No abstract

Purpose. Hepcidin is an acute-phase protein involved also in regulation of iron homeostasis. The aim of the study was to prospectively assess for the first time the hepcidinEL concentration in patients with subacute thyroiditis (SAT), to identify biochemical determinants of hepcidinEL concentration and evaluate the potential role of hepcidin in SAT diagnosis and monitoring. Methods. Out of 40 patients with SAT initially recruited, restrictive inclusion criteria fulfilled 21 subjects aged 45±10 years and 21 healthy control subjects (CS). HepcidinEL concentration, thyroid status, and iron homeostasis were evaluated at SAT diagnosis and following therapy and compared with CS. Results. The median hepcidinEL concentration at SAT diagnosis is higher than that in CS (48.8 (15.9-74.5) ng/mL vs. 18.2 (10.2-23.3) ng/mL, p=0.009) and is significantly lower after treatment (4.0 (1.2-10.0) ng/mL, p=0.007) compared with CS. The ROC analysis for hepcidinEL at SAT diagnosis revealed that area under the curve (AUC) is 0.735 (p=0.009), and the cut-off for hepcidinEL concentration is 48.8 ng/mL (sensitivity 0.52 and specificity 0.95). HepcidinEL in SAT patients correlated with CRP (r=0.614, p=0.003), ferritin (r=0.815, p<0.001), and aTPO (r = -0.491, p=0.024). On multiple regression, the correlation between hepcidinEL and ferritin was confirmed (p<0.001). Conclusions. SAT is accompanied by a significant increase in hepcidin, which reflects an acute-phase inflammatory process. Parameters of iron homeostasis improved significantly while inflammatory indices got lower following recovery. The potential role of hepcidin as a predictive factor of the risk of SAT relapse needs to be assessed in studies on larger groups of SAT patients.

The purpose of the study was to measure the hepcidin concentration and evaluate Fe homeostasis indices in a prospective study on patients with newly diagnosed hypothyroidism in the course of Hashimoto’s thyroiditis (HT) and following successful therapy. The prospective observational study consisted of 34 patients. The clinical evaluation and laboratory tests were performed at diagnosis (T0) and after restoration of euthyreosis 12 weeks later (T1). The median level of hepcidin was significantly lower (p = 0.002) after recovery (7.7 [6.2–13.0] ng/mL) than that before treatment (17.4 [7.6–20.4] ng/mL), while creatinine (p = 0.011) and GFR (p < 0.001) significantly improved after euthyroidism was achieved. A positive correlation was observed between hepcidin and fT3 (p = 0.033, r = 0.465) at T0. In the females, the level of hepcidin positively correlated with ferritin concentration before (p < 0.001, r = 0.928) and after treatment (p < 0.001, r = 0.835). A statistically significant difference was observed in RDW-CV (red blood cell distribution width - coefficient of variation) between the hypothyroid and euthyroid states. In conclusion, a decrease in hepcidin concentration during the transition from the hypothyroid state to euthyroidism in patients with HT is associated with the observed dynamics in iron homeostasis, mainly reflected by improvement in RDW-CV and significant correlations between ferritin and hepcidin as well as between hepcidin and fT3.

Ghrelin appears to be an essential factor in driving adrenal tumours development.

Subclinical hypothyroidism or high-normal levels of TSH did not affect RDW in a significant manner in the studied population. Our results demonstrates that overt hypothyroidism may contribute to deterioration of CHF reflected in changes of RDW value. < p > < /p >.

No abstract

A 15-year-old woman was diagnosed with hypothyroidism and unilateral ectopic thyroid. Levothyroxine treatment was introduced; however, the patient was non-compliant and took the medication irregularly. When she presented to an endocrinologist at the age of 30, she had not been using levothyroxine for at least 6 months. Surprisingly, she was clinically and biochemically euthyroid. Due to decreased echogenicity on ultrasound examination, enhanced vascularization on Color Doppler examination and increased concentration of anti-TSH receptor autoantibodies, she was diagnosed with Graves’ disease. Eventually, she underwent total thyroidectomy due to diagnosis of follicular neoplasm in fine-needle aspiration biopsy of the focal lesion found in the thyroid gland. To our knowledge, our patient is the first described with ectopic thyroid, presenting a nodular variant of Graves’ disease and no signs of orbitopathy, who was initially hypothyroid and became euthyroid in the course of autoimmune thyroid disease.Electronic supplementary materialThe online version of this article (doi:10.1007/s12020-013-0117-6) contains supplementary material, which is available to authorized users.

The treatment of Graves' orbitopathy (GO) remains a diagnostic and therapeutic challenge for clinicians worldwide. The elimination of risk factors, such as encouraging smoking cessation and achieving euthyroidism, are the most important and usually sufficient treatment methods in most mild cases. A course of selenium may also be beneficial. High-dose systemic corticosteroid therapy remains the first-line therapy in moderate-to-severe orbitopathy; however in some patients such treatment may be insufficient. Radiotherapy for GO has been used for decades and is considered to be effective in active GO, although less than systemic corticosteroids. Unfortunately, there are only eight randomised studies that may be analysed to assess its true effectiveness and applicability. It has been indicated that radiotherapy affects mainly eye motility and soft tissue changes, with almost no influence on exophthalmos. The combination of these two therapies has proven to be even more effective than either treatment alone, especially in subjects with resistant or recurrent GO. Orbital radiotherapy seems to be a safe procedure with few adverse effects observed long after the therapy. It should be avoided in patients with retinopathy, due to diabetes mellitus and hypertension, and in young subjects (< 35 years old). Orbital radiotherapy, as a safe and generally effective second-line therapy, is used in some countries as a supporting method during the second course of systemic corticosteroid therapy, if the response to the first course is unsatisfactory. StreszczenieLeczenie orbitopatii tarczycowej w przebiegu choroby Gravesa-Basedowa (GO, Graves' orbitopathy) nadal pozostaje dla klinicystów z całe-go świata dużym wyzwaniem terapeutycznym. Modyfikacja czynników ryzyka poprzez zaprzestanie palenia papierosów, wyrównanie hormonalne czy środki działające miejscowo uważane są za najważniejsze, a zarazem najskuteczniejsze metody leczenia w przypadku łagodnej GO. Korzyści może przynieść również stosowanie preparatów selenu. Leczenie dożylne preparatami glikokortykosteroidów pozostaje terapią pierwszego rzutu w przypadku umiarkowanej oraz ciężkiej GO, chociaż u niektórych pacjentów takie leczenie jest niewystarczające. Radioterapia jest stosowana w leczeniu GO od wielu dziesięcioleci i jest uznawana za skuteczną w przypadku aktywnej postaci choroby, jednak dającą gorsze wyniki niż systemowa terapia glikokortykosteroidami. Aktualnie dostępnych jest jedynie 8 randomizowanych prac, które dostarczają rzetelnych informacji do analizy skuteczności i radioterapii w GO. Wykazano, że efektem radioterapii jest głównie zwiększenie ruchomości gałek ocznych oraz pozytywny wpływ na zmiany patologiczne tkanek miękkich oczodołu, bez istotnego wpływu na stopień wytrzeszczu. Połączenie obu metod leczenia okazało się być bardziej efektywne niż każda z terapii zastosowana osobno, szczególnie w przypadku opornej bądź nawracającej GO. Radioterapia oczodołów wydaje się metodą bezpieczną, obarczoną niewielkim ryzykiem działań niepożądanych, pojawiających s...