THST appears justified in ThyrCa patients following initial therapy. As most primary studies were imperfect, future research will better define the effect of THST upon ThyrCa clinical outcomes.
Major depressive disorder has been associated with low bone mineral density. The strength of this association, however, varies greatly among studies; the direction of the causative link is still controversial, and the etiology remains unclear. We aimed to confirm this association, assess its magnitude and estimate its clinical relevancy. A total of 535 articles were initially identified and the research synthesis was based on 33 qualified articles. Of these, 25 articles (or 76 %) showed an inverse relationship between major depression or minor depression or depressive symptoms and bone mineral density or bone turnover. Meta-analysis could be performed on 20 of the initially selected 33 articles. Standardized weighted differences in mean AP spine, total femur and femoral neck bone mineral density, each from at least 10 studies, were computed in g/cm 2 and transformed into percent differences. At each site, bone mass was lower in subjects with depression as compared to controls: AP spine bone mineral density was 4.73 % lower (95 % CI −7.28 % to −2.19 %, p < 0.0001; n = 16 studies), total femur bone mineral density was 3.53 % lower (95 % CI −5.66 % to −1.41 %, p < 0.001; n = 13 studies), and femoral neck bone mineral density was 7.32 % lower (95 % CI −10.67 % to −3.96 %; p < 0.0005; n = 8 studies). In conclusion, major depressive disorder was associated with lower bone mineral density at the AP spine, femoral neck, and total femur. The deficits in bone mineral density in subjects with depression are of clinical significance and likely to increase fracture risk over the lifetime of these subjects.
Several authors have suggested a positive association between Hashimoto thyroiditis (HT) and breast cancer (BrCa). Others have refuted these findings; hence, this subject remains controversial. We therefore reviewed the world literature on this subject accumulated over the last 50 years and performed a quantitative research synthesis, a meta-analysis variant. The incidence risk ratios and 95% confidence intervals (CI's) were calculated for each study and the combined relative risk (RR) was estimated. We found 37 relevant studies, of which only 13 were accessible to analysis. A significant association (RR=1.40; CI=1.29-1.53, P<0.022) was found for 6 of the 13 studies pertaining to 1,431 women. However, in the cumulative population of 14,226 women (from all 13 studies), we failed to demonstrate an association between the diagnoses of HT and BrCa (RR=1.07; CI=0.99-1.15; P=0.08). In conclusion, we believe that selection bias or institutional referral bias, in at least some of the "positive" studies, may have led to the spurious recognition of an association between HT and BrCa, especially as both of these conditions are highly prevalent in women between the 4th and 7th decade of life.
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