Impacts of Drugs on Alzheimer’s Diseases

In 1901, Alois Alzheimer first reported Alzheimer’s disease. It is a disease that destroys memory and other essential mental functions mostly observed in an older person and mainly in women. Various treatment techniques have been used, which involve Ayurveda, homeopathy, modern drugs, etc. Turmeric, Ashwagandha, Brahmi, Ghrita, etc. are some ayurvedic medicines used to cure this disease, but they were relatively slow in processing. Drugs like Donepezil, Galantamine, and Rivastigmine are speedy, and thus they are in the market nowadays. In this review article, we will give information and awareness about the drugs therapy used for disease treatment and their effects.

Tall Cell Variant of Papillary Thyroid Carcinoma: Recognizing a Rare Aggressive Variant

Papillary Thyroid Cancer (PTC) accounts for 80–90% of all thyroid malignancies [1]. The most common morphology is the classical papillary which has an indolent course. Aggressive variants exist, of which Tall Cell Variant (TCV) is the most common. TCV is defined as a PTC in which 30% or more of tumor cells are 2-3 times as long as they are wide [1,2]. The histology image (Figure 1A, magnification 4x) shows tumor cells arranged back to back with abundant eosinophilic cytoplasm, and typical nuclear features of PTC; namely overlapping enlarged nuclei, intranuclear grooves, and occasional pseudoinclusions. Figure 1B (magnification: 20x) shows a high power view of the same case where the tall cell features of individual tumor cells can be better appreciated (arrows). This important feature should be recognized and reported in pathology reports as TCVs exhibit worse clinical course with extensive lymph node metastasis, extra thyroidal extension and high rate of recurrence [1,2].

Macro-TSH in Covid-19 Patients with an Underlying Thyroid Condition: A Case Series and Literature Review

Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that began in Wuhan (China), that spread rapidly worldwide, seriously affecting the population leading to a public health emergency declared by the World Health Organization. It is unknown how SARS-CoV-2 infection can affect thyroid function. In this study, we describe the characteristics of an unusual analytical interference that may explain the false detection of hypothyroidism in patients with SARS-CoV-2 infection. This is the first time that a phenomenon of this nature has been described in patients with COVID-19 and underlying thyroid dysfunction. Material and Methods: Observational study of patients admitted for severe COVID-19 infection and underlying thyroid disease. Results: TSH levels presented an atypical pattern different from that of Euthyroid Sick Syndrome (ESS), confirmed by the lack of response to substitution treatment. We develop different studies to confirm or eliminate potential interferences, being diagnosed of a possible macro-TSH. Conclusion: It is important to consider that in patients with COVID-19 and high concentrations of TSH and thyroid hormones within reference ranges with lack of response to treatment, one of the possible causes to consider is the presence of macro-TSH. The presence of macro-TSH interference in COVID-19 patients requires extreme precautions to avoid errors in diagnosis or treatment (replacement dose adjustment) in patients with hypothyroidism secondary to an underlying disease.

Can Epicardial Adipose Tissue be Defined as an Early Marker of Treatment Decisions of Subclinical Hypothyroidism in Childhood?

Introduction and Aim: Childhood overt hypothyroidism is a chronic disease that affect many system adversely and requires treatment. However, Subclinical Hypothyroidism (SH) ,defined obvious cases, impacts on other systems are unknown and there is no common approach to be treated. Moreover, SH may continue for many years, before they become overt hypothyroidism. Cardiovascular System (CVS) is one of the host system, which hypothyroidism adversely affects. Epicardial Adipose Tissue thickness (EAT) is known to be an important marker in terms of the cardiovascular risks. We aimed to determine the effects on CVS in children with SH. Material and Methods: The study included were 100 cases, which are 1-18 years had categorized in two groups; control group (50 children), who had no signs of thyroidal dysfunction and case group (50 children) who had diagnosed with SH, are recruited in the study. SH was diagnosed according to the slightly higher TSH than the upper limit (4.2M/L), normal free T4 and T3 levels. Medical Treatment (LT4) was decided according to the levels of TSH, sT3, sT4 and clinical status. EAT was determined by transthoracic echocardiographic measurements in millimeters. The SH cases were classified into two groups in terms of medical treatment. EAT thickness was measured in patients with treated group (SH1) and non-treated group (SH2) at admission (EAT0) and at 6. months (EAT 6). Results: Epicardial adipose tissue thickness was significantly higher in SH children, than the children without thyroid dysfunction. The mean value of the EAT in control group was 2,11 ± 0,52mm. Mean of EAT0 was 4,08 ± 1,41 in group SH1, mean of EAT0 was 4,31 ± 1,09mm in group SH2. In addition, mean of EAT6 was 3.65 ± 1,27mm in group SH1 and mean of EAT6 was 4,16 ± 1,10 in group SH2. Although there were a decrease in both group SH1 and SH2, at EAT6 compared to the EAT0, and this decrease was more significant in group SH1. Discussion: This study suggests that subclinical hypothyroidism effects adversly the cardiovascular system in children before hypothyroidism become overt. In future this data may be marker at the begining of LT4 treatment in children with SH.

Oral Iodine Supplementation in Very Low Birth Weigh Infants. Thyroid Function and Neurodevelopmental Follow Up at 24 Months. A Randomized Clinical Trial

Background: The trace element Iodine (I) is essential for the synthesis of thyroid hormones. Premature babies need >30μg I/kg/day (ICCIDD recommendations). Neonates and especially preterm infants are a population at risk of suffering the consequences of iodine deficiency, because of the impact of neonatal hypothyroxinemia on brain development. Aims: The main aim of this project is to prevent the mental retardation and increased risk of cerebral palsy of premature infants, which is partially caused by neonatal hypothyroxinemia. We gave Oral iodine supplementation in very premature babies during the neonatal period. Methods: Population: we included 94 infants born <1500g. Intervention group: we administered 30μg I/kg /day of iodine in oral drops to 47 infants from first day of life until hospital discharge. Control group: 47 infants without supplements. The study was approved by the Ethics Committee. Samples of different formulas, maternal milk was kept for the determination of the iodine content. Interventions: Blood, food and urine samples (collected at 1, 7, 15, 21, 30 days after birth and at discharge). Measurements: milk and urine for iodine determination (Benotti method). Blood samples: for thyroid hormones (T4, free T4, T3 and TSH) and tyroglobulin. Their neurological development was assessed at 2 years of age (Bayley Test). Results: Iodine content of mothers´ breast milk: 15 (5.0) μg I/dL (range 1-60); Infants in the supplemented group reached the recommendations from the first days of life. Infants in the control group did not reach the recommended intake of iodine to 60 days of life. We found a positive relation between iodine intake and the concentrations of thyroid hormones until 60 days of life. Conclusion: Thyroid function is related to iodine intake in preterm infants. Breast milk appears to be the best source of iodine for the premature infant. Preterm babies on formula preparations and with exclusive parenteral nutrition are at high risk of iodine deficiency. Therefore, supplements should be added if iodine intake is found to be inadequate. Acknowledgments. We are grateful to the Fondo de Investigaciones Sanitarias (National Grant 06/1310 for financial support).