Postoperative Treatment in a Patient After Hemithyroidectomy: the Therapeutic Challenges of a Hidden Thyrotropinoma

Objectives: We report the unusual case of a patient with a thyrotropinoma, discovered after a hemithyroidectomy for a suspicious thyroid nodule, and its therapeutic challenges. Materials and methods: In a patient who underwent hemithyroidectomy for cold thyroid nodule, hyperthyroid symptoms persisted, despite stopping levothyroxine treatment. Further investigation was carried out through the following laboratory tests: thyroid-stimulating hormone (TSH) test; free thyroxine (fT4) test; and the thyrotropin releasing hormone (TRH) test. A pituitary magnetic resonance imaging (MRI) scan and genetic analysis was also carried out. The test results confirmed the diagnosis of a thyrotropinoma. Results: Treatment with long-acting somatostatin analogues normalised thyroid hormones and symptoms of hyperthyroidism. Conclusion: The diagnostic approach to the thyroid nodule should include a detailed clinical and biochemical examination. Initial biochemical evaluation by TSH alone does not allow detecting inappropriate TSH secretion that may increase the risk of thyroid malignancy. In case of a thyrotropinoma, the ideal treatment consists of combined care of central and peripheral thyroid disease

Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* survey of Belgian specialists *THESIS: treatment of hypothyroidism in Europe by specialists: an international survey.

[en] BACKGROUND: Hypothyroidism is a topic that continues to provoke debate and controversy with regards to specific indications, type of thyroid hormone substitution and efficacy. We investigated the use of thyroid hormones in clinical practice in Belgium, a country where currently only levothyroxine (LT4) tablet formulations are available. METHOD: Members of the Belgian Endocrine Society were invited to respond to an online questionnaire. Results were compared with those from other THESIS surveys. RESULTS: Eighty (50%) of the invited 160 individuals, completed the questionnaire. LT4 was the first treatment of choice for all respondents. As secondary choice, some also prescribed liothyronine (LT3) and LT4 + LT3 combinations (2 and 7 respondents, respectively). Besides hypothyroidism, 34 and 50% of respondents used thyroid hormones for infertile euthyroid TPOAb positive women and the treatment of a growing non-toxic goiter, respectively. Had alternative formulations of LT4 to tablets been available (soft gel or liquid L-T4), 2 out of 80 (2.5%) participants would consider them for patients achieving biochemical euthyroidism but remaining symptomatic. This proportion was higher in case of unexplained poor biochemical control of hypothyroidism (13.5%) and in patients with celiac disease or malabsorption or interfering drugs (10%). In symptomatic euthyroid patients, 20% of respondents would try combined LT4 + LT3 treatment. Psychosocial factors were highlighted as the main contributors to persistent symptoms. CONCLUSIONS: LT4 tablets is the preferred treatment for hypothyroidism in Belgium. A minority of the respondents would try combined LT4 + LT3 in symptomatic but biochemically euthyroid patients. Thyroid hormones are prescribed for euthyroid infertile women with thyroid autoimmunity and patients with non-toxic goiter, a tendency noted in other European countries, despite current evidence of lack of benefit

Female infertility: Do we forget the thyroid?

SCOPUS: ed.jinfo:eu-repo/semantics/publishe

Thyroid autoimmunity and pregnancy in euthyroid women

Women with thyroid autoimmunity (TAI), predominately characterized by increased levels of thyroid peroxidase antibody (TPOAb), are at risk for developing pregnancy related complications. In this review, we discuss the importance of TAI during natal and perinatal stages. Before pregnancy, TAI is associated with higher mean serum TSH levels and certain causes of subfertility. During pregnancy, TAI increases the risk of an insufficient response of the thyroid to an increasing strain induced by pregnancy, and consequently (subclinical) hypothyroidism might develop. Euthyroid women with TAI have a higher rate of maternal and foetal complications, but it seems that causality cannot be pinned down to thyroid dysfunction alone. Almost half of the women known with TAI prior to pregnancy will also develop post-partum thyroiditis (PPT). However, any relation between PPT and post-partum depression remains uncertain. More research is required to explain possible associations between TAI and pregnancy morbidities, and studies should focus on a better understanding of TAI as such. Given the many unanswered questions, at present, it is not recommended to screen all (potentially) pregnant women for the presence of TAI.SCOPUS: re.jinfo:eu-repo/semantics/publishe

A rare case of hypoglycemia in a patient with elevated right hemidiaphragm.

A 57-year-old woman was admitted to the emergency department, presenting with episodes of altered consciousness and behaviour which, upon further examination, were linked to periods of recurrent hypoglycaemia. Imaging revealed a large mass in the right thoracic cavity while blood analysis demonstrated diminished C-peptide, (pro-)insulin, insulin-like growth factor 1 (IGF-I) and IGF binding protein 3 levels. Based on these findings, an IGF-II secreting tumour was suspected. Before the excision of the tumour, euglycaemia could only be achieved by means of intravenous glucose administration and the use of oral corticosteroids. Anatomopathologically the diagnosis of a solitary fibrous tumour (SFT) was confirmed. Immunoblot analysis on the serum revealed elevated 'big'-IGF-II levels, confirming our initial diagnosis of Doege-Potter syndrome in SFT

A rare case of hypoglycemia in a patient with elevated right hemidiaphragm.

A 57-year-old woman was admitted to the emergency department, presenting with episodes of altered consciousness and behaviour which, upon further examination, were linked to periods of recurrent hypoglycaemia. Imaging revealed a large mass in the right thoracic cavity while blood analysis demonstrated diminished C-peptide, (pro-)insulin, insulin-like growth factor 1 (IGF-I) and IGF binding protein 3 levels. Based on these findings, an IGF-II secreting tumour was suspected. Before the excision of the tumour, euglycaemia could only be achieved by means of intravenous glucose administration and the use of oral corticosteroids. Anatomopathologically the diagnosis of a solitary fibrous tumour (SFT) was confirmed. Immunoblot analysis on the serum revealed elevated 'big'-IGF-II levels, confirming our initial diagnosis of Doege-Potter syndrome in SFT

Erratum: 2021 European Thyroid Association Guideline on Thyroid Disorders prior to and during Assisted Reproduction (European Thyroid Journal (2020) 9 (281-295) DOI: 10.1159/000512790)

In the article by Poppe et al. entitled “2021 European Thyroid Association Guideline on Thyroid Disorders prior to and during Assisted Reproduction” [Eur Thyroid J 2020;9:281–295, DOI: 10.1159/000512790], the fourth author’s name was misspelled and should correctly read Gesthimani Mintziori. The authorship is therefore as follows: Kris Poppea Peter Bisschopb Laura Fugazzolac Gesthimani Mintziorid David Unuanee Andrea Weghoferf aEndocrine Unit, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium; bDepartment of Endocrinology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; cDivision of Endocrine and Metabolic Diseases, IRCCS Istituto Aux ologico Italiano, and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; dUnit of Reproductive Endocrinology, First Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece; eDepartment of Internal Medicine, Endocrine Unit, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium; fDepartment of Gynecological Endocrinology & Reproductive Medicine, Medical University of Vienna, Vienna, Austria

2021 European Thyroid Association Guideline on Thyroid Disorders prior to and during Assisted Reproduction

Severe thyroid dysfunction may lead to menstrual disorders and subfertility. Fertility problems may persist even after restoring normal thyroid function, and then an assisted reproductive technology (ART) may be a solution. Prior to an ART treatment, ovarian stimulation is performed, leading to high oestradiol levels, which may lead to hypothyroidism in women with thyroid autoimmunity (TAI), necessitating levothyroxine (LT4) supplements before pregnancy. Moreover, women with the polycystic ovarian syndrome and idiopathic subfertility have a higher prevalence of TAI. Women with hypothyroidism treated with LT4 prior to ART should have a serum TSH level 4.0 mIU/L and improved with LT4 therapy. In meta-analyses that mainly included women with TSH levels >4.0 mIU/L, LT4 treatment increased live birth rates, but that was not the case in 2 recent interventional studies in euthyroid women with TAI. The importance of the increased use of intracytoplasmic sperm injection as a type of ART on pregnancy outcomes in women with TAI deserves more investigation. For all of the above reasons, women of subfertile couples should be screened routinely for the presence of thyroid disorders.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Determinants of cognition in adults with type 1 diabetes – a key role for physical activity

National audienceINTRODUCTION. Les déséquilibres glycémiques accompagnant le diabète de type 1 (DT1) peuvent conduire, au long terme, à un léger déclin des fonctions cognitives[1]. Chez les personnes non diabétiques, l’activité physique (AP) est reconnue pour ses effets bénéfiques au niveau cérébral, notamment via l’augmentation de facteurs neurotrophiques (facteur neurotrophique dérivé du cerveau, BDNF, et IGF-1). METHODOLOGIE. Chez 95 adultes DT1, des régressions multiples ascendantes ont été réalisées pour estimer les liens entre les performances à une batterie de tests cognitifs et le niveau habituel d’AP et de sédentarité (questionnaires IPAQ et MAQ) en tenant compte des concentrations sériques de BDNF et d’IGF-1 total (prélèvement sanguin) et des facteurs classiques pouvant influencer les fonctions cognitives (démographiques : âge, sexe, IMC, niveau d’éducation ; liés au DT1 : mode d’administration de l’insuline, glycémie du moment, HbA1c, nombre d’épisodes hypoglycémiques sévères durant la vie, âge du diagnostic du DT1, durée du diabète, complications micro/macrovasculaires). RESULTATS. Le niveau d’AP prédisait positivement la flexibilité mentale (performance au TMT B-A: B– 0,05 ; SE(B) 0,03 ; P=0.05 pour le MAQ, MET-h/sem et B– 0,001 ; SE(B) 0,00 ; P=0.018 pour l’IPAQ, MET-min/sem) et ce indépendamment des niveaux de sédentarité, de BDNF et d’IGF-1.Le niveau d’AP n’influençait pas les autres domaines cognitifs évalués (i.e., la vitesse de traitement et la recherche visuo-spatiale avec le TMT-A, la résistance aux interférences avec le Stroop, la mémoire spatiale avec le SMT, la mémoire de travail avec le OPSPAN). Les autres facteurs qui influençaient la plupart des domaines cognitifs étaient l’âge, le niveau d’éducation, le nombre d’épisodes hypoglycémiques sévères, et les complications macrovasculaires. CONCLUSION. L’association entre le niveau d’AP et la flexibilité mentale chez les adultes DT1 souligne l’importance de mettre en place des programmes d’AP, en vue de préserver les fonctions exécutives au long terme