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EN
Cabozantinib, the latest available in Poland medication for the treatment of renal cell carcinoma, registered in this indication by the European Medicines Agency (EMA) in September 2016, has been available in several cancer centers in Poland since November 2016 as part of the expanded access program. Primary hypothyroidism is a common complication during thyrosine kinase inhibitors (TKI) treatment, although there are few reports of its occurrence during treatment with cabozantinib, which belongs to this medication group. We present a case of rapid development of clinically apparent hypothyroidism after cabozantinib treatment and report data on this complication in the group of our patients.
EN
Introduction: The purpose of this study was to determine the incidence of radiation induced hypothyroidism after treatment with radiotherapy alone or in combination with surgery/chemotherapy in head & neck cancer patients. Methods: This study was a retrospective non-randomized trial performed on 100 patients of head & neck cancer in whom definitive radiotherapy, postoperative radiotherapy or radiotherapy in combination with chemotherapy was given. Values of TSH, T3 & T4 were analyzed at baseline and at 6 monthly follow-up. Subclinical hypothyroidism was defined as TSH value of > 4 mU/L and Clinical hypothyroidism was taken as TSH > 10 mU/L with decreased T3 & T4. Results: Out of 100 patients, 73 individuals were euthyroid at the end of 2-year follow-up, 21% had subclinical hypothyroidism and 6% had clinical hypothyroidism. The incidence of subclinical hypothyroidism in the surgery plus radiotherapy group and the radiotherapy group was 22.3% & 50%, respectively. The incidence of clinical hypothyroidism in the surgery plus radio therapy group and the radiotherapy group was 6.5% & nil, respectively. Conclusion: The incidence of hypothyroidism is high in head & neck cancer patients receiving radiotherapy. The risk is higher in patients who undergo surgery in combination with radiotherapy. Regular thyroid function test is, therefore, recommended.
PL
Wstęp. Niedoczynność tarczycy jest chorobą przewlekłą, wymagającą zazwyczaj dożywotniego leczenia hormonalnego. Pomimo terapii w jej przebiegu niejednokrotnie pojawiają się dokuczliwe objawy, takie jak: zmęczenie, senność, stany depresyjne, zaparcia, ciągłe uczucie zimna, a w przypadku stosowania zbyt dużych dawek – symptomy nadczynności tarczycy. Niedoczynność tego gruczołu może być przyczyną subiektywnie obniżonej jakości życia i zmian w dotychczasowym funkcjonowaniu biopsychospołecznym. Cel pracy. Określenie wpływu niedoczynności tarczycy na jakość życia. Materiał i metody. W badaniu wzięło udział 60 osób (56 kobiet i 4 mężczyzn) w wieku powyżej 18 lat z rozpoznaną niedoczynnością tarczycy, będących pod kontrolą poradni endokrynologicznej w roku 2010 i grupa 40 osób zdrowych (35 kobiet i 5 mężczyzn) bez rozpoznanej choroby tarczycy. W pracy zastosowano analizę dokumentacji medycznej oraz kwestionariusz do oceny jakości życia WHOQoL-BREF. Wyniki. Średnia jakości życia chorych jest gorsza niż grupy kontrolnej i wynosi odpowiednio (3,4 ± 0,83 vs. 3,8 ± 0,56), przy czym nie stwierdzono tutaj zależności statystycznej. Samoocena stanu zdrowia w grupie osób chorych jest zdecydowanie gorsza (2,8 ± 0,89) i jest istotna statystycznie. W każdej z domen chorzy na niedoczynność tarczycy osiągnęli gorsze wyniki niż grupa kontrolna. Różnice istotne statystycznie p < 0,05 zaobserwowano w domenie somatycznej, psychologicznej i socjalnej kwestionariusza WHOQoL-BREF. Wnioski. Badania nie wykazały zależności między subiektywną oceną jakości życia osób chorych na niedoczynność tarczycy a faktem zachorowania. Natomiast choroba oddziałuje na jakość życia zależną od zdrowia i na poszczególne dziedziny życia. Czynniki społeczno-demograficzne wpływają na wyniki jakości życia w tej grupie chorych.
EN
Background. Hypothyroidism is a chronic disease requiring lifelong treatment which is usually hormonal. Despite its progress in therapy often appear bothersome symptoms such as fatigue, sleepiness, depression, constipation, constant feeling of cold. Hypothyroidism can cause subjectively reduce in quality of life and changes in the functioning of the biopsychosocial status. Objectives. The aim of the study was to determine the effect of hypothyroidism on quality of life. Material and methods. The study involved 60 patients (56 women and 4 men) aged over 18 years diagnosed with who were under the control of the endocrine clinic. In the study we used medical data analysis and the WHOQoL-BREF questionnaire to assesa the quality of life in patients with hypothroidism. Results. The average quality of life of patients with hypothyroidism is worse than in the control group (3.4 ± 0.83 vs. 3.8 ± 0.56). Self-assessment of health status in the group of patients with: is much worse (2.8 ± 0.89) than in the control group and it is statistically significant. In each domain, patients with hypothyroidism have achieved worse results than the control group. Differences statistically significant p < 0.05 was observed in the somatic, psychological and social domain of the WHOQoL-BREF. Conclusions. The study found no relationship between subjective assessment of the quality of life of people with hypothyroidism and the fact of illness. In contrast, the disease affects the quality of life, health and dependent on individual areas of life. The socio-demogrfaic factors influence the results.
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EN
Introduction and aim. Oxidative stress is one of the complications that accompany defects in thyroid hormone levels. This study was designed to evaluate oxidative stress markers in patients with hypothyroidism. Material and methods. This case control study was comprised of forty-two hypothyroid patients aged 36–46 years and forty age matched (35–43 years) healthy control participants randomly selected from the Endocrine Clinic of Al-Yarmook Hospital in Iraq. Blood levels of thyroid hormones malondialdehyde, glutathione, and paraoxonase-1 were assessed. Body mass index was calculated for each patient and control participant. Results. Regarding the data of oxidative stress markers in hypothyroid patients compared to controls, a significant elevation was reported in blood levels of malondialdehyde and a significant reduction was found in blood levels of glutathione (p=0.031). On the other hand, the blood levels of paraoxonase-1 were significantly different in hypothyroid patients compared with the control. Conclusion. Elevated blood levels of malondialdehyde and declined blood levels of glutathione in hypothyroid patients are a signal of oxidative stress and consequently increase the risk of cardiovascular complications.
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Content available remote Vasopressin and oxytocin release and the thyroid function
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EN
The aim of the present investigations was to examine the effects of the states of hypothyroidism or hyperthyroidism on vasopressin (AVP) and oxytocin (OT) release under conditions of equilibrated water metabolism as well as of osmotic stimulation, brought about by the dehydration or hypertonic saline administration. The euhydrated and simultaneously hypothyroid rats showed decreased hypothalamic AVP and OT content and somewhat higher but not significant neurohypophysial AVP content. In these animals the raised OT (but not AVP) plasma level has been observed. In hyperthyroid rats drinking tap water ad libitum the neurohypophysial AVP and OT content significantly diminished; plasma OT concentration (but not AVP) was then elevated. The state of osmotic stimulation was the reason of different response of the hypothalamo-neurohypohysial system function in hypo- or hyperthyroid rats. Significant decreases of neurohypophysial AVP and OT content were found in both hypothyroid dehydrated as well as hypothyroid hypertonic saline-treatment rats as compared with hypothyroid euhydrated ones. On the contrary, in the state of hyperthyroidism AVP content in the neurohypophysis distinctly raised in dehydrated and salt-loaded rats; in these last neurohypophysial OT content increased as well. Plasma OT (but not AVP) distinctly diminished in hyperthyroid and simultaneously dehydrated or hypertonic saline injected rats in relation to hyperthyroid control subgroup. Data from the present study suggest that: 1) altered thyroid gland function affects vasopressin and oxytocin release from the hypothalamo-neurohypophysial system in the state of equilibrated water metabolism; 2) the state of hypo- or hyperthyroidism modifies the response of AVP-ergic and OT-ergic neurons upon the osmoreceptors/osmodetectors stimulation. It may be sypposed that OT-ergic neurons display greater than AVP-ergic neurons sensitivity upon the thyroid hormone influence.
PL
Schorzenia tarczycy wiodące do zaburzeń jej czynności endokrynnej występują często. Laboratoryjna ocena zaburzeń czynności tarczycy jest oparta na oznaczaniu stężenia we krwi hormonu tyreotropowego (TSH) oraz wolnej frakcji tyroksyny (FT4) i trijodotyrniny (FT3). Interpretacja wyników jest zgodna z zasadami regulacji wydzielania TSH, w tym ujemnego sprzężenia zwrotnego ze stężeniem FT3 i FT4. Ocena czynności tarczycy w oparciu o te badania może być utrudniona przy zaburzonej funkcji osi podwzgórze - przysadka - tarczyca. Wyniki powinny być ostrożnie interpretowane w ciężkich chorobach pozatarczycowych i w ciąży. Odmiennego podejścia wymaga monitorowanie leczenia substytucyjnego i tyreostatycznego. Wartości decyzyjne stężenia TSH powinny uwzględniać zmienność populacyjną i być dobierane empirycznie. Odrębny problem stanowi metodyka oznaczania wolnych hormonów tarczycy, która wymaga udoskonalenia.
EN
Diseases of the thyroid gland leading to its endocrine dysfunction are a very common ailment. Labaratory assessment of thyroid dysfunction is based on thyrotropin (TSH), free fractions of thyroxine (FT4) and triiodothyroine (FT3) blood concentration measurements. The interpretation of the results takes place in accordance with the rules of regulation of TSH secretion including negative feedback with FT3 and FT4 levels. However, the assessment of thyroid function based on these tests may be complicated in the case of the dysfunction of the hypothalamic- pituitary- thyroid axis. The results should be interpreted carefully in the case of severe nonthyroidal disorders, as well as during pregnancy. The monitoring of the replacement or thyrostatic treatment requires a different approach. The decision values of TSH concentration should comply population variability and be established empirically. Another issue makes the methodology of free thyroid hormones assays, which are in need of further improvement.
EN
Background: There are limited data about the influence of hypothyroidism and hyperthyroidism on the connective tissue component and smooth muscle cells of the thoracic aorta. The aim was to study the histological changes of the wall of the thoracic aorta in the hypothyroid and hyperthyroid rats. Morphometric measurements were also done. Materials and methods: Thirty adult rats were used. They were divided into control, hyperthyroid, and hypothyroid groups. Each group consisted of 10 rats. The animals were sacrificed at the end of 8 weeks and the descending aorta was excised. Sections were stained with haematoxylin and eosin, orcein and Masson’s trichrome stains. The morphometric measurement included: number of smooth muscle cell nuclei, number of the elastic lamellae, thickness of the tunica media, elastic fibre optic density, and relative collagen area. Results: Atheromatous plagues had been observed in the hyperthyroid group. Thinning and rupture of the elastic lamellae had been observed in the hypothyroid group; these were accompanied with intimal ulceration and aortic dissection. The average number of smooth muscle cell nuclei in the hyperthyroid group had doubled and tripled compared to their fellows in the control and hypothyroid groups, respectively. The thickness of the tunica media increased in the hyperthyroid and hypothyroid groups by 75% and 35%. In addition, the relative collagen area increased in the previously mentioned groups by 142% and 120%, respectively. On the other hand, the mean elastic fibre optic density decreased in both groups by 30%. Conclusions: Structure wall affections of the intima and media of the descending aorta were associated with the thyroid hormone dysfunctions. These changes were more severe in the hypothyroid group. (Folia Morphol 2013; 72, 4: 333–339)
EN
The voice is the basic communication tool, the color or quality of which may be affected by metabolic or endocrine diseases, as well as gastroesophageal reflux disease and laryngopharyngeal reflux disease. Obesity is the abnormal or excessive accumulation of fat, which poses a health risk. Changes in the body due to fat accumulation are likely to contribute to the ‘respiratory symptoms of obesity’ such as wheezing and breathlessness. The topic of the influence between obesity and the voice requires further research. Diabetes mellitus is a metabolic chronic disease in which the pancreas does not produce enough insulin or when the body cannot use it effectively. It is reported that patients with poor glycaemic control and neuropathy are characterised by a significant difference in voice assessment. Reflux disease is a chronic condition in which acidic gastric contents move into the oesophagus (GERD) or the pharynx or the larynx (LPRD). It is indicated that there are changes in voice quality in patients struggling with reflux disease compared to healthy individuals. Hypothyroidism and hyperthyroidism are conditions caused by an abnormal production of hormones by this gland. In their course, enlargement of the thyroid gland may occur, thereby constricting the vocal cords and causing dysphonia. This topic requires further research. Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of the reproductive age. The results of the studies on the correlation between PCOS and voice disorders are not consistent. The aim of this article is to draw attention to and emphasise how greatly the human voice organ is affected by common diseases that the 21st century man struggles with.
PL
Głos to podstawowe narzędzie komunikacji, na którego barwę czy jakość mogą wpływać schorzenia metaboliczne lub endokrynologiczne oraz choroba refluksowa. Otyłość to nieprawidłowe lub nadmierne nagromadzenie się tłuszczu, stanowiące zagrożenie zdrowotne. Zmiany zachodzące w organizmie z uwagi na odkładanie się tłuszczu prawdopodobnie przyczyniają się do wystąpienia „oddechowych objawów otyłości”, takich jak świszczący oddech czy duszność. Temat wpływu otyłości na głos wymaga dalszych badań. Cukrzyca to metaboliczna choroba przewlekła, w przebiegu której trzustka nie wytwarza wystarczającej ilości insuliny lub gdy organizm nie może jej skutecznie wykorzystać. Wskazuje się, iż osoby chore, ze słabą kontrolą glikemii oraz z neuropatią, cechują się istotną różnicą w ocenie głosu. Choroba refluksowa jest przewlekłym schorzeniem charakteryzującym się przemieszczaniem się kwaśnej treści żołądkowej do przełyku (GERD) lub też gardła czy krtani (LPRD). Wskazuje się, iż istnieją zmiany w jakości głosu u pacjentów zmagających się z chorobą refluksową w porównaniu z osobami zdrowymi. Niedoczynność oraz nadczynność tarczycy to schorzenia spowodowane zaburzoną produkcją hormonów przez ten gruczoł. W ich przebiegu może dojść do powiększenia tarczycy, a tym samym zwężenia strun głosowych i wystąpienia dysfonii. Temat ten wymaga dalszych badań. Zespół policystycznych jajników (PCOS) jest najczęstszym zaburzeniem hormonalnym u kobiet w wieku rozrodczym. Wyniki analizowanych badań dotyczących korelacji pomiędzy PCOS a zaburzeniami głosu nie są zgodne. Celem niniejszego artykułu jest zwrócenie uwagi i podkreślenie, jak ogromny wpływ na narząd ludzkiego głosu wywierają jednostki chorobowe, z jakimi zmaga się człowiek w XXI wieku.
EN
The connective tissue matrix of the heart remains under regulatory influence of the thyroid hormones. Some conflicting data describe the connective tissue changes in subjects with thyroid gland disorders. The aim of the study was to assess the changes of the connective tissue accumulation in the heart of rats in the state of hypothyroidism and to answer the question whether TSH is involved in mechanism of the observed phenomena. Hypothyroidism in rats was induced by methylotiouracil treatment or by thyreoidectomy. The thyroid hormones [freeT3 (fT3), freeT4 (fT4)] and pituitary TSH were measured in plasma with radioimmunological method. The glycosaminoglycans (GAG) and total collagen were measured in heart muscle of both left and right ventricles. Cells from the rat’s heart were isolated and cultured. The cells were identified as myofibroblasts by electron microscopy method. The effects of TSH in concentrations ranging from 0.002 to 20 mIU/ml, on connective tissue accumulation in heart myofibroblasts cultures were tested. The primary hypothyroidism was developed both in groups with thyroidectomy and with methylthiouracil. The levels of fT3 and fT4 both in rats with thyreoidectomy and animals treated with methylthiouracil were decreased and TSH level in these two experimental groups was elevated. In the heart of the rats with experimental hypothyroidism increased content of both GAG and collagen was found. Myofibroblast number in culture was increased by TSH. Regardless of the method of its induction, hypothyroidism increased collagen and GAG contents in the heart. TSH is not involved in regulation of collagen and glycosaminoglycans accumulation in the heart of rats affected with primary hypothyroidism.
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