Iodine supply of pregnant women in the Czech Republic

Radovan Bílek, Nataša Kaňová, Veronika Mindžáková, David Neumann, Jan Jiskra, Lydie Ryšavá, Václav Zamrazil

Vnitr Lek 2016, 62(Suppl 3):10-16  

Introduction:Iodine deficiency is a global public health problem which is particularly noticeable in pregnant or breastfeeding women and their children. Even mild iodine deficiency during pregnancy can lead to damage to the developing brain and thus affecting the fetus intelligence, his cognitive and neurological function, embryogenesis and growth. Patients:In the period 2010-2015 was determined by spectrophotometry at the Institute of Endocrinology the basal urinary iodine in 532 pregnant women at the age of 32 ± 5 (18-44) years, which came from Prague, Hradec Kralove and Mlada Boleslav. It was located 349 women in...

The course of differentiated thyroid microcarcinoma in patients treated by different therapeutic strategies

Marianna Grigerová, Martin Griger, Emília Mojtová, Ján Podoba

Vnitr Lek 2016, 62(Suppl 3):17-21  

Low risk differentiated thyroid microcarcinoma therapy is a controversial area of thyroid tumor management. Major international medical societies and reputable institutes consider lobectomy to be sufficient therapeutic intervention for the pT1a cN0cM0 stage of papillary thyroid microcarcinoma. However different views and therapeutic strategies exist and result in unnecessary overtreatment and worsening of patient's quality of life. We researched the course of the differentiated thyroid microcarcinoma in patients using different therapeutic strategies: lobectomy, total thyroidectomy, total thyroidectomy with central compartment prophylactic lymphadenectomy...

The SPACE project (Stav Pacientů Akceptovaných diabetologem Cestou Exportu/The Health Records of Patients Accepted by a Diabetologist by way of Export)

Milan Kvapil

Vnitr Lek 2016, 62(Suppl 3):22-27  

Introduction:A structured care of patients with diabetes is in place in the Czech Republic and the majority of patients are followed up by a diabetologist in outpatient diabetes units. The SPACE project (The Health Records of Patients Accepted by a Diabetologist by way of Export) was initiated to address the lack of the data which would allow for objective evaluation of how the cooperation in the care of patients with diabetes works in the real-life health care practice in the Czech Republic. Goal:Gaining the description of anthropometric parameters, presence of complications, the chosen therapy and metabolic state of patients...

Iodine supply and iodinuria among the Czech population between the years 1995 and 2016

Lydie Ryšavá, Jaroslav Kříž, Lucie Kašparová, Tereza Křížová, Monika Žoltá, Petra Lisníková

Vnitr Lek 2016, 62(Suppl 3):28-32  

Monitoring of Ioduria and Iodine saturation are essential tools for evaluation of effectivness of measures aimed at elimination of diseases caused by iodine deficiency. Between 1995 and 2016 monitoring of ioduria was udertaken in various population groups in Czech Republic. The most recent study (2015) found only 37 % of pregnant women in optimal range of ioduria (150-300 mcg/l), in iodopenic range 27 %, while 6 % of these had severe iodopenia below 50 mcg/l. In a group of 3y old children investigated in the same year, 57 % were found to have Ioduria within the recommended range (90-299 mcg/l), 24 % had higher than recommended Ioduria (300-499 mcg/l)...

Urinary iodine concentration in adult patients with type 1 diabetes mellitus

Michala Vosátková, Denisa Janíčková Žďárská, Václav Zamrazil, Martina Salátová, Martin Hill, Karel Vondra

Vnitr Lek 2016, 62(Suppl 3):33-39  

Introduction:In patients with type 1 and 2 diabetes mellitus only rare data concerning the status of iodine supplementation and impact of possible iodine deficiency is available. Aim:To get basic information about (a) state of supply with iodine in patients with type 1 diabetes mellitus (DM1T), (b) the difference from non-diabetic population, (c) possible association of iodine saturation with some clinical and laboratory features of the diabetic syndrome, including the state of thyroid gland. Subjects and methods:We examined 54 men and 51 women treated with DM1T in a cross-sectional study. Age: median 42 years...

Thyroid cancer in children and adolescents and its molecular genetic background

Běla Bendlová, Vlasta Sýkorová, Eliška Václavíková, Josef Včelák, Rami Katra, Pavla Sýkorová, Petr Vlček, Šárka Dvořáková

Vnitr Lek 2016, 62(Suppl 3):40-44  

Thyroid cancer is the main endocrine malignancy. Its incidence is steadily growing and what is alarming is its increase in children and adolescent population. Pediatric thyroid carcinomas differ from the adult ones in phenotype as well as in genetics. These carcinomas tend to be clinically more aggressive, with more frequent local and distant metastases. However, their long-term prognosis is better in comparison with the adult thyroid cancers. Due to the rarity of the disease, there is lack of data on genetic changes in this age group. Knowledge on the genetic background of thyroid cancer in children will help to precise diagnosis and prognosis of...

Endocrine complications of modern cancer therapy

Jan Čáp

Vnitr Lek 2016, 62(Suppl 3):45-49  

Treatment with tyrosine kinase inhibitors leads to thyroid dysfunction in up to one half of treated patients, hypothyroidism being the most common. It is caused by destructive thyroiditis, impaired transport of T₄ into the cell and deiodinase induction. Bexarotene is a nuclear retinoid X receptor agonist. Its application is accompanied with central hypothyroidism and hypertriglyceriaemia in virtually all patients and it also increases thyroxin metabolism. Autoimmune endocrine side effects are common in cancer immunotherapy. Cytokines (interpheron α and interleukin 2) cause autoimmune thyroiditis in 2-10 % of treated patients. Therapy...

Levothyroxine therapy - factors influencing its outcome

Marcela Dvořáková

Vnitr Lek 2016, 62(Suppl 3):50-55  

The article gives an overview of the circumstances-eating habits, disorders of absorption in the intestinal and other disease, certain drugs and substances occurring in nature affecting the metabolism of thyroid hormones on many levels, thyroid disruptors, for which compensation may be healing broken thyroid function to be unsatisfactory in spite of following the rules of substitution treatment. Knowledge of these conditions and adapting to them timely by adjusting either the eating habits or thyroid hormone by adjusting benefits, allowing the patient to improve his subjective feelings from treatment and improving compliance.

Endocrine orbitopathy - the topic still alive

Zdeněk Fryšák, David Karásek, Milan Halenka

Vnitr Lek 2016, 62(Suppl 3):56-62  

Endocrine orbitopathy (EO) must be understood mainly as a result of oxidative stress. The pathological process finally affects both the appearance and vision of the patient. In the case of inappropriate or late treatment or lack of patient cooperation, it significantly influences the quality of life of those affected. In spite of the sophisticated diagnostic algorithms, in some cases it is difficult to confirm the diagnosis of EO. The range of laboratory methods, the essential part of the diagnostic process, has only recently been extended by the possibility of quantification of specific, stimulating immunoglobulins (TSI). A major shortcoming may be...

Are the thyroid hormones and thyrotropin associated with cardiometabolic risks and insulin resistance even in euthyroid subjects?

Vojtěch Hainer, Hana Zamrazilová, Irena Aldhoon Hainerová

Vnitr Lek 2016, 62(Suppl 3):63-67  

Associations of both hypothyroidism and subclinical hypothyroidism with metabolic syndrome are well established. Nowadays, more attention has been paid to the role of thyroid hormones and thyrotropin (TSH) within the euthyroid range on the development of cardiometabolic health risks. The paper summarizes current knowledge related to the associations of lower free thyroxine (fT₄) level and higher levels of both free triiodothyronine (fT₃) and TSH with body adiposity, metabolic syndrome and insulin resistance in euthyroid subjects. In our recent study of obese euthyroid adolescents, we revealed that fasting insulin and homeostasis...

Current and future therapy of acromegaly

Václav Hána

Vnitr Lek 2016, 62(Suppl 3):68-72  

Acromegaly is a rare disease caused by overproduction of growth hormone, which significantly worsens quality of life and increases morbidity and mortality of patients. Modern specialized surgery, radiosurgery, radiotherapy and pharmacotherapy substantially improved therapeutical possibilities and the perspective of patients. Current therapeutic modalities enable to create individually tailored therapy for the specific patient and suppress the acromegalic activity. Novel forms of currently used active substances and even conceptually new forms of pharmacotherapy are under preparation and testing (eg. octreotide in capsules, CAM2029, Somatoprim, ATL1103).

Cardiorenal syndrome - biomarkers and mediators

Jiří Charvát

Vnitr Lek 2016, 62(Suppl 3):73-76  

Symptomatic cardiorenal syndrome presents the clinical condition with the serious prognosis when treatment is hardly succesful. A lot of inflammatory and hormonal factors used as biomarkers in clinical practice participate on the initiation, development and progression of cardiorenal syndrome. It means they play role of mediators between heart and kidney and therefore have the significant position in clinical presentation. However the mutual relations between heart and kidney are formed earlier already in the asymptomatic period. The detection of such changes and its correction is the real challenge. The follow-up of hormonal changes and its modulation...

TSH secreting adenomas

Jana Ježková, Josef Marek

Vnitr Lek 2016, 62(Suppl 3):77-81  

Adenomas which secrete thyrotropic hormone (thyrotropinomas) are rare and constitute less than 3 % of pituitary adenomas. In laboratory studies there is a typical elevation of thyroid hormones with nonsupressible TSH. In differential diagnostics it is necessary to distinguish above all the syndrome of resistance to thyroid hormones. Clinical symptoms are usually mild and correspond to symptoms of hyperthyroidism. Goiter is a common finding. In 80 % of cases thyrotropinomas are diagnosed in a stage of invasively growing macroadenoma. The primary treatment is neurosurgical removal adenoma which results in cure in 40 % of patients. Other treatment options...

Central Thyroid Disorders

Michal Kršek

Vnitr Lek 2016, 62(Suppl 3):82-86  

Vast majority of thyroid function disturbances have primary (peripheral) etiology due to thyroid gland disorders. Rarely, dysfunction of central regulatory structures, hypothalamus and pituitary, can be a cause of both, hyperthyroidism and hypothyroidism. Despite being very rare, it is important to be aware of them not to misdiagnose their etiology. Early and correct etiological diagnosis is necessary for proper cure and decrease of morbidity and mortality of affected patients. Present review article summarizes basics and specific features of central disturbances of thyroid function, their clinical signs, diagnosis, differential diagnosis and treatment.

Vitamin D and Polycystic Ovary Syndrome

Ivica Lazúrová, Jana Figurová, Ingrid Dravecká

Vnitr Lek 2016, 62(Suppl 3):87-91  

Currently there is growing evidence on possible influence of vitamin D (VD) on reproductive function in both females and males. The relationship between VD and clinical or laboratory manifestations of polycystic ovary syndrome (PCOS) seems to be mostly evaluated. Patients with PCOS have been demonstrated to have significantly lower levels of serum VD and they also have the higher prevalence of vitamin D deficiency as compared to controls. Some studies documented the relation of VD to serum androgen levels, other found that VD correlated with metabolic parameters (body weight, insulin resistance and lipid profile) only. Several interventional studies...

Thyroid hormones and cardiovascular system

Zdeňka Límanová, Jan Jiskra

Vnitr Lek 2016, 62(Suppl 3):92-98  

Cardiovascular system is essentially affected by thyroid hormones by way of their genomic and non-genomic effects. Untreated overt thyroid dysfunction is associated with higher cardiovascular risk. Although it has been studied more than 3 decades, in subclinical thyroid dysfunction the negative effect on cardiovascular system is much more controversial. Large meta-analyses within last 10 years have shown that subclinical hyperthyroidism is associated with higher cardiovascular risk than subclinical hypothyroidism. Conversely, in patients of age > 85 years subclinical hypothyroidism was linked with lower mortality. Therefore, subclinical hyperthyroidism...

The endocannabinoid system and bone

Mikuláš Pura, Peter Vaňuga

Vnitr Lek 2016, 62(Suppl 3):99-102  

Recent studies suggest an important role for the skeletal endocannabinoid system in the regulation of bone mass in both physiological and pathological conditions. Both major endocannabinoids (anandamid and 2-arachidonoylglycerol), endocannabinoid receptors - CB₁-receptor (CB₁R) a CB₂-receptor (CB₂R) and the endocannabinoid metabolizing enzymes are present or expressed in osteoblasts and osteoclasts. Previous studies identified multiple risk and protective variants of CNR2 gene dealing with the relationship to bone density and/or osteoporosis. Selective CB₁R/ CB₂R-inverse agonists/antagonists...

Solution of Iodine deficiency in the Czech Republic - history and current situation. 20 years of work of prof. Václav Zamrazil for Commission for the solution of Iodine deficiency

Lydie Ryšavá, Jaroslav Kříž

Vnitr Lek 2016, 62(Suppl 3):103-106  

Diseases caused by Iodine deficit are preventable. Inter resort Commission for the solution of Iodine deficiency (MKJD) at State Institute for Health (SZU) in Prague has been taking effective measures which satisfied requirements of the Principles for sustainable elimination of diseases caused by Iodine deficiency ICCD WHO: 96 % of households is using iodized salt, average Iodine content is 25 mg/1 kg of salt. Data from studies show ioduria less 100 mcg/l in only 9 per cent of seniors, 5 % of children 7-10 years, 3 % of children 10-12 years. Under 50 mcg only 1 % of children 10-12 years. Median of iodurias is below 300 mcg/l (seniors 185 mcg/l, children...

Psycho-immuno-endocrinology of the thyroid gland

Ivan Šterzl, Karolína Absolonová, Petr Matucha

Vnitr Lek 2016, 62(Suppl 3):107-114  

Historically endocrinologists and psychiatrists are aware that disturbances in thyroid disease in beginning or even in clinically intensified states of thyrotoxicosis or hypothyroidism exhibit pathological mental manifestations, masking or potentiating the underlying disease. Immune system disorders cause thyroid organ-specific autoimmune process. This autoimmune thyroid disease binds with a number of disorders in both endocrine or non-endocrine organs. This appears in vascular, neurological, skin, connective tissue, gastrointestinal tract and mental pathology. These disorders are part of autoimmune polyglandular syndromes (APS) type I -III, especially...

Thyroid carcinomas - current therapeutic procedures

Petr Vlček, Dana Nováková

Vnitr Lek 2016, 62(Suppl 3):115-120  

Incidence of differentiated thyroid carcinomas, especially papillary carcinomas, in recent decades worldwide increase. This is especially the detection of small tumor sizes up to two centimeters. Causes of the increase of these cancers are either increased number of thyroid investigations, but also the actual increase of this disease. The subject of expert discussion on this topic is mainly assessment of the severity of newly diagnosed tumors, the choice of treatment strategy and choice of follow-up of patients. Given that a large part of tumor detected in an early stage and due to the success of the current treatment options for the prognosis of thyroid...

Vitamin D and autoimmune thyroid diseases

Karel Vondra

Vnitr Lek 2016, 62(Suppl 3):121-125  

From the recent literature data it may be concluded that vitamin D deficiency is associated with increased risk of thyroid autoimmunity development and thus should be considered as an additional important risk factor for both chronic autoimmune thyroiditis (postpartum thyroiditis including) and Graves' disease. A higher risk of Graves' disease development is also associated with several polymorphisms in the gene encoding for vitamin D binding protein and for the specific receptor of active form of vitamin D - 1,25-(OH)₂D₃ in the respective target cells. Whether careful supplementation with vitamin D aimed to normalize low 25(OH)D...

Testosterone and mortality

Luboslav Stárka

Vnitr Lek 2016, 62(Suppl 3):127-130  

Subnormal levels of testosterone are frequently found in men of higher age category. Hypogonadal men have lower life expectancy than men with full androgenization and cardiovascular disease, obesity or diabetes is often associated with hypotestosteronemia. Low testosterone level is risk factor for these diseases. However, until now it is not clear whether testosterone deficiency is a cause or consequence of atherosclerosis or metabolic syndrome. A handful of symptoms and metabolic risk markers in hypogonadal men can be ameliorated by testosterone supplementation. Testosterone treatment increased sexual activity and well-being and had a moderate benefit...

Congenital Adrenal Hyperplasia in Adults

Jana Vrbíková

Vnitr Lek 2016, 62(Suppl 3):131-134  

Congenital adrenal hyperplasia is a life-long disease requiring an integrated therapy. It may negatively influence the quality of life. In childhood, the main problems of the care of these patients involve sex determination and ensuring optimum growth and puberty. The therapeutic goals for adults are the prevention of Addisonian crisis and ensuring the best possible quality of life, including fertility.

Polypharmacy viewed not only through the prism of multi-morbidity, but also as an independent geriatric syndrome

Pavel Weber, Hana Meluzínová, Dana Prudius, Katarína Bielaková

Vnitr Lek 2016, 62(Suppl 3):135-139  

Polypharmacy is common in the elderly, especially in the late age (over 75 years). Usually it is closely related to the geriatric multi-morbidity. The authors highlight the medication used in the anticipated positive and potential negative potential. While physicians often must make difficult trade-offs between the guidelines on one hand and complicated multi-morbidity, on the other hand, while trying to avoid polypharmacy (≥ 5 drugs), especially excessive polypharmacy (≥ 10 drugs). Multimorbid elderly patients who are treated in accordance with guidelines typically use large amounts of medicaments. This polypharmacy increases the risk of adverse...

Multiple Endocrine Neoplasia I (Wermer's Syndrome), Forms of Clinical Manifestation, 5 Case Studies

Karolína Drbalová, Kateřina Herdová, Petr Krejčí, Monika Nývltová, Svatopluk Solař, Lenka Vedralová, Pavel Záruba, David Netuka, Petr Bavor

Vnitr Lek 2016, 62(Suppl 3):140-149  

Multiple Endocrine Neoplasia (MEN) is a condition in which several endocrine organs of an individual are affected by adenoma, hyperplasia and less often carcinoma, either simultaneously or at different stages of life. Two existing syndromes, MEN1 and MEN2 (2A, 2B), in literature is also mentioned MEN4, are associated also with other non-endocrine disorders. MEN1 (Wermer syndrome) affects the pituitary, parathyroid, and pancreatic area. 95 % of patients show very early manifestation of hyperparathyroidism, often before 40 years of age. Multiple adenomas gradually involve all four parathyroid glands. The first clinical sign of MEN1 includes recurrent...

Prof. MUDr. Václav Zamrazil, DrSc., slaví 80. narozeniny

Běla Bendlová, Luboslav Stárka

Vnitr Lek 2016, 62(Suppl 3):3-4  

Václav Zamrazil osmdesátníkem

Jaroslav Blahoš

Vnitr Lek 2016, 62(Suppl 3):5