SUN-492 Treatment of Uncontrolled Graves’ Disease Reveals Underlying Thyroiditis

Thyrotoxicosis is a life-threatening condition that may result from poor adherence to medical therapy. We describe the case of a patient with Graves’ disease and a history of medication non-compliance who presented with tachyarrhythmia and heart failure (HF). His protracted course after weeks of inpatient treatment with thionamides, iodine, resin and beta-blockers, was followed by a dramatic improvement within days of adding steroids, suggesting the presence of concurrent untreated thyroiditis. Case Description: A 38-year-old man with an 18-month history of known Graves’ disease presented to the endocrinology clinic requesting thyroidectomy. He complained of 3 weeks of worsening palpitations, shortness of breath, bilateral lower extremity edema, and frequent loose stools. History revealed frequent interruption of thionamide and recent discontinuation of propranolol due to patient’s perceived lack of improvement. Physical exam showed a thin male with a large goiter. He was in moderate distress due to tachypnea. He had atrial fibrillation with rapid ventricular rate (A Fib with RVR) but was not in pulmonary edema. Laboratories showed a suppressed TSH (<0.02 mIU/L [0.45 - 4.70 mIU/L]), a free T4 above the level of detection (>6.99 ng/dL [0.78 - 2.20 ng/dL], and a total T3 level of above 781 pg/mL (97.0 - 170.0 ng/dL). Methimazole 30 mg BID and propranolol 40 mg TID were started, followed within a few hours with potassium iodine (SSKI) 3 drops TID. Although the patient’s HF improved and there was down-trending of free T4, he continued to have A fib with RVR. SSKI and propranolol were increased; diltiazem 90 mg QID and cholestyramine 2g BID were later added. Despite aggressive treatment, the patient continued to have intermittent tachyarrhythmia, postponing his planned thyroidectomy for weeks. Dexamethasone 2mg Q8H was then started aiming to further decrease T4 to T3 conversion. Interestingly, within 48 hours of the start of steroid therapy, his free T4 level markedly decreased and was well within the normal range several days later when he underwent a successful thyroidectomy, with no further tachyarrhythmia recurrence. Discussion: Thyrotoxicosis is aggressively treated given its high mortality rate. Treatment algorithms guide physicians to categorize hyperthyroidism either as the type associated with increased hormone synthesis and secretion or that which results from increased hormone release due to gland destruction. This thought process may lead, as in our case, to a delay in appropriate therapy and an increased risk of disease complications. Furthermore, providers should not assume that the lack of treatment response in a patient with Graves’ disease is the result of medication non-adherence. The possibility of coexisting thyroiditis and the absence of a treatment regimen that effectively addresses both underlying processes may be the actual cause for the lack of clinical improvement.

PHYLOGENETIC ANALYSIS OF 16S rRNA GENE FRAGMENT OF ANTIBIOTIC-PRODUCING PLS 76 ISOLATE

Exploitation of extremophiles as novel bioactive compounds sources has been increasing. The aim of this study was to evaluate the activity and the class of antibiotic produced by a thermo-halophilic isolate PLS 76, as well as to identify the genotype of the isolate. The activity was determined by a disc diffusion method, while the antibiotic class was determined qualitatively by chemical reactions using ninhydrin, iodine vapour and potassium iodine. The genotype was determined by sequencing the 16S rRNA gene fragment and the phylogenetic tree from the sequence data. The results showed that PLS 76 was a Gram-negative bacterium and able to produce polypeptide antibiotic, which showed a slight activity on E. coli and S. aureus. Sequence alignment of the 16S rRNA gene fragment showed that PLS 76 was most related to Geobacillus kaustophilus. These results may be used to utilise the isolated for further antibiotic study.

ANALYSIS OF MASS PORTIONS OF BIOGENIC ELEMENTS IN DENTAL TISSUE

Hard dental tissues represent ideal tissues for assessing the long-term effects of exposure to toxic metals. The aim of this paper was to determine the representation and the relation between mass portions of the following elements: carbon, oxygen, sodium, magnesium, aluminum, chlorine, potassium, iodine and lead in certain parts of the teeth (enamel-dentine line, dentine, pulp) with rats with experimentally induced diabetes mellitus (DM) by using SEM/EDS analysis, after 14 and 30 days of exposing animals to lead. Material and methods of work: The study was conducted in rats of Wistar strains divided into two groups. The first experimental group (A1) consisted of 8 rats, taking lead in the course of 14 days at a concentration of 1500 ppm and the second experimental group (A2) consisted of 8 rats taking lead in the course of 30 days at a concentration of 1500 ppm. The rats from group А1 and А2 had induced diabetes mellitus by using the Alloxan which was administered intraperitoneally at a dose of 100mg per kilogram of body weight. The teeth samples were analyzed by scanning electron microscopy (SEM). Results: No lead was detected in the teeth of rats with experimentally induced diabetes that received lead in drinking water in the course of 14 days, while the average values of mass portions of other examined elements amounted to: carbon -24,25 %, oxygen – 38,17%, sodium -0,9%, magnesium -0,11%, aluminum – 0,07%, chlorine – 0,21% and iodine – 0,32%. The average values of the mass portions of examined elements in the enamel of teeth of rats receiving lead in the course of 30 days amounted to: lead -0,36%, carbon-31,09%, oxygen – 41,13%, sodium – 0,91%, magnesium – 0,21%, chlorine – 0,22%, potassium – 0,03% and iodine – 0,17%. Conclusion: Mass portions of elements found in the teeth enamel of rats receiving lead in the course of 30 days with experimentally induced diabetes were higher but with no statistically significant difference compared to the mass portions of elements in the group of teeth of rats taking lead through drinking water in the course of 14 days with experimentally induced diabetes, too. The lead was detected in the teeth of rats that received lead for 30 days with induced diabetes but only in the enamel.

The effect of preliminary processing and different methods of cooking on the iodine content and selected antioxidative properties of carrot (Daucus carota L.) biofortified with (potassium) iodine

Carrot is a vegetable that contains many nutrients and has strong antioxidant activity as well as pro-health potential. The level of bioactive compounds is strongly connected with the production chain. The thermal treatment of food products induces several biological, physical and chemical changes. In this study, changes in the levels of iodine, total carotenoids, total polyphenols as well as the antioxidant activity of unpeeled and peeled controls and carrots biofortified with (potassium) iodine (KJ) during cultivation due to the cooking and steaming process were investigated. The use of thermal processes resulted in a lower concentration of iodine in the roots of the control as well as in carrots biofortified with (potassium) iodine. In addition, peeling carrots caused higher losses of this trace element in the control and the biofortified carrots cooked or steamed for various times. In this study, a significant growth of the total carotenoids in peeled carrots biofortified with (potassium) iodine and of the total polyphenols in unpeeled carrots biofortified with (potassium) iodine under the influence of the cooking and steaming processes was observed compared with raw peeled and unpeeled biofortified carrots, respectively. Antioxidant activity significantly increased in the unpeeled and peeled carrots biofortified with (potassium) iodine under all thermal treatments in comparison with the raw unpeeled and peeled biofortified carrots.

Bioactive Components in Human Milk Along the First Month of Life: Effects of Iodine Supplementation during Pregnancy

Background/Aims: Human milk is considered the most suitable food for infants. The potential benefits of breastfeeding can be explained by the presence of different growth and neurotrophic factors in human milk. This study was designed to detect some biomarkers in human milk, which could be involved in the infant neurodevelopment and in the regulation of the maturation of neonatal intestine (brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), glial fibrillary acidic protein (GFAP), fibroblast growth factor 21 (FGF21), lysophosphatidic acid (LPA) and autotaxin (ATX)), and compare them on the basis of the consumption of iodine supplements or multivitamins. Methods: A prospective study included 37 healthy breastfeeding mothers, divided into 3 different groups: (1) 10 mothers who did not take supplements, (2) 17 mothers who took potassium iodine (KI) 200 µg/day and (3) 10 mothers who took a multivitamin supplement. Results: The concentrations of BDNF, GDNF, GFAP, FGF21, LPA and ATX in human milk were not significantly different in women who took a multivitamin or KI supplement compared with those who did not take any supplement. Conclusions: The presence of neurotrophic factors in human milk is neither modified by the consumption of supplements nor by their type.