We have demonstrated an association between FT4 levels within the normal reference range and lipids, in accordance with the earlier observed association between (sub)clinical hypothyroidism and hyperlipidemia. Moreover, low normal FT4 levels were significantly associated with increased insulin resistance. These findings are consistent with an increased cardiovascular risk in subjects with low normal thyroid function.

Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disorder, which results from a germ line mutation in the APC (adenomatous polyposis coli) gene. FAP is characterized by the formation of hundreds to thousands of colorectal adenomatous polyps. Although the development of colorectal cancer stands out as the most prevalent complication, FAP is a multisystem disorder of growth. This means, it is comparable to other diseases such as the MEN syndromes, Von Hippel-Lindau disease and neurofibromatosis. However, the incidence of many of its clinical features is much lower. Therefore, a specialized multidisciplinary approach to optimize health care-common for other disorders-is not usually taken for FAP patients. Thus, clinicians that care for and counsel members of high-risk families should have familiarity with all the extra-intestinal manifestations of this syndrome. FAPrelated complications, for which medical attention is essential, are not rare and their estimated lifetime risk presumably exceeds 30%. Affected individuals can develop thyroid and pancreatic cancer, hepatoblastomas, CNS tumors (especially medulloblastomas), and various benign tumors such as adrenal adenomas, osteomas, desmoid tumors and dental abnormalities. Due to improved longevity, as a result of better prevention of colorectal cancer, the risk of these clinical problems will further increase.We present a clinical overview of extra-intestinal manifestations, including management and treatment options for the FAP syndrome. Furthermore, we provide recommendations for surveillance of FAP complications based on available literature.

A full starting dose of levothyroxine in cardiac asymptomatic patients with primary hypothyroidism is safe and may be more convenient and cost-effective than a low starting dose regimen.

We confirmed the positive relationship of the presence of TPOAbs with levels of TSH and showed that TPOAbs and TSH predict future development of hypothyroidism. These results are consistent with the presence of TPOAbs necessitating a compensatory increase in levels of TSH for maintenance of euthyroidism, even in the euthyroid range.

1 The aim of the present study was to investigate whether antimigraine ergot compounds may act at endothelial 5-hydroxytryptamine (5-HT) receptors which trigger the release of endothelium-derived relaxing factor (EDRF). Changes in tone of porcine isolated pulmonary arteries were measured isometrically. The integrity of the endothelium was assessed by the bradykinin-induced relaxation of prostaglandin F2a (PGF2,, 3 pM)-precontracted vessels.2 The ergot derivatives ergotamine, dihydroergotamine (DHE) and dihydroergocristine, as well as 5-HT and (± )-a-methyl-5-HT, elicited a reversible endothelium-dependent relaxation of PGF2,-precontracted arterial ring segments. The relaxation to both ergotamine and 5-HT was associated with an increase in cyclic GMP. After pretreatment of the vessels with NG-nitro-L-arginine methyl ester (200 tM), or removal of endothelium by mechanical rubbing, the relaxant responses were abolished.3 The mean pEC50 values for relaxant responses followed the order: (±)-a-methyl-5-HT (8.80)>5-HT (8.75)> ergotamine (8.17)> DHE (7.70)> 5-carboxamidotryptamine (7.62)> dihydroergocristine (7.17). 4 The relaxant effects of both ergotamine and dihydroergotamine were resistant to block by indomethacin (3 tM), prazosin (1 uM) and ketanserin (1 uM). However, the ergotamine-induced relaxation was highly susceptible to block by pizotifen (pA2= 8.23), norclozapine (pA2= 8.20), methiothepin (-log IC50 = 7.26), rauwolscine (pA2 = 7.24) and mesulergine (pA2 = 6.64). Each antagonist inhibited the relaxant responses to (±)-a-methyl-5-HT in the same manner with similar potency as that determined against ergotamine.

Long-term GnRH agonist treatment is an acceptable choice for treatment of postmenopausal hyperandrogenism in patients where ovarian origin of androgen excess is ascertained, and especially in those patients who have an increased risk for surgery due to comorbidities or who are unwilling to undergo bilateral oophorectomy.

Subclinical hypothyroidism (SCH), defined as the finding of an elevated serum thyroid-stimulating hormone (TSH) level with a normal free T4 level, is frequently observed in the general population. A recent publication, in data obtained from the LifeLines Cohort Study, showed a SCH prevalence of 10% in a relatively young group of individuals with mean age of 46 years. 1 Earlier studies have shown SCH prevalences of 4-20% in the adult population, mainly depending on age, sex, dietary iodine intake, and the cut-off concentrations of serum TSH used to define the condition. 2 In a large meta-analysis, Rodondi et al. 3 reported an association between SCH and the development of cardiovascular disease (CVD), but a significantly increased risk of both coronary heart disease (CHD) events and mortality was only seen in participants with TSH levels of 10 mU/L or higher.Subclinical hyperthyroidism, defined as the finding of a serum TSH level below the lower limit of the laboratory's reference range with a normal free T4 level, is less common. Reported prevalences range from 0.6% to 1.8% in the adult population, again depending on age, sex, and iodine intake. 2 Studies on the association of subclinical hyperthyroidism with mortality showed conflicting results: some studies demonstrated increased all-cause mortality, 4 while others did not. 5 However, recently an independent association has been shown between lower TSH levels and increased cardiovascular mortality during long-term follow-up in thyroid cancer patients on TSH-suppressive therapy. 6 It is known that an increased left ventricular mass, impaired diastolic dysfunction and increased risk on atrial fibrillation can be found during TSH-suppressive therapy.There are also several reports on the relationship between TSH and ageing, and both a progressive increase and decrease in TSH levels with advancing age have been reported. 7,8 Investigators from the Leiden 85-plus study 9 reported, in individuals aged 85 years and older, that SCH was associated with better survival than in subjects with normal TSH levels. However, such observational results should be interpreted with caution as other alterations in the oldest age group also are associated with better survival, such as high blood pressure and high cholesterol.In this issue, Chen et al. 10 report a very elegant prospective follow-up study on the relationship between TSH levels and outcome in patients with heart failure (HF). They followed a total of 5599 patients with a diagnosis of HF at a health maintenance organization and assessed both cardiac-related hospitalizations and mortality in this large cohort. The median follow-up period was slightly over 14 months. From their results it became apparent that both a high TSH level and a low TSH level were associated with an increased mortality rate. Patients were divided in quartiles of TSH levels, and the mortality in the highest quartile was 36% higher than in the second quartile. This was observed in the entire cohort, which included subjects previously diagnosed with ...

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