Papers by Graziano Ceresini
Endocrine
Purpose Patients undergoing thyroidectomy for differentiated thyroid cancer (DTC) may require 131... more Purpose Patients undergoing thyroidectomy for differentiated thyroid cancer (DTC) may require 131-radioactive iodine (RAI) administration for remnant ablation or disease treatment. After ingestion, RAI resides within the gastrointestinal tract potentially leading to mucosal damage and abnormalities in the absorption of levothyroxine (LT4). The aim of this study was to evaluate whether serum FT4 peak, induced by a LT4 challenge, changes according to the LT4 formulation (solid or liquid) in both RAI and non-RAI-treated DTC patients. Methods This was a monocentric controlled clinical trial, with a parallel two-groups (1:1) randomization of sequence of LT4 formulation. Patients received 200 mcg LT4 orally administered at 08:00 h, in both solid and liquid formulation, at one-week interval, at baseline and after 1, 3, and 6 months from RAI administration. At each time-point, circulating FT4 was evaluated both before LT4 assumption as well as after 1 and 3 h. FT4 increments were evaluated ...
Journal of Endocrinological Investigation
Purpose Malignancy prediction in indeterminate thyroid nodules is still challenging. We prospecti... more Purpose Malignancy prediction in indeterminate thyroid nodules is still challenging. We prospectively evaluated whether the combination of ultrasound (US) risk stratification and molecular testing improves the assessment of malignancy risk in Bethesda Category IV thyroid nodules. Methods Ninety-one consecutively diagnosed Bethesda Category IV thyroid nodules were prospectively evaluated before surgery by both ACR- and EU-TIRADS US risk-stratification systems and by a further US-guided fine-needle aspiration cytology (FNAC) for the following molecular testing: BRAFV600E, N-RAS codons 12/13, N-RAS codon 61, H-RAS codons 12/13, H-RAS codon 61, K-RAS codons 12/13, and K-RAS codon 61 point-mutations, as well as PAX8/PPARγ, RET/PC1, and RET/PTC 3 rearrangements. Results At histology, 37% of nodules were malignant. No significant association was found between malignancy and either EU- or ACR-TIRADS. In total, 58 somatic mutations were identified, including 3 BRAFV600E (5%), 5 N-RAS 12/13 (...
Endocrine, 2016
To evaluate the causes of the first referral to an endocrine visit of patients with thyroid cance... more To evaluate the causes of the first referral to an endocrine visit of patients with thyroid cancer in a mildly iodine-deficient area and to correlate them with prognostic features. We studied 298 consecutive patients (64 M and 234 F) with thyroid cancer. Of these, 281 had differentiated thyroid cancer. The causes of referral were categorized as follows: (Group A) clinical evidence of a neck lump; (Group B) incidental imaging in subjects without known thyroid diseases; (Group C) incidental imaging during a workup of thyroid disorders. Also, in differentiated thyroid cancer cases, clinical, histomorphologic, and prognostic parameters were compared among the three different groups of referral causes. In both total thyroid cancer and differentiated thyroid cancer cohorts, Group A, B, and C accounted for about 25, 35, and 40 % of causes, respectively. Considering the differentiated thyroid cancer, in Group B, ultrasound accounted for 94 % of cases, with 73 % resulting from screening or serendipitous study. Within a median follow-up of 5.6 [IQR: 2.7-9.5] years, disease-free survival was significantly lower in patients of Group A (Log-Rank test p = 0.030 vs. the other groups of causes). However, at the Cox multivariate analysis only male sex (p = 0.002) and stage (p = 0.005), but not referral cause, resulted independent predictors of events. In patients without known thyroid disease, unjustified thyroid ultrasound represents the main cause of referral of thyroid cancer patients to the first endocrine visit. The fact that this is not related to the disease-free survival strengthens the concept of the uselessness of thyroid cancer screening.
The Journal of clinical endocrinology and metabolism, Jan 7, 2016
The currently applied reference ranges for thyroid function are under debate. Despite evidence th... more The currently applied reference ranges for thyroid function are under debate. Despite evidence that thyroid function within the reference range is related with several cardiovascular disorders, its association with the risk of stroke has not been evaluated previously. We identified studies through systematic literature search and the Thyroid Studies Collaboration, a collaboration of prospective cohort studies. Studies measuring baseline thyroid-stimulating hormone (TSH), free thyroxine (FT4) and stroke outcomes were included and we collected Individual Participant Data (IPD) from each study, including thyroid function measurements and incident all stroke (combined fatal and non-fatal) and fatal stroke. The applied reference range for TSH levels was between 0.45-4.49 mIU/L. We collected IPD on 43,598 adults with TSH within the reference range from 17 cohorts, with median follow-up of 11.6 years (interquartile range 5.1-13.9), including 449,908 person-years. Age- and sex-adjusted pool...
The American Journal of Geriatric Psychiatry, 2016
Late-life major depression is associated with increased cardiovascular risk and impaired autonomi... more Late-life major depression is associated with increased cardiovascular risk and impaired autonomic control of the heart, as evident from reduced heart rate variability (HRV). Moreover, antidepressant drug therapy also might be associated with further reductions of HRV. In the SEEDS study, we investigated whether sertraline associated with physical exercise protocols led to improvements of HRV, compared with antidepressant drug therapy alone. Single-blind randomized controlled trial. Psychiatric consultation-liaison program for primary care. Patients aged 65-85 years with major depression, recruited from primary care. Sertraline plus structured, tailored group physical exercise (S + EX) versus sertraline alone (S) for 24 weeks. HRV indices (RR, percentage of NN intervals greater than 50 msec [pNN50], square root of the mean squared differences of successive NN intervals [RMSSD], standard deviation of heart rate [SDHR], standard deviation of the NN interval [SDNN], high-frequency band [HF], low-frequency band [LF], and their ratio [LF/HF]) were measured at baseline, week 12, and week 24. Psychiatric and medical assessments. Participants displayed significant improvements of most HRV indices over time, irrespective of the group assignment (pNN50, RMSSD, SDHR, SDNN, HF, LF, and LF/HF). Moreover, patients in the S + EX group displayed greater increases of different HRV indices(RR, pNN50, RMSSD, SDHR, SDNN, HF, and LF) compared with those in the S group. The combination of structured physical exercise and sertraline might exert positive effects on the autonomic control of the heart among older patients with major depression.
Hormone and Metabolic Research, 1989
Psychoneuroendocrinology, May 31, 2003
Social isolation and lack of social support have deleterious effects on health, thus being regard... more Social isolation and lack of social support have deleterious effects on health, thus being regarded as one of the most relevant causes of diseases in human and other mammalian species. However, only few are the studies aimed at evaluating the psychoneuroimmunological functions of individually housed subjects. The present study was designed to understand how the behavior and the physiology of male house mice might be affected by individual housing. We first analyzed whether individual housing of different duration (1-42 days) would result in immuno-endocrine dysfunction (experiment 1). Then we investigated whether housing conditions would affect the reaction to an acute mild psychological stress (experiments 2 and 3). There were three main findings: first, individually housing mice for increasing time periods did not induce any major immuno-endocrine effects compared to a stable sibling group housing. Therefore, prolonged isolation does not seem to dramatically impair mice immuno-endocrine functions. Second, when exposed to a mild acute stress, i.e. forced exposure to a novel environment, isolated mice showed higher basal corticosterone and lower type 1 (IL-2) and type 2 (IL-4) cytokines as well as splenocytes proliferation compared to group housed male mice. Finally, when faced with a free choice between a novel environment and their home exploration of the novel environment, thus suggesting a low anxiety profile. Altogether, our findings suggest that individual housing in itself does not change immunocompetence and corticosterone level, but does affect reactivity to a stressor. In fact, individually housed mice showed high behavioral arousal, as well as altered immuno-endocrine parameters, when challenged with mild psychological novelty-stress.
Journal of Endocrinological Investigation, Jul 20, 2009
DHEA and its sulfate derivative (DHEAS) decline with age. The decline in DHEAS levels has been as... more DHEA and its sulfate derivative (DHEAS) decline with age. The decline in DHEAS levels has been associated with many physiological impairments in older persons including cognitive dysfunction. However, data regarding the possible relationship between DHEAS and cognition are scant. We investigated whether DHEAS levels are associated with presence and development of lower cognitive function measured by the Mini Mental State Examination (MMSE) in older men and women. One thousand and thirty-four residents aged > or =65 yr of the InCHIANTI Study with data available on DHEAS and MMSE were randomly selected. MMSE was administered at baseline and 3 yr later. Among these, 841 completed a 3-yr follow-up. Parsimonious models obtained by backward selection from initial fully-adjusted models were used to identify independent factors associated with MMSE and DHEAS. The final analysis was performed in 755 participants (410 men and 345 women) with MMSE score > or =21. A significant age-related decline of both DHEAS levels (p<0.001) and MMSE score (p<0.001) was found over the 3-yr follow-up. At enrolment, DHEAS was significantly and positively associated with MMSE score, independently of age and other potential confounders (beta+/-SE 0.003+/-0.001, p<0.005). Low baseline DHEAS levels were predictive of larger decline of MMSE and this relationship was significant after adjusting for covariates (beta+/-SE -0.004+/-0.002, p<0.03). Our data show a significant and positive association between DHEAS and cognitive function, assessed by MMSE test. Low DHEAS levels predict accelerated decline in MMSE score during the 3-yr follow-up period.
Minerva Ginecologica, Mar 1, 2007
Androgen deficiency in older men can be related to age associated changes of neuro-endocrine mech... more Androgen deficiency in older men can be related to age associated changes of neuro-endocrine mechanisms controlling the hormones secreted by the testis and adrenal cortex. We listed the clinical consequences of androgen deficiency at three different levels in three areas: somatic (body composition, glucidic and lipid metabolism, erythropoiesis), sexual and psychological (cognition and affectivity). Observational studies and randomized placebo controlled trials have been reviewed from medical literature. Testosterone, now preferentially administered as transdermal gel, and dehydroepiandrosterone represent two possible treatments. New compounds designed to target androgen receptors in specific tissues are promising options as anabolic agents.
Journal of Investigative Medicine, 2013
The development of thyroid antibodies and the alteration of thyroid function are the most common ... more The development of thyroid antibodies and the alteration of thyroid function are the most common disorders associated with interferon alfa therapy in individuals with chronic hepatitis C (CHC).In this study, we compared the course of Graves disease (GD) between patients diagnosed with CHC and treated with interferon alfa and uninfected patients. We retrospectively analyzed data from 39 GD patients (15 men and 24 women, group 1) affected by CHC and treated with interferon alfa and from 43 uninfected GD patients (19 men and 24 women, group 2) who were seen at our institution from 1999 to 2011. All GD patients were treated with methimazole (MMI). Daily dose of MMI, duration of MMI therapy, and remission rate were evaluated in both groups. The daily dose of MMI was found to be lower in group 1 as compared with group 2 (9.74 ± 5.94 mg/d vs 14.12 ± 8.64 mg/d in group 1 vs group 2, respectively, P < 0.01). In addition, the duration of MMI treatment was found to be lower in group 1 as compared with group 2 (13.98 ± 13.0 months vs 38.86 ± 27.13 months in group 1 vs group 2, respectively; P < 0.01). The remission rate from GD was higher in the patients of group 1 in comparison with the patients of group 2 (87.17 % vs 48.86% in group 1 vs group 2, respectively, P < 0.005). Altogether, our data demonstrate a more favorable course of GD in the patients with CHC treated with interferon alfa compared with GD occurring in the patients without CHC.
Recenti Progressi in Medicina, Jul 1, 1985
Journal of the American Geriatrics Society, 2016
To determine the association between plasma thyroid-stimulating hormone (TSH), free triiodothyron... more To determine the association between plasma thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels and all-cause mortality in older adults who had levels of all three hormones in the normal range. Longitudinal. Community-based. Euthyroid Invecchiare in Chianti study participants aged 65 and older (N = 815). Plasma TSH, FT3, and FT4 levels were predictors, and 9-year all-cause mortality was the outcome. Cox proportional hazards models adjusted for confounders were used to examine the relationship between TSH, FT3, and FT4 quartiles and all-cause mortality over 9 years of follow-up. During follow-up (mean person-years 8,643.7, range 35.4-16,985.0), 181 deaths occurred (22.2%). Participants with TSH in the lowest quartile had higher mortality than the rest of the population. After adjusting for multiple confounders, participants with TSH in the lowest quartile (hazard ratio = 2.22, 95% confidence interval = 1.19-4.22) had significantly higher al...
J Amer Geriat Soc, 2009
OBJECTIVES: To investigate thyroid function testing abnormalities in older persons and to explore... more OBJECTIVES: To investigate thyroid function testing abnormalities in older persons and to explore the relationship between thyroid dysfunction and cognition. DESIGN: Cross-sectional. SETTING: Community-based. PARTICIPANTS: One thousand one hundred seventy-one men and women aged 23 to 102. MEASUREMENTS: Thyroid function was evaluated by measuring plasma concentrations of thyrotropin (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). Cognition was evaluated using the Mini-Mental State Examination (MMSE). Prevalence of overt and subclinical thyroid dysfunction was evaluated in different age groups (o65 vs !65). Age trends in TSH, FT4, and FT3 were examined in euthyroid participants. The cross-sectional association between thyroid dysfunction and MMSE score was evaluated adjusting for confounders. RESULTS: Subclinical hypothyroidism and subclinical hyperthyroidism were more prevalent in older than in younger participants (subclinical hypothyroidism, 3.5% vs 0.4%, Po.03; subclinical hyperthyroidism, 7.8% vs 1.9%, Po.002). In euthyroid participants, TSH and FT3 declined with age, whereas FT4 increased. Older participants with subclinical hyperthyroidism had lower MMSE scores than euthyroid subjects (22.61 AE 6.88 vs 24.72 AE 4.52, Po.03). In adjusted analyses, participants with subclinical hyper-thyroidism were significantly more likely to have cognitive dysfunction (hazard rate 5 2.26, P 5.003). CONCLUSION: Subtle age-related changes in FT3, FT4, and TSH occur in individuals who remain euthyroid. Subclinical hyperthyroidism is the most prevalent thyroid dysfunction in Italian older persons and is associated with cognitive impairment. J Am Geriatr Soc 57: 89-93, 2009.
Thyroid, 2006
Objective: Estrogen receptors (ERs) have been demostrated in the vessel structures of several sys... more Objective: Estrogen receptors (ERs) have been demostrated in the vessel structures of several systems. Little is known on the presence of ERs in the thyroid vessels. Design: We immunohistochemically evaluated both ER-a and ER-b immunoreactivity (IR) in both vascular and follicular ...
Acta Bio Medica Atenei Parmensis, 2010
During the last decade, a significant body of evidence has accumulated, indicating that the decli... more During the last decade, a significant body of evidence has accumulated, indicating that the declining activity of the GH-IGF-I axis with aging might play a role in the development of frailty and in several pathological conditions commonly seen during aging, such as atherosclerosis, cardiovascular disease, and cognitive decline. GH therapy has become widely popular as antiaging therapy in order to counteract the age-related decline in muscle mass and strength and the increase in fat mass. However there are only few proven beneficial effects of GH therapy in healthy elderly subjects and its use remains highly controversial in the scientific community. In this paper we will review the current evidence related to the use of GH and/or GH-secretagogues in normal and pathological aging.
International Journal of Endocrinology, 2015
Anemia is a multifactorial condition whose prevalence increases in both sexes after the fifth dec... more Anemia is a multifactorial condition whose prevalence increases in both sexes after the fifth decade of life. It is a highly represented phenomenon in older adults and in one-third of cases is "unexplained." Ageing process is also characterized by a "multiple hormonal dysregulation" with disruption in gonadal, adrenal, and somatotropic axes. Experimental studies suggest that anabolic hormones such as testosterone, IGF-1, and thyroid hormones are able to increase erythroid mass, erythropoietin synthesis, and iron bioavailability, underlining a potential role of multiple hormonal changes in the anemia of aging. Epidemiological data more consistently support an association between lower testosterone and anemia in adult-older individuals. Low IGF-1 has been especially associated with anemia in the pediatric population and in a wide range of disorders. There is also evidence of an association between thyroid hormones and abnormalities in hematological parameters under overt thyroid and euthyroid conditions, with limited data on subclinical statuses. Although RCTs have shown beneficial effects, stronger for testosterone and the GH-IGF-1 axis and less evident for thyroid hormones, in improving different hematological parameters, there is no clear evidence for the usefulness of hormonal treatment in improving anemia in older subjects. Thus, more clinical and research efforts are needed to investigate the hormonal contribution to anemia in the older individuals.
Acta Bio Medica Atenei Parmensis, 2010
Subclinical thyroid disease (STD) is defined as circulating concentrations of free T4 and free T3... more Subclinical thyroid disease (STD) is defined as circulating concentrations of free T4 and free T3 within their respective reference ranges in the presence of abnormal circulating concentrations of TSH. SCD is being diagnosed more frequently in clinical practice and is reported to be more prevalent in elderly as compared to young or adult subjects. The clinical impact of subclinical thyroid dysfunction is still a matter of debate, although it has been associated with various negative clinical outcomes, such as increased cardiovascular risk, reduction in bone density, decline in cognitive function, and increased risk of overt thyroid dysfunction. The treatment of STD is controversial and there is no consensus on the TSH cutoff values which can be used as indicators for treatment, especially in elderly subjects. In the present review, we report data on the prevalence of STD and on the potential clinical consequences of these disorders. Also, data of the Literature regarding the issue of the treatment of STD in relation to the age of the patient are reported.
Journal of endocrinological investigation
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Papers by Graziano Ceresini