José López

Patterns of Iodine Intake and Urinary Iodine Concentrations During Pregnancy and Blood Thyroid-Stimulating Hormone Concentrations in the Newborn Progeny

BACKGROUND Appropriate maternal intake of iodine during pregnancy is essential for maternal thyroxine production and thyroid status of the fetus. It should be possible to enhance iodine intake during pregnancy by using iodine fortified salt or taking iodine supplements. In the present report we determined the status of iodine nutrition in pregnant women who were stratified on the basis of their history of taking or not taking iodized salt or iodine supplements. The study was performed in Toledo (Spain), a region in which prior studies have noted borderline iodine sufficiency. Iodine nutrition was assessed by measuring urinary iodine concentration (UIC) and neonatal thyrotropin (TSH). METHODS UIC was measured in 525 pregnant women. They were grouped according to their history of iodine intake. Diet Group 1 patients (n = 69) did not take iodized salt or iodine supplements during pregnancy. Diet Group 2 patients (n = 75) took iodized salt but not iodine supplements during pregnancy. Diet Group 3 patients (n = 381) took iodine supplements during pregnancy. Plasma determinations included TSH, free thyroxine, thyroid peroxidase antibody, and thyroglobulin antibody. UIC was measured in a single urine sample from all the pregnant women. Neonatal TSH was measured in capillary spot blood from all the neonates as part of a screening for congenital metabolic abnormalities. RESULTS The median UIC in all subjects was 164 μg/L (interquartile range [IR]: 116-245). The median UICs in Diet Groups 1, 2, and 3 were 134.5 (IR: 90-196), 146 (IR: 103-205), and 183 (IR: 124-261) μg/L, respectively (p = not significant [NS] for Diet Group 1 vs. 2; p < 0.01 for Diet Group 2 vs. 3; all other comparisons NS). The median (IR) TSH of the neonates in all Diet Groups was 1.0 (IR: 0.7-1.6) μU/mL. Only 2 neonates had blood TSH concentrations >5 mU/L. Neonatal blood TSH concentrations were similar in all Diet Groups. CONCLUSIONS In a region with a history of borderline iodine deficiency the UICs were below 150 μg/L in a substantial percentage of pregnant women who did not take iodine supplements, regardless of whether or not they took iodized salt. Our results support the use of iodine supplements from the start of the pregnancy, or even before pregnancy in women who live in regions with a history of even small degrees of iodine deficiency. In addition, neonate TSH screening is not the best tool to assess whether the iodine status in populations is ideal.

Situación de control metabólico y pautas de tratamiento en pacientes con diabetes tipo 1 en Castilla-La Mancha: estudio de diabetes tipo 1 en Castilla-La Mancha

OBJECTIVE To assess glycemic control, the degree of control of cardiovascular risk factors, and treatment schemes used in patients with type 1 diabetes mellitus (T1DM) in Castilla-La Mancha (Spain). PATIENTS AND METHODS A cross-sectional, multicenter study on adult patients with T1DM seen at outpatient endocrinology clinics for 12 months (from September 2009 to August 2010). Diabetes duration was > 5 years in all cases. Sociodemographic, clinical, anthropometric, and laboratory variables were collected, as well as treatment data. A multivariate logistic regression analysis was used to assess variables independently associated to good glycemic control. RESULTS A total of 1465 patients (48.5% women) with a mean age of 39.4±13.5 years and a mean diabetes duration of 19.4±10.6 years, were enrolled. Mean glycosylated hemoglobin (HbA1c) level was 7.8%, and 26% had HbA1c values ≤7%. Predictors of good glycemic control (HBA1c ≤7%) included intensive insulin treatment [odds ratio (OR): 2.56], non-smoking status (OR: 1.66), and a higher educational level (OR: 1.33). Fifteen percent of patients were obese, 35% had dyslipidemia, 23% were hypertensive, and 26% smoked. Four or more of the recommended control goals were achieved by 68% of patients, but more than 33% required additional drug treatment. CONCLUSIONS Glycemic control was inadequate in this cohort of T1DM patients. Promotion of healthy attitudes and intensification of insulin treatment may improve glycemic control. Prevalence of cardiovascular risk factors is high, although a great proportion of patients achieve good lipid and blood pressure control.

Control metabólico y de factores de riesgo cardiovascular en una cohorte de pacientes con diabetes mellitus. Resultados a los 4 años

OBJECTIVES To assess control of blood glucose and other cardiovascular risk factors in diabetic patients monitored at an outpatient endocrinology clinic. To ascertain treatment used and its changes over time. PATIENTS AND METHODS A cohort of 424 randomly selected diabetic patients (both type 1 and type 2) was monitored from 2004 to 2008. Final cohort size was 343 patients. Data were collected about epidemiological characteristics, cardiovascular risk factors, chronic complications, glycemic, lipid and blood pressure control, and treatment at baseline and 4 years. RESULTS After 4 years, the proportion of patients achieving glycosylated hemoglobin levels less than 7% remained stable (type 1: 18.5% in 2004 vs 21.7% in 2008, type 2: 26.6% vs 26.5%). The degree of achievement of lipid and blood pressure (BP) control levels increased in both groups. The complexity of treatment schemes used to achieve these results significantly increased. CONCLUSIONS Stabilization of glycemic control after 4 years of follow-up was a positive result, considering the long course of diabetes, progressive pancreatic function impairment, and complexity of our cohort. Treatment optimization significantly improved BP and lipid control in the study group.

[Differentiated thyroid carcinoma: survival and prognostic factors].

BACKGROUND AND AIMS: Differentiated thyroid carcinoma (DTC) is the most common endocrine tumor. DTC has a good prognosis and survival rates higher than 85%. The aim of our study was to assess our current survival rate and to analyze prognostic factors. PATIENTS AND METHODS: A retrospective analysis was conducted of 308 patients with DTC (93.5% with papillary tumors, 78.8% women). Mean age at diagnosis was 45.4±15.8years, and mean follow-up time was 8.9±6.8years. The whole group was treated and followed up using the same protocol at our hospital. The following data were collected: age at diagnosis, sex, histology, TNM stage, treatments, and date and cause of death. Survival probability was calculated using Kaplan-Meier analyses. Prognostic factors were analyzed using a univariate log rank test and a multivariate Cox regression analysis model. RESULTS: Twenty-six patients died during follow-up, 15 of them (4.9%) from DTC. Thyroid carcinoma-related survival was 92.7% for the whole group. In multivariate analyses, the following parameters were associated to a significantly increased risk of death from DTC: presence of distant metastases, follicular histology, age at diagnosis older than 60years, and extrathyroid invasion. DISCUSSION: Our survival rate is similar to that reported in literature. Assessment of prognostic factors related to an increased risk of death in our patient group, is essential to establish active therapeutic approaches in high risk patients.

Alteraciones endocrino-metabólicas inducidas por bexaroteno en el tratamiento del linfoma cutáneo de células T

Introduccion La utilizacion de bexaroteno, agonista selectivo del receptor de retinoide X (RXR), en pacientes con linfoma cutaneo de celulas T (CTLC), ha puesto de manifiesto la aparicion de dos complicaciones frecuentes, como son el hipotiroidismo central y la hipertrigliceridemia. Nos proponemos comprobar las repercusiones en las hormonas tiroideas y los lipidos plasmaticos en un pequeno grupo de pacientes con CTLC tratados con bexaroteno. Pacientes y metodo Presentamos a 6 pacientes (2 mujeres, 4 varones) con CTLC, en distintos estadios de la enfermedad y resistentes por lo menos a un tratamiento sistemico previo, que recibieron tratamiento con bexaroteno a dosis de 300 mg/m 2 . Se evaluo la TSH basal y la T4 libre y los lipidos plasmaticos (colesterol y trigliceridos) al inicio del tratamiento, a las 4 y las 8 semanas y, en los pacientes en que se suspendio el tratamiento, 4 semanas despues de finalizado. Resultados En 4 de 6 pacientes, la funcion tiroidea antes del tratamiento con bexaroteno era normal, en un paciente se desconocia y otro habia sido diagnosticado previamente de hipotiroidismo primario autoinmunitario subclinico. A las 4 semanas de iniciado el tratamiento, todos mostraron una disminucion de las concentraciones de tirotropina (TSH) y tiroxina (LT4), y 4 precisaron tratamiento con dosis sustitutivas de levotiroxina. Todos los pacientes presentaron elevaciones en las concentraciones plasmaticas de colesterol y/o trigliceridos que requirieron tratamiento con estatinas o fenofibrato. En aquellos en que se suspendio el bexaroteno, las hormonas tiroideas y los lipidos retornaron a cifras similares a las basales. Conclusiones El tratamiento con bexaroteno en pacientes con CTLC induce la aparicion de alteraciones endocrino-metabolicas, como hipotiroidismo central y dislipemia mixta, que requieren tratamiento con dosis sustitutivas de levotiroxina y farmacos hipolipemiantes en la mayoria de las ocasiones. Dichas alteraciones son reversibles tras la suspension del farmaco.

Evolución del hiperparatiroidismo primario en 56 pacientes. Comparación entre hiperparatiroidismo hipercalcémico y normocalcémico

Introduccion Actualmente, el hiperparatiroidismo primario (HPP) se considera una enfermedad escasamente sintomatica y poco progresiva. El HPP normocalcemico (HPPN) es una entidad reconocida e identificada esencialmente por complicaciones asociadas al HPP (osteoporosis y urolitiasis). Pacientes y metodo Estudio de 56 pacientes con HPP no operados o con seguimiento minimo de 1 ano previo a la paratiroidectomia. Se subdividio a los pacientes en HPP hipercalcemico (HPPH) (27 pacientes) y HPPN (29 pacientes). Se pretendio analizar las comorbilidades hipertension arterial [HTA] y nefrolitiasis) en el grupo total y en cada subgrupo, valorar la evolucion anual de calcemia, fosfatemia, paratirina PTH) y fosfatasa alcalina sericas, calciuria, filtrado glomerular y densidad mineral osea lumbar durante un periodo de 1 a 5 anos y hallar posibles diferencias entre HPPH y HPPN para estas variables. Resultados El 55,4% de los pacientes presentaban HTA y se registraron episodios de nefrolitiasis en el 37,5% de los casos. No se apreciaron cambios a lo largo del tiempo en los parametros bioquimicos y densitometricos ni en el grupo total ni por subgrupos. Excepto en los valores de calcio, fosforo y PTH sericos no se hallaron diferencias entre HPPH y HPPN. Conclusiones El HPP parece una enfermedad poco progresiva si bien no se incluyo en este estudio a los pacientes remitidos precozmente a cirugia con seguimiento previo escaso que podrian corresponder a casos mas agresivos. El HPPN es una entidad asociada a complicaciones similares a las del HPPH por lo que pensamos deberia someterse a los mismos criterios de derivacion quirurgica.

Hipotiroidismo y gestación: importancia del control periconcepcional

Objetivo : Conocer los efectos del embarazo en las necesidades de tiroxina (T 4 ) en un grupo de mujeres diagnosticadas de hipotiroidismo previo a la gestacion y valorar la importancia del adecuado control de la funcion tiroidea preconcepcional. Pacientes : Se analizan los datos de 48 gestaciones en 46 pacientes hipotiroideas (39 con hipotiroidismo autoinmunitario, 7 con hipotiroidismo tras 131I o posquirurgico) durante el periodo 1999-2001. Todas las pacientes fueron controladas antes, durante y despues de la gestacion. Se estudiaron las concentraciones de tirotropina (TSH), T 4 libre y la dosis de T 4 en cada visita. Se analizo separadamente un subgrupo de pacientes que presentaba concentraciones normales de TSH (valores normales, 0,5-4 μU/ml) en la visita antes del embarazo (grupo “normo”; n = 28). Resultados : En el grupo total se aumento la dosis sustitutiva en 29 de las 48 pacientes (60,4%); la dosis media durante el embarazo es un 27,1% superior a la dosis inicial. En el primer trimestre se aumento la dosis al 45,8% de las pacientes (incremento medio de 14,6 ± 22 μg/dia), en el segundo trimestre, al 33,3% (incremento de 7,3 ± 13 μg/dia) y en el tercero, al 12,5% (incremento de 2,7 ± 8,2 μg/dia). La dosis posgestacion fue significativamente superior a la utilizada antes del embarazo. En el grupo “normo” la dosis de T 4 aumento en 13 de las 28 pacientes (46,4%); la dosis media durante el embarazo fue un 11,6% superior a la dosis inicial. La distribucion del aumento por trimestres fue superponible a la del grupo total. La dosis final posgestacion no fue diferente de la dosis inicial. Conclusiones : La gestacion ocasiona un aumento de las necesidades de T 4 en un porcentaje alto de los pacientes de nuestro grupo. Un control adecuado del hipotiroidismo antes del embarazo disminuye la proporcion de pacientes que necesitan incrementar la dosis de T 4 asi como la cuantia de este aumento.