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When it comes to thyroid cancer follow-up, serum microRNA profiles have earned new respect
CHICAGO –
The usual tool for trying to detect recurrence while following patients with papillary thyroid cancer after surgery has been the serum thyroglobulin assay. However, management of papillary thyroid cancer has become more conservative, involving lobectomy and isthmusectomy on the affected side rather than total gland resection. The benefit of the conservative approach is to avoid complications while maintaining an overall survival rate equivalent to the more extensive approach.
The investigators measured 754 miRNAs in serum samples of 11 patients with papillary thyroid cancer both before and 30 days after surgical thyroidectomy. They re-evaluated major candidate miRNAs using absolute quantitative polymerase chain reaction analysis in an independent cohort of 44 other patients with papillary thyroid cancer or benign nodules or 20 healthy controls, Dr. Rosignolo said at the annual meeting of the Endocrine Society.
The 2 miRNAs most significantly associated with thyroid tumors were then assessed in matched serum samples (before and 30 days, and 1 to 2 years after surgery) from the 20 PTC patients with complete follow-up datasets and results correlated with American Thyroid Association (ATA) responses to therapy.
Serum levels of both miRNAs after 1 to 2 years of follow-up were consistent with ATA responses to therapy in all patients, including two patients who developed structural evidence of disease whose thyroglobulin assay results remained negative (less than 1 ng/mL) for cancer recurrence.
Fifteen of the 20 patients had excellent or indeterminate responses to therapy as defined by 2015 ATA guidelines. In these 15 cases, and in the single patient with a biochemical incomplete response, expression levels of miR-146a-5p and miR-221-3p decreased after surgery and remained low at the 1- to 2-year visit.
It was a very different story for the 4 patients with structural incomplete responses at 1 to 2 years. In this subgroup, initial postoperative declines in serum miR-146a-5p and miR-221-3p levels were followed by increases to levels at the 1- to 2-year visit that were similar to or higher than those found prior to surgery.
The study was funded by the Umberto Di Mario Foundation, Banca d’Italia, University of Rome Sapienza, the program of Biotechnologies and Clinical Medicine of the University of Rome Sapienza, the European Medical Writers Association, and the Umberto Di Mario Foundation.
SOURCE: Rosignolo F et al. J Endo Soc. 2017;1(1)3-13. ENDO 2018, Abstract OR17-1.
CHICAGO –
The usual tool for trying to detect recurrence while following patients with papillary thyroid cancer after surgery has been the serum thyroglobulin assay. However, management of papillary thyroid cancer has become more conservative, involving lobectomy and isthmusectomy on the affected side rather than total gland resection. The benefit of the conservative approach is to avoid complications while maintaining an overall survival rate equivalent to the more extensive approach.
The investigators measured 754 miRNAs in serum samples of 11 patients with papillary thyroid cancer both before and 30 days after surgical thyroidectomy. They re-evaluated major candidate miRNAs using absolute quantitative polymerase chain reaction analysis in an independent cohort of 44 other patients with papillary thyroid cancer or benign nodules or 20 healthy controls, Dr. Rosignolo said at the annual meeting of the Endocrine Society.
The 2 miRNAs most significantly associated with thyroid tumors were then assessed in matched serum samples (before and 30 days, and 1 to 2 years after surgery) from the 20 PTC patients with complete follow-up datasets and results correlated with American Thyroid Association (ATA) responses to therapy.
Serum levels of both miRNAs after 1 to 2 years of follow-up were consistent with ATA responses to therapy in all patients, including two patients who developed structural evidence of disease whose thyroglobulin assay results remained negative (less than 1 ng/mL) for cancer recurrence.
Fifteen of the 20 patients had excellent or indeterminate responses to therapy as defined by 2015 ATA guidelines. In these 15 cases, and in the single patient with a biochemical incomplete response, expression levels of miR-146a-5p and miR-221-3p decreased after surgery and remained low at the 1- to 2-year visit.
It was a very different story for the 4 patients with structural incomplete responses at 1 to 2 years. In this subgroup, initial postoperative declines in serum miR-146a-5p and miR-221-3p levels were followed by increases to levels at the 1- to 2-year visit that were similar to or higher than those found prior to surgery.
The study was funded by the Umberto Di Mario Foundation, Banca d’Italia, University of Rome Sapienza, the program of Biotechnologies and Clinical Medicine of the University of Rome Sapienza, the European Medical Writers Association, and the Umberto Di Mario Foundation.
SOURCE: Rosignolo F et al. J Endo Soc. 2017;1(1)3-13. ENDO 2018, Abstract OR17-1.
CHICAGO –
The usual tool for trying to detect recurrence while following patients with papillary thyroid cancer after surgery has been the serum thyroglobulin assay. However, management of papillary thyroid cancer has become more conservative, involving lobectomy and isthmusectomy on the affected side rather than total gland resection. The benefit of the conservative approach is to avoid complications while maintaining an overall survival rate equivalent to the more extensive approach.
The investigators measured 754 miRNAs in serum samples of 11 patients with papillary thyroid cancer both before and 30 days after surgical thyroidectomy. They re-evaluated major candidate miRNAs using absolute quantitative polymerase chain reaction analysis in an independent cohort of 44 other patients with papillary thyroid cancer or benign nodules or 20 healthy controls, Dr. Rosignolo said at the annual meeting of the Endocrine Society.
The 2 miRNAs most significantly associated with thyroid tumors were then assessed in matched serum samples (before and 30 days, and 1 to 2 years after surgery) from the 20 PTC patients with complete follow-up datasets and results correlated with American Thyroid Association (ATA) responses to therapy.
Serum levels of both miRNAs after 1 to 2 years of follow-up were consistent with ATA responses to therapy in all patients, including two patients who developed structural evidence of disease whose thyroglobulin assay results remained negative (less than 1 ng/mL) for cancer recurrence.
Fifteen of the 20 patients had excellent or indeterminate responses to therapy as defined by 2015 ATA guidelines. In these 15 cases, and in the single patient with a biochemical incomplete response, expression levels of miR-146a-5p and miR-221-3p decreased after surgery and remained low at the 1- to 2-year visit.
It was a very different story for the 4 patients with structural incomplete responses at 1 to 2 years. In this subgroup, initial postoperative declines in serum miR-146a-5p and miR-221-3p levels were followed by increases to levels at the 1- to 2-year visit that were similar to or higher than those found prior to surgery.
The study was funded by the Umberto Di Mario Foundation, Banca d’Italia, University of Rome Sapienza, the program of Biotechnologies and Clinical Medicine of the University of Rome Sapienza, the European Medical Writers Association, and the Umberto Di Mario Foundation.
SOURCE: Rosignolo F et al. J Endo Soc. 2017;1(1)3-13. ENDO 2018, Abstract OR17-1.
REPORTING FROM ENDO 2018
Key clinical point: Serum microRNA profiles hold promise for postsurgical monitoring of patients with papillary thyroid cancer.
Major finding: Of eight tested, two serum microRNA profiles – miR-146a-5p and miR-221-3p – were the most promising thyroid tumor biomarkers.
Study details: Prospective analysis of the blood of 31 patients with papillary thyroid cancer before and after surgery to assess which markers were most sensitive to cancer.
Disclosures: The study was funded by the Umberto Di Mario Foundation, Banca d’Italia, University of Rome Sapienza, the program of Biotechnologies and Clinical Medicine of the University of Rome Sapienza, the European Medical Writers Association, and the Umberto Di Mario Foundation.
Source: Rosignolo F et al. J Endo Soc. 2017;1(1):3-13. ENDO 2018, Abstract OR17-1.
Without reliability, testosterone testing may fall short
CHICAGO – is one addition to the evaluation of men with suspected hypogonadism that is included in the revised clinical practice guideline on testosterone therapy in men with hypogonadism, issued March 17 by the Endocrine Society. The previous guideline was issued in 2010.
“Since 2010, the CDC has provided an accuracy-based standardization program for T (CDC Hormone Standardization Program for Testosterone). Although several commercial laboratories, some assay manufacturers, and some academic laboratories are now CDC certified, most T immunoassay kit manufacturers and local hospital-based laboratories have not been certified. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays for TT generally offer higher concentrations of specificity, sensitivity, and precision (especially in the low range) than do most immunoassays. Clinicians should ideally measure TT using a CDC-certified assay or an assay verified by an accuracy-based external quality control program,” according to the guideline.
Diagnosis, treatment, and follow-up of men with suspected hypogonadism often involve nuanced decisions, according to guideline panel chair Shalender Bhasin, MB, an endocrinologist who is professor of medicine at both Harvard Medical School and Brigham and Women’s Hospital, in Boston. The guideline will be published in its entirety in the May 2018 print issue of The Journal of Clinical Endocrinology & Metabolism.
Evaluation for suspected hypogonadism is indicated in men with symptoms and signs of testosterone deficiency – decreased libido, unexplained anemia, and/or osteopenia – and unequivocally and consistently low serum total testosterone and/or free testosterone concentrations, according to the guideline, which is co-sponsored by European Society of Endocrinology and endorsed by the European Academy of Andrology.
The guideline illuminates one area of diagnostic uncertainty that has dogged clinicians: Should one use age-specific testosterone levels? All the guideline authors speaking at the panel, in addition to Dr. Bhasin – Glenn R. Cunningham, MD, Baylor College of Medicine in Houston; Alvin M. Matsumoto, MD, VA Puget Sound Health Care System, Seattle; and Maria A. Yialamas, MD, Brigham and Women’s Hospital, Boston – agreed that age-specific testosterone levels do not improve diagnosis.
“The harmonized Reference range for TT in healthy, nonobese young men (aged 19 to 39 years) was 264 to 916 ng/dL (9.2 to 31.8 nmol/L) using the 2.5th and 97.5th percentile, and 303 to 852 ng/dL (10.5 to 29.5 nmol/L) using the 5th and 95th percentile (31). Clinicians can use this range for all CDC-certified TT assays,” according to the guideline.
Asking about history to explain low testosterone levels is an often overlooked part of patient evaluation. Two known causes of low testosterone in men often are not part of history taking but should be. One is use of opioids. The other is withdrawal from anabolic steroids. The best way to root these out in a history is to ask about any recent surgery and use of anabolic steroids, said Dr. Bhasin, speaking at the annual meeting of the Endocrine Society.
When it works, testosterone can make some men feel better: Testosterone replacement was associated with increased libido, erectile function, and sexual activity. However, testosterone replacement had no effect on energy and/or mood.
Not every man over the age of 65 with low testosterone is a candidate for testosterone replacement. There are some risks associated with its use; PSA may rise within 6 months of starting testosterone replacement, leaving physicians and men facing the issue of whether to have a prostate biopsy. The guideline recommends evaluating the patients with PSA the first time within 3-12 months after the start of therapy. When the test shows that PSA has risen, the decision of whether to have a prostate biopsy is one that should be shared by the patient and physician.
Dr. Bhasin declared financing from the National Institute on Aging, the National Institute of Nursing Research, the Patient-Centered Outcomes Research Institute, AbbVie, Metro International Biotechnology, Alivegen, Abbott, Transition Therapeutics, and Function Promoting Therapies.
SOURCE: ENDO 2018
CHICAGO – is one addition to the evaluation of men with suspected hypogonadism that is included in the revised clinical practice guideline on testosterone therapy in men with hypogonadism, issued March 17 by the Endocrine Society. The previous guideline was issued in 2010.
“Since 2010, the CDC has provided an accuracy-based standardization program for T (CDC Hormone Standardization Program for Testosterone). Although several commercial laboratories, some assay manufacturers, and some academic laboratories are now CDC certified, most T immunoassay kit manufacturers and local hospital-based laboratories have not been certified. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays for TT generally offer higher concentrations of specificity, sensitivity, and precision (especially in the low range) than do most immunoassays. Clinicians should ideally measure TT using a CDC-certified assay or an assay verified by an accuracy-based external quality control program,” according to the guideline.
Diagnosis, treatment, and follow-up of men with suspected hypogonadism often involve nuanced decisions, according to guideline panel chair Shalender Bhasin, MB, an endocrinologist who is professor of medicine at both Harvard Medical School and Brigham and Women’s Hospital, in Boston. The guideline will be published in its entirety in the May 2018 print issue of The Journal of Clinical Endocrinology & Metabolism.
Evaluation for suspected hypogonadism is indicated in men with symptoms and signs of testosterone deficiency – decreased libido, unexplained anemia, and/or osteopenia – and unequivocally and consistently low serum total testosterone and/or free testosterone concentrations, according to the guideline, which is co-sponsored by European Society of Endocrinology and endorsed by the European Academy of Andrology.
The guideline illuminates one area of diagnostic uncertainty that has dogged clinicians: Should one use age-specific testosterone levels? All the guideline authors speaking at the panel, in addition to Dr. Bhasin – Glenn R. Cunningham, MD, Baylor College of Medicine in Houston; Alvin M. Matsumoto, MD, VA Puget Sound Health Care System, Seattle; and Maria A. Yialamas, MD, Brigham and Women’s Hospital, Boston – agreed that age-specific testosterone levels do not improve diagnosis.
“The harmonized Reference range for TT in healthy, nonobese young men (aged 19 to 39 years) was 264 to 916 ng/dL (9.2 to 31.8 nmol/L) using the 2.5th and 97.5th percentile, and 303 to 852 ng/dL (10.5 to 29.5 nmol/L) using the 5th and 95th percentile (31). Clinicians can use this range for all CDC-certified TT assays,” according to the guideline.
Asking about history to explain low testosterone levels is an often overlooked part of patient evaluation. Two known causes of low testosterone in men often are not part of history taking but should be. One is use of opioids. The other is withdrawal from anabolic steroids. The best way to root these out in a history is to ask about any recent surgery and use of anabolic steroids, said Dr. Bhasin, speaking at the annual meeting of the Endocrine Society.
When it works, testosterone can make some men feel better: Testosterone replacement was associated with increased libido, erectile function, and sexual activity. However, testosterone replacement had no effect on energy and/or mood.
Not every man over the age of 65 with low testosterone is a candidate for testosterone replacement. There are some risks associated with its use; PSA may rise within 6 months of starting testosterone replacement, leaving physicians and men facing the issue of whether to have a prostate biopsy. The guideline recommends evaluating the patients with PSA the first time within 3-12 months after the start of therapy. When the test shows that PSA has risen, the decision of whether to have a prostate biopsy is one that should be shared by the patient and physician.
Dr. Bhasin declared financing from the National Institute on Aging, the National Institute of Nursing Research, the Patient-Centered Outcomes Research Institute, AbbVie, Metro International Biotechnology, Alivegen, Abbott, Transition Therapeutics, and Function Promoting Therapies.
SOURCE: ENDO 2018
CHICAGO – is one addition to the evaluation of men with suspected hypogonadism that is included in the revised clinical practice guideline on testosterone therapy in men with hypogonadism, issued March 17 by the Endocrine Society. The previous guideline was issued in 2010.
“Since 2010, the CDC has provided an accuracy-based standardization program for T (CDC Hormone Standardization Program for Testosterone). Although several commercial laboratories, some assay manufacturers, and some academic laboratories are now CDC certified, most T immunoassay kit manufacturers and local hospital-based laboratories have not been certified. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays for TT generally offer higher concentrations of specificity, sensitivity, and precision (especially in the low range) than do most immunoassays. Clinicians should ideally measure TT using a CDC-certified assay or an assay verified by an accuracy-based external quality control program,” according to the guideline.
Diagnosis, treatment, and follow-up of men with suspected hypogonadism often involve nuanced decisions, according to guideline panel chair Shalender Bhasin, MB, an endocrinologist who is professor of medicine at both Harvard Medical School and Brigham and Women’s Hospital, in Boston. The guideline will be published in its entirety in the May 2018 print issue of The Journal of Clinical Endocrinology & Metabolism.
Evaluation for suspected hypogonadism is indicated in men with symptoms and signs of testosterone deficiency – decreased libido, unexplained anemia, and/or osteopenia – and unequivocally and consistently low serum total testosterone and/or free testosterone concentrations, according to the guideline, which is co-sponsored by European Society of Endocrinology and endorsed by the European Academy of Andrology.
The guideline illuminates one area of diagnostic uncertainty that has dogged clinicians: Should one use age-specific testosterone levels? All the guideline authors speaking at the panel, in addition to Dr. Bhasin – Glenn R. Cunningham, MD, Baylor College of Medicine in Houston; Alvin M. Matsumoto, MD, VA Puget Sound Health Care System, Seattle; and Maria A. Yialamas, MD, Brigham and Women’s Hospital, Boston – agreed that age-specific testosterone levels do not improve diagnosis.
“The harmonized Reference range for TT in healthy, nonobese young men (aged 19 to 39 years) was 264 to 916 ng/dL (9.2 to 31.8 nmol/L) using the 2.5th and 97.5th percentile, and 303 to 852 ng/dL (10.5 to 29.5 nmol/L) using the 5th and 95th percentile (31). Clinicians can use this range for all CDC-certified TT assays,” according to the guideline.
Asking about history to explain low testosterone levels is an often overlooked part of patient evaluation. Two known causes of low testosterone in men often are not part of history taking but should be. One is use of opioids. The other is withdrawal from anabolic steroids. The best way to root these out in a history is to ask about any recent surgery and use of anabolic steroids, said Dr. Bhasin, speaking at the annual meeting of the Endocrine Society.
When it works, testosterone can make some men feel better: Testosterone replacement was associated with increased libido, erectile function, and sexual activity. However, testosterone replacement had no effect on energy and/or mood.
Not every man over the age of 65 with low testosterone is a candidate for testosterone replacement. There are some risks associated with its use; PSA may rise within 6 months of starting testosterone replacement, leaving physicians and men facing the issue of whether to have a prostate biopsy. The guideline recommends evaluating the patients with PSA the first time within 3-12 months after the start of therapy. When the test shows that PSA has risen, the decision of whether to have a prostate biopsy is one that should be shared by the patient and physician.
Dr. Bhasin declared financing from the National Institute on Aging, the National Institute of Nursing Research, the Patient-Centered Outcomes Research Institute, AbbVie, Metro International Biotechnology, Alivegen, Abbott, Transition Therapeutics, and Function Promoting Therapies.
SOURCE: ENDO 2018
REPORTING FROM ENDO 2018
EVATAR model: Endocrinology on a chip
into how female reproductive organs communicate with each other and the liver via the endocrine system.
The project was first funded in 2012 by a National Institutes of Health grant that aimed to spur development of experimental hardware, and now researchers at Northwestern University, Chicago, headed by Teresa K. Woodruff, PhD, have bioengineered a 3-D model of the female reproductive tract and the liver using living cells and tissues. The resulting model is small enough to fit in the palm of your hand.
“Cells in aggregate organs are in constant communication with each other and the conversation is provided by the endocrine system. This is a completely new era in biology helping us illuminate disease systems we could not otherwise, such as polycystic ovary disease [PCOS],” said Dr. Woodruff, who is the Thomas J. Watkins Memorial professor of obstetrics and gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University.
Until the development of EVATAR, there was no good animal or other model of female reproductive diseases, such as cancer, PCOS, and infertility.
The EVATAR 3-D system is composed of plastic cubes, each representing the target organs of the female reproductive tract. The tissue lining each cube is assembled from multiple cell lineages to create individual follicles that enclose and support oocytes, oviductal/fallopian tubes, uterine myometrium and endometrium, the cervix, and the vagina. The cubes are then connected with tiny tubes, so that the fluid representing human blood and the hormones contained therein can flow between each of the cube compartments.
The EVATAR also contains cells from the liver. Using this system, researchers can study the effects of drugs on the female reproductive system and examine the drug metabolites in the liver.
Variations on EVATAR currently in development include 3-D models of the male reproductive system, dubbed “Guy in a Cube,” she quipped.
into how female reproductive organs communicate with each other and the liver via the endocrine system.
The project was first funded in 2012 by a National Institutes of Health grant that aimed to spur development of experimental hardware, and now researchers at Northwestern University, Chicago, headed by Teresa K. Woodruff, PhD, have bioengineered a 3-D model of the female reproductive tract and the liver using living cells and tissues. The resulting model is small enough to fit in the palm of your hand.
“Cells in aggregate organs are in constant communication with each other and the conversation is provided by the endocrine system. This is a completely new era in biology helping us illuminate disease systems we could not otherwise, such as polycystic ovary disease [PCOS],” said Dr. Woodruff, who is the Thomas J. Watkins Memorial professor of obstetrics and gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University.
Until the development of EVATAR, there was no good animal or other model of female reproductive diseases, such as cancer, PCOS, and infertility.
The EVATAR 3-D system is composed of plastic cubes, each representing the target organs of the female reproductive tract. The tissue lining each cube is assembled from multiple cell lineages to create individual follicles that enclose and support oocytes, oviductal/fallopian tubes, uterine myometrium and endometrium, the cervix, and the vagina. The cubes are then connected with tiny tubes, so that the fluid representing human blood and the hormones contained therein can flow between each of the cube compartments.
The EVATAR also contains cells from the liver. Using this system, researchers can study the effects of drugs on the female reproductive system and examine the drug metabolites in the liver.
Variations on EVATAR currently in development include 3-D models of the male reproductive system, dubbed “Guy in a Cube,” she quipped.
into how female reproductive organs communicate with each other and the liver via the endocrine system.
The project was first funded in 2012 by a National Institutes of Health grant that aimed to spur development of experimental hardware, and now researchers at Northwestern University, Chicago, headed by Teresa K. Woodruff, PhD, have bioengineered a 3-D model of the female reproductive tract and the liver using living cells and tissues. The resulting model is small enough to fit in the palm of your hand.
“Cells in aggregate organs are in constant communication with each other and the conversation is provided by the endocrine system. This is a completely new era in biology helping us illuminate disease systems we could not otherwise, such as polycystic ovary disease [PCOS],” said Dr. Woodruff, who is the Thomas J. Watkins Memorial professor of obstetrics and gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University.
Until the development of EVATAR, there was no good animal or other model of female reproductive diseases, such as cancer, PCOS, and infertility.
The EVATAR 3-D system is composed of plastic cubes, each representing the target organs of the female reproductive tract. The tissue lining each cube is assembled from multiple cell lineages to create individual follicles that enclose and support oocytes, oviductal/fallopian tubes, uterine myometrium and endometrium, the cervix, and the vagina. The cubes are then connected with tiny tubes, so that the fluid representing human blood and the hormones contained therein can flow between each of the cube compartments.
The EVATAR also contains cells from the liver. Using this system, researchers can study the effects of drugs on the female reproductive system and examine the drug metabolites in the liver.
Variations on EVATAR currently in development include 3-D models of the male reproductive system, dubbed “Guy in a Cube,” she quipped.
Mission to Mars: Endocrinologists take on populating deep space
by studying the effects of space radiation and other factors on male and female fertility, according to Teresa K. Woodruff, PhD, the Thomas J. Watkins Memorial Professor of Obstetrics & Gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University, Chicago, who is chairing a session on March 17 at the 2018 Endocrine Society annual meeting entitled: “Mission to Mars.”
The project was developed based on the anticipation that “we will continue to explore space as an inhabitable frontier.” The talks in this session will examine endocrine-based reproduction such as sperm function and biologic fertilization that has occurred in space, noted Dr. Woodruff, who is also professor of molecular biosciences in the Weinberg College of Arts and Sciences and professor of biomedical engineering in the McCormick School of Engineering, both at Northwestern University.
Dr. Woodruff currently has a grant under review by the National Aeronautics and Space Administration that is relevant to the mission of populating space. “If we are going to populate space, which we will need to do based on the length of time we will be there, we are going to have to get gametes into space,” she said. There will be more and more research effort focused on the needs of the humans who are “non-Earth dwelling,” she said.
The next step might be to study embryo development in that environment. Such research would take place at the International Space Station.
“I am interested in endocrine disruptors. What we learn from the study of the challenges to reproduction in space we will be able to apply on earth,” Dr. Woodruff said.
Also on the panel will be Joseph S. Tash, PhD, of Kansas University, Kansas City, whose grant on Space Flight Impacts on Gonadal and Gamete Function already has NASA funding, according to Dr. Woodruff.
by studying the effects of space radiation and other factors on male and female fertility, according to Teresa K. Woodruff, PhD, the Thomas J. Watkins Memorial Professor of Obstetrics & Gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University, Chicago, who is chairing a session on March 17 at the 2018 Endocrine Society annual meeting entitled: “Mission to Mars.”
The project was developed based on the anticipation that “we will continue to explore space as an inhabitable frontier.” The talks in this session will examine endocrine-based reproduction such as sperm function and biologic fertilization that has occurred in space, noted Dr. Woodruff, who is also professor of molecular biosciences in the Weinberg College of Arts and Sciences and professor of biomedical engineering in the McCormick School of Engineering, both at Northwestern University.
Dr. Woodruff currently has a grant under review by the National Aeronautics and Space Administration that is relevant to the mission of populating space. “If we are going to populate space, which we will need to do based on the length of time we will be there, we are going to have to get gametes into space,” she said. There will be more and more research effort focused on the needs of the humans who are “non-Earth dwelling,” she said.
The next step might be to study embryo development in that environment. Such research would take place at the International Space Station.
“I am interested in endocrine disruptors. What we learn from the study of the challenges to reproduction in space we will be able to apply on earth,” Dr. Woodruff said.
Also on the panel will be Joseph S. Tash, PhD, of Kansas University, Kansas City, whose grant on Space Flight Impacts on Gonadal and Gamete Function already has NASA funding, according to Dr. Woodruff.
by studying the effects of space radiation and other factors on male and female fertility, according to Teresa K. Woodruff, PhD, the Thomas J. Watkins Memorial Professor of Obstetrics & Gynecology, the vice chair of research for the department of obstetrics and gynecology, and the chief of the division of reproductive science and medicine at Northwestern University, Chicago, who is chairing a session on March 17 at the 2018 Endocrine Society annual meeting entitled: “Mission to Mars.”
The project was developed based on the anticipation that “we will continue to explore space as an inhabitable frontier.” The talks in this session will examine endocrine-based reproduction such as sperm function and biologic fertilization that has occurred in space, noted Dr. Woodruff, who is also professor of molecular biosciences in the Weinberg College of Arts and Sciences and professor of biomedical engineering in the McCormick School of Engineering, both at Northwestern University.
Dr. Woodruff currently has a grant under review by the National Aeronautics and Space Administration that is relevant to the mission of populating space. “If we are going to populate space, which we will need to do based on the length of time we will be there, we are going to have to get gametes into space,” she said. There will be more and more research effort focused on the needs of the humans who are “non-Earth dwelling,” she said.
The next step might be to study embryo development in that environment. Such research would take place at the International Space Station.
“I am interested in endocrine disruptors. What we learn from the study of the challenges to reproduction in space we will be able to apply on earth,” Dr. Woodruff said.
Also on the panel will be Joseph S. Tash, PhD, of Kansas University, Kansas City, whose grant on Space Flight Impacts on Gonadal and Gamete Function already has NASA funding, according to Dr. Woodruff.
Endocrine Society Preview: The 2018 meeting will be ‘a journey to innovation’
Attendees at the upcoming Endocrine Society annual meeting in Chicago can expect many of the scheduled sessions to be practice changing, according to Ann Danoff, MD, clinical chair of this year’s meeting program.
Endocrine Society President Lynnette K. Nieman, MD, will lead off the plenary sessions on March 17, by presenting awards to six visionary investigators. Noteworthy among these will be the work of Diana Lynn Blithe, PhD, National Institutes of Health, for her research on male contraception. Dr. Blithe will speak about what’s in the clinical pipeline and what direction future research will take.
The second plenary session has an intriguing title – Rhythm and Blues. This session will cover circadian rhythmicity, which is, coincidentally, the research area of the three joint winners of the 2017 Nobel Prize in Physiology or Medicine.
In a plenary sessions scheduled for March 17, at 3:00 p.m., the topic under discussion will be the issue of circadian rhythm and metabolic health. Dysregulation of light and dark exposure puts people at risk for a variety of metabolic disease, said Dr. Danoff, who is chief of the medical service at the Philadelphia Veterans Affairs Medical Center. Specifically, two of the presentations – one on Circadian Rhythms, Blue Light, and Setting Your Internal Clock and the other on Improving Health by Time-Restricted Eating – are likely to be enlightening.
The Endocrine Society has revamped this year’s approach to sessions on guidelines to take the format of a discussion of how the guidelines affect patients on case-by-case basis. The moderator of each session will not be a member of the guideline-writing committee, but the panelists will be committee members.
New guidelines to be discussed are those dealing with gender incongruence and testosterone therapy. The session on transgender issues in endocrinology will take place on March 19, and is entitled Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The session on testosterone therapy is entitled: Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline, also on March 19.
Another change to the approach taken to guidelines are sessions that go beyond the guidelines to discuss patients who fall between the cracks. Topics of these sessions are osteoporosis, indeterminate thyroid nodules, and challenging hyperprolactinemia and prolactinoma cases The panels involved in these discussions may include a surgeon, and two-thirds of them will include a fellow. “I am committed to the bringing along of young trainees,” said Dr. Danoff.
And what is an annual meeting without a few debates? On March 18, there will be a debate on Debate: This House Believes that Adrenal Vein Sampling Has a Major Role to Play in the Management of Patients with Primary Aldosteronism. Speaking in favor will be William F. Young Jr., MD, of the Mayo Clinic in Rochester, Minn., and against will be Paul Michael Stewart, MD, of the University of Leeds (England). Another debate topic, scheduled for March 17, will be The LDL Limbo: How Low Should You Go? Taking up the side that Benefits of LDL Reduction Are Continuous and Extend to Extremely Low Levels will be Steven Nissen, MD, of the Cleveland Clinic. There to discuss Lower LDL Is Better but What About Very-Low LDL? will be Henry N. Ginsberg, MD, Columbia University College of Physicians and Surgeons, New York.
Attendees at the upcoming Endocrine Society annual meeting in Chicago can expect many of the scheduled sessions to be practice changing, according to Ann Danoff, MD, clinical chair of this year’s meeting program.
Endocrine Society President Lynnette K. Nieman, MD, will lead off the plenary sessions on March 17, by presenting awards to six visionary investigators. Noteworthy among these will be the work of Diana Lynn Blithe, PhD, National Institutes of Health, for her research on male contraception. Dr. Blithe will speak about what’s in the clinical pipeline and what direction future research will take.
The second plenary session has an intriguing title – Rhythm and Blues. This session will cover circadian rhythmicity, which is, coincidentally, the research area of the three joint winners of the 2017 Nobel Prize in Physiology or Medicine.
In a plenary sessions scheduled for March 17, at 3:00 p.m., the topic under discussion will be the issue of circadian rhythm and metabolic health. Dysregulation of light and dark exposure puts people at risk for a variety of metabolic disease, said Dr. Danoff, who is chief of the medical service at the Philadelphia Veterans Affairs Medical Center. Specifically, two of the presentations – one on Circadian Rhythms, Blue Light, and Setting Your Internal Clock and the other on Improving Health by Time-Restricted Eating – are likely to be enlightening.
The Endocrine Society has revamped this year’s approach to sessions on guidelines to take the format of a discussion of how the guidelines affect patients on case-by-case basis. The moderator of each session will not be a member of the guideline-writing committee, but the panelists will be committee members.
New guidelines to be discussed are those dealing with gender incongruence and testosterone therapy. The session on transgender issues in endocrinology will take place on March 19, and is entitled Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The session on testosterone therapy is entitled: Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline, also on March 19.
Another change to the approach taken to guidelines are sessions that go beyond the guidelines to discuss patients who fall between the cracks. Topics of these sessions are osteoporosis, indeterminate thyroid nodules, and challenging hyperprolactinemia and prolactinoma cases The panels involved in these discussions may include a surgeon, and two-thirds of them will include a fellow. “I am committed to the bringing along of young trainees,” said Dr. Danoff.
And what is an annual meeting without a few debates? On March 18, there will be a debate on Debate: This House Believes that Adrenal Vein Sampling Has a Major Role to Play in the Management of Patients with Primary Aldosteronism. Speaking in favor will be William F. Young Jr., MD, of the Mayo Clinic in Rochester, Minn., and against will be Paul Michael Stewart, MD, of the University of Leeds (England). Another debate topic, scheduled for March 17, will be The LDL Limbo: How Low Should You Go? Taking up the side that Benefits of LDL Reduction Are Continuous and Extend to Extremely Low Levels will be Steven Nissen, MD, of the Cleveland Clinic. There to discuss Lower LDL Is Better but What About Very-Low LDL? will be Henry N. Ginsberg, MD, Columbia University College of Physicians and Surgeons, New York.
Attendees at the upcoming Endocrine Society annual meeting in Chicago can expect many of the scheduled sessions to be practice changing, according to Ann Danoff, MD, clinical chair of this year’s meeting program.
Endocrine Society President Lynnette K. Nieman, MD, will lead off the plenary sessions on March 17, by presenting awards to six visionary investigators. Noteworthy among these will be the work of Diana Lynn Blithe, PhD, National Institutes of Health, for her research on male contraception. Dr. Blithe will speak about what’s in the clinical pipeline and what direction future research will take.
The second plenary session has an intriguing title – Rhythm and Blues. This session will cover circadian rhythmicity, which is, coincidentally, the research area of the three joint winners of the 2017 Nobel Prize in Physiology or Medicine.
In a plenary sessions scheduled for March 17, at 3:00 p.m., the topic under discussion will be the issue of circadian rhythm and metabolic health. Dysregulation of light and dark exposure puts people at risk for a variety of metabolic disease, said Dr. Danoff, who is chief of the medical service at the Philadelphia Veterans Affairs Medical Center. Specifically, two of the presentations – one on Circadian Rhythms, Blue Light, and Setting Your Internal Clock and the other on Improving Health by Time-Restricted Eating – are likely to be enlightening.
The Endocrine Society has revamped this year’s approach to sessions on guidelines to take the format of a discussion of how the guidelines affect patients on case-by-case basis. The moderator of each session will not be a member of the guideline-writing committee, but the panelists will be committee members.
New guidelines to be discussed are those dealing with gender incongruence and testosterone therapy. The session on transgender issues in endocrinology will take place on March 19, and is entitled Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The session on testosterone therapy is entitled: Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline, also on March 19.
Another change to the approach taken to guidelines are sessions that go beyond the guidelines to discuss patients who fall between the cracks. Topics of these sessions are osteoporosis, indeterminate thyroid nodules, and challenging hyperprolactinemia and prolactinoma cases The panels involved in these discussions may include a surgeon, and two-thirds of them will include a fellow. “I am committed to the bringing along of young trainees,” said Dr. Danoff.
And what is an annual meeting without a few debates? On March 18, there will be a debate on Debate: This House Believes that Adrenal Vein Sampling Has a Major Role to Play in the Management of Patients with Primary Aldosteronism. Speaking in favor will be William F. Young Jr., MD, of the Mayo Clinic in Rochester, Minn., and against will be Paul Michael Stewart, MD, of the University of Leeds (England). Another debate topic, scheduled for March 17, will be The LDL Limbo: How Low Should You Go? Taking up the side that Benefits of LDL Reduction Are Continuous and Extend to Extremely Low Levels will be Steven Nissen, MD, of the Cleveland Clinic. There to discuss Lower LDL Is Better but What About Very-Low LDL? will be Henry N. Ginsberg, MD, Columbia University College of Physicians and Surgeons, New York.
Ertugliflozin gets FDA thumbs-up for glucose control
The Food and Drug Administration has approved ertugliflozin for use both as monotherapy and in combination with sitagliptin or metformin to control blood glucose in patients with type 2 diabetes.
The FDA approval covers ertugliflozin monotherapy (Steglatro, Merck and Pfizer) and ertugliflozin plus sitagliptin, a dipeptidyl peptidase–4 (DPP-4) inhibitor, as a fixed-dose combination (Steglujan, Merck) and ertugliflozin plus metformin (Segluromet, Merck).
Ertugliflozin is the third sodium glucose cotransporter 2 (SGLT2) inhibitor to win FDA approval. Another such agent, empagliflozin, recently won a second indication for lowering the risk for cardiovascular death in adults with type 2 diabetes and established heart disease.
The American Diabetes Association recognized the value of SGLT2 inhibitors in patients with type 2 diabetes in its 2018 Standards of Care in Diabetes, now recommending that clinicians consider adding agents proved to reduce major cardiovascular events and cardiovascular death – such as the SGLT2 inhibitor empagliflozin or the glucagonlike peptide–1 agonist liraglutide – to the regimens of patients with diabetes and atherosclerotic cardiovascular disease (Diabetes Care 2018;41(Suppl. 1):S86-S104. doi: 10.2337/dc18-S009).
The Food and Drug Administration has approved ertugliflozin for use both as monotherapy and in combination with sitagliptin or metformin to control blood glucose in patients with type 2 diabetes.
The FDA approval covers ertugliflozin monotherapy (Steglatro, Merck and Pfizer) and ertugliflozin plus sitagliptin, a dipeptidyl peptidase–4 (DPP-4) inhibitor, as a fixed-dose combination (Steglujan, Merck) and ertugliflozin plus metformin (Segluromet, Merck).
Ertugliflozin is the third sodium glucose cotransporter 2 (SGLT2) inhibitor to win FDA approval. Another such agent, empagliflozin, recently won a second indication for lowering the risk for cardiovascular death in adults with type 2 diabetes and established heart disease.
The American Diabetes Association recognized the value of SGLT2 inhibitors in patients with type 2 diabetes in its 2018 Standards of Care in Diabetes, now recommending that clinicians consider adding agents proved to reduce major cardiovascular events and cardiovascular death – such as the SGLT2 inhibitor empagliflozin or the glucagonlike peptide–1 agonist liraglutide – to the regimens of patients with diabetes and atherosclerotic cardiovascular disease (Diabetes Care 2018;41(Suppl. 1):S86-S104. doi: 10.2337/dc18-S009).
The Food and Drug Administration has approved ertugliflozin for use both as monotherapy and in combination with sitagliptin or metformin to control blood glucose in patients with type 2 diabetes.
The FDA approval covers ertugliflozin monotherapy (Steglatro, Merck and Pfizer) and ertugliflozin plus sitagliptin, a dipeptidyl peptidase–4 (DPP-4) inhibitor, as a fixed-dose combination (Steglujan, Merck) and ertugliflozin plus metformin (Segluromet, Merck).
Ertugliflozin is the third sodium glucose cotransporter 2 (SGLT2) inhibitor to win FDA approval. Another such agent, empagliflozin, recently won a second indication for lowering the risk for cardiovascular death in adults with type 2 diabetes and established heart disease.
The American Diabetes Association recognized the value of SGLT2 inhibitors in patients with type 2 diabetes in its 2018 Standards of Care in Diabetes, now recommending that clinicians consider adding agents proved to reduce major cardiovascular events and cardiovascular death – such as the SGLT2 inhibitor empagliflozin or the glucagonlike peptide–1 agonist liraglutide – to the regimens of patients with diabetes and atherosclerotic cardiovascular disease (Diabetes Care 2018;41(Suppl. 1):S86-S104. doi: 10.2337/dc18-S009).
Thyroid cancer incidence: It’s not all good news
ORLANDO – The incidence of thyroid cancer in the United States between 2000-2013 has dropped in whites while increasing in blacks and Hispanics, Anupam Kotwal, MBBS, said during a press briefing at the annual meeting of the Endocrine Society.
Other recently reported data have shown a steady gradual incidence in thyroid cancer between 1974-2013 (JAMA. 2017 Mar 31. doi:10.1001/jama.2017.2719).
From 2000 to 2013, the incidence of thyroid cancer as a whole increased from 7.4 to 14.5 cases per 100,000 population with an annual percent increase of 6.7% from 2000-2009 (P less than .05) and 2.4% from 2010 to 2013 (P less than .05). In Hispanics and African-Americans, thyroid cancer incidence has continuously increased, with an annual percent increase of 4.7% (P less than .05) and 5.1% (P less than .05) respectively, whereas for non-Hispanic whites, the annual percent increase decelerated from 7.1% (P less than .05) before 2009 to 2.2% after 2009.
Looking at changes to incidence by age, non-Hispanic white women over the age of 75 are the only ones to see a decrease, from 6.5 cases per 100,000 in 2010 to 2.4 cases per 100,000 population in 2014. The investigations reported the same acceleration of incidence among everyone under the age of 20 years.
These findings are consistent with recent reports demonstrating that thyroid cancer is the 2nd most common cancer among Hispanic females, female adolescents and young adults.
Dr. Kotwal reported that he had no relevant conflicts of interest.
ORLANDO – The incidence of thyroid cancer in the United States between 2000-2013 has dropped in whites while increasing in blacks and Hispanics, Anupam Kotwal, MBBS, said during a press briefing at the annual meeting of the Endocrine Society.
Other recently reported data have shown a steady gradual incidence in thyroid cancer between 1974-2013 (JAMA. 2017 Mar 31. doi:10.1001/jama.2017.2719).
From 2000 to 2013, the incidence of thyroid cancer as a whole increased from 7.4 to 14.5 cases per 100,000 population with an annual percent increase of 6.7% from 2000-2009 (P less than .05) and 2.4% from 2010 to 2013 (P less than .05). In Hispanics and African-Americans, thyroid cancer incidence has continuously increased, with an annual percent increase of 4.7% (P less than .05) and 5.1% (P less than .05) respectively, whereas for non-Hispanic whites, the annual percent increase decelerated from 7.1% (P less than .05) before 2009 to 2.2% after 2009.
Looking at changes to incidence by age, non-Hispanic white women over the age of 75 are the only ones to see a decrease, from 6.5 cases per 100,000 in 2010 to 2.4 cases per 100,000 population in 2014. The investigations reported the same acceleration of incidence among everyone under the age of 20 years.
These findings are consistent with recent reports demonstrating that thyroid cancer is the 2nd most common cancer among Hispanic females, female adolescents and young adults.
Dr. Kotwal reported that he had no relevant conflicts of interest.
ORLANDO – The incidence of thyroid cancer in the United States between 2000-2013 has dropped in whites while increasing in blacks and Hispanics, Anupam Kotwal, MBBS, said during a press briefing at the annual meeting of the Endocrine Society.
Other recently reported data have shown a steady gradual incidence in thyroid cancer between 1974-2013 (JAMA. 2017 Mar 31. doi:10.1001/jama.2017.2719).
From 2000 to 2013, the incidence of thyroid cancer as a whole increased from 7.4 to 14.5 cases per 100,000 population with an annual percent increase of 6.7% from 2000-2009 (P less than .05) and 2.4% from 2010 to 2013 (P less than .05). In Hispanics and African-Americans, thyroid cancer incidence has continuously increased, with an annual percent increase of 4.7% (P less than .05) and 5.1% (P less than .05) respectively, whereas for non-Hispanic whites, the annual percent increase decelerated from 7.1% (P less than .05) before 2009 to 2.2% after 2009.
Looking at changes to incidence by age, non-Hispanic white women over the age of 75 are the only ones to see a decrease, from 6.5 cases per 100,000 in 2010 to 2.4 cases per 100,000 population in 2014. The investigations reported the same acceleration of incidence among everyone under the age of 20 years.
These findings are consistent with recent reports demonstrating that thyroid cancer is the 2nd most common cancer among Hispanic females, female adolescents and young adults.
Dr. Kotwal reported that he had no relevant conflicts of interest.
AT ENDO 2017
Key clinical point:
Major finding: The incidence of thyroid cancer has dropped from 7 cases per 100,000 in 2000 to 2.2 cases per 100,000 in 2013 among whites. Among blacks it has increased from 5 cases to 7 cases per 100,000 over that time frame and in Hispanics from 7 cases to 12 cases per 100,000.
Data source: Data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results data base.
Disclosures: The study received no external funding. Dr. Kotwal reported he had no relevant financial conflicts of interest.
Rotterdam Study: High T4 levels increased the risk for atherosclerotic events, death
ORLANDO – Elevated serum levels of free T4 are associated with a greater risk of atherosclerotic events and, in some cases, death, among adults in their 60s, Arjola Bano, MD, said at a press briefing at the annual meeting of the Endocrine Society.
Earlier research has shown that high FT4 levels are associated with a greater likelihood of development of atherosclerosis. But no one has looked beyond that to see if an excess of FT4 can change the course of the disease.
The investigators used electron beam computed tomography to measure coronary artery calcification. Confounders such as age, sex, smoking, alcohol intake, body mass index, total cholesterol, triglycerides, systolic blood pressure, diabetes, and use of anti-hypertension or lipid lowering medications were controlled for using multivariable-adjusted Cox proportional and logistic regression models.
Dr. Bano reported that during a median follow-up of 8.8 years (range, 4.5-11.8 years), there were 580 ASCV deaths and 1,130 first-time hard ASCV events. The risk of ASCV mortality increased with higher FT4 levels (hazard ratio, 2.35; 95% confidence interval, 1.61-3.41 per 1 ng/dL) and lower TSH levels (HR, 0.92; 95% CI, 0.84-1.00/1 logTSH), predominantly among participants with prevalent ASCV disease (HR, 5.76; 95% CI, 2.79-11.89 for FT4; HR, 0.81; 95% CI, 0.69-0.95 for TSH).
In addition, higher FT4 levels were associated with higher risk of first-time hard ASCV event (HR, 1.87; 95% CI, 1.34-2.59). Also, FT4 levels were positively associated with having a high CAC score (OR, 2.34; 95% CI, 1.36-4.04).
It is noteworthy that results remained similar after restricting the analyses to participants with thyroid function within reference ranges, she stressed.
How to explain these findings? These data suggest that the link between thyroid function and atherosclerosis is mediated through yet unexplored cardiovascular risk factors or via alternative pathways.
Dr. Bano and her associates all report that they have no relevant financial conflicts of interest.
ORLANDO – Elevated serum levels of free T4 are associated with a greater risk of atherosclerotic events and, in some cases, death, among adults in their 60s, Arjola Bano, MD, said at a press briefing at the annual meeting of the Endocrine Society.
Earlier research has shown that high FT4 levels are associated with a greater likelihood of development of atherosclerosis. But no one has looked beyond that to see if an excess of FT4 can change the course of the disease.
The investigators used electron beam computed tomography to measure coronary artery calcification. Confounders such as age, sex, smoking, alcohol intake, body mass index, total cholesterol, triglycerides, systolic blood pressure, diabetes, and use of anti-hypertension or lipid lowering medications were controlled for using multivariable-adjusted Cox proportional and logistic regression models.
Dr. Bano reported that during a median follow-up of 8.8 years (range, 4.5-11.8 years), there were 580 ASCV deaths and 1,130 first-time hard ASCV events. The risk of ASCV mortality increased with higher FT4 levels (hazard ratio, 2.35; 95% confidence interval, 1.61-3.41 per 1 ng/dL) and lower TSH levels (HR, 0.92; 95% CI, 0.84-1.00/1 logTSH), predominantly among participants with prevalent ASCV disease (HR, 5.76; 95% CI, 2.79-11.89 for FT4; HR, 0.81; 95% CI, 0.69-0.95 for TSH).
In addition, higher FT4 levels were associated with higher risk of first-time hard ASCV event (HR, 1.87; 95% CI, 1.34-2.59). Also, FT4 levels were positively associated with having a high CAC score (OR, 2.34; 95% CI, 1.36-4.04).
It is noteworthy that results remained similar after restricting the analyses to participants with thyroid function within reference ranges, she stressed.
How to explain these findings? These data suggest that the link between thyroid function and atherosclerosis is mediated through yet unexplored cardiovascular risk factors or via alternative pathways.
Dr. Bano and her associates all report that they have no relevant financial conflicts of interest.
ORLANDO – Elevated serum levels of free T4 are associated with a greater risk of atherosclerotic events and, in some cases, death, among adults in their 60s, Arjola Bano, MD, said at a press briefing at the annual meeting of the Endocrine Society.
Earlier research has shown that high FT4 levels are associated with a greater likelihood of development of atherosclerosis. But no one has looked beyond that to see if an excess of FT4 can change the course of the disease.
The investigators used electron beam computed tomography to measure coronary artery calcification. Confounders such as age, sex, smoking, alcohol intake, body mass index, total cholesterol, triglycerides, systolic blood pressure, diabetes, and use of anti-hypertension or lipid lowering medications were controlled for using multivariable-adjusted Cox proportional and logistic regression models.
Dr. Bano reported that during a median follow-up of 8.8 years (range, 4.5-11.8 years), there were 580 ASCV deaths and 1,130 first-time hard ASCV events. The risk of ASCV mortality increased with higher FT4 levels (hazard ratio, 2.35; 95% confidence interval, 1.61-3.41 per 1 ng/dL) and lower TSH levels (HR, 0.92; 95% CI, 0.84-1.00/1 logTSH), predominantly among participants with prevalent ASCV disease (HR, 5.76; 95% CI, 2.79-11.89 for FT4; HR, 0.81; 95% CI, 0.69-0.95 for TSH).
In addition, higher FT4 levels were associated with higher risk of first-time hard ASCV event (HR, 1.87; 95% CI, 1.34-2.59). Also, FT4 levels were positively associated with having a high CAC score (OR, 2.34; 95% CI, 1.36-4.04).
It is noteworthy that results remained similar after restricting the analyses to participants with thyroid function within reference ranges, she stressed.
How to explain these findings? These data suggest that the link between thyroid function and atherosclerosis is mediated through yet unexplored cardiovascular risk factors or via alternative pathways.
Dr. Bano and her associates all report that they have no relevant financial conflicts of interest.
AT ENDO 2017
Key clinical point: Major finding: The odds of an atherosclerotic event were 2.28 times higher in adults with elevated FT4 levels than those with high TSH, even when the high levels were still within the normal range.
Data source: Prospective study of 9,231 adults followed over 8.8 years.
Disclosures: Dr. Bano and her associates all report that they have no relevant financial conflicts of interest.
Milk interferes with levothyroxine absorption
ORLANDO – Consuming milk and levothyroxine at the same time reduced the absorption of the thyroid hormone replacement, according to Deborah Chon, MD, speaking at a press briefing at the annual meeting of the Endocrine Society.
This finding comes from a small study of 10 healthy adults with normal TSH concentration at baseline. The study participants had a mean age of 34 years and 6 were men.
The total serum T4 absorption over 6 hours, calculated as area under the curve, was significantly lower when participants took levothyroxine and milk concurrently, compared with taking it alone (67.26 vs. 73.48; P equals .02).
The best interval between taking levothyroxine and drinking milk has yet to be established, according to Dr. Chon, who is on the faculty of the University of California, Los Angeles. Findings from earlier research showed that use of elemental calcium supplements interfere with absorption of levothyroxine.
In 2014, levothyroxine became the most commonly prescribed drug in the United States, according to a survey by the IMS Institute for Healthcare Informatics, now QuintilesIMS. Patients who need to take it because of Hashimoto’s thyroiditis or after thyroidectomy are often unhappy with how they feel. Dose adjustments are common as endocrinologists struggle to improve patients’ quality of life. It may be that a simple strategy of not taking the thyroid replacement at the same time as milk might leave patients feeling better.
Dr. Chon reported having no relevant financial conflicts of interest.
This article was updated 4/10/17.
ORLANDO – Consuming milk and levothyroxine at the same time reduced the absorption of the thyroid hormone replacement, according to Deborah Chon, MD, speaking at a press briefing at the annual meeting of the Endocrine Society.
This finding comes from a small study of 10 healthy adults with normal TSH concentration at baseline. The study participants had a mean age of 34 years and 6 were men.
The total serum T4 absorption over 6 hours, calculated as area under the curve, was significantly lower when participants took levothyroxine and milk concurrently, compared with taking it alone (67.26 vs. 73.48; P equals .02).
The best interval between taking levothyroxine and drinking milk has yet to be established, according to Dr. Chon, who is on the faculty of the University of California, Los Angeles. Findings from earlier research showed that use of elemental calcium supplements interfere with absorption of levothyroxine.
In 2014, levothyroxine became the most commonly prescribed drug in the United States, according to a survey by the IMS Institute for Healthcare Informatics, now QuintilesIMS. Patients who need to take it because of Hashimoto’s thyroiditis or after thyroidectomy are often unhappy with how they feel. Dose adjustments are common as endocrinologists struggle to improve patients’ quality of life. It may be that a simple strategy of not taking the thyroid replacement at the same time as milk might leave patients feeling better.
Dr. Chon reported having no relevant financial conflicts of interest.
This article was updated 4/10/17.
ORLANDO – Consuming milk and levothyroxine at the same time reduced the absorption of the thyroid hormone replacement, according to Deborah Chon, MD, speaking at a press briefing at the annual meeting of the Endocrine Society.
This finding comes from a small study of 10 healthy adults with normal TSH concentration at baseline. The study participants had a mean age of 34 years and 6 were men.
The total serum T4 absorption over 6 hours, calculated as area under the curve, was significantly lower when participants took levothyroxine and milk concurrently, compared with taking it alone (67.26 vs. 73.48; P equals .02).
The best interval between taking levothyroxine and drinking milk has yet to be established, according to Dr. Chon, who is on the faculty of the University of California, Los Angeles. Findings from earlier research showed that use of elemental calcium supplements interfere with absorption of levothyroxine.
In 2014, levothyroxine became the most commonly prescribed drug in the United States, according to a survey by the IMS Institute for Healthcare Informatics, now QuintilesIMS. Patients who need to take it because of Hashimoto’s thyroiditis or after thyroidectomy are often unhappy with how they feel. Dose adjustments are common as endocrinologists struggle to improve patients’ quality of life. It may be that a simple strategy of not taking the thyroid replacement at the same time as milk might leave patients feeling better.
Dr. Chon reported having no relevant financial conflicts of interest.
This article was updated 4/10/17.
AT ENDO 2017
Key clinical point:
Major finding: Calculated as an area under the curve, simultaneous consumption of levothyroxine and milk reduced absorption of the supplement by a mean of 67.26 vs. 73.48 when taken without milk.
Data source: A pharmacokinetic study of 10 healthy subjects.
Disclosures: Dr. Chon reported having no relevant conflicts of interest.
Quality of life in hypothyroidism is key, but no treatment guide exists
ORLANDO – The quality of life of someone with treated hypothyroidism is worse than that of the general population and requires endocrinologists to think “outside the pill box,” said Anna M. Sawka, MD, PhD, of the University of Toronto, at a spring symposium presented by the American Thyroid Association.
While issues such as whether monotherapy with T4 is the treatment of choice or whether there is a subset of patients who might benefit from treatment with either T4/T3 in combination or even with extract of dessicated thyroid, many patients with treated hypothyroidism continue to feel bad, judging from discussion during the symposium.
As defined by the CDC, health-related quality of life can be energy level, mood, health risks and condition, functional and socioeconomic status. Here, at this meeting, the focus is on treatment. But QoL is so much more than that. It is recorded by the patient; it’s their perceptions. Of the available disease-specific–measures of QoL, many have not been validated.
One group of researchers assessed four QoL assessment questionnaires and gave top rating to the ThyPRO (thyroid-specific patient reported outcome) questionnaire for use in patients with hypothyroidism due to Hashimoto’s disease or thyroidectomy (J Clin Epidemiol. 2016 Oct;78:63-72).
The ThyPRO looks at two factors that are key to QoL in hypothyroidism: satisfaction with thyroid hormone and symptom control.
Looking at hypothyroidism from the perspective of the patient is catching on in endocrinology. Dr. Sawka reviewed data from 6 studies of QoL in people with treated hypothyroidism. The years of the studies ranged from 2002 to 2017 and the number of patients ranged from 58 to 591. While only one study used the ThyPRO, all found that QoL was worse in patients with treated hypothyroidism than in the general population.
Findings from one study based on in-depth interviews with 16 patients, of whom 5 had hypothyroidism and 11 had hyperthyroidism, showed that a key trait of either condition was that of losing control over their physical and mental states, with the hypothyroid group reporting feeling drained while the others said they felt sped up. The signs of hypothyroidism can be attributed to other things, such as aging or stress, and that ambiguity frustrated the patients in the study. Also key was the experience of having to negotiate their disease, with a keen awareness that their endocrinologist did not validate their experience, that they had to look to lab tests to tell them the state of their disease, and they had to deal with functional limitations (Qual Health Research. 2015 Jul;25[7]:945-53).
Dr. Sawka reported that she has no financial disclosures.
ORLANDO – The quality of life of someone with treated hypothyroidism is worse than that of the general population and requires endocrinologists to think “outside the pill box,” said Anna M. Sawka, MD, PhD, of the University of Toronto, at a spring symposium presented by the American Thyroid Association.
While issues such as whether monotherapy with T4 is the treatment of choice or whether there is a subset of patients who might benefit from treatment with either T4/T3 in combination or even with extract of dessicated thyroid, many patients with treated hypothyroidism continue to feel bad, judging from discussion during the symposium.
As defined by the CDC, health-related quality of life can be energy level, mood, health risks and condition, functional and socioeconomic status. Here, at this meeting, the focus is on treatment. But QoL is so much more than that. It is recorded by the patient; it’s their perceptions. Of the available disease-specific–measures of QoL, many have not been validated.
One group of researchers assessed four QoL assessment questionnaires and gave top rating to the ThyPRO (thyroid-specific patient reported outcome) questionnaire for use in patients with hypothyroidism due to Hashimoto’s disease or thyroidectomy (J Clin Epidemiol. 2016 Oct;78:63-72).
The ThyPRO looks at two factors that are key to QoL in hypothyroidism: satisfaction with thyroid hormone and symptom control.
Looking at hypothyroidism from the perspective of the patient is catching on in endocrinology. Dr. Sawka reviewed data from 6 studies of QoL in people with treated hypothyroidism. The years of the studies ranged from 2002 to 2017 and the number of patients ranged from 58 to 591. While only one study used the ThyPRO, all found that QoL was worse in patients with treated hypothyroidism than in the general population.
Findings from one study based on in-depth interviews with 16 patients, of whom 5 had hypothyroidism and 11 had hyperthyroidism, showed that a key trait of either condition was that of losing control over their physical and mental states, with the hypothyroid group reporting feeling drained while the others said they felt sped up. The signs of hypothyroidism can be attributed to other things, such as aging or stress, and that ambiguity frustrated the patients in the study. Also key was the experience of having to negotiate their disease, with a keen awareness that their endocrinologist did not validate their experience, that they had to look to lab tests to tell them the state of their disease, and they had to deal with functional limitations (Qual Health Research. 2015 Jul;25[7]:945-53).
Dr. Sawka reported that she has no financial disclosures.
ORLANDO – The quality of life of someone with treated hypothyroidism is worse than that of the general population and requires endocrinologists to think “outside the pill box,” said Anna M. Sawka, MD, PhD, of the University of Toronto, at a spring symposium presented by the American Thyroid Association.
While issues such as whether monotherapy with T4 is the treatment of choice or whether there is a subset of patients who might benefit from treatment with either T4/T3 in combination or even with extract of dessicated thyroid, many patients with treated hypothyroidism continue to feel bad, judging from discussion during the symposium.
As defined by the CDC, health-related quality of life can be energy level, mood, health risks and condition, functional and socioeconomic status. Here, at this meeting, the focus is on treatment. But QoL is so much more than that. It is recorded by the patient; it’s their perceptions. Of the available disease-specific–measures of QoL, many have not been validated.
One group of researchers assessed four QoL assessment questionnaires and gave top rating to the ThyPRO (thyroid-specific patient reported outcome) questionnaire for use in patients with hypothyroidism due to Hashimoto’s disease or thyroidectomy (J Clin Epidemiol. 2016 Oct;78:63-72).
The ThyPRO looks at two factors that are key to QoL in hypothyroidism: satisfaction with thyroid hormone and symptom control.
Looking at hypothyroidism from the perspective of the patient is catching on in endocrinology. Dr. Sawka reviewed data from 6 studies of QoL in people with treated hypothyroidism. The years of the studies ranged from 2002 to 2017 and the number of patients ranged from 58 to 591. While only one study used the ThyPRO, all found that QoL was worse in patients with treated hypothyroidism than in the general population.
Findings from one study based on in-depth interviews with 16 patients, of whom 5 had hypothyroidism and 11 had hyperthyroidism, showed that a key trait of either condition was that of losing control over their physical and mental states, with the hypothyroid group reporting feeling drained while the others said they felt sped up. The signs of hypothyroidism can be attributed to other things, such as aging or stress, and that ambiguity frustrated the patients in the study. Also key was the experience of having to negotiate their disease, with a keen awareness that their endocrinologist did not validate their experience, that they had to look to lab tests to tell them the state of their disease, and they had to deal with functional limitations (Qual Health Research. 2015 Jul;25[7]:945-53).
Dr. Sawka reported that she has no financial disclosures.
AT AN ATA SYMPOSIUM