Thyroid Diseases: Bartalena L

Bartalena L, Baldeschi L, Dickinson AJ, Eckstein A, Kendall-Taylor P, Marcocci C, Mourits MP, Perros P, Boboridis K, Boschi A, Currò N, Daumerie C, Kahaly GJ, Krassas G, Lane CM, Lazarus JH, Marinò M, Nardi M, Neoh C, Orgiazzi J, Pearce S, Pinchera A, Pitz S, Salvi M, Sivelli P, Stahl M, von Arx G, Wiersinga WM. · Department of Clinical Medicine, University of Insubria, Varese, Italy. · Thyroid. · Pubmed #18341379 No free full text.

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Tanda ML, Bartalena L. · No affiliation provided · J Endocrinol Invest. · Pubmed #16794359 No free full text.

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Bartalena L. · No affiliation provided · J Clin Endocrinol Metab. · Pubmed #16148347 links to  free full text

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Bartalena L. · No affiliation provided · J Endocrinol Invest. · Pubmed #16075919 No free full text.

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Bartalena L, Marcocci C, Pinchera A. · No affiliation provided · J Clin Endocrinol Metab. · Pubmed #15579734 links to  free full text

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Bartalena L. · No affiliation provided · J Endocrinol Invest. · Pubmed #15055465 No free full text.

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Bartalena L, Marcocci C, Pinchera A. · No affiliation provided · J Clin Endocrinol Metab. · Pubmed #14715819 links to  free full text

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Bartalena L. · No affiliation provided · J Endocrinol Invest. · Pubmed #12035933 No free full text.

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Bartalena L, Tanda ML. · Department of Clinical Medicine, University of Insubria, Varese, Italy. · N Engl J Med. · Pubmed #19264688 No free full text.

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Tanda ML, Bogazzi F, Martino E, Bartalena L. · Division of Endocrinology, Department of Clinical Medicine, University of Insubria, Ospedale di Circolo, Viale Borri, 57, 21100 Varese, Italy. · Eur J Endocrinol. · Pubmed #18667589 links to  free full text

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Bartalena L, Lai A, Compri E, Marcocci C, Tanda ML. · Department of Clinical Medicine, University of Insubria, Division of Endocrinology, Ospedale di Circolo, Varese, Italy. · Ophthal Plast Reconstr Surg. · Pubmed #18645425 No free full text.

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Bartalena L, Marcocci C, Lai A, Tanda ML. · Department of Clinical Medicine, Section of Endocrinology, University of Insubria, 21100 Varese, Italy. · J Endocrinol Invest. · Pubmed #18591894 No free full text.

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Dionigi G, Dionigi R, Bartalena L, Tanda ML, Piantanida E, Castano P, Annoni M, Boni L, Rovera F, Bacuzzi A, Vanoli P, Sessa F. · Centro di Ricerche in Endocrinochirurgia, Dipartimento di Scienze Chirurgiche , Università degli Studi dell'Insubria, Varese. · Minerva Chir. · Pubmed #17947947 No free full text.

Abstract: Thyroid surgery, one of the most common interventions in endocrine surgery, is practiced by many specialists who perform this procedure exclusively. It accounts for the bulk of work even in reference centers that treat rare endocrine tumors (e.g. adrenal and gastrointestinal tract cancer). Better results are obtained by experienced and skilled operators. Surgeons who correctly perform thyroid surgery can achieve excellent outcomes even in other areas of endocrine surgery. So it is surprising that not more is being done to teach the procedure, which has always been considered something of an art, perhaps because surgical treatment of rare endocrine tumors is more stimulating to teach than routine surgical procedures. Nonetheless, teaching correct surgical technique is essential for reducing and avoiding postoperative complications caused by inadequate experience and knowledge. Numerous studies have reported that the incidence of complications is high and that the rate is growing: 5% involve permanent injury to the recurrent laryngeal nerve after intervention for a benign tumor, despite repeated reports that the incidence could be reduced to near zero or at least to 1%. Alarmingly high is the 20% incidence of persistent hypoparathyroidism after total thyroidectomy. Here, too, accurate technique could reduce this rate to 1%. An important point is that permanent laryngeal nerve injury and persistent hypoparathyroidism are both sources of considerable discomfort for patients. One of the chief objectives of modern endocrine surgery is, therefore, to reduce the complications rate to acceptable levels by establishing adequate, uniform teaching protocols and universal guidelines that would help improve the practice of surgery.

Dionigi G, Bianchi V, Rovera F, Boni L, Piantanida E, Tanda ML, Dionigi R, Bartalena L. · Department of Surgical Sciences, University of Insubria, Azienda Ospedaliero-Universitario, Fondazione Macchi 57, Varese, Italy. · Expert Rev Anticancer Ther. · Pubmed #17555398 No free full text.

Abstract: Since medullary thyroid cancer (MTC) was first recognized as a distinct tumor in 1959, it became clear that MTC is more difficult to cure than papillary thyroid cancer and has higher rates of recurrence and mortality. MTC represents 5-8% of thyroid cancers. It derives from parafollicular cells of the ultimobranchial body derived from the neural crest. MTC secretes calcitonin and other hormonal peptides and is considered part of the amine precursor uptake and decarboxilation system. MTC may occur either as a hereditary or nonhereditary entity. Hereditary MTC can occur either alone as the familial MTC or as the thyroid manifestation of multiple endocrine neoplasia (MEN) type 2 syndromes (MEN 2A MEN 2B). Activating point mutations of the RET proto-oncogene have demonstrated to be causative of the familial form of medullary thyroid cancer, both isolated familial MTC and associated with MEN 2A and 2B. In the last 10 years, major improvements and new technologies have been proposed and applied in thyroid surgery; among these are molecular diagnosis with genetic screening and mini-invasive video-assisted thyroidectomy. The history of thyroid surgery starts with Billroth, Kocher and Halsted, who developed the technique for thyroidectomy between 1873 and 1910. Prophylactic surgery for patients carrying a positive RET proto-oncogene has proven to be highly effective in curing those likely to experience the development of MTC. Video-assisted procedures with central compartment dissection have proved feasible for patients carrying a positive RET proto-oncogene. This paper reviews relevant medical literature published in the English language on surgery of MTC in well-controlled trials. We discuss the particular ethical and legal issues that thyroid prophylactic surgery raises. Searches were last updated in February 2007.

Dionigi G, Dionigi R, Bartalena L, Boni L, Rovera F, Villa F. · Department of Surgical Sciences, Medical School, University of Insubria, Viale Borri 57, 21100, Varese, Italy. · Expert Rev Anticancer Ther. · Pubmed #17020456 No free full text.

Abstract: Optimal treatment for differentiated thyroid carcinoma is controversial with respect to the extent of thyroid resection, the extent and technique of nodal dissection and use of prophylactic radioiodine treatment. Postoperative complications, such as recurrent laryngeal nerve injury and definitive hypoparathyroidism, have carried great weight in the discussion regarding how radical the surgical treatment should be. The discussion of whether total thyroidectomy or lesser procedures should be the treatment for thyroid carcinomas has been protracted. Now, reasonable agreement exists that total thyroidectomy is the best treatment and the focus of the discussion has moved to the treatment of lymph nodes. At the time of diagnosis, node metastases are a common finding in patients with differentiated thyroid cancer, in particular papillary carcinoma. The argument supporting a radical approach to lymph node excision is that the presence of node metastases increases the recurrence rate. Advocates for the conservative approach believe that little association exists between node metastases and death from thyroid carcinoma. This paper reviews relevant medical literature published in the English language on surgery of lymph nodes in differentiated thyroid cancer with well-controlled trials. Searches were last updated in June 2006.

Bartalena L, Marcocci C, Tanda ML, Piantanida E, Lai A, Marinò M, Pinchera A. · Department of Clinical Medicine, University of Insubria, Varese, Italy. · J Endocrinol Invest. · Pubmed #16075933 No free full text.

Abstract: Graves' ophthalmopathy (GO), the most frequent extrathyroidal manifestation of Graves' disease, is a disorder of autoimmune origin, the pathogenic mechanisms of which are still incompletely understood. Although GO is severe in only 3-5% of affected individuals, quality of life is severely impaired even in patients with mild GO. Management of severe GO can be either medical or surgical (orbital decompression, eye muscle or lid surgery). Medical management relies on the use of high-dose systemic glucocorticoids or orbital radiotherapy, either alone or in combination. Studies carried out in the last 5 yr have shown that glucocorticoids are more effective through the i.v. route than through the oral route. However, particular attention should be paid to possible liver toxicity of i.v. glucocorticoids. Recent randomized clinical trials have, with one exception, confirmed that orbital radiotherapy is an effective and safe therapeutic procedure for GO. At variance with previous encouraging data, recent randomized clinical trials have shown that currently available SS analogs are not very effective in the management of GO. Antioxidants might have a role, at least in mild forms of GO. Particular attention should be paid to correction of risk factors (cigarette smoking, thyroid dysfunction, radioiodine therapy) involved in GO progression.

Bartalena L, Tanda ML, Piantanida E, Lai A. · Department of Clinical Medicine, University of Insubria, Division of Endocrinology, Ospedale di Circolo, Viale Borri, 57, 21100 Varese, Italy. · Eur J Endocrinol. · Pubmed #15994740 links to  free full text

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Bartalena L, Tanda ML, Bogazzi F, Piantanida E, Lai A, Martino E. · Division of Endocrinology, Department of Clinical Medicine, Ospedale di Circolo, University of Insubria, Viale Borri, 57, 21100 Varese, Italy. · Expert Opin Pharmacother. · Pubmed #15952916 No free full text.

Abstract: Pharmacological treatment, usually by thionamides (carbimazole, methimazole, propylthiouracil) is, in addition to radioiodine therapy and thyroidectomy, one of the available therapies for Graves' hyperthyroidism. Thionamides represent the treatment of choice in pregnant women, during lactation, in children and adolescents and in preparation for radioiodine therapy or thyroidectomy. Side effects are relatively frequent but are in general mild and transient. Two main regimens are available: titration method (use of the lowest dose maintaining euthyroidism; duration: 12-18 months) and block-and-replace method. Neither one has clear advantages in terms of outcome but the latter method is associated with more frequent side effects. Hyperthyroidism relapses in approximately 50% of patients, to whom ablative therapy should be offered.

Bartalena L, Tanda ML, Piantanida E, Lai A. · Division of Endocrinology, University of Insubria, Varese, Italy. · J Endocrinol Invest. · Pubmed #15233224 No free full text.

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Bartalena L, Wiersinga WM, Pinchera A. · Department of Clinical Medicine, University of Insubria, Varese, Italy. · J Endocrinol Invest. · Pubmed #15165007 No free full text.

Abstract: Graves' ophthalmopathy (GO) is an autoimmune orbital disorder most commonly associated with Graves' disease. Recent studies have underscored the role that orbital cells, particularly fibroblasts and adipocytes, play in causing the increase in orbital content responsible for clinical manifestations of the disease. GO seems to be related to autoimmune reactions triggered by autoreactive T lymphocytes of thyroid origin, which recognize antigen(s) shared by thyroid and orbit. The nature of the antigen (or antigens) involved is not fully understood, but TSH receptor is likely to be involved. Cytokines secreted by T lymphocytes, macrophages and fibroblasts play an essential role in perpetuating the disease. Animal models of GO have been developed, but results have not clarified GO pathogenesis yet. Progress in the management of the ophthalmopathy has been very limited, and glucocorticoids, orbital radiotherapy and orbital decompression remain the mainstays in GO treatment. Novel treatments, such as somatostatin analogues, antioxidants, cytokine antagonists are currently under investigation, as well as the effects of total thyroid ablation. Cessation of smoking currently represents the only form of GO (secondary and tertiary) prevention.

Bartalena L, Tanda ML, Piantanida E, Lai A, Pinchera A. · Department of Clinical Medicine, Division of Endocrinology, University of Insubria, Varese, Italy. · J Endocrinol Invest. · Pubmed #15165006 No free full text.

Abstract: The relationship between treatment for hyperthyroidism and course of Graves' ophthalmopathy (GO) has been and still is a matter of debate. Literature often presents conflicting data, due to several influencing factors, such as selection bias, nonrandomized and uncontrolled or retrospective features of many studies, nonstandardized evaluation of ocular changes. However, it seems clear that neither antithyroid drug treatment nor thyroidectomy affect the natural course of GO, while radioiodine therapy may cause, in about 15% of cases, GO progression. The latter is more likely in patients who smoke, have pre-existing GO and more severe hyperthyroidism, or whose post-radioiodine hypothyroidism is not promptly corrected by L-thyroxine. GO progression after radioiodine therapy can be prevented by concomitantly treating patients with glucocorticoids, thus making radioiodine therapy a safe procedure also in GO patients. The presence of GO should not, therefore, influence the choice of treatment for hyperthyroidism. Should antithyroid drug treatment or thyroidectomy be selected for patients with mild ophthalmopathy, no treatment for GO is necessary, while a short course of moderate doses of glucocorticoids is advised if radioiodine therapy is chosen. In patients with severe GO, treatment of hyperthyroidism and management of GO proceed independently of each other, and either definitive (radioiodine or thyroidectomy) or conservative (antithyroid drugs) treatment for hyperthyroidism can be selected while treating GO. The authors' preference goes to the former, because it depletes intrathyroidal autoreactive T lymphocytes and removes thyroid antigens, which are likely to be involved in the pathogenesis of autoimmune reactions of the ophthalmopathy.

Bartalena L, Tanda ML, Piantanida E, Lai A. · Division of Endocrinology, University of Insubria, Varese, Italy. · Biofactors. · Pubmed #14757966 No free full text.

Abstract: Graves' ophthalmopathy (GO) is a disorder of autoimmune origin caused by a complex interplay of endogenous and environmental factors. After recognition of one or more antigens shared by thyroid and orbit, activated T lymphocytes infiltrating the orbit trigger a cascade of events leading to production of cytokines, growth factors and oxygen reactive species. Proliferation of adipocytes and fibroblasts then follows, with an increased synthesis of glycosaminoglycans (GAG), which attract water and cause edema of orbital structures and venous congestion. Proliferation of orbital fibroblasts and adipocytes, both in the retroocular tissue and in the perimysium of extraocular muscles, are among the most important events leading to the increased volume of orbital structures (fibroadipose tissue and extraocular muscles). The contribution of oxygen reactive species to the changes occurring in the orbit is underscored by in vitro studies. Superoxide radical stimulates orbital fibroblasts to proliferate and to produce GAG. Furthermore, hydrogen peroxide induces expression of HLA-DR and heat shock protein-72, involved in antigen recognition and T-lymphocyte recruitment. Cigarette smoking, which is probably the most important environmental factor associated with GO occurrence and maintenance, might also act, among other mechanisms, by enhancing generation of oxygen reactive species and reducing antioxidant production. Substances such as nicotinamide, allopurinol and pentoxifylline reduce superoxide- or hydrogen peroxide-induced proliferation of fibroblasts, GAG production and HLA-DR or HSP-72 expression by GO orbital fibroblasts, possibly through scavenging oxygen free radicals. Two small, non-randomized and/or uncontrolled studies investigated the effects of nicotinamide, allopurinol or pentoxifylline on GO. Favorable results were reported, but data are not fully convincing and the true effectiveness of these agents needs to be verified in randomized, controlled trials enrolling a larger number of patients.It currently seems unlikely that they may find a relevant place in the limited armamentarium available for the management of severe GO.

Bogazzi F, Martino E, Bartalena L. · Department of Endocrinology, University of Pisa, Pisa, Italy. · J Endocrinol Invest. · Pubmed #12739747 No free full text.

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Wiersinga WM, Bartalena L. · Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. · Thyroid. · Pubmed #12487767 No free full text.

Abstract: Graves' ophthalmopathy is clinically relevant in approximately 50% of patients with Graves' disease, severe forms affecting 3%-5% of patients. Two age peaks of incidence are observed in the fifth and seventh decades of life, with slight differences between women and men. The disease is more frequent in women than in men, although the female-to-male ratio is only 1:4 in severe forms of eye disease. The natural history of Graves' ophthalmopathy is incompletely defined, but in many instances, especially in mild forms, the disease may remit or improve spontaneously. The onset of the ophthalmopathy is in most cases concomitant with the onset of hyperthyroidism, but eye disease may precede or follow hyperthyroidism. Cigarette smoking plays an important role in the occurrence of the ophthalmopathy, and is also associated with a higher degree of disease severity and a lower effectiveness of its medical treatment. Primary prevention (i.e., avoidance of the occurrence of the ophthalmopathy) is presently not feasible, but smoking withdrawal in relatives of patients with Graves' disease might be important. In terms of secondary prevention (i.e., avoidance of progression of subclinical eye disease into overt and severe ophthalmopathy) in addition to refraining from smoking, early and accurate control of thyroid dysfunction (both hyperthyroidism and hypothyroidism), as well as early diagnosis and treatment of mild eye disease are important. As to the role that management of hyperthyroidism may play in the course of Graves' ophthalmopathy, while antithyroid drugs and thyroidectomy are not disease-modifying treatments, radioiodine therapy causes a progression of the ophthalmopathy in approximately 15% of patients, especially high-risk patients, who smoke, have severe hyperthyroidism or uncontrolled hypothyroidism, high levels of thyrotropin (TSH)-receptor antibody, or preexisting eye disease. However, the risk of radioiodine-associated progression of the opthalmopathy can be eliminated by concomitant treatment with middle-dose glucocorticoids. In terms of tertiary prevention (i.e., avoidance of deterioration and complications of overt disease) early immunosuppressive treatment or orbital decompression, as appropriate, are essential tools. Smoking withdrawal may increase the effectiveness of immunosuppressive treatment.

Marcocci C, Bartalena L, Marinò M, Rocchi R, Mazzi B, Menconi F, Morabito E, Pinchera A. · Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy. · Ophthal Plast Reconstr Surg. · Pubmed #12439051 No free full text.

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