Новости эндокринологии, записная книжка

[ELENA_VLAD]

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Background
Women positive for thyroid peroxidase antibodies (TPO-Ab) have a higher risk of recurrent pregnancy loss. Evidence on whether levothyroxine treatment improves pregnancy outcomes in women who are TPO-Ab positive women with recurrent pregnancy loss is scarce. The aim of this study was to determine if levothyroxine increases live birth rates in women who were TPO-Ab positive with recurrent pregnancy loss and normal thyroid function.
Methods
The T4LIFE trial was an international, double-blind, placebo-controlled, phase 3 study done in 13 secondary and tertiary hospitals in the Netherlands, one tertiary hospital in Belgium, and one tertiary hospital in Denmark. Women (18–42 years) who were TPO-Ab positive, had two or more pregnancy losses, and had a thyroid stimulating hormone (TSH) concentration within the institutional reference range were eligible for inclusion. Women were excluded if they had antiphospholipid syndrome (lupus anticoagulant, anticardiolipin IgG or IgM antibodies, or β2-glycoprotein-I IgG or IgM antibodies), other autoimmune diseases, thyroid disease, previous enrolment in this trial, or contraindications for levothyroxine use. Before conception, women were randomly assigned (1:1) to receive either levothyroxine or placebo orally once daily. The daily dose of levothyroxine was based on preconception TSH concentration and ranged from 0·5–1·0 μg/kg bodyweight. Levothyroxine or placebo was continued until the end of pregnancy. The primary outcome was live birth, defined as the birth of a living child beyond 24 weeks of gestation measured in the intention-to-treat population. The trial was registered within the Netherlands Trial Register, NTR3364 and with EudraCT, 2011-001820-39.
Results
Between Jan 1, 2013, and Sept 19, 2019, 187 women were included in the study: 94 (50%) were assigned to the levothyroxine group and 93 (50%) were assigned to the placebo group. The trial was prematurely stopped when 187 (78%) of the 240 predefined patients had been included because of slow recruitment. 47 (50%) women in the levothyroxine group and 45 (48%) women in the placebo group had live births (risk ratio 1·03 [95% CI 0·77 to 1·38]; absolute risk difference 1·6% [95% CI –12·7 to 15·9]). Seven (7%) women in the levothyroxine group and seven (8%) in the placebo group reported adverse events, none of them were directly related to the study procedure.
Interpretation

Compared with placebo, levothyroxine treatment did not result in higher live birth rates in euthyroid women with recurrent pregnancy loss who were positive for TPO-Ab. On the basis of our findings, we do not advise routine use of levothyroxine in women who are TPO-Ab positive with recurrent pregnancy loss and normal thyroid function.

[ghrh44]

Независимая от ТТГ и свТ4 роль антител в феномене потери беременности была известна давно. Именно поэтому АТА рекомендует тироксин у женщин с ТТГ >10, но без антител, но у женщин с ТТГ 4-10, но с антителами, таки да рекомендует. Тироксин никоим образом не может повлиять на титр антител: разница в риске выкидыша 1.6% ( от -12 до +15). Поэтому смысл делания этой работы заключается в том, что хотя пользы от тироксина во втором случае от мала до нуля, но никто врача обвинить в бездеятельности не сможет:-). Адвокаты кусают локти.

[ghrh44]

Сообщение от Melnichenko

Dramatic, Durable Hair Growth With Oral JAK Inhibitor
— Oral baricitinib superior to placebo at 36 weeks in BRAVE-AA1 and BRAVE-AA2 trials
by Charles Bankhead, Senior Editor, MedPage Today March 27, 2022


BOSTON -- An oral Janus kinase (JAK) inhibitor produced significant, durable hair growth, including scalp, eyebrows, and eyelashes in patients with severe alopecia areata, according to long-term data from two randomized trials.

Almost 40% of patients achieved a Severity of Alopecia Tool (SALT) score ≤20 (total percentage of hair loss) at 52 weeks with a higher dose of baricitinib (Olumiant), and almost 30% had a SALT score ≤10. The patients had a mean SALT score >80 at baseline. Almost half of the patients had met response criteria for eyebrow and eyelash regrowth, reported Brett King, MD, PhD, of Yale School of Medicine in New Haven, Connecticut.

Эх, опубликовали бы это на год раньше, Уилл Смит не дал бы пuбличную пощёчину Крису Року на церемонии Оскара за шутку по поводу алопеции у своей жены.

Но зато, что бы народ читал в "жёлтой прессе" в очередях в супермаркетах и обсуждал в сетях? Других же важных проблем в мире нет, не так ли?

А вот не попробовать ли барицитиниб у акромегаликов? Сигнал ГР передаётся через JAK-STAT комплеkc. Забей JAK и... что будет с ИФР-1?
Очередная сумасшедшенькая идея....

[ELENA_VLAD]

[Ссылки доступны только зарегистрированным пользователям ]

The mpact of moderately high preconception TSH levels on ovarian reserve among euthyroid infertile women undergoing ARTBackground: Thyroid dysfunction is prevalent in reproductive-aged women and has been identified as a risk factor for female infertility.
However, it remains largely unclear whether subtle thyroid dysfunction, as estimated by moderately high TSH levels within the normal range, is associated with ovarian reserve in infertile women prior to assisted reproductive technology (ART).
Methods: This cross-sectional study involved 3501 euthyroid infertile women, including 2189 women with TSH levels ≤2.5 μIU/mL and 1312 women with high-normal TSH levels (2.51-4.20 μIU/mL). Ovarian reserve markers were compared between women with low- and high-normal TSH levels. Correlation analysis and regression models were used to estimate the association of TSH levels with ovarian reserve. In addition, the association of subtle thyroid dysfunction with ovarian reserve was further evaluated after stratification for different infertility diagnoses and statuses of thyroid autoimmunity (TAI).
Results: In the total population, women with high-normal TSH levels had significantly decreased AMH concentrations (p<0.001), a lower bilateral AFC (p<0.001), and a higher prevalence of diminished ovarian reserve (DOR) (p=0.018) than women with low-normal TSH levels. The TSH levels showed a negative association with both AMH levels (r=-0.050, p=0.003) and bilateral AFC (r=-0.071, p<0.001). Furthermore, the association of high-normal TSH levels with decreased AMH and AFC was more prominent in infertile women with ovulation dysfunction (p=0.002, p=0.002), unexplained infertility (p=0.020, p=0.028), or negative TAI (both p<0.001).
Conclusions: These data suggested that subtle thyroid dysfunction was associated with DOR in infertile women prior to ART, which will add evidence that strengthens the systematic screening of TSH levels/TAI in infertile women and contribute to the discussion of specific TSH cutoff values in predicting ovarian reserve.

[FilippovaYulia]

А можно и мне поучаствовать? 28 апреля 2022 г. - новое руководство ESMO по применению системной терапии при тяжелых случаях рака щитовидной железы [Ссылки доступны только зарегистрированным пользователям ]
ESMO Clinical Practice Guideline update on the use of systemic therapy in
advanced thyroid cancer
S. Filetti, C. Durante, D. M. Hartl, Leboulleux, L.D. Locati, K. Newbold, M.G. Papotti10 & A. Berruti, on behalf of the ESMO Guidelines Committee*
Мощно пробило ностальгией... РНЦРР. Огромный этап в моей жизни, хотя и недолгий. Приятно вспомнить...
Начинали в 2017 году с сорафенибом и ленватинибом, в личном архиве есть красивые картинки редкого вида кожной сыпи на сорафенибе. Сама учила пациентов, как "выбивать" рекомендованный Москвой препарат в регионах (без зазрения совести пользуясь волгоградским опытом в сочетании с московским авторитетом).
И в какую же громаду таргетной терапии нынче оно вырастает. В помощь тераностике.

[Melnichenko]

Ну, жизнь идёт.
Новости с ENDO: кагрилинтид + семаглутид ( Ново)- ответка на тирзепатит Эли Лилли , но тут любопытен кагрилинид - это анилин и он дополнительно уменьшает опорожнение желудка

[Melnichenko]

Как страшно жить !Accidental exposure to glimepiride from adulterated medication resulting in severe hypoglycaemia
in Endocrinology, Diabetes & Metabolism Case Reports
Authors: Annabelle G Hayes1,2, Mahesh M Umapathysivam1,2, and David J Torpy1,2
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Correspondence should be addressed to A G Hayes; Email: [Ссылки доступны только зарегистрированным пользователям ]
DOI: [Ссылки доступны только зарегистрированным пользователям ]
Volume/Issue: Volume 2022: Issue 1
Article Type: Research Article
Online Publication Date: 01 Jun 2022
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Abstract
Summary
Sulphonylureas are insulinotropic and are not only useful in patients with diabetes but also act in non-diabetic individuals where hypoglycaemia and hyperinsulinism mimic insulinoma. We present a 63-year-old man who presented with inadvertent sulphonylurea-induced life-threatening hypoglycaemia on two occasions, resulting in hazardous and invasive investigation. Biochemistry revealed endogenous hyperinsulinaemia, with elevated serum c-peptide and insulin concentrations during symptomatic hypoglycaemia, and plasma glucose of 1.7 mmol/L. There was no history of sulphonylurea use prompting anatomical insulinoma studies to locate an insulinoma. However, a routine plasma insulinoma screen-detected glimepiride. Directed history implicated a medication taken for erectile dysfunction prior to disturbed consciousness, with alcohol. The tablets, obtained online, were analysed by mass spectrometry and contained tadalafil and dapoxetine as advertised but also contained glimepiride.

[Melnichenko]

Вот сейчас благодаря нашему кхн Виталию Иоутси - запросто исследовать состав - дЭАС в китайских травках, СМ в крови невинно гипующих и даже аналоги инсулина.
Есть технические сложности, но в целом эпоха тайных поисков под подушками и в вещах ушла в прошлое

[FilippovaYulia]

Как-то в разговоре с Галиной Афанасьевной упоминалась мудрая мысля, что было бы неплохо проверять и тех, у кого "инсулин колем, а сахара высоченные". Эту мыслю, несомненно, мыслил любой эндокринолог, которому после безвременной кончины "бабушки, которой от сахара никакой инсулин не помогал" скорбящие родственники притаскивали агромадные пакеты с этим самым нетронутым инсулином. Частенько уже изрядно просроченным. В наследство доктору, так сказать.

[Melnichenko]

Юля, по моему, эту мысль высказали Вы первой, и я на наших конференциях уже говорила, что по сути это заказ от практического здравоохранения. Во всяком случае, некомплаетность при первом типе , наверное, можно было бы доказывать по инсулину крови. Надо помозговать.