Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

https://www.unitypoint.org/desmoines/filesimages/Cancer%20Education/Oncology%20Nursing%20Conference/2015/2014%20NCCN%20Clin%20Pract%20Guidelines%20Male%20Sex%20Dysf.pdf

Clinical practice guidelines in oncology

Background: A number of recent advances in our understanding of thyroid physiology may shed light on why some patients feel unwell while taking levothyroxine monotherapy. The purpose of this task force was to review the goals of levothyroxine therapy, the optimal prescription of conventional levothyroxine therapy, the sources of dissatisfaction with levothyroxine therapy, the evidence on treatment alternatives, and the relevant knowledge gaps. We wished to determine whether there are sufficient new data generated by well-designed studies to provide reason to pursue such therapies and change the current standard of care. This document is intended to inform clinical decision-making on thyroid hormone replacement therapy; it is not a replacement for individualized clinical judgment. Methods: Task force members identified 24 questions relevant to the treatment of hypothyroidism. The clinical literature relating to each question was then reviewed. Clinical reviews were supplemented, when relevant, with related...

Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement

Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroidstimulating hormone (TSH) level: mildly increased TSH levels (4.0–10.0 mU/l) and more severely increased TSH value (>10 mU/l). An initially raised serum TSH, with FT 4 within reference range, should be investigated with a repeat measurement of both serum TSH and FT 4 , along with thyroid peroxidase antibodies, preferably after a 2- to 3-month interval. Even in the absence of symptoms, replacement therapy with L -thyroxine is recommended for younger patients ( 10 mU/l. In younger SCH patients (serum TSH <10 mU/l) with symptoms suggestive of hypothyroidism, a trial of L -thyroxine replacement therapy should be considered. For such patients who have been started on L -thyroxine for symptoms attributed to SCH, response to treatment should be reviewed 3 or 4 months after a serum TSH within reference range is reached. If there is no improvement in symptoms, L -thyroxine therapy should generally be

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2013 ETA Guideline: Management of Subclinical Hypothyroidism

Plant secondary metabolites have been a fertile area of chemical investigation for many years, driving the development of both analytical chemistry and of new synthetic reactions and methodologies. The subject is multi-disciplinary with chemists, biochemists and plant scientists all contributing to our current understanding. In recent years there has been an upsurge in interest from other disciplines, related to the realisation that secondary metabolites are dietary components that may have a considerable impact on human health, and to the development of gene technology that permits modulation of the contents of desirable and undesirable components. Plant Secondary Metabolites: Occurrence, Structure and Role in the Human Diet addresses this wider interest by covering the main groups of natural products from a chemical and biosynthetic perspective with illustrations of how genetic engineering can be applied to manipulate levels of secondary metabolites of economic value as well as those of potential importance in diet and health. These descriptive chapters are augmented by chapters showing where these products are found in the diet, how they are metabolised and reviewing the evidence for their beneficial bioactivity. © 2006 by Blackwell Publishing Ltd.

Plant Secondary Metabolites: Occurrence, Structure And Role In The Human Diet

BackgroundThe use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition. MethodsWe conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving 737 adults who were at least 65 years of age and who had persisting subclinical hypothyroidism (thyrotropin level, 4.60 to 19.99 mIU per liter; free thyroxine level within the reference range). A total of 368 patients were assigned to receive levothyroxine (at a starting dose of 50 μg daily, or 25 μg if the body weight was <50 kg or the patient had coronary heart disease), with dose adjustment according to the thyrotropin level; 369 patients were assigned to receive placebo with mock dose adjustment. The two primary outcomes were the change in the Hypothyroid Symptoms score and Tiredness score on a thyroid-related quality-of-life questionnaire at 1 year (range of each scale is 0 to 100, with higher scores indicati...

https://serval.unil.ch/resource/serval:BIB_F5DE9BB8608A.P001/REF.pdf

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism.

Objective: To report eight case histories, and in vivo and in vitro studies showing coffee's potential to impair thyroxine (T4) intestinal absorption. Design: Of eight women with inappropriately hi...

http://www.kodomo-kenkou.com/cretin/default/file_download/43

Altered intestinal absorption of L-thyroxine caused by coffee.

The purpose of this work is to evaluate if the coffee-associated malabsorption of tablet levothyroxine (l-T4) is reduced by soft gel capsule. We recruited 8 patients with coffee-associated l-T4 malabsorption including one hypothyroid patient. For 6 months, the patients were switched to the capsule maintaining the l-T4 daily dose. Patients took the capsule with water, having coffee 1 h later (proper habit, PH) on days 1–90, or with coffee ≤5 min later (improper habit, IH) on days 91–180. After 6 months, 2 patients volunteered for an acute loading test of 600 μg l-T4 (capsule) ingested with water (PH) or with coffee (IH). In the single hypothyroid patient, the post-switch TSH ranged 0.06–0.16 mU/L (PH) versus 5.8–22.4 mU/L pre-switch (PH) and 0.025–0.29 mU/L (IH) versus 26–34 mU/L pre-switch (IH). In the other 7 patients, post-switch TSH was 0.41 ± 0.46 (PH) versus 0.28 ± 0.20 pre-switch (PH) (P = 0.61) and 0.34 ± 0.30 (IH) versus 1.23 ± 1.47 pre-switch (IH) (P < 0.001). Importantly, TSH levels in PH versus IH habit did not differ post-switch (P = 0.90), but they did pre-switch (P < 0.0001). The proportions of post-switch TSH levels <0.10 mU/L with PH (33.3 %) or with IH (33.3 %) were borderline significantly greater than the corresponding pre-switch levels with PH (10.3 %) (P = 0.088) or with IH (0 %) (P = 0.0096). In the two volunteers, the l-T4 loading test showed that coffee influenced l-T4 pharmacokinetics minimally. Soft gel capsules can be used in patients who are unable/unwilling to change their IH of taking l-T4.

A novel formulation of l-thyroxine (l-T4) reduces the problem of l-T4 malabsorption by coffee observed with traditional tablet formulations

Context: Proton-pump inhibitors (PPIs) impair tablet levothyroxine (LT4) intestinal absorption by increasing the gastric pH and decreasing LT4 dissolution in the stomach. Objective: The purpose of this study was to verify whether a liquid formulation of LT4 would correct LT4 malabsorption induced by PPIs. Design: This was a prospective observational cohort study. The study was conducted from 2012 to 2013, and the mean duration of the follow-up was 23.7 ± 11.9 weeks. Setting: The study was conducted in a tertiary university hospital outpatients clinic. Patients: Upon informed consent, we recruited 24 consecutive adult patients (18 women and 6 men), who took LT4 for replacement (n = 14) or suppressive purposes (n = 10) and who had absorption of tablet LT4 impaired by PPIs. Intervention: The 24 patients were switched from the tablet to the oral solution LT4 at the same daily dose. Main Outcome Measures: Significantly lower mean TSH levels were seen with the oral solution than with the tablet as were signific...

/pdf/switching-levothyroxine-from-the-tablet-to-the-oral-solution-ezxc5z0dj1.pdf

Switching Levothyroxine From the Tablet to the Oral Solution Formulation Corrects the Impaired Absorption of Levothyroxine Induced by Proton-Pump Inhibitors

Background: Chronic urticaria is a common clinical condition whose etiology, in about 75% of cases, is unknown and is therefore called chronic idiopathic urticaria (CIU). A link between CIU and autoimmune thyroid diseases was proposed several decades ago. Here we review this topic. Summary: Several studies have been performed to determine if and to what degree there is an association between CIU and autoimmune thyroid diseases, particularly autoimmune thyroiditis. Many of these studies were not well controlled, however. Approximately one-fourth of CIU patients have serological evidence of thyroid autoimmunity, suggesting that these two disorders are associated. The mechanisms for the apparent association between CIU and serological evidence of thyroid autoimmunity are not clear. There are no data regarding the correlations between CIU and histological features of autoimmune thyroiditis or hypothyroidism. Despite this, there are anecdotal reports regarding L-thyroxine administration in patients with CIU. C...

Urticaria and thyroid autoimmunity.

Anaplastic thyroid cancer (ATC) is often incurable because it doesn't respond to radioiodine, radiotherapy or chemotherapy, and new therapeutic approaches are needed. Peroxisome proliferator-activated receptor-gamma (PPARg) gene and protein are present in ATC cells, and PPARg ligands inhibit cell proliferation, induce apoptosis, and also down regulate the invasive potential of ATC cells. Also, inhibitors of the Aurora serine/threonine kinases have antineoplastic effect on ATC cells in vitro and on ATC xenografts. Tyrosine kinases inhibitors are actually under evaluation for the treatment of ATC, for example imanitib or sorafenib. Other studies have focused on evaluating antiangiogenic agents for treatment of ATC. These agents include: combretastatin A4 phosphate, aplidin, PTK787/ZK222584, and human VEGF monoclonal antibodies (bevacizumab, cetuximab). Small-molecule adenosine triphosphate (ATP) competitive inhibitors directed intracellularly at epidermal growth factor receptor (EGFR)'s tyrosine kinase, such as erlotinib, or gefitinib are also under evaluation. The development of drugs that have multiple therapeutic targets and the utilization of multiple cancer-targeting agents are both emerging strategies for ATC treatment. For example, a preclinical study evaluated the activity of a dual inhibitor of EGFR and vascular endothelial growth factor (VEGF), NVP-AEE788, alone and in combination with paclitaxel for the treatment of ATC. Even if new therapeutic approaches against ATC are under development, more research is needed to finally identify therapies able to control and to cure this disease. The possibility of testing the sensitivity of primary ATC cells from each subject to different drugs could increase the effectiveness of the treatment in the next future.

Giovanna Saraceno

Papers

Altered intestinal absorption of L-thyroxine caused by coffee.

A novel formulation of l-thyroxine (l-T4) reduces the problem of l-T4 malabsorption by coffee observed with traditional tablet formulations

Switching Levothyroxine From the Tablet to the Oral Solution Formulation Corrects the Impaired Absorption of Levothyroxine Induced by Proton-Pump Inhibitors

Urticaria and thyroid autoimmunity.

New targeted therapies for anaplastic thyroid cancer.