المؤلفون: Capriello, Silvia, Ferrari, Silvia Martina, Gatto, Ilenia, Santaguida, Maria Giulia, Fallahi, Poupak, Antonelli, Alessandro, Mangino, Giorgio, Romeo, Giovanna, Virili, Camilla, Centanni, Marco

المساهمون: Capriello, Silvia, Ferrari, Silvia Martina, Gatto, Ilenia, Santaguida, Maria Giulia, Fallahi, Poupak, Antonelli, Alessandro, Mangino, Giorgio, Romeo, Giovanna, Virili, Camilla, Centanni, Marco

مصطلحات موضوعية: B regulatory cell, Hashimoto’s thyroiditi, Th17, polyautoimmunity, systemic sclerosi, human, interleukin-10, autoimmune disease, B-Lymphocytes, regulatory, Hashimoto disease, scleroderma, systemic

الوصف: Systemic sclerosis (SSc) is a systemic autoimmune disease in which gastrointestinal disorders represent a complication in up to 90% of patients. SSc may associate with thyroid autoimmune disorders, with Hashimoto's thyroiditis (HT) being the more prevalent worldwide. Previous studies have examined the behavior of Th17 lymphocytes and Breg cells in patients with HT and concomitant autoimmune organ-specific disorders. These immune phenotypes seem to play a significant role in the pathogenesis of both these autoimmune processes, but their behavior when these two disorders coexist has not been described. We analyzed Th17 and Breg (CD24hiCD38hi) cell subsets in 50 subjects (45F/5M; median age = 49 years): 18 were healthy donors (HD), 20 had isolated HT, and 12 had SSc, seven of whom had both HT and SSc. Breg cells' function was also evaluated by measuring their IL-10 production when stimulated by specific activators. An increased percentage of Th17 lymphocytes characterized HT patients as compared to both HD and the whole group of SSc patients (p = 0.0018). On the contrary, the percentage of unstimulated Breg cells in SSc patients was higher (p = 0.0260), either associated or not with HT, as compared to both HT patients and HD, which, instead, showed a similar percentage of Breg cells. Following a specific stimulation with CpG, the percentages of Breg cells were increased in the whole sample of SSc patients (p < 0.001) as well as in isolated SSc and in SSc+HT ones as compared to isolated HT. However, qualitative analysis, obtained through the detection of the IL-10-producing phenotype, revealed that the percentage of CpG-stimulated CD24hiCD38hi-IL10+cells was significantly decreased in SSc patients (p < 0.0001) with no difference between isolated SSc and SSc+HT patients. The IL-10-producing phenotype was instead slightly increased in HT patients as compared to HD (4.1% vs. 2.8%). The presence of SSc seems to be characterized by an enrichment of total Breg cells but by a reduced Breg IL-10-producing phenotype, ...

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/35874691; info:eu-repo/semantics/altIdentifier/wos/WOS:000829250800001; volume:13; firstpage:1; lastpage:8; numberofpages:8; journal:FRONTIERS IN IMMUNOLOGY; http://hdl.handle.net/11573/1652724Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85134307246

الإتاحة: https://doi.org/10.3389/fimmu.2022.921260Test
http://hdl.handle.net/11573/1652724Test

المؤلفون: Virili, Camilla, Capriello, Silvia, Stramazzo, Ilaria, Brusca, Nunzia, Santaguida, Maria Giulia, Gargano, Lucilla, Bagaglini, Maria Flavia, Bruno, Giovanni, Severi, Carola, Centanni, Marco

المساهمون: Virili, Camilla, Capriello, Silvia, Stramazzo, Ilaria, Brusca, Nunzia, Santaguida, Maria Giulia, Gargano, Lucilla, Bagaglini, Maria Flavia, Bruno, Giovanni, Severi, Carola, Centanni, Marco

مصطلحات موضوعية: hypothyroidism, atrophic gastriti, gastric juice pH, levothyroxine malabsorption, levothyroxine softgel

الوصف: BackgroundSoftgel levothyroxine (LT4) preparation showed a better in vitro dissolution profile at increasing pH as compared to tablet LT4 preparation. Clinical studies suggested a better performance of softgel LT4 preparation in patients with gastric disorders but whether this finding is related to gastric juice pH variation in vivo is not known. MethodsTwenty-eight hypothyroid patients (24F/4M; median age=50 treated with tablet LT4 (median dose= 1.65 mu g/kg/day) and with stable thyroid stimulating hormone (TSH) values on target ( mU/l) have been shifted to softgel LT4 preparation. The dose of softgel LT4 has been titrated to obtain a similar individual serum TSH value. All subjects followed a specific treatment schedule, taking LT4 in fasting condition and then abstaining from eating or drinking for at least 1 hour. Owing to the presence of long-lasting dyspepsia or of already known gastric disorders, all patients underwent endoscopy, upon informed consent. Gastric juice has been collected during endoscopy to measure gastric pH. Then we plotted the dose of LT4 with the gastric pH obtained in vivo, before and after the switch tablet/softgel preparation in all patients. ResultsUpon the switch tablet/softgel preparation, the therapeutic LT4 dose was very slightly reduced (-6%) in the whole sample. However, the individual variations revealed the existence of two populations, one without any dose reduction (A) and the other showing a dose reduction >20% (B). Upon matching with the actual gastric pH, patients with normal pH (A: n=17; 14F/3M, median 1.52) no showed a lower softgel LT4 requirement. Instead, among patients with reduced gastric acid production (B: n=11; 10F/1M, median pH 5.02) the vast majority (10/11; 91%, p<0.0001) benefited from a lower dose of softgel LT4 (median = -23%, p<0.0001). Interestingly, the dose of LT4 in tablet correlated with pH value (Spearman's rho =0.6409; p = 0.0002) while softgel dose was independent from gastric juice pH (Spearman's rho =1.952; p = 0.3194). ...

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/36225208; info:eu-repo/semantics/altIdentifier/wos/WOS:000867374200001; volume:13; firstpage:1; lastpage:8; numberofpages:8; journal:FRONTIERS IN ENDOCRINOLOGY; https://hdl.handle.net/11573/1672004Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85139565044

الإتاحة: https://doi.org/10.3389/fendo.2022.1002583Test
https://hdl.handle.net/11573/1672004Test

المؤلفون: Virili, Camilla, Bruno, Giovanni, Santaguida, Maria Giulia, Gargano, Lucilla, Stramazzo, Ilaria, De Vito, Corrado, Cicenia, Alessia, Scalese, Giulia, Porowska, Barbara, Severi, Carola, Centanni, Marco

المصدر: Endocrine ; volume 77, issue 1, page 102-111 ; ISSN 1559-0100

مصطلحات موضوعية: Endocrinology, Endocrinology, Diabetes and Metabolism

الوصف: Purpose Despite the absorption of oral thyroxine (T4) occurs in the small bowel, several patients with gastric disorders show an increased need for T4. In vitro evidence suggested that medium pH variations interfere with T4 dissolution. This study was aimed at finding the proof of concept of a direct relationship between the minimal effective dose of T4 and the actual gastric juice pH. Patients and methods Among 311 consecutively thyroxine-treated patients, 61 bearing Hashimoto’s thyroiditis (52 F/9 M; median age = 51 years) who complained persistent dyspepsia and/or upper abdominal symptoms following a noninvasive workup for gastrointestinal disorders, underwent EGDS with multiple biopsies and gastric juice pH measurement. All patients accepted to take thyroxine in fasting conditions, abstaining from eating or drinking for one hour. Results Thyroxine requirement increased along with the rising gastric pH ( ρ = 0.4229; p = 0.0007). A multivariate analysis revealed that gastric pH was, beside body mass index, the far more important independent variable in determining the effective dose of T4 ( p = 0.001). The ROC curve revealed that the pH threshold for an increased thyroxine requirement was at 2.28, being the AUC by 78%. Subdividing patients by the histologic findings, it appeared a significant increase ( p = 0.0025) along with the progressive damage of gastric mucosa. Conclusion The in vivo measurement of gastric pH highlighted its key role in determining the minimal effective dose of oral T4 and may explain the interference of food, of some drugs and gut disorders on levothyroxine treatment

الإتاحة: https://doi.org/10.1007/s12020-022-03056-1Test

المؤلفون: Cozzolino, Alessia, Filardi, Tiziana, Simonelli, Ilaria, Grani, Giorgio, Virili, Camilla, Stramazzo, Ilaria, Santaguida, Maria Giulia, Locantore, Pietro, Maurici, Massimo, Gianfrilli, Daniele, Isidori, Andrea M, Durante, Cosimo, Pozza, Carlotta, ,

المصدر: European Thyroid Journal ; volume 11, issue 3 ; ISSN 2235-0802

مصطلحات موضوعية: Endocrinology, Diabetes and Metabolism

الوصف: Context Significant uncertainty exists about the diagnostic accuracy of ultrasonographic (US) features used to predict the risk of thyroid cancer in the pediatric population. Moreover, there are no specific indications for thyroid nodule evaluation in patients during the transition age. Objective The meta-analysis aimed to address the following question: which thyroid nodule US features have the highest accuracy in predicting malignancy in the transition age. Methods We performed a meta-analysis of observational/cohort/diagnostic accuracy studies dealing with thyroid nodule sonography, reporting US features, and using histology as a reference standard for the diagnosis of malignancy and histology or cytology for the diagnosis of benignity in the transition age (mean/median age 12–21 years). Results The inclusion criteria were met by 14 studies, published between 2005 and 2020, including 1306 thyroid nodules (mean size 17.9 mm) from 1168 subjects. The frequency of thyroid cancer was 36.6%. The US features with the highest diagnostic odds ratio (DOR) for malignancy were the presence of suspicious lymph nodes (DOR: 56.0 (95% CI: 26.0–119.0)), a ‘taller than wide’ shape of the nodule (6.0 (95% CI: 2.0–16.0)), the presence of microcalcifications (13.0 (95% CI: 6.0–29.0)) and irregular margins (9.0 (95% CI: 5.0–17.0)). Heterogeneity among the studies was substantial. Conclusions Following the diagnosis of a thyroid nodule in the transition age, a thorough US examination of the neck is warranted. The detection of suspicious lymph nodes and/or thyroid nodules with a ‘taller than wide’ shape, microcalcifications, and irregular margins is associated with the highest risk of malignancy in the selection of nodules candidates for biopsy.

الإتاحة: https://doi.org/10.1530/etj-22-0039Test
https://etj.bioscientifica.com/view/journals/etj/11/3/ETJ-22-0039.xmlTest
https://etj.bioscientifica.com/downloadpdf/journals/etj/11/3/ETJ-22-0039.xmlTest

المؤلفون: Grani, Giorgio, Zatelli, Maria Chiara, Alfò, Marco, Montesano, Teresa, Torlontano, Massimo, Morelli, Silvia, Deandrea, Maurilio, Antonelli, Alessandro, Francese, Cecilia, Ceresini, Graziano, Orlandi, Fabio, Maniglia, Adele, Bruno, Rocco, Monti, Salvatore, Santaguida, Maria Giulia, Repaci, Andrea, Tallini, Giovanni, Fugazzola, Laura, Monzani, Fabio, Giubbini, Raffaele, Rossetto, Ruth, Mian, Caterina, Crescenzi, Anna, Tumino, Dario, Pagano, Loredana, Pezzullo, Luciano, Lombardi, Celestino Pio, Arvat, Emanuela, Petrone, Luisa, Castagna, Maria Grazia, Spiazzi, Giovanna, Salvatore, Domenico, Meringolo, Domenico, Solaroli, Erica, Monari, Fabio, Magri, Flavia, Triggiani, Vincenzo, Castello, Roberto, Piazza, Cesare, Rossi, Roberta, Ferraro Petrillo, Umberto, Filetti, Sebastiano, Durante, Cosimo

المساهمون: Grani, Giorgio, Zatelli, Maria Chiara, Alfò, Marco, Montesano, Teresa, Torlontano, Massimo, Morelli, Silvia, Deandrea, Maurilio, Antonelli, Alessandro, Francese, Cecilia, Ceresini, Graziano, Orlandi, Fabio, Maniglia, Adele, Bruno, Rocco, Monti, Salvatore, Santaguida, Maria Giulia, Repaci, Andrea, Tallini, Giovanni, Fugazzola, Laura, Monzani, Fabio, Giubbini, Raffaele, Rossetto, Ruth, Mian, Caterina, Crescenzi, Anna, Tumino, Dario, Pagano, Loredana, Pezzullo, Luciano, Lombardi, Celestino Pio, Arvat, Emanuela, Petrone, Luisa, Castagna, Maria Grazia, Spiazzi, Giovanna, Salvatore, Domenico, Meringolo, Domenico, Solaroli, Erica, Monari, Fabio, Magri, Flavia, Triggiani, Vincenzo, Castello, Roberto, Piazza, Cesare, Rossi, Roberta, Ferraro Petrillo, Umberto, Filetti, Sebastiano, Durante, Cosimo

مصطلحات موضوعية: differentiated thyroid cancer, evidence based guideline, clinical practice, risk stratification

الوصف: Background: One of the most widely used risk stratification systems for estimating individual patients' risk of differentiated thyroid cancer (DTC) persistence or recurrence is proposed by the American Thyroid Association (ATA) guidelines. The 2015 revision, that has increased the number of patients considered at low or intermediate risk, has been validated in several retrospective, single referral-center studies. The aims of this study were to evaluate the real-world performance of the 2015 ATA Risk Stratification System in predicting the response to treatment 12 months after the initial treatment and to determine the extent to which this performance is affected by the treatment center in which it is used. Methods: A prospective cohort of DTC patients collected by the Italian Thyroid Cancer Observatory (ITCO) web-based database was analyzed. We reviewed all records present in the database and selected consecutive cases that satisfied inclusion criteria: 1) histological diagnosis of DTC, with the exclusion of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP); 2) complete data of the initial treatment and pathological features; 3) results of 1-year follow-up visit (6-18 months after the initial treatment), including all data needed to classify the estimated response to treatment. Results: The final cohort was composed of 2071 patients from 40 centers. The ATA risk of persistent/recurrent disease was classified as low in 1109 patients (53.6%), intermediate in 796 (38.4%), and high in 166 (8.0%). Structural incomplete responses were documented in only 86 (4.2%) patients: 1.5% in the low-risk, 5.7% in the intermediate-risk, and 14.5% in the high-risk group. The baseline ATA risk class proved to be a significant predictor of structural persistent disease, both for intermediate- (OR 4.67; 95% CI 2.59-8.43) and high-risk groups (OR 16.48; 95% CI 7.87-34.5). The individual recruiting center did not significantly influence the prediction of the 1-year status. Conclusions: The ATA risk ...

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/32475305; info:eu-repo/semantics/altIdentifier/wos/WOS:000547645900001; volume:31; issue:2; firstpage:264; lastpage:271; numberofpages:8; journal:THYROID; http://hdl.handle.net/11573/1408376Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85091392452

الإتاحة: https://doi.org/10.1089/thy.2020.0272Test
http://hdl.handle.net/11573/1408376Test

المؤلفون: Cellini, Miriam, Santaguida, Maria Giulia, Stramazzo, Ilaria, Capriello, Silvia, Brusca, Nunzia, Antonelli, Alessandro, Fallahi, Poupak, Gargano, Lucilla, Centanni, Marco, Virili, Camilla

المساهمون: Cellini, Miriam, Santaguida, Maria Giulia, Stramazzo, Ilaria, Capriello, Silvia, Brusca, Nunzia, Antonelli, Alessandro, Fallahi, Poupak, Gargano, Lucilla, Centanni, Marco, Virili, Camilla

مصطلحات موضوعية: recurrent pregnancy loss, miscarriage, Hashimoto's thyroiditis, hypothyroidism

الوصف: BACKGROUND: An increased rate of recurrent miscarriage has been described in patients with autoimmune thyroid disease. However, there is a lack of studies that assess the rate of recurrent pregnancy loss (RPL) in patients with Hashimoto's thyroiditis (HT) isolated or with concurrent non-endocrine autoimmune disorders (NEAD). The objective of the study was to assess the rate of recurrent pregnancy loss in patients with HT isolated or accompanied with non-endocrine autoimmune diseases. METHODS: This is a retrospective observational cohort study with systematic review of the NEAD with concurrent HT in an outpatient Endocrinology Unit at a University Hospital. Among the 3480 consecutively examined women with HT, 87 patients met the criteria of RPL and represented the study group. Sixty-five of them had isolated HT and 22 women had HT+NEAD. RESULTS: The rate of RPL in women with HT was 2.1% versus 5.64% observed in women with HT+NEAD (OR=2.78, 95%CI=1.70-4.57; p<0.0001). Upon subdivision, this difference was still evident in euthyroid patients (p<0.0001), while it disappeared in hypothyroid women (p=0.21). RPL did not correlate with the autoantibody concentrations nor in women with isolated HT nor in those with HT+NEAD. The presence of antiphospholipid syndrome (APS) explained RPL in 3/22 (14%) patients with HT+NEAD, the remaining being related to different autoimmune disorders. Interestingly, even subtracting the patients with APS, RPL was more frequent in patients with poly-autoimmunity than in patients with isolated HT (p=0.0013). CONCLUSIONS: The co-presence of NEAD is correlated with a higher risk of RPL in women with HT. The association with APS may explain only a fraction of RPL rate in patients with polyautoimmunity.

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/31910128; info:eu-repo/semantics/altIdentifier/wos/WOS:000524895400016; volume:30; issue:3; firstpage:457; lastpage:462; numberofpages:6; journal:THYROID; https://hdl.handle.net/11568/1027844Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85081945011

الإتاحة: https://doi.org/10.1089/thy.2019.0456Test
https://hdl.handle.net/11568/1027844Test

المؤلفون: Grani, Giorgio, Zatelli, Maria Chiara, Alfò, Marco, Montesano, Teresa, Torlontano, Massimo, Morelli, Silvia, Deandrea, Maurilio, Antonelli, Alessandro, Francese, Cecilia, Ceresini, Graziano, Orlandi, Fabio, Maniglia, Adele, Bruno, Rocco, Monti, Salvatore, Santaguida, Maria Giulia, Repaci, Andrea, Tallini, Giovanni, Fugazzola, Laura, Monzani, Fabio, Giubbini, Raffaele, Rossetto, Ruth, Mian, Caterina, Crescenzi, Anna, Tumino, Dario, Pagano, Loredana, Pezzullo, Luciano, Lombardi, Celestino Pio, Arvat, Emanuela, Petrone, Luisa, Castagna, Maria Grazia, Spiazzi, Giovanna, Salvatore, Domenico, Meringolo, Domenico, Solaroli, Erica, Monari, Fabio, Magri, Flavia, Triggiani, Vincenzo, Castello, Roberto, Piazza, Cesare, Rossi, Roberta, Ferraro Petrillo, Umberto, Filetti, Sebastiano, Durante, Cosimo

المساهمون: Grani, Giorgio, Zatelli, Maria Chiara, Alfò, Marco, Montesano, Teresa, Torlontano, Massimo, Morelli, Silvia, Deandrea, Maurilio, Antonelli, Alessandro, Francese, Cecilia, Ceresini, Graziano, Orlandi, Fabio, Maniglia, Adele, Bruno, Rocco, Monti, Salvatore, Santaguida, Maria Giulia, Repaci, Andrea, Tallini, Giovanni, Fugazzola, Laura, Monzani, Fabio, Giubbini, Raffaele, Rossetto, Ruth, Mian, Caterina, Crescenzi, Anna, Tumino, Dario, Pagano, Loredana, Pezzullo, Luciano, Lombardi, Celestino Pio, Arvat, Emanuela, Petrone, Luisa, Castagna, Maria Grazia, Spiazzi, Giovanna, Salvatore, Domenico, Meringolo, Domenico, Solaroli, Erica, Monari, Fabio, Magri, Flavia, Triggiani, Vincenzo, Castello, Roberto, Piazza, Cesare, Rossi, Roberta, Ferraro Petrillo, Umberto, Filetti, Sebastiano, Durante, Cosimo

مصطلحات موضوعية: differentiated thyroid cancer, evidence based guideline, clinical practice, risk stratification

الوصف: One of the most widely used risk stratification systems for estimating individual patients' risk of differentiated thyroid cancer (DTC) persistence or recurrence is proposed by the American Thyroid Association (ATA) guidelines. The 2015 revision, that has increased the number of patients considered at low or intermediate risk, has been validated in several retrospective, single referral-center studies. The aims of this study were to evaluate the real-world performance of the 2015 ATA Risk Stratification System in predicting the response to treatment 12 months after the initial treatment and to determine the extent to which this performance is affected by the treatment center in which it is used.

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/32475305; info:eu-repo/semantics/altIdentifier/wos/WOS:000547645900001; journal:THYROID; http://hdl.handle.net/11577/3341809Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85091392452

الإتاحة: https://doi.org/10.1089/thy.2020.0272Test
http://hdl.handle.net/11577/3341809Test

المؤلفون: Virili, Camilla, Stramazzo, Ilaria, Santaguida, Maria Giulia, Bruno, Giovanni, Brusca, Nunzia, Capriello, Silvia, Cellini, Miriam, Severi, Carola, Gargano, Lucilla, Centanni, Marco

المساهمون: Virili, Camilla, Stramazzo, Ilaria, Santaguida, Maria Giulia, Bruno, Giovanni, Brusca, Nunzia, Capriello, Silvia, Cellini, Miriam, Severi, Carola, Gargano, Lucilla, Centanni, Marco

مصطلحات موضوعية: IBD, hypothyroidism, levothyroxine absorption, microbiota, ulcerative colitis

الوصف: Background: Thyroxine absorption takes place at the small intestine level and several disorders affecting this intestinal tract lead to thyroxine malabsorption. An increased need for thyroxine has also been observed in gastric disorders due to variations in drug dissolution and/or in its ionization status. Ulcerative colitis (UC) is an inflammatory bowel disease that has been postulated as a potential cause of the increased need for thyroxine, but there is a lack of evidence on this topic. This study is aimed at measuring the thyroxine requirement in hypothyroid patients with UC. Patients and Methods: Among 8,573 patients with thyroid disorders consecutively seen in our referral center from 2010 to 2017, we identified 34 patients with a definite diagnosis of UC. Thirteen of them were hypothyroid (12 F/1 M; median age = 53 years), bearing UC during the remission phase and in need for thyroxine treatment, thus representing the study group. The dose of T4 required by UC patients has been compared to the one observed in 51 similarly treated age- and weight-matched patients, compliant with treatment and clearly devoid of any gastrointestinal and /or pharmacological interference. Results: To reach the target serum TSH, the dose of thyroxine had to be increased in twelve out of thirteen (92%) hypothyroid patients with ulcerative colitis. The median thyroxine dose required by UC patients was 1.54 μg/kg weight/day, that is 26% higher than the control patients, to reach a similar TSH (1.23 μg/kg weight/day; p = 0.0002). Since half of our study group consisted of patients aged over 60 years old, we analyzed the effect of age on the subdivision in two classes. Six out of seven (86%) adult patients (<60 years) required more T4 than those in the respective control group (1.61 vs. 1.27 μg/kg weight/day; +27%; p < 0.0001). An increased dose (+17%; p = 0.0026) but to a lesser extent, was also observed in all patients over 60 years, as compared to the control group. Conclusions: In almost all hypothyroid patients with UC, ...

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/31040825; info:eu-repo/semantics/altIdentifier/wos/WOS:000464945200002; volume:10; journal:FRONTIERS IN ENDOCRINOLOGY; http://hdl.handle.net/11573/1279691Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85066895271

الإتاحة: https://doi.org/10.3389/fendo.2019.00233Test
http://hdl.handle.net/11573/1279691Test

المؤلفون: Virili, Camilla, Antonelli, Alessandro, Santaguida, Maria Giulia, Benvenga, Salvatore, Centanni, Marco

المساهمون: Virili, Camilla, Antonelli, Alessandro, Santaguida, Maria Giulia, Benvenga, Salvatore, Centanni, Marco

الوصف: Levothyroxine, a largely prescribed drug with a narrow therapeutic index, is often a lifelong treatment. The therapeutic efficacy of thyroxine may be marred by behavioral, pharmacologic and pathologic issues acting as interfering factors. Despite a continuous search for an optimal thyroxine treatment, a significant number of patients fail to show a complete chemical and/or clinical response to this reference dose of thyroxine. Gastrointestinal malabsorption of oral thyroxine represents an emerging cause of refractory hypothyroidism and may be more frequent than previously reputed.In this review article we aimed at examining the pharmacologic features of thyroxine preparations and their linkage with the intestinal absorption of the hormone. We have stressed the major biochemical and pharmacologic characteristics of thyroxine and its interaction with the putative transporter at the intestinal level. We have examined the interfering role of nutrients, foods, and drugs on thyroxine absorption at gastric and intestinal level. The impact of gastrointestinal disorders on thyroxine treatment efficacy has been also analyzed, in keeping with the site of action and the interfering mechanisms. Based on the evidence obtained from the literature, we also propose a schematic diagnostic workup for the most frequent and, often hidden, gastrointestinal diseases impairing thyroxine absorption.

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/30476027; info:eu-repo/semantics/altIdentifier/wos/WOS:000460616200006; volume:40; issue:1; firstpage:118; lastpage:136; numberofpages:19; journal:ENDOCRINE REVIEWS; http://hdl.handle.net/11568/936596Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85060022425

الإتاحة: https://doi.org/10.1210/er.2018-00168Test
http://hdl.handle.net/11568/936596Test

المؤلفون: Virili, Camilla, Giovanella, Luca, Fallahi, Poupak, Antonelli, Alessandro, Santaguida, Maria Giulia, Centanni, Marco, Trimboli, Pierpaolo

المساهمون: Virili, Camilla, Giovanella, Luca, Fallahi, Poupak, Antonelli, Alessandro, Santaguida, Maria Giulia, Centanni, Marco, Trimboli, Pierpaolo

مصطلحات موضوعية: Drugs dissolution, Gastrointestinal disorder, Oral liquid levothyroxine, Thyroxine absorption, Thyroxine malabsorption, Endocrinology, Diabetes and Metabolism

الوصف: Background: In the last years, levothyroxine (LT4) has been commercialized also in liquid formulation, which is less sensitive to the factors known to reduce the absorption of tablet LT4. To date, there is no robust information that liquid LT4 can improve pharmacologic thyroid homeostasis of patients with reduced efficacy of tablet LT4. This analysis aimed at achieving solid evidence that switching thyroxine treatment from tablet to liquid preparation improves patients' TSH levels. Methods: The search was performed in PubMed/MEDLINE and Scopus database based on the terms "thyroid," "levothyroxine," and "liquid," and updated until September 25, 2017. Studies were included only if they described patients with suboptimal TSH on tablet LT4, subsequently switched to liquid LT4. Results: The literature search retrieved 462 articles and six were finally included. The pooled mean difference of TSH value between tablet and liquid LT4 was 4.23 mIU/L (95% CI from 3.69 to 4.77). Mild heterogeneity was found (I260%). Overall mean difference of TSH was significant (p < 0.0001). Conclusion: The present meta-analysis showed that patients with suboptimal TSH on tablet LT4 can have a significantly improved TSH by switching to liquid LT4 formulation at unchanged dose.

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/29434573; info:eu-repo/semantics/altIdentifier/wos/WOS:000423360600001; volume:9; issue:JAN; numberofpages:6; journal:FRONTIERS IN ENDOCRINOLOGY; http://hdl.handle.net/11568/909252Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85041124817; https://www.frontiersin.org/articles/10.3389/fendo.2018.00010/fullTest

الإتاحة: https://doi.org/10.3389/fendo.2018.00010Test
http://hdl.handle.net/11568/909252Test