E. Roti

Thyroid papillary microcarcinoma: a descriptive and meta-analysis study.

The authors review anatomical, clinical characteristics and prevalence of thyroid microcarcinoma. Diagnostic procedures and risk factors of aggressiveness at diagnosis and during follow-up are also covered. The possible clinical, pathologic and therapeutic risk factors are analyzed by meta-analysis study. Treatment procedures by different authors and guidelines suggested by societies are reported.

Thyroid hemiagenesis and incidentally discovered papillary thyroid cancer: case report and review of the literature.

Thyroid hemiagenesis (TH) is a rare congenital abnormality in which one thyroid lobe fails to develop. Its prevalence is uncertain, because the absence of one thyroid lobe does not usually cause clinical symptoms. The detection of TH is usually incidental when the evaluation of other thyroid disorders is requested. It is more frequently found in female than in male patients (3:1 ratio) and in the left lobe compared to the right lobe. We report the case of a 54-yr-old man, presenting with a large multinodular right-sided goiter, with mediastinal extension and dysphagia. Thyroid scan and ultrasound study showed the absence of the left lobe. The patient underwent surgery for compressive symptoms, and the operation confirmed the absence of the left lobe. Histological examination demonstrated a multinodular goiter with papillary carcinoma. To our knowledge, this case represents the first reported case of association between TH and papillary thyroid carcinoma in a male patient, and the second in which the tumor arose in the right lobe.

Value of routine measurement of serum calcitonin concentrations in patients with nodular thyroid disease: A multicenter study

Background: The routine measurement of serum calcitonin (CT) has been proposed for patients with nodular thyroid disease (NTD), to detect unsuspected medullary thyroid carcinoma (MTC) before surgery. Objective: To assess the prevalence of hyper-calcitoninemia and MTC in NTD patients; to compare the ability of CT measurement and fine needle aspiration cytology (FNAC) to predict MTC; to identify age groups of NTD patients who should be better candidates than others to undergo routine measurement of CT. Patients and methods: 1425 consecutive patients, referred from April 1, 2003, through March 31, 2004, to four Italian endocrine centers due to NTD, were grouped depending on age, and underwent basal and, in some cases, pentagastrin (Pg)-stimulated CT measurement, FNAC and, when indicated, surgery. Serum CT concentrations were measured by an immunoluminometric assay (ILMA). Results: Hyper-calcitoninemia was found in 23 out of 1425 patients. MTC was discovered in 9 patients, all >40 yr old and showing high CT levels. Sensitivity of basal and Pg-stimulated CT to predict MTC before surgery was 100% for both tests, whereas specificity was 95 and 93%, respectively. CT specificity reached 100% when a cutoff value of 20 pg/ml was taken. FNAC showed an overall 86% sensitivity. When >10 mm MTC nodules were considered, FNAC sensitivity approached 100%. On the contrary, a correct cytological diagnosis was obtained in only one out of five patients with <10 mm MTC nodules (microMTC); in one patient with histologically proved microMTC, FNAC even demonstrated a benign lesion. Hypercalcitoninemia or MTC were associated with chronic thyroiditis in 30 or 33% of cases, respectively. C-cell hyperplasia was found in 57% of hypercalcitoninemic patients without MTC. Conclusions: Basal CT measurement detects elevated CT values in 1.6% of NTD patients. Although CT is not a specific marker of MTC, its routine measurement represents a useful tool in the pre-operative evaluation of NTD patients, particularly those >40 yr old presenting with nodules <10 mm, even when FNAC does not show malignant features. To our knowledge, this is the first trial using ILMA to assess the ability of pre-operative CT measurement to predict MTC in a large series of NTD patients.

New paradigms in neuroendocrinology: relationships between obesity, systemic inflammation and the neuroendocrine system.

Obesity may be an independent risk factor for coronary artery disease and contribute to a chronic state of systemic inflammation leading to atherosclerosis and metabolic abnormalities, such as diabetes, insulin resistance, dyslipidemia and hypertension. Visceral fat, in fact, may act as an endocrine organ, synthesizing and releasing atherogenic inflammatory cytokines, whose circulating levels depend on the individual’s nutritional state, and the extent and anatomical location of fat stores. Unsuspected viral infections might also be involved in enhancing autocrine/ paracrine mechanisms of cytokine release from omental fat. Elevated levels of blood cytokines may interact with the neuroendocrine system, autonomic nerves and peripheral lymphatic organs. This may lead to local inflammatory reactions in many body compartments, in particular in the heart tissue, possibly affecting the process of circulatory recovery in obese subjects, and predisposing these patients to a greater risk of myocardial inflammatory disease than individuals with normal body mass index. Circulating levels of inflammatory cytokines might be considered to determine risk categories for development of cardiovascular complications in obese subjects. In addition, their reduction with pharmacological antagonists might prevent and/or control acute cardiovascular events and increase energy expenditure in obese patients, especially after surgical treatment, through reduction of cytokine inhibition of the hypothalamic-pituitary-thyroid axis.

Free and bound leptin in prepubertal children with Down's syndrome and different degrees of adiposity.

Objective: To evaluate plasma total, free (FL) and protein-bound (BL) leptin in children with Downs syndrome (DS) and different degrees of adiposity and its relationship with thyroid stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3).Subjects: A total of 24 prepubertal clinically euthyroid DS children.Methods: Plasma leptin, TSH, FT4, and FT3 concentrations were determined by immunometric/radioimmunologic assays. FL and BL were evaluated by fast protein liquid chromatography.Results: In DS children, leptin circulates in two fractions, corresponding to BL and FL. The amount of BL and FL is negatively and positively correlated to body mass index (BMI), respectively. Plasma leptin concentrations correlate with BMI, but not with TSH, FT4, and FT3.Conclusions: In prepubertal DS children, leptin circulates as both BL and FL, correlates with adiposity and its concentration appears independent of thyroid function.Sponsorship: MIUR, Università degli Studi di Milano, Banca Popolare di Milano Foundation.

Total, free and bound leptin and thyroid function in elderly women with different body weights

Objectiveu2002 The present study was aimed at evaluating the relationship of total leptin, and its free leptin (FL) and bound leptin (BL) fractions with adipose mass in very old euthyroid women, in relationship to thyroid function.

Sarcoidosis of the thyroid gland associated with hyperthyroidism: Review of the literature and report of two peculiar cases

Sarcoidosis is a systemic disease characterized by non-caseating granulomas that rarely involve the thyroid gland. Thyroid sarcoidosis has seldom been documented, and few cases have so far been described in association with hyperthyroidism. Here, we review the literature on this association, report two patients presenting with hyperthyroidism and histologically-proven sar-coidosis, and discuss related clinical, biochemical, pathological and genetic findings.

Interferone e tireopatie

RiassuntoGli interferoni (IFN) α, β e γ sono dotati di azioni antiproliferative, antivirali e immunomodulatorie. Nella pratica clinica gli IFN sono utilizzati nel trattamento di malattie neoplastiche e virali, tra cui le epatiti virali. Durante il trattamento con IFN è stata osservata la comparsa di anticorpi anti-tiroide e di malattie tiroidee con una prevalenza variabile dallo 0% fino al 61%. L’ipotiroidismo, la disfunzione tiroidea più comune indotta da IFN, si può manifestare durante la terapia con IFN o dopo la sospensione. La sintomatologia è generalmente molto sfumata e la diagnosi è posta quando le concentrazioni di TSH sono elevate. I pazienti possono proseguire la terapia con IFN e iniziare la terapia sostitutiva con levotiroxina. La tireotossicosi da IFN comprende l’ipertiroidismo da malattia di Graves con captazione tiroidea del 131I (RAIU) elevata o normale e la tireotossicosi da distruzione ghiandolare infiammatoria con RAIU assente o ridotta. Può manifestarsi durante la terapia con IFN o dopo la sospensione. L’ipertiroidismo da malattia di Graves insorto durante la terapia con IFN è caratterizzato da modesti sintomi e segni; i pazienti possono proseguire la terapia con IFN in associazione a basse dosi di metimazolo. La tireotossicosi distruttiva è generalmente transitoria senza sintomi e segni di flogosi; in questi pazienti è consigliabile sospendere la terapia con IFN e iniziare la terapia con basse dosi di cortisonici per 30–60 giorni.