Sergej Hojker

Thyroid volume changes during pregnancy and after delivery in an iodine-sufficient Republic of Slovenia

OBJECTIVE Literature data concerning thyroid enlargement during pregnancy are not conclusive. Our aim was to systematically follow the thyroid volume changes during pregnancy and after delivery in an iodine-sufficient area. STUDY DESIGN Prospective study of healthy pregnant women living in an iodine-sufficient area. We followed 118 pregnant women with the mean age 30.9+/-4.1 years in the first trimester (mean 11.2+/-2.5 weeks of pregnancy), in the third trimester (mean 31.6+/-1.7 weeks of pregnancy), and 4 months after delivery (mean 15.9+/-3.9 weeks). Additionally, 71 women were also evaluated 14 months after delivery (mean 13.3+/-1.1 months). All women were negative for thyroid autoantibodies. We measured urinary iodine concentration (UIC), thyroid volume, serum TSH, and body mass index (BMI). After delivery, in a subgroup of women we also estimated the colour flow Doppler sonography (CFDS) patterns 0, I, II and III, where thyroid vascularity increased from pattern 0 to III, and the peak systolic velocity (PSV) using a 7.5 mHz linear transducer. RESULTS Median UIC in the third trimester (176 microg/g creatinine) was significantly higher than 4 and 14 months after delivery (P=0.030, P<0.001, respectively). Thyroid volume in the third trimester (11.3+/-3.1 mL) was significantly greater (P<0.001) than in the first trimester (8.7+/-2.5 mL), 4 months after delivery (8.6+/-2.5) and 14 months after delivery (7.8+/-2.4 mL). TSH concentration was significantly higher in the third trimester than in the first trimester and 4 months after delivery (P=0.007, P=0.006, respectively). As expected, BMI was the highest in the third trimester. CFDS pattern I was more frequent 4 months after delivery than 14 months after delivery (P<0.001). Similarly, PSV was significantly higher 4 months after delivery than 14 months after delivery (P<0.001). Linear regression analysis revealed TSH and BMI as significant independent predictors for thyroid volume. CONCLUSION In an iodine-sufficient area, thyroid volume increases during pregnancy and decreases after delivery, and the changes in volume are associated with changes in TSH and BMI. They may be viewed as indicators for metabolic and haemodynamic changes during pregnancy.

Thyroid function in the third trimester of pregnancy and after delivery in an area of adequate iodine intake

To establish whether the higher thyroid stimulating hormone (TSH) levels and lower levels of the 2 free thyroid hormones noted toward the end of pregnancy are in relation with iodine supply.

Thyroid volume and intrathyroidal blood flow increase during pregnancy

© 2006 Blackwell Publishing Ltd, Clinical Endocrinology , 65 , 826–831 with macroprolactinoma had a BMI of ≥ 30 kg/m 2 . Patients with macroprolactinoma hold eight positions of the first 14 BMI ranks (all ≥ 40 kg/m 2 ), including the top three (BMI ≥ 50 kg/m 2 ) although they represented only 129 of the total 430 pituitary adenoma patients. Mean BMI in patients presenting with macroprolactinoma was as high as BMI in patients presenting with Cushing’s disease (who often lose weight following successful surgery) and significantly higher than that in patients with NFA, also when adjusted for gender and age. 8 Within the patients with macroprolactinoma, BMI was not correlated with PRL levels at first presentation. When compared to the patients with NFA (tumours of comparable sizes), the higher BMI in patients with macroprolactinoma cannot be attributed to the degree of suprasellar extension or the pattern of pituitary failure. We have been looking for weight loss in patients with macroprolactinoma whose tumour was controlled by surgery (and radiotherapy), but obviously those well controlled with regard to PRL and losing weight had been treated with bromocriptine or cabergoline, i.e. dopamine agonists. We truly wonder (and doubt) whether Serri et al . 1 or anyone else have observed a series of patients whose body weight, insulin resistance and CRP decreased specifically in response to selective surgical removal of PRL-secreting tumour cells; we have rather seen the opposite, patients with pronounced weight gain years following pituitary surgery for prolactinoma (three of them, to a BMI of ≥ 40 kg/m 2 ). We agree that nowadays treatment with dopamine agonists is the therapy of choice for such patients, and we certainly also concur with the view that PRL levels are easier to measure and monitor than central dopaminergic tone. As opposed to Serri et al. , 1 we propose that hyperprolactinaemia (which may reflect reduced central dopaminergic input and thus be a marker, but not a cause) per se does not contribute to an increased BMI and features of the insulin resistance/metabolic syndrome, and that dopamine 2 receptor stimulation rather than decreasing PRL levels may be beneficial with regard to the control of parameters belonging to the risk cluster for cardiovascular disease.

Newborn Screening in Slovenia.

Abstract Introduction. Newborn screening in whole Slovenia started in 1979 with screening for phenylketonuria (PKU). Congenital hypothyroidism (CH) was added into the programme in 1981. The aim of this study was to analyse the data of neonatal screening in Slovenia from 1993 to 2012 for PKU, and from 1991 to 2012 for CH. Methods. Blood samples were collected from the heels of newborns between the third and the fifth day after birth. Fluorometric method was used for screening for PKU, CH screening was done by dissociationenhanced lanthanide fluorescent immunoassay (DELFIA). Results. From 1993 to 2012, from 385,831 newborns 57 were identified with PKU. 184 newborns out of 427,396 screened from 1991 to 2012, were confirmed for CH. Incidences of PKU and CH in the periods stated are 1:6769 and 1:2323, respectively. Conclusions. Successful implementation of newborn screening for PKU and CH has helped in preventing serious disabilities of the affected children. Adding screening for new metabolic diseases in the future would be beneficial. Izvleček Uvod. Presejanje novorojencev v Sloveniji se je začelo leta 1979 s presejanjem za fenilketonurijo (PKU). Leta 1981 je bil v program presejanja dodan še kongenitalni hipotireoidizem (CH). Cilj te raziskave je analiza podatkov presejanja novorojencev v Sloveniji v obdobju med letoma 1993 in 2012 za PKU ter med letoma 1991 in 2012 za CH. Metode. Vzorci krvi so bili odvzeti petim novorojencem med tretjim in petim dnem življenja. Pri presejanju za PKU se uporablja fluorometrična metoda, presejanje za CH pa poteka z metodo DELFIA. Rezultati. Od leta 1993 do leta 2012 je bil presejalni test za PKU izveden pri 358.831 novorojencih. Pri 57 otrocih je bil PKU potrjen. Pri 427.396 novorojencih med letoma 1991 in 2012 je bil izveden presejalni test za CH. Pri 184 otrocih je bil CH potrjen. V navedenih obdobjih je bila incidenca PKU 1:6769 in incidenca CH 1:2323. Zaključki. Uspešna implementacija presejanja novorojencev za PKU in CH je imela pomembno vlogo pri preprečevanju resnih zapletov pri obolelih otrocih. Smiselno bi bilo v program presejanja vključiti nove metabolne bolezni.

Beneficial effects of adequate iodine supply on characteristics of thyroid autonomy

Our aim was to establish the characteristics of thyroid autonomy (TA) in Slovenian patients and the required therapeutic dose of radioiodine before and ten years after the increase in mandatory salt iodization from previous 10 mg of potassium iodide to 25 mg per kg in 1999 because almost no data about TA and radioiodine treatment with respect to iodine supply are available.

An Advantageous Role of Spectral Doppler Sonography in the Evaluation of Thyroid Dysfunction During the Postpartum Period.

To evaluate the diagnostic value of spectral Doppler sonography in women with thyroid dysfunction during the first postpartum year.

PROCALCITONIN AND INTERLEUKIN-6 AS MARKERS OF SEVERE INFECTION IN CHILDREN WITH FEBRILE NEUTROPENIA

Background. The results of the study conducted to determine whether procalcitonin (PCT) and interleukin-6 (IL-6) are more sensitive and specific markers of severe infection in children with febrile neutropenia (FN) than routinelly used C-reactive protein (CRP) are presented in the article. 68 episodes of FN experienced by 32 patients were divided into three groups according to the site of infection. Group 1: episodes of bacteraemia and/or clinical sepsis (n = 16), group 2: episodes of focal infection (n = 16) and group 3: episodes of fever of unknown origin (FUO) (n = 36). Blood samples for further PCT and IL-6 determination were collected on three consecutive days. CRP concentrations were measured daily in each patient until the resolution of fever. PCT, IL-6 and CRP concentrations were measured on one occassion in each of the 18 afebrile patients with malignant disase forming the reference group. Serum PCT and IL-6 concentrations were measured by immunochemiluminometric and immunoenzymatic assay. Receiver Operating Characteristic (ROC) curves were used to determine optimum sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of the studied parameters. Conclusions. PCT and IL-6 were found to be earlier and more sensitive markers of severe infection in neutropenic patients than CRP. The erliest one was IL-6, followed by PCT and CRP. Sequential determination of PCT up to 72 hours improved its diagnostic value, which was not the case for IL-6.In patients with gramnegative bacteraemias PCT concentracions were 3–5 times higher comparing to grampositive, whereas IL-6 concentrations were comparable in both groups.

PREGNANCY AND THYROID

Background. In conditions with appropriate iodine intake, thyroid gland adapts to changes during pregnancy without any consequences. Fetal need for thyroid hormones in the first trimester is directly connected with transplacental transport of thyroid hormones. Fetal synthesis of thyroid hormones depends on availability of iodine in the feto-placental unit. Hypo- and hyperthyroidism during pregnancy are risk factors for pregnant woman and for normal development of fetus and child. Conclusions. Pregnant women with appropriately treated thyroid diseases have the same outcome of pregnancy as healthy women, and neuroendocrinological development of children is not impaired. If the disease is unrecognized or untreated, complications of pregnancy and delivery occur more frequently. Therefore, timely recognition and treatment of the diseases with appropriate drugs during pregnancy and, also, after delivery is very important.