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Czarnywojtek A, Gut P, Sowiński J, Ruchała M, Ferlito A, Dyrka K. A NEW HYPOTHESIS IN THE TREATMENT OF RECURRENT GLIOBLASTOMA MULTIFORME (GBM). PART 2: IS THERE AN ALTERNATIVE THERAPY OPTION IN RECURRENT GM WHEN ALL STANDARD TREATMENTS HAVE BEEN EXHAUSTED? POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:433-435. [PMID: 37756466 DOI: 10.36740/merkur202304120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Glioblastoma multiforme (GBM) is the most aggressive and malignant brain tumor. The average survival time for a patient diagnosed with GBM, using standard treatment methods, is several months. Besides the routinely applied treatments such as neurosurgery, radiotherapy, and chemotherapy, progress is being made in the field of oncology, offering hope for improved treatment outcomes. New treatment methods include individualized multimodal immunotherapy (IMI) and modulated electro-hyperthermia. The coauthor of the above series of articles (parts 1 and 2) - A.Cz. presents the concept of a new, potentially breakthrough treatment option for recurrent GBM. A.Cz. was diagnosed with GBM in August 2021. Exhaustion of standard treatment methods, as well as immunotherapy and virotherapy, only provided temporary relief. Unfortunately, after a few months, the disease recurred. Having little to lose, A.Cz. accepted an ablative dose of 2960 MBq (80 mCi) of I131, based on available literature data. Three days before the administration of radioiodine therapy (RIT), A.Cz. prophylactically blocked the thyroid's ability to absorb the radioisotope. In June 2023, approximately 7 weeks after receiving single I131 dose, the MRI examination confirmed a 30% reduction in the tumor's size. Based on this, one can speculate that Iodine-131 therapy may be an alternative treatment option for GBM patients in the future. However, this hypothesis requires confirmation in further clinical studies.
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Affiliation(s)
- Agata Czarnywojtek
- DEPARTMENT OF PHARMACOLOGY, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND; CHAIR AND DEPARTMENT OF ENDOCRINOLOGY, METABOLISM AND INTERNAL MEDICINE, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND
| | - Paweł Gut
- CHAIR AND DEPARTMENT OF ENDOCRINOLOGY, METABOLISM AND INTERNAL MEDICINE, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND
| | - Jerzy Sowiński
- CHAIR AND DEPARTMENT OF ENDOCRINOLOGY, METABOLISM AND INTERNAL MEDICINE, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND
| | - Marek Ruchała
- CHAIR AND DEPARTMENT OF ENDOCRINOLOGY, METABOLISM AND INTERNAL MEDICINE, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND
| | - Alfio Ferlito
- COORDINATOR OF THE INTERNATIONAL HEAD AND NECK SCIENTIFIC GROUP, 35100 PADUA, ITALY
| | - Kamil Dyrka
- CHAIR AND DEPARTMENT OF ENDOCRINOLOGY, METABOLISM AND INTERNAL MEDICINE, POZNAN UNIVERSITY OF MEDICAL SCIENCES, POZNAN, POLAND
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Medić F, Bakula M, Alfirević M, Bakula M, Mucić K, Marić N. AMIODARONE AND THYROID DYSFUNCTION. Acta Clin Croat 2022; 61:327-341. [PMID: 36818930 PMCID: PMC9934045 DOI: 10.20471/acc.2022.61.02.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/11/2021] [Indexed: 02/10/2023] Open
Abstract
Thyroid gland has a key role in maintaining the body homeostasis. Thyroxine is the main hormone secreted from the thyroid gland, its effect being predominantly achieved after the intracellular conversion of thyroxine to triiodothyronine, which exhibits a higher affinity for the receptor complex, thus modifying gene expression of the target cells. Amiodarone is one of the most commonly used antiarrhythmics in the treatment of a broad spectrum of arrhythmias, usually tachyarrhythmias. Amiodarone contains a large proportion of iodine, which is, in addition to the intrinsic effect of the medication, the basis of the impact on thyroid function. It is believed that 15%-20% of patients treated with amiodarone develop some form of thyroid dysfunction. Amiodarone may cause amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyrotoxicosis (AIT). AIT is usually developed in the areas with too low uptake of iodine, while AIH is developed in the areas where there is a sufficient iodine uptake. Type 1 AIT is more common among patients with an underlying thyroid pathology, such as nodular goiter or Graves' (Basedow's) disease, while type 2 mostly develops in a previously healthy thyroid. AIH is more common in patients with previously diagnosed Hashimoto's thyroiditis. Combined types of the diseases have also been described. Patients treated with amiodarone should be monitored regularly, including laboratory testing and clinical examinations, to early detect any deviations in the functioning of the thyroid gland. Supplementary levothyroxine therapy is the basis of AIH treatment. In such cases, amiodarone therapy quite often need not be discontinued. Type 1 AIT is treated with thyrostatic agents, like any other type of thyrotoxicosis. If possible, the underlying amiodarone therapy should be discontinued. In contrast to type 1 AIT, the basic pathophysiological substrate of which is the increased synthesis and release of thyroid hormones, the basis of type 2 AIT is destructive thyroiditis caused by amiodarone, desethylamiodarone as its main metabolite, and an increased iodine uptake. Glucocorticoid therapy is the basis of treatment for this type of disease.
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Affiliation(s)
- Filip Medić
- Department of Obstetrics and Gynecology, Sveti Duh University Hospital, Zagreb, Croatia
| | - Miro Bakula
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Internal Medicine, Sveti Duh University Hospital, Zagreb, Croatia;,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Maša Alfirević
- Department of Urology, Sveti Duh University Hospital, Zagreb, Croatia
| | - Maja Bakula
- Merkur University Hospital, Vuk Vrhovac University Clinic for Diabetes and Metabolism, Zagreb, Croatia
| | - Katarina Mucić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nikolina Marić
- Intensive Care Unit, Department of Internal Medicine, Sveti Duh University Hospital, Zagreb, Croatia
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Creo A, Anderson H, Cannon B, Lteif A, Kumar S, Tebben P, Iqbal AM, Ramakrishna A, Pittock S. Patterns of amiodarone-induced thyroid dysfunction in infants and children. Heart Rhythm 2019; 16:1436-1442. [PMID: 30904484 DOI: 10.1016/j.hrthm.2019.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart Rhythm Society guidelines recommend obtaining thyroid function tests (TFTs) at amiodarone initiation and every 6 months thereafter in adults, with no specific pediatric recommendations. Untreated hypothyroidism in young children negatively affects brain development and somatic growth, yet the optimal screening frequency for pediatric patients remains unclear, and limited data exist on pediatric amiodarone-induced thyroid dysfunction. OBJECTIVE The purpose of this study was to describe the patterns of amiodarone-induced thyroid dysfunction in pediatric patients. METHODS We established a retrospective cohort of 527 pediatric patients who received amiodarone between 1997 and 2017. We defined amiodarone therapy lasting 3-30 days as "short term" and >30 days as "long term." RESULTS The final cohort (n = 150) consisted of 27 neonates (18%), 25 infants (16%), 27 young children (18%), and 71 children (47%). Of the children in whom TFTs were checked, half (50.8%) developed a thyroid-stimulating hormone (TSH) value above the reference for age. Neonates had the highest median peak TSH values in both short- and long-term groups: 23.5 mIU/L (interquartile range 11.4-63.1) and 28.8 mIU/L (interquartile range 11.4-34.4), respectively. Although concurrent use of inotropic support was significantly associated with lower initial TSH values, no variable related to cardiac illness or type of heart disease was associated with peak TSH values. CONCLUSION Neonates and infants receiving amiodarone had more thyroid dysfunction with greater degrees of TSH elevation than older children. TSH elevations occurred early, even with short-term exposure. Given the concern for brain development and growth in hypothyroid children, our results suggest the need for more rigorous pediatric-specific thyroid monitoring guidelines.
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Affiliation(s)
- Ana Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Heather Anderson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Bryan Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Aida Lteif
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Peter Tebben
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Anoop Mohamed Iqbal
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Akhila Ramakrishna
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Siobhan Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota.
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Gorenek B, Boriani G, Dan GA, Fauchier L, Fenelon G, Huang H, Kudaiberdieva G, Lip GYH, Mahajan R, Potpara T, Ramirez JD, Vos MA, Marin F, Blomstrom-Lundqvist C, Rinaldi A, Bongiorni MG, Sciaraffia E, Nielsen JC, Lewalter T, Zhang S, Gutiérrez O, Fuenmayor A. European Heart Rhythm Association (EHRA) position paper on arrhythmia management and device therapies in endocrine disorders, endorsed by Asia Pacific Heart Rhythm Society (APHRS) and Latin American Heart Rhythm Society (LAHRS). Europace 2018; 20:895-896. [DOI: 10.1093/europace/euy051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/25/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gheorge-Andrei Dan
- University of Medicine and Pharmacy “Carol Davila”, Colentina University Hospital, Bucharest, Romania
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | | | - He Huang
- Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rajiv Mahajan
- The University of Adelaide, Lyell McEwin Hospital, Royal Adelaide Hospital and SAHMRI, Adelaide, Australia
| | - Tatjana Potpara
- School of Medicine, Belgrade University; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | | | | | | | | | | | | | | | - Shu Zhang
- Beijing Fuwai Hospital, Beijing, China
| | | | - Abdel Fuenmayor
- Electrophysiology and Arrhythmia Section, Cardiovascular Research Institute, University Hospital of The Andes, Avenida 16 de Septiembre, Mérida 5101, Venezuela
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von Haehling S, Bělohlávek J, Er F, Gassanov N, Guarracino F, Bouvet O. Landiolol for rate control management of atrial fibrillation in patients with cardiac dysfunction. Eur Heart J Suppl 2018; 20:A19-A24. [PMID: 30188957 PMCID: PMC5909772 DOI: 10.1093/eurheartj/sux035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Atrial fibrillation (AFib) is frequently associated with heart failure. Guidelines for AFib management have been recently updated and include an algorithm for acute heart rate control based on left ventricular ejection fraction and haemodynamics. Landiolol is an injectable ultra-short beta-blocker with very high beta-1 selectivity, listed in Japanese Guidelines for AFib management as potential option for rate control of patient with heart failure. Landiolol is now available in Europe with indication of controlling heart rate in AFib and supraventricular tachycardia. This review discusses existing clinical data in Japan and perspectives of landiolol use for acute rate control of AFib patients with cardiac dysfunction.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, Göttingen, Germany
| | - Jan Bělohlávek
- Department of Internal Medicine, Cardiovascular Medicine, General Teaching Hospital and 1st Faculty of Medicine, Charles University, U Nemocnice 2, Praha 2, Prague, Czech Republic
| | - Fikret Er
- Department of Cardiology, Rhythmology and Intensive Care Medicine, Klinikum Gütersloh, Germany
| | - Natig Gassanov
- Department of Cardiology, Rhythmology and Intensive Care Medicine, Klinikum Gütersloh, Germany
| | - Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Cardiothoracic and Vascular Anaesthesia, Azienda Ospedaliero Universitaria Pisana, Via Roma n. 67, Pisa, Italy
| | - Olivier Bouvet
- Department of Clinical Research and Pharmaceutical Development, Amomed Pharma GmbH Vienna, Austria
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Lebedeva EA, Iablonskaia IA, Bulgakova SV. Amiodarone-induced thyrotoxicosis: state of the art. ACTA ACUST UNITED AC 2017. [DOI: 10.14341/ket2017231-38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
В обзоре представлены данные литературы последних лет о патогенезе, диагностике, лечении амиодарон-индуцированного тиреотоксикоза (АИТ), который является частым осложнением терапии амиодароном (Ам). Описаны изменения секреции и метаболизма тиреоидныхгомонов под влиянием кратковременной и длительной терапии Ам. Развитие АИТ всегда приводит к ухудшению течения аритмии, усугублению недостаточности кровообращения, утяжелению состояния пациента. Выделяют АИТ 1 типа и АИТ 2 типа, а также смешанную форму. Описаны диагностические критерии АИТ 1 и 2 типа. Наиболее информативным тестом для дифференциальной диагностики АИТ 1, 2 типов и смешанных форм является сонография щитовидной железы с допплеровским исследованием кровотока и сканирование с 99mTc-sestaMIBI. Тактика лечения определяется типом АИТ, состоянием сердечно-сосудистой системы, риском повторных аритмий. Консервативное лечение зависит от типа АИТ и осуществляется тиреостатиками или глюкокортикоидами. Обсуждается возможность продолжения антиаритмической терапии Ам у пациентов, перенесших АИТ. При АИТ 1 типа и смешанной форме требуется отмена препарата, если это невозможно – радикальное лечение тиреотоксикоза (радиойодтерапия, тиреоидэктомия). АИТ 2 типа является самолимитирующимся процессом, при жизненно угрожающих аритмиях прием Ам может быть продолжен. Показана эффективность радиойодтерапии для радикального лечения тиреотоксикоза при АИТ 1 и 2 типа, несмотря на низкий захват радиойода. Однако этот вопрос требует дальнейшего изучения и обсуждения. Для быстрого восстановления эутиреоза у тяжелых больных применяют плазмаферез и тиреоидэктомию.
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Palladino A, D'Ambrosio P, Papa AA, Petillo R, Orsini C, Scutifero M, Nigro G, Politano L. Management of cardiac involvement in muscular dystrophies: paediatric versus adult forms. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2016; 35:128-134. [PMID: 28484313 PMCID: PMC5416740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Muscular dystrophies are a group of genetic disorders characterized by muscle degeneration and consequent substitution by fat and fibrous tissue. Cardiac involvement is an almost constant feature in a great part of these diseases, as both primary myocardial involvement and secondary involvement due to respiratory insufficiency, pulmonary hypertension or reduced mobility. Primary myocardial involvement usually begins more precociously compared to the secondary involvement. In fact the first signs of cardiomyopathy can be observed in the first decade of life in muscular dystrophies with childhood onset and later in adult form of muscular dystrophies as myotonic dystrophy type 1. At least an annual cardiac follow-up is recommended in these patients including clinical and instrumental examination (ECG, 24h Holter monitoring, ECHO), to detect cardiac involvement. A more frequent monitoring may be required according to the type of cardiomyopathy and the patient's needs. In this short review practical guide-lines are shown for physicians routinely involved in the management of these patients.
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Affiliation(s)
- Alberto Palladino
- Cardiomyology and Medical Genetics, Department of Experimental Medicine
| | - Paola D'Ambrosio
- Cardiomyology and Medical Genetics, Department of Experimental Medicine
| | - Andrea Antonio Papa
- Cardiomyology and Medical Genetics, Department of Experimental Medicine
- Arrhythmologic Unit, Department of Cardiology. University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberta Petillo
- Cardiomyology and Medical Genetics, Department of Experimental Medicine
| | - Chiara Orsini
- Cardiomyology and Medical Genetics, Department of Experimental Medicine
| | | | - Gerardo Nigro
- Arrhythmologic Unit, Department of Cardiology. University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine
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