSH and anti-thyroid antibodies. Results: The patients with HT had higher body mass (p=0.008), body mass index (BMI) (p=0.02), Waist-Hip Ratio (WHR) (0.01) and fat mass (p=0.02) than had the controls. In HT group increased body mass was observed in 72% of the patients (overweight in 38% and obesity in 35% of them), as compared with 38% of overweight/obesity in the control group. Thyroid volume was significantly lower (p=0.01) and anti-peroxidase antibodies level was two times higher in the group with the treatment period > 2 years, but the patients with relatively short treatment period were 7 kg heavier and their fat mass was 6 kg higher than in the subjects treated longer than 2 years. Conclusions: Our results suggest that the patients with HT, even in euthyreosis, have significantly higher body mass, BMI, WHR and fat mass than healthy individuals, which is probably associated with previous disturbances that led to the increase in fat mass at the stage of hypothyroidism. The observed changes tend to normalize during L-thyroxine replacement therapy

PRRT as an alternative method of treatment in patient with glucagonoma syndrome: A case report

Introduction: Glucagonoma is a rare pancreatic neuroendocrine tumor derived from alpha-cells of the islet of Langerhans. Due to oversecretion of glucagon it is associated with a characteristic paraneoplastic phenomenon, called glucagonoma syndrome, which consists of necrolytic migratory erythema (NME), weight loss, diabetes mellitus, diarrhea, normochromic normocytic anemia, deep vein thrombosis or pulmonary embolism and neuropsychiatric disturbances. Treatment modalities include surgical removal of tumor, somatostatin analogs and peptide receptor radionuclide therapy (PRRT). Case report: We present a case of 61-year-old woman diagnosed with glucagonoma in April 2012. Initially, body-caudal pancreatomy and resection of regional lymph nodes were performed. Five months after surgery, a PET-CT scan detected pathological mass with expression of somatostatin receptors in pancreatic body and metastases to regional lymph nodes. What is more, since April 2014 the patient had complained about persistent pruritus of the entire body. At present, due to the nonsurgical pancreatic mass and metastases she is treated with somatostatin analogs and PRRT. During this therapy the pruritus had decreased and currently there is no sign of cutaneous disease. Moreover, reduction of tumor size was obtained. Conclusions: PRRT may reduce tumor size and by reducing bothersome symptoms substantially improve the quality of life in patients with SSTR-positive tumor