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Autoimmune thyroid disorders in pregnancy and after delivery (Regional screening of thyroid disorders in pregnancy)
Špitálníková, Sylvie ; Horáček, Jiří (advisor) ; Límanová, Zdeňka (referee) ; Zamrazil, Václav (referee)
Our universal screening revealed a relatively high prevalence of autoimmune thyroid disorders (AITD), namely Hashimoto's thyroiditis (HT) and postpartum thyroiditis (PPT), and incipient hypothyroidism in an unselected population of pregnant women from a chosen district, roughly similar to that in foreign studies. Most of the disorders recognized in this way were asymptomatic, and if only high-risk women, defined according to the recommended guidelines, were examined, a large proportion of pregnant women with thyroid disorders would be neither followed by an endocrinologist, nor treated. The universal screening for thyroid autoimmunity and dysfunction appears to be more beneficial for improving the care of pregnant and postpartum women and their children than limiting the testing on women with risk factors only. For the evaluation of TSH levels in pregnant women in the first trimester of pregnancy, the range 0.15-3.5 mIU/l appeared to be the most appropriate one with respect to the method used. On the basis of the results obtained, we believe that the use of the screening target of 3.5 mIU/l and the treatment target of 2.5 mIU/l in women identified as having HT brings satisfactory outcomes. Pregnant women who were treated properly and in time showed a lower occurrence of complications in pregnancy....
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Molecular- genetic analysis of the Thyroid carcinomas
Sýkorová, Vlasta ; Bendlová, Běla (advisor) ; Zamrazil, Václav (referee) ; Peterka, Miroslav (referee)
Introduction: Thyroid cancer represents more than 90% of endocrine tumors and its incidence, predominantly of papillary thyroid carcinoma (PTC), is still increasing in the Czech Republic. Several genetic changes are known, but thein impact to phenotype is still controversial. Aims: To study of the genetic causes (RET/PTC, BRAF and RAS alterations) and the role of RET polymorphisms in thyroid cancer (predominantly PTC), and to correlate genotype with phenotype. Subjects and Methods: Overall 234 PTC tissues, 8 poorly differentiated carcinomas, 3 anaplastic carcinomas, 23 medullary carcinomas, 6 follicular carcinomas and one follicular adenoma were analyzed. Samples of fresh frozen thyroid tissues, fine-needle aspiration biopsies and paraffin-embedded formalin-fixed tissue sections of patients with thyroid cancer and blood samples of healthy controls were used for analysis. The expression of RET/PTC rearrangements was detected on agarose gel. Five RET polymorphisms were analyzed using specific TaqMan probes. Detection of mutations in the BRAF gene and three RAS genes was performed by direct sequencing. Presence of alteration was correlated with clinicopathological parameters. Results: We found out that some RET polymophisms are associated with development of RET/PTC rearrangements in PTC and proved,...
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The incidence of thyroid in selected regions of the Czech Republic in terms of saturation with iodine
Dvořáková, Marcela ; Zamrazil, Václav (advisor) ; Topolčan, Ondřej (referee) ; Stárka, Luboslav (referee) ; Čáp, Jan (referee)
24 9. SUMMARY 1. Natural sources such as water or soil contain iodine in low amounts in the Czech Republic. 2. Clinical manifestations of iodopenia were severe and occured in certain geographical areas in the past. 3. Iodization of table salt started in the fifties of the last century as a result of extensive epidemiological research and since then it has significantly improved iodine saturation in general. 4. Further steps in iodine prophylaxis in the mid-nineties of the 20th century have improved iodine saturation according to ICCIDD/WHO criteria. 5. Resolution of iodine deficiency does not represent, however, a closed chapter. 6. Individuals at risk, such as pregnant or breastfeeding women and patients on a salt- restricted diet, are worthy of public health concern. 7. There needs to be increased awareness of chronic excess of iodine with respect to an increasing prevalence of autoimmune thyroid disorders. 8. There is a need to continue education of the general population focused on adequate iodine intake from various foods (see products, milk) and to maintain a daily iodine intake in the "optimal ranges". Based on the international criteria, the Czech Republic is iodine sufficient country. This happened due to a multidisciplinary collaboration coordinated by the Regional Iodine Deficiency Council...
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Effect of carbamazepine on thyroid hormone homeostasis
Šimko, Julius ; Šonka, Karel (advisor) ; Mareš, Jan (referee) ; Zamrazil, Václav (referee)
8. Summary Introduction: While carbamazepine (CBZ) treatment may affect serum thyroid hormone concentrations it rarely leads to clinically important hypothyroidism. This study was aimed to evaluate an early effect of CBZ on thyroid status in hypothyroid patients with thyroid hormone replacement, as compared with patients without a thyroid disorder. Methods: Twenty-nine patients indicated for CBZ treatment were followed prospectively. Their thyrotropin (TSH), total thyroxine (TT4), free thyroxine (FT4) and antibodies against thyreoperoxidase (TPO- ab) and thyreoglobulin (TG-ab) serum levels were assayed before the start of CBZ medication (150 mg/d increasing to 450 mg/d), and then their TSH, TT4 and FT4 serum levels were assayed at week intervals for 7 weeks. Nineteen patients had no thyroid disorder before CBZ treatment (control group A), whereas 10 patients were treated with L-thyroxine (median 100μg/d ) for hypothyroidism and were stable before CBZ treatment (group B). The fluctuations of thyroid status after the start of CBZ treatment were compared between the groups. Results: In the control group, TT4 was significantly decreased by ca. 15 to 25 %, starting from the 1st week of treatment (Friedman, p<0.001), while FT4 was decreased by only ca. 10 to 15 %, and the significance (p<0.001) was delayed till...
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Changes of bone mass density in selected endocrine diseases
Vašátko, Tomáš ; Čáp, Jan (advisor) ; Zamrazil, Václav (referee) ; Hána, Václav (referee)
Osteoporosis is a serious social and medical problem. About 6% people suffer from osteoporosis in European countries. As for aetiology it is a multi-factorial disease. Endocrinopaties play an important role in it's development. We focused on three specific endocrinopaties with relation to bone metabolism in our study. Goal of the study: 1/ To evaluate the influence of long term thyroid hormone therapy (substitution and suppressive dose) on bone mass and bone metabolism. 2/ To evaluate the possibility of prediction of bone mass increase after the operation in patients with mild primary hyperparathyroidism. 3/ To evaluate changes of bone mass, bone metabolism and body composition in patients with growth hormone deficiency treated with growth hormone substitution. Patients and methods: 1/ a) First - cross sectional part of the study - 76 patients on suppressive dose of L-thyroxine therapy, 34 patients on substitution therapy. We examined bone markers and bone mass in each group. We evaluated how each of the two doses of therapy influences the bone metabolism and we compared the groups with each other. b) In second - prospective part of the study - we observed the changes of bone mass in the course of the time (5 years) in each group. 2/ Retrospective cross-sectional study - 54 patients with primary...
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Investigation of thyroid disorder in pregnancy and reference intervals in evaluation of maternal thyroid function
Springer, Drahomíra ; Zima, Tomáš (advisor) ; Průša, Richard (referee) ; Zamrazil, Václav (referee)
The importance of maternal thyroxine for the development of the fetus brain early in pregnancy has received increasing acceptance. It has more recently become evident that maternal hypothyroxinemia results in the birth of children with decreased mental and psychomotor development. In our group of 7,530 women in 9-11 week of pregnancy were determined TSH, anti TPOAb and FT4. For evaluation of results was necessary to set reference intervals for pregnant women. The TSH reference interval was determined to be 0.06 - 3.67 mU/l and for FT4 9.8 - 23.43 pmol/l was used. The limit for anti-TPO positivity was determined to be 143 kU/l. A raised concentration of TSH was found in 5.14% of women; and a suppression of TSH was found in 2.90% of women and 11.5% of pregnant women were found positive. Serum concentrations of FT4 were lower in TPOAb positive as compared to TPOAb negative women and differences of FT4 in euthyroid women with suppressed, normal and elevated TSH were found. (...) In Czech Republic, case finding screening is able to disclose only about 20% of asymptomatic mild or deep hypothyroidism or women with positive anti TPO in pregnancy. Foreign study report 70% of these high-risk pregnant women, consequently is evident need of general screening of pregnancy thyroid failure in Czech Republic. Moreover the...
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Influance of international integration process for Czech national Bank
Zamrazil, Václav ; Vostrovská, Zdenka (advisor) ; Cieslar, Vladislav (referee)
This bachelor study evaluates the relationships between the Czech National Bank and selected international institutions -- ECB, IMF and WB, focusing on gradual integration of the Czech Republic into international economic and financial structures, in particular to EU. The Czech national Bank and its role are introduced, as well as those of the other three institutions. The description of individual institutions is followed by brief analyses of mutual relationships between them and the CNB. The main findings of the study are firstly strong intensification of mutual cooperation, secondly gradually changing role of CNB. While the CR and the CNB were net recipient of technical assistance, expert advisory acticvities and financial assistance in the Nineties, the CNB has been playing more and more active role in the field of international cooperation.
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