THYROSIM App for Education and Research Predicts Potential Health Risks of Over-the-Counter (OTC) Thyroid Supplements.

THYROSIM App for Education and Research Predicts Potential Health Risks of Over-the-Counter (OTC) Thyroid Supplements.

Thyroid. 2016 Feb 19;

Authors: Han SX, Eisenberg M, Larsen PR, DiStefano Iii JJ

Abstract
BACKGROUND: Computer simulation tools for education and research are making increasingly effective use of the internet and personal devices. To facilitate these activities in endocrinology and metabolism, we developed and further validated a mechanistically-based simulator of human thyroid hormone and thyrotropin regulation dynamics, implementing it as a facile and freely accessible web-based and personal device application (the THYROSIM app). We elucidate and demonstrate its utility here in a research context by exploring key physiological effects of over-the-counter thyroid supplements.
METHODS: THYROSIM has a simple and intuitive user interface for teaching and conducting simulated "what-if" experiments. User-selectable "experimental" test-input dosages (oral, IV-pulses, IV-infusions) are represented by animated graphical icons integrated with a cartoon of the hypothalamic-pituitary-thyroid axis. Simulations of familiar T3, T4 and TSH temporal dynamic responses to these exogenous stimuli are reported graphically along with normal ranges on the same single interface page; and multiple sets of simulated experimental results are superimposable, to facilitate comparative analyses.
RESULTS AND CONCLUSIONS: We show that THYROSIM accurately reproduces a wide range of published clinical study data reporting hormonal kinetic responses to large and small oral hormone challenges. Simulation examples of partial-thyroidectomies and malabsorption illustrate typical usage, by optionally changing thyroid gland secretion and/or gut absorption rates - expressed as percentages of normal - as well as additions of oral hormone dosing, all directly on the interface, and visualizing the kinetic responses to these challenges. Classroom and patient education usage - with public health implications - is illustrated by predictive simulated responses to nonprescription thyroid health supplements analyzed previously for T3 and T4 content. Notably, we found T3 in supplements has potentially more serious pathological effects than does T4 - concomitant with low-normal TSH levels. Some preparations contain enough T3 to generate thyrotoxic conditions, with supernormal serum T3-spiking and subnormal serum T4 and TSH levels and, in some cases, with normal or low-normal range TSH levels due to thyroidal axis negative feedback. These results suggest that appropriate regulation of these products is needed.

PMID: 26895744 [PubMed - as supplied by publisher]

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WEIGHT LOSS AND VARIATION OF LEVOTHYROXINE (L-T4) REQUIREMENTS IN HYPOTHYROID OBESE PATIENTS AFTER BARIATRIC SURGERY.

WEIGHT LOSS AND VARIATION OF LEVOTHYROXINE (L-T4) REQUIREMENTS IN HYPOTHYROID OBESE PATIENTS AFTER BARIATRIC SURGERY.

Thyroid. 2016 Feb 19;

Authors: Fierabracci P, Martinelli S, Tamberi A, Piaggi P, Basolo A, Pelosini C, Ricco I, Magno S, Querci G, Ceccarini G, Scartabelli G, Salvetti G, Vitti P, Santini F

Abstract
BACKGROUND: Obesity and hypothyroidism are both common disorders within the general population. Obese hypothyroid subjects require higher doses of L-T4 as compared to normal weight individuals. Previous studies on the effects of bariatric surgery on L-T4 dose requirements in hypothyroid subjects provided conflicting results. The aim of this study was to evaluate the L-T4 requirements in a group of obese subjects with acquired hypothyroidism, before and after weight loss achieved by bariatric surgery.
METHODS: Ninety-three obese hypothyroid subjects (age: 48 ± 9 yrs, BMI: 45.9 ± 5.6 kg/m2), were evaluated before and 28 ± 8 months after bariatric surgery. Changes in the L-T4 dose, anthropometric measures, and hormone values were evaluated. In 20 patients data of body composition, assessed by dual energy X-ray absorptiometry, were also analyzed.
RESULTS: On average, after weight loss, a significant reduction of the total dose of L-T4 was documented (from 130.6 ± 48.5 to 116.2 ± 38.6 µg/day, p<0.001). The L-T4 dose had to be reduced in 47 patients, it was unchanged in 34 while it had to be increased in 12 patients affected by autoimmune thyroiditis. Reduction of the L-T4 dose was proportional to reduction of the lean mass.
CONCLUSIONS: The weight loss that is achieved with modern surgical bariatric procedures is associated with a reduction of L-T4 requirements in most hypothyroid subjects, which appears related to a decrease of the lean mass. Occasionally, a concurrent decline of residual thyroid function, as it occurs in autoimmune thyroiditis, can counteract this phenomenon and eventually produce an increase of L-T4 needs. We believe that during the weight loss phase that follows bariatric surgery there is no need for preventive adjustments of the L-T4 dose, but serum thyroid hormones and TSH should be periodically monitored, to detect possible variations of L-T4 requirements and to allow proper corrections of the therapy.

PMID: 26895690 [PubMed - as supplied by publisher]

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Tufted angioma of the maxilla: a rare case with unique clinical presentation.

Tufted angioma of the maxilla: a rare case with unique clinical presentation.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Dec 19;

Authors: Katsoulas N, Nikitakis N, Theologie-Lygidakis N, Lianou V, Tsiklakis K, Iatrou I, Sklavounou-Andrikopoulou A

Abstract
Tufted angioma is an uncommon benign vascular tumor usually presenting in early childhood and affecting mainly the skin. It has been associated with Kasabach-Merritt syndrome, a severe coagulopathy of poor prognosis. There have been very few published cases of oral tufted angiomas, and maxillary bone involvement has not been hitherto reported. We present a case of a 10-year-old Caucasian boy with an erythematous left maxillary gingival mass accompanied by subjacent hard tissue swelling. Radiologic evaluation revealed an irregular mixed radiolucent and radiopaque area in the left maxilla, accompanied by alveolar ridge erosion, cortical plate expansion, and displacement and divergence of the premolars. The histopathologic examination showed scattered irregular tufted lobules of variably sized vascular spaces inside the subepithelial connective tissue and among the underlying bone trabeculae, exhibiting a "cannonball" appearance. Immunohistochemical evaluation found positivity for CD31, CD34, and smooth muscle actin, and a final diagnosis of tufted angioma with osseous involvement was rendered. A thorough review of the pertinent literature revealed only 9 previously published intraoral tufted angioma cases, the salient demographic and clinicopathologic features of which are summarized.

PMID: 26896438 [PubMed - as supplied by publisher]

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Pulsatile tinnitus and a temporal bone mass.

Pulsatile tinnitus and a temporal bone mass.

Eur Ann Otorhinolaryngol Head Neck Dis. 2016 Feb 16;

Authors: Ginat DT, Gluth MB

PMID: 26895763 [PubMed - as supplied by publisher]

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The influence of multiple sensory impairments on functional balance and difficulty with falls among U.S. Adults.

The influence of multiple sensory impairments on functional balance and difficulty with falls among U.S. Adults.

Prev Med. 2016 Feb 16;

Authors: Wilson SJ, Garner JC, Loprinzi PD

Abstract
OBJECTIVE: Studies have looked at the individual associations of sensory impairment on balance, but no population-based studies have examined their combined association on balance and difficulty with falls. Thus, the purpose of this study was to examine both the independent associations and combined associations of visual impairment, peripheral neuropathy, and self-reported hearing loss with the odds of reporting difficulty with falls and functional balance.
METHODS: Data from the 2003-2004 National Health and Nutrition Examination Survey were used. Vision and peripheral neuropathy were objectively measured, and hearing was self-reported. Balance testing consisted of a modified Romberg test. After exclusions, 1662 (40-85years of age) participants provided complete data on the study variables.
RESULTS: Sensory impairment was associated with perceived difficulty of falls and functional balance. Participants who presented a single sensory impairment had 29% reduced odds of having functional balance (95% CI=0.54-0.93, p=0.01) and increased odds of reporting difficulty with falls by 61% (95% CI=0.99-2.60, p=0.05). Moreover, our multisensory models showed some evidence of a dose-response relationship, in that sensory impairment of multiple sensory systems was associated with worse balance (OR =0.59, CI=0.35-1.00, p=0.05) and perceived difficulty of falls (OR =5.02, 95% CI=1.99-12.66, p=0.002) when compared to those with less sensory impairment.
CONCLUSION: Multiple sensory impairment is associated with significantly higher odds of both reporting difficulty with falls and balance dysfunction, which may lead to a subsequent fall, ultimately compromising the individual's health.

PMID: 26896633 [PubMed - as supplied by publisher]

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Challenges in the pharmacological management of epilepsy and its causes in the elderly.

Challenges in the pharmacological management of epilepsy and its causes in the elderly.

Pharmacol Res. 2016 Feb 16;

Authors: Ferlazzo E, Sueri C, Gasparini S, Aguglia U

Abstract
Epilepsy represents the third most common neurological disorders in the elderly after cerebrovascular disorders and dementias. The incidence of new-onset epilepsy peaks in this age group. The most peculiar aetiologies of late-onset epilepsy are stroke, dementia, and brain tumours. However, aetiology remains unknown in about half of the patients. Diagnosis of epilepsy may be challenging due to the frequent absence of ocular witnesses and the high prevalence of seizure-mimics (i.e. transient ischemic attacks, syncope, transient global amnesia or vertigo) in the elderly. The diagnostic difficulties are even greater when patients have cognitive impairment or cardiac diseases. The management of late-onset epilepsy deserves special considerations. The elderly can reach seizure control with low antiepileptic drugs (AEDs) doses, and seizure-freedom is possible in the vast majority of patients. Pharmacological management should take into account pharmacokinetics and pharmacodynamics of AEDs and the frequent occurrence of comorbidities and polytherapy in this age group. Evidences from double-blind and open-label studies indicate lamotrigine, levetiracetam and controlled-release carbamazepine as first line treatment in late-onset epilepsy.

PMID: 26896787 [PubMed - as supplied by publisher]

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Using the Physical Examination to Diagnose Patients with Acute Dizziness and Vertigo.

Using the Physical Examination to Diagnose Patients with Acute Dizziness and Vertigo.

J Emerg Med. 2016 Feb 16;

Authors: Edlow JA, Newman-Toker D

Abstract
BACKGROUND: Emergency department (ED) patients who present with acute dizziness or vertigo can be challenging to diagnose. Roughly half have general medical disorders that are usually apparent from the context, associated symptoms, or initial laboratory tests. The rest include a mix of common inner ear disorders and uncommon neurologic ones, particularly vertebrobasilar strokes or posterior fossa mass lesions. In these latter cases, misdiagnosis can lead to serious adverse consequences for patients.
OBJECTIVE: Our aim was to assist emergency physicians to use the physical examination effectively to make a specific diagnosis in patients with acute dizziness or vertigo.
DISCUSSION: Recent evidence indicates that the physical examination can help physicians accurately discriminate between benign inner ear conditions and dangerous central ones, enabling correct management of peripheral vestibular disease and avoiding dangerous misdiagnoses of central ones. Patients with the acute vestibular syndrome mostly have vestibular neuritis, but some have stroke. Data suggest that focused eye movement examinations, at least when performed by specialists, are more sensitive for detecting early stroke than brain imaging, including diffusion-weighted magnetic resonance imaging. Patients with the triggered episodic vestibular syndrome mostly have benign paroxysmal positional vertigo (BPPV), but some have posterior fossa mass lesions. Specific positional tests to provoke nystagmus can confirm a BPPV diagnosis at the bedside, enabling immediate curative therapy, or indicate the need for imaging.
CONCLUSIONS: Emergency physicians can effectively use the physical examination to make a specific diagnosis in patients with acute dizziness or vertigo. They must understand the limitations of brain imaging. This may reduce misdiagnosis of serious central causes of dizziness, including posterior circulation stroke and posterior fossa mass lesions, and improve resource utilization.

PMID: 26896289 [PubMed - as supplied by publisher]

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Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching.

Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching.

Surg Endosc. 2016 Feb 19;

Authors: Tae K, Song CM, Ji YB, Sung ES, Jeong JH, Kim DS

Abstract
BACKGROUND: The oncologic outcome of robotic thyroidectomy is not yet well established. The aim of this study was to evaluate the recurrence rate after robotic thyroidectomy in comparison with conventional thyroidectomy for papillary thyroid carcinoma (PTC).
METHODS: We analyzed 896 patients with PTC who either underwent robotic (212 patients using a gasless unilateral axillary or an axillo-breast approach) or conventional cervical thyroidectomy (684 patients) with/without central neck dissection between October 2008 and February 2014. We excluded patients who underwent concomitant lateral neck dissection or completion thyroidectomy, and cases with T4 tumor, tumor lager than 4 cm, other types of thyroid cancer, recurrent cancer, and distant metastasis. A propensity score matching analysis was done with ten covariates including age, gender, body mass index, tumor size, multifocality, bilaterality, extrathyroidal extension, type of thyroidectomy, extent of central neck dissection, and RAI ablation to reduce selection bias.
RESULTS: In baseline data, the male ratio and the mean age were lower in the robotic group. Stage, multifocality, and bilaterality were higher in the conventional group. The rate of total thyroidectomy was higher in the conventional group. The two matched groups of each 185 patients were produced and well balanced by propensity score matching. In the comparison of propensity score matched groups, operative time was longer in the robotic group (P < 0.001), and postoperative complications did not differ between the two groups, except for transient hypoparathyroidism and formation of seroma. The recurrence rate did not differ between the two groups after a mean follow-up of 43.6 months (0.5 and 1.1 % in the robotic and conventional groups, respectively, P = 0.375).
CONCLUSION: The oncologic outcome of robotic thyroidectomy in 5-year experience is comparable to that of conventional thyroidectomy in selected patients with PTC.

PMID: 26895921 [PubMed - as supplied by publisher]

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