Biomedical subjects

M E Girelli

Publications and source records attributed to M E Girelli.

At least 37 records · Page 2Linked to original sources

PubMed1993

Course of depression in Cushing's syndrome: response to treatment and comparison with Graves' disease.

Depression in a common, life-threatening complication of Cushing's syndrome and may occur in several other endocrine disorders. It is not clear, however, whether distinct features pertain to hypercortisolism. We studied depression in Cushing's syndrome differentiating pituitary-dependent and pituitary-independent forms, its incidence compared to Graves' disease, and its appearance in the prodromal phase of both conditions. To 66 consecutive patients with Cushing's syndrome and 70 with Graves' disease, after treatment, a semistructured interview for depressive symptoms based on Paykel's clinical interview for depression was administered. In Cushing's syndrome, the response of depression to normalization of urinary cortisol levels was evaluated by Kellner's global rating method. There was a significant difference in the occurrence of depression (p < 0.001) between Cushing's syndrome (62%) and Graves' disease (23%). Depression appeared in the prodromal phase in 27% of patients with Cushing's syndrome and in 14% of those with Graves' disease, but the difference was not significant. In Cushing's syndrome, there were no significant differences in depression between patients with pituitary-dependent (n = 41) and pituitary-independent (n = 20) forms, or in their response to treatment. About 70% of patients fully recovered from their depression, whereas there was no substantial change in the others and even worsening in 2. Our findings in Cushing's syndrome and Graves' disease are in agreement with previous investigations using specific diagnostic criteria for depression. We found a tendency for this symptom to manifest in the prodromal phase of both illnesses. An endocrine etiology should be, therefore, considered in depressed patients not responding to standard psychiatric treatment.

Adult↗

PubMed1993

Life events in the pathogenesis of Graves' disease. A controlled study.

Contradictory findings have been reported about a possible causal relationship of life stress to Graves' disease. We evaluated this issue by investigating the occurrence of stressful life events in the year before the first signs of disease onset, using methods that have been found to be valid and reliable in psychosomatic research. Seventy consecutive patients with Graves' disease and a control group of 70 healthy subjects, matched for sociodemographic variables, were studied. Paykel's Interview for Recent Life Events (a semistructured research interview covering 64 life events) was administered to patients, not during the acute phase of illness but while on remission, by antithyroid drug treatment. Patients with Graves' disease reported significantly more life events compared to controls (p < 0.001). They also had more independent events (p < 0.001) and events that had an objective negative impact (p < 0.001) according to an independent rater, unaware whether the events had occurred in patients or controls. All categories of events were found to be significantly more frequent in patients suffering from Graves' disease than in controls. By rigorous methods (inclusion of patients with Graves' disease only, careful dating of the onset of symptoms, accurate event definition, delay of the interview upon disease remission, use of a blind rater for judging independence and objective negative impact), our results support the concept of an excess of life events in Graves' disease. Stressful life events may affect the regulatory mechanisms of immune function in a number of ways. Within the extreme complexity of the phenomena implicated in the pathogenesis of autoimmune thyroid hyperfunction, our findings emphasize the role of emotional stress.

Adolescent↗

PubMed1993

[Medullary thyroid carcinoma: prognostic factors].

Fifty-one patients treated by total thyroidectomy plus nodal neck dissection of necessity for medullary thyroid carcinoma (MTC) with a minimum follow-up of 10 years (mean 14.5, max 22 years) were divided into three groups according to the outcome (alive disease-free; alive with disease; dead) and were compared in order to analyze the prognostic factors of MTC. Twenty years actuarial survival rate for age at diagnosis less than 50 years versus age over 50 (90% vs 45%) as well as for stage II versus stage III (85% vs 55%) was statistically different (p < 0.005 and p < 0.05 respectively). About 60% of recurrences were observed within 5 years after surgical treatment. Recurrence rate for stage III (70%) versus stage II (20%) was statistically different, but it was not for the age. Survival rate for patients with bony metastases (50% at 1 and 30% at 3 years) versus patients with other than bony metastases (100% at 10 years) was statistically different.

Actuarial Analysis↗

PubMed1993

TSH-receptor antibody (TSH-R Ab) variations in patients undergoing subtotal thyroidectomy for Graves' disease: a prospective study.

Variations in circulating TSH-R Ab were correlated to the thyroid function outcome in a group of 43 patients who received subtotal thyroidectomy for Graves' disease. There were 36 females and 7 males, ranging in age from 18 to 63 years (mean +/- SD = 41.3 +/- 9.5 years). All patients were operated on by the same surgeon, with the same surgical technique, leaving a remnant of 4-5 grams of thyroid. When a condition of subclinical hypothyroidism was found after surgery, thyroid function was tested again within 2-3 months. Thus, in cases with persisting elevated TSH levels, L-thyroxine was administered. During follow-up a progressive decrease in the prevalence of euthyroid patients was documented (51.2% at 3 months, 30.2% at 2 years, 28% at 4 years), with a parallel increase in cases of subclinical and overt hypothyroidism. Two patients with persisting detectable TSH-R Abs showed recurrent disease within 2 years after surgery. No case of relapse was observed among patients who became TSH-R Ab negative. TSH-R Abs remained detectable in 68% of euthyroid and in 63.6% of subclinical hypothyroid patients before L-thyroxine administration, whereas TSH-R Abs remained positive in only 30% of patients with overt hypothyroidism, and became undetectable in most patients with subclinical hypothyroidism after L-thyroxine was begun. The persistence of TSH-R Abs in patients who have undergone surgery for Graves' disease should be considered a risk condition for relapse. These patients must be carefully followed-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Different features of pulmonary metastases in differentiated thyroid cancer: natural history and multivariate statistical analysis of prognostic variables.

We studied 134 patients with differentiated thyroid cancer and pulmonary metastases. All were treated with total or near total thyroidectomy, radioiodine and L-thyroxine. The prognostic value of the following variables in three groups of patients were evaluated by univariate and multivariate analysis: age at diagnosis, sex, histologic type, tumor extension, cervical lymph node metastases, mediastinic metastases, presence of metastases in distant sites other than lungs (multiple distant metastases) and morphological (chest x-rays) and functional (131I uptake) features of lung metastases. Univariate analysis identified patient age (p < 0.0001), morphological and functional features of lung metastases (p < 0.0001), presence of multiple distant metastases (p < 0.0001) and histologic type (p = 0.04) as significant prognostic factors. Multivariate analysis showed only morphological (p = 0.0014) and functional (p < 0.0001) features of lung metastases and the presence of multiple distant metastases (p = 0.01) as significant and independent variables. The data show that early (pre-radiological) scintigraphic diagnosis and 131I therapy of lung metastases appear to be the most important elements in obtaining both a significant improvement in survival rate and a prolonged disease-free time interval in these patients.

Adenocarcinoma, Follicular↗

PubMed1992

Acute and chronic effects of high glucocorticoid levels on hypothalamic-pituitary-thyroid axis in man.

It is known that glucocorticoids can influence anterior pituitary hormones other than ACTH. Their effects on the hypothalamic-pituitary-thyroid axis are controversial. To further investigate this issue, the acute and chronic effects of high plasma cortisol levels on TSH secretion were evaluated in 20 normal subjects and in 14 patients with Cushing's syndrome. In normals, high plasma cortisol levels were obtained by giving ACTH 250 micrograms or CRH 100 micrograms iv as a bolus or by an hydrocortisone 500 mg infusion over 1 h. Acute cortisol increase produced no effect both on basal and TRH-stimulated TSH secretion. In patients with Cushing's syndrome, basal TSH levels, low or suppressed, showed an impaired response to TRH, inversely correlated with urinary cortisol values. After successful surgery, TSH and its response to TRH became normal in concomitance with the normalization of plasma and urinary cortisol levels. Our data show the lack of an acute inhibitory effect of high plasma cortisol levels on TRH-TSH axis. However, after long-term exposure to high plasma cortisol levels, i.e. Cushing's syndrome, inhibition of both basal and TRH-stimulated TSH secretion was demonstrated. These findings indicate that only prolonged hypercortisolism does interfere with pituitary TSH secretion. The underlying mechanisms are still unclear.

Adrenocorticotropic Hormone↗

PubMed1992

Clinical meaning of circulating antithyroglobulin antibodies in differentiated thyroid cancer: a prospective study.

In recent studies of patients with differentiated thyroid cancer (DTC), an association between the persistence of tumor and the presence of circulating anti-thyroglobulin antibodies (TgAbs) have been described. The aim of the present study was to evaluate TgAb variations before and after total thyroid ablation and to correlate TgAb levels to the outcome of disease. Forty-three patients with DTC were studied (35 female, 8 male; 33 patients had papillary cancer and 10 follicular cancer). Tumor was intrathyroid in 20 cases, had spread to the lymph nodes in 19 and to the lungs in 4. All patients underwent total thyroidectomy and 131I therapy, and were then treated by suppressive doses of L-thyroxine. After a mean follow-up of 3.55 yr, TgAbs became undetectable in 24 patients (all were considered tumor-free), whereas TgAbs remained elevated in 19 cases. In 5 of these 19 patients, disease progression or persistence was documented (to the lymph nodes in three and to the lungs in two). TgAb levels were higher in patients with persistent disease in comparison with those tumor-free. Serum thyroglobulin (S-Tg) results were only elevated in the two patients with persistent disease in the lungs. Our data suggest that TgAbs determination may give some additional information to the follow-up of patients with DTC: the disappearance of TgAbs after therapy seems to represent a favorable prognostic factor, while the persistence of circulating TgAbs, particularly at high levels and in the absence of detectable S-Tg, may be representative of disease.

Adenocarcinoma↗

PubMed1991

Expression of class I and II human leukocyte antigens by thyrocytes and lymphocytic infiltration on human thyroid tumors. An immunofluorescence study.

Surgical thyroid sections from 30 papillary carcinomas (PC), six medullary carcinomas (MC), three anaplastic carcinomas (AC), two follicular carcinomas (FC), and 16 adenomas (AD) were examined with an indirect immunofluorescence technique employing different monoclonal antibodies to evaluate the expression of human leukocyte antigen (HLA)-A, B, C (Class I) and DR, DP, DQ (Class II) by thyrocytes, together with the phenotype and distribution of inflammatory cells. Ten PC and four FC were also investigated for the presence of intercellular adhesion molecule-1 (ICAM-1). In situ deposits of immunocomplexes and circulating thyroid autoantibodies were also evaluated. An increased expression of Class I antigens was found in all PC and FC, in 33% of MC and AC, and in 31% of AD. An anomalous expression of Class II antigens was observed in 70% of PC, in 50% of FC, in 33% of AC, in 19% of AD, and in none of the MC. Expression of DP or DQ was revealed only in a portion of the DR-positive glands. A reduction of microsomal autoantigen expression was found. No ICAM-1-positive thyrocytes were detected. A moderate T-lymphocytic infiltrate was noticed only in PC, where it was correlated with DR and DP and/or DQ coexpression. B-cells and natural killer cells were virtually absent. The authors speculate that the weak Class II antigens expression, together with the partial or complete loss in microsomal autoantigen and the absence of ICAM-1 by thyrocytes, may account for the limited engagement of immunocompetent cells observed in thyroid tumors.

Adenoma↗

PubMed1991

Combined chemotherapy with bleomycin, adriamycin, and platinum in advanced thyroid cancer.

Twenty-two advanced consecutive thyroid cancer patients with varying histologies were treated with the so called BAP regime which consisted of bleomycin (B) 30 mg a day for three days, adriamycin (A) 60 mg/m2 iv in day 5, and cisplatinum (P) 60 to mg/m2 iv in day 5. Patients with progressive, symptomatic recurrent or disseminated disease unresponsive to hormonal and/or isotopic treatment were eligible. Nine patients had an objective response: two long-lasting complete and seven partial responses were observed out of 21 evaluable patients. Stable disease was observed in four additional patients. The median duration of response was 12 months (range, 6-29). The total series experienced a median survival of 11 months (range, 1 to 57), with 2 patients actually disease free. Several histologic types of thyroid carcinoma responded, but the best responses were observed in medullary and anaplastic giant-cell carcinomas. Toxicity was reversible in all but one patient. Of the patients failing on BAP chemotherapy three responded to a four drug second line combination containing vincristine, fluorouracil, BCNU and methotrexate. BAP regime can achieve reasonable palliation, and probably increases survival, in poor-prognosis thyroid cancers.

Adenocarcinoma↗

PubMed1990

Thyroid function in patients with Down syndrome: preliminary results from non-institutionalized patients in the Veneto region.

We investigated thyroid function of 108 home-reared Down syndrome (DS) patients. Five had overt hypothyroidism, 2 were hyperthyroid, and 33 had high TSH values with an exaggerated response to TRH test despite hormone levels in the normal range. This finding indicated subclinical hypothyroidism. Antithyroid antibodies (antimicrosome and antithyroglobulin) were present in 13 patients. At the same time we investigated 73 parents: only one mother was hypothyroid and antithyroid autoantibodies were found in only 8% of Down syndrome parents.

Adolescent↗

PubMed1990

Severe hyperthyroidism due to metastatic papillary thyroid carcinoma with favorable outcome.

A case of extremely severe hyperthyroidism due to bone metastasis of papillary thyroid cancer is described. Hyperthyroidism began in this patient soon after the discovery of pelvic metastasis and worsened after total thyroidectomy and after the first dose of radioiodine. The administration of methimazole, prednisone and multiple, fractioned and small doses of radioiodine cured the hyperthyroidism and stabilized the neoplastic growth. Hyperthyroidism lasted for at least six months and hypothyroidism appeared only after seven months. Thus, the fractionation of the doses of radioiodine together with antithyroid drugs appears to be an effective treatment in patients with hyperthyroidism due to metastatic thyroid cancer.

Aged↗

PubMed1990

Usefulness of the combined antithyroglobulin antibodies and thyroglobulin assay in the follow-up of patients with differentiated thyroid cancer.

A total of 1050 patients with differentiated thyroid cancer (DTC) have been followed in the Thyroid Center of Padua by means of serum thyroglobulin (Tg) measured with IRMA method and anti-Tg antibodies (TgAb) assays. Circulating TgAbs were detected in 102 (9.7%) patients. In 32 of these 102, TgAbs were evaluated before and after total thyroidectomy and 131I ablation. In these patients no relationship was found between preoperative serum TgAb levels on the one hand and tumor stage at diagnosis or outcome of the disease on the other. During the follow-up, TgAb serum levels decreased or disappeared in 21 cases considered tumor-free, while they remained unchanged or even increased, in comparison with the preoperative ones, in 11 patients, 5 with proven metastases and 6 considered tumor-free. Evaluating the whole group of 102 TgAb-positive patients, we observed that TgAb serum levels, measured after thyroid ablation, were significantly higher in cases with metastases than in those considered tumor-free (653.0 +/- 196.9 vs 157.7 +/- 116.5 U/ml, m +/- SD, p less than 0.0001). In the group of patients with metastases and circulating TgAbs, Tg serum levels were elevated in 27% of cases on TSH-suppressive therapy and in 44% off therapy when nodal metastases were present, and in 67% of cases on TSH-suppressive therapy and in 83% off therapy when distant metastases were present.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1989

Favorable long term results in patients with small differentiated thyroid cancer not treated with radioiodine.

Data on a group of 110 patients with differentiated thyroid cancer not treated by radioiodine are reported. Most of them had intrathyroid (stage I) papillary or capsuled follicular cancer of less than 3 cm diameters. They all received thyroxine at TSH suppressive doses. The follow-up ranged between 4 and 25 years, mean 8.7. No patient died of tumor. Two very old patients died free of disease. Four recurrences occurred, within 8 years, all in patients over 45 years, all local or nodal, all papillary, 3 out of 4 after total thyroidectomy. This study shows that radioiodine therapy may be avoided and that lobectomy may be sufficient in patients under 45 years with small papillary or capsuled follicular cancer.

Adolescent↗

PubMed1989

Severe hyperthyroidism due to neoplastic TSH hypersecretion in an old man.

A case is reported of neoplastic TSH hypersecretion in a 62-year-old man with severe hyperthyroidism and cardiovascular disease. He had been known to be hyperthyroid for 14 yr, and had been treated by thyreostatic drugs and subtotal thyroidectomy without satisfactory results. When he was referred to our Center, he was frankly hyperthyroid with both TSH (14 microU/ml) and thyroid hormone serum levels (TT4 24 micrograms/dl, TT3 370 ng/dl, FT41 7.9) above the normal range. alpha-subunit serum level was markedly increased (7.2 ng/ml), while beta-subunit was only 0.3 ng/ml. Skull X-ray showed an enlarged sella turcica with destruction of the dorsum and an intrasellar tumor was visualized on conventional and computer tomography. TSH response was absent after TRH and domperidone, while TSH serum levels decreased by 25% after bromocriptine. Methimazole therapy temporarily decreased serum thyroid hormones to normal levels, while TSH levels rose to 34 microU/ml, thus indicating that pituitary-thyroid feed-back was maintained at a higher set point. Surgical attempt failed because of cardiac problems during anesthesia. Radiotherapy plus methimazole was begun and TSH serum levels first increased markedly, up to 140 microU/ml, and then progressively decreased without reaching normal values. After methimazole withdrawal hyperthyroidism recurred.

Bromocriptine↗

PubMed1988

Long term thyroid function after subtotal thyroidectomy for Graves' disease.

Between 1973 and 1980, 93 patients with Graves' disease underwent subtotal thyroidectomy by the same surgeon (the size of thyroid remnant was 4 g per side). No case of operative mortality, no case of thyroid storm nor of surgical complications occurred. Three months after surgery 40% of patients were euthyroid, 25% had overt hypothyroidism, 35% had subclinical hypothyroidism. In the following yr important variations of thyroid function were observed. The number of patients with subclinical hypothyroidism decreased slowly (22% and 9% at 3 and 6 yr, respectively), and some became euthyroid, some hypothyroid, others relapsed. Seven patients had recurrent hyperthyroidism. In particular at 3 yr 45% of patients were euthyroid, 28% had overt hypothyroidism, 22% had subclinical hypothyroidism, 4% had recurrence; at 6 yr 56% were euthyroid, 32% had overt hypothyroidism, 9% had subclinical hypothyroidism, 3% had recurrence. Four out of the 8 patients operated under 20-yr-old became hypothyroid in comparison with only 2 out of the 15 patients over 50-yr-old. Relapses were present only in patients operated at less than 40-yr and only in females. No correlation was found between thyroid lymphocytic infiltration and thyroid function after surgery, nor between the presence of antithyroid antibodies and hypothyroidism. All cases who relapsed had high TMA titers both before and after operation. This study confirms the need for accurate follow-up after subtotal thyroidectomy for Graves' disease.

Adolescent↗

PubMed1987

Acute and chronic effects of dextro-thyroxine on pituitary thyroid axis and on reverse triiodothyronine production in euthyroid subjects.

Serum levels of thyroxine (T4), triiodothyronine (T3), reverse triiodothyronine (rT3) and TSH were measured in euthyroid subjects after a single dose of 4 mg D-thyroxine (DT4) or of 0.25 mg L-thyroxine (LT4). The same parameters and TSH response to TRH were also evaluated in 7 dyslipidemic patients before and after one month of treatment with 6 mg DT4. T4 levels increased about 165% at h 4 after DT4 and only 47% after LT4; T3 levels remained unchanged until h 10 both after DT4 and after LT4; rT3 levels increased almost 179% after DT4 and only 32% after LT4. TSH levels decreased about 30% after both DT4 and LT4. In the long term study similar variations of the same parameters were observed: basal TSH levels decreased and TSH response to TRH was inhibited in all patients but one; T4 levels increased 62%, T3 levels increased 35%, while rT3 levels increased 545%. Our results show that: both acute and long-term treatment with DT4 suppress TSH secretion; DT4 both in acute and in long-term administration, is preferentially dealogenated in the alaninic ring with production of rDT3, instead of in the phenolic ring with production of DT3. This may contribute to explain its lower metabolic activity.

Adult↗

PubMed1987

Thyroid autoantibodies: a good marker for the study of symptomless autoimmune thyroiditis.

In 3737 subjects without clinically thyroid disorders we evaluated the incidence of thyroid microsomal and thyroglobulin antibodies. These autoantibodies were found in 7% of a normal population, in 9% of patients with various non-autoimmune diseases, and in 11-16% of groups who either had or were at risk for autoimmune diseases: patients with IDDM, vitiligo, alopecia areata, idiopathic hypoparathyroidism, Addison's disease, and first-degree relatives of IDDM patients. Functional thyroid evaluation with TRH test was performed in 197 seropositive subjects and 144 seronegative controls. One-quarter (26%) of the subjects with thyroid autoantibodies showed functional abnormalities on TRH testing, whereas only 2.8% of the 144 seronegative controls showed subclinical hypothyroidism. After an observation period of 12-44 months, 102 persistently seropositive subjects were reassessed and 31% of them showed an impairment in TRH test response.

Adult↗

PubMed1986

Critical evaluation of serum thyroglobulin (Tg) levels during thyroid hormone suppression therapy versus Tg levels after hormone withdrawal and total body scan: results in 291 patients with thyroid cancer.

Serum thyroglobulin (Tg) levels were measured during thyroid-hormone suppressive therapy in 291 patients who had been treated for well-differentiated thyroid carcinoma. The findings were compared with those of a subsequent total body scan (TBS) and with Tg levels measured after thyroid-hormone withdrawal. Of the patients with low Tg levels during suppressive therapy, 91.6% were subsequently shown to be free of disease or to have only remnants in the thyroid bed, whereas 8.4% had metastases (false-negative). Of the patients with false-negative findings, 89.3% had nodal metastases; 60.8% of the patients with nodal metastases exhibiting radioiodine uptake and only 23% of those with nonfunctioning nodal metastases had low Tg levels during suppression therapy. After thyroid-hormone withdrawal, all but 1 of the patients with nodal metastases had high Tg levels. All but 2 of the patients with distant metastases had high Tg levels during suppression therapy; 1 of these 2 patients exhibited high Tg levels after T3 withdrawal. No differences between Tg levels in patients with functioning and non-functioning metastases were found. Our study indicates that Tg assays performed during suppressive therapy have a fairly good predictive value and can be used as a general guide in the follow-up of thyroid cancer. However, since most differentiated metastases produce Tg only when stimulated by thyroid-stimulating hormone, measurements of Tg levels after the discontinuation of suppressive therapy would also seem to be necessary.

Adolescent↗