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Article ; Online: How can we prevent disease relapse in Graves' orbitopathy after immunosuppressive treatment?

Campi, Irene / Fugazzola, Laura

Expert review of endocrinology & metabolism

2022 Volume 17, Issue 4, Page(s) 269–274

MeSH term(s)	Glucocorticoids ; Graves Ophthalmopathy/drug therapy ; Humans ; Iodine Radioisotopes ; Recurrence
Chemical Substances	Glucocorticoids ; Iodine Radioisotopes
Language	English
Publishing date	2022-07-13
Publishing country	England
Document type	Editorial ; Research Support, Non-U.S. Gov't
ISSN	1744-8417
ISSN (online)	1744-8417
DOI	10.1080/17446651.2022.2100344
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Article ; Online: Variation in Thyroid Hormone Metabolism May Affect COVID-19 Outcome.

Persani, Luca / Campi, Irene

The Journal of clinical endocrinology and metabolism

2022 Volume 107, Issue 7, Page(s) e3078–e3079

MeSH term(s)	COVID-19 ; Heterozygote ; Humans ; Iodide Peroxidase/genetics ; Polymorphism, Genetic ; Thyroid Hormones/metabolism
Chemical Substances	Thyroid Hormones ; Iodide Peroxidase (EC 1.11.1.8)
Language	English
Publishing date	2022-03-24
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/clinem/dgac152
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Article ; Online: Factitious thyrotoxicosis and thyroid hormone misuse or abuse.

Persani, Luca / dell'Acqua, Marco / Ioakim, Stamatina / Campi, Irene

Annales d'endocrinologie

2023 Volume 84, Issue 3, Page(s) 367–369

Abstract: Factitious thyrotoxicosis (FTT) is a common form of thyroid hormone (TH) abuse involving voluntary but concealed intake of an excessive amount of TH. In most cases, FTT seeks to improve body composition with a decrease in body fat and weight while ... ...

Abstract	Factitious thyrotoxicosis (FTT) is a common form of thyroid hormone (TH) abuse involving voluntary but concealed intake of an excessive amount of TH. In most cases, FTT seeks to improve body composition with a decrease in body fat and weight while maintaining apparent fitness. It is frequent in Munchausen syndrome, to attract attention for care. It can involve excessive intake either of thyroxine (T4) or of thyroid extracts or liothyronine (T3). In addition, several dietary supplements available on-line were shown to contain clinically relevant amounts of T4 and T3. TH abuse also occurs in elite athletes and bodybuilders, to reach the appropriate weight and prioritize fat loss. Diagnosis should be suspected whenever the typical features of hyperthyroidism or endogenous thyrotoxicosis are not present, as prolonged overlooked TH abuse can lead to severe consequences, including life-threatening events.
MeSH term(s)	Humans ; Thyrotoxicosis/diagnosis ; Thyroid Hormones ; Thyroxine ; Triiodothyronine ; Hyperthyroidism/diagnosis
Chemical Substances	Thyroid Hormones ; Thyroxine (Q51BO43MG4) ; Triiodothyronine (06LU7C9H1V)
Language	English
Publishing date	2023-03-22
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	299-9
ISSN	2213-3941 ; 0003-4266
ISSN (online)	2213-3941
ISSN	0003-4266
DOI	10.1016/j.ando.2023.03.008
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Article ; Online: Unusual causes of hyperthyrotropinemia and differential diagnosis of primary hypothyroidism: a revised diagnostic flowchart.

Campi, Irene / Dell'Acqua, Marco / Stellaria Grassi, Elisa / Cristina Vigone, Maria / Persani, Luca

European thyroid journal

2023 Volume 12, Issue 4

Abstract: The clinical consequences of primary hypothyroidism include cardiovascular morbidity, increased mortality, and poor quality of life; therefore guidelines endorsed by several Scientific Societies recommend measuring circulating thyroid-stimulating hormone ...

Abstract	The clinical consequences of primary hypothyroidism include cardiovascular morbidity, increased mortality, and poor quality of life; therefore guidelines endorsed by several Scientific Societies recommend measuring circulating thyroid-stimulating hormone (TSH) in patients at risk. The assessment of serum TSH levels is also deemed to be the most robust and accurate biomarker during the management of replacement therapy in patients with a previous diagnosis of primary hypothyroidism. In line with a reflex TSH laboratory strategy, free thyroxine is measured only if the TSH falls outside specific cutoffs, in order to streamline investigations and save unjustified costs. This serum TSH-based approach to both diagnosis and monitoring has been widely accepted by several national and local health services; nevertheless, false-negative or -positive testing may occur, leading to inappropriate management or treatment. This review aims to describe several infrequent causes of increased circulating TSH, including analytical interferences, resistance to TSH, consumptive hypothyroidism, and refractoriness to levothyroxine replacement treatment. We propose a clinical flowchart to aid correct recognition of these various conditions, which represent important potential pitfalls in the diagnosis and treatment of primary hypothyroidism.
MeSH term(s)	Humans ; Diagnosis, Differential ; Quality of Life ; Software Design ; Hypothyroidism/diagnosis ; Thyrotropin
Chemical Substances	Thyrotropin (9002-71-5)
Language	English
Publishing date	2023-06-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2659767-6
ISSN	2235-0802 ; 2235-0640
ISSN (online)	2235-0802
ISSN	2235-0640
DOI	10.1530/ETJ-23-0012
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Article: Syndromes of Resistance to Thyroid Hormone Action.

Persani, Luca / Campi, Irene

Experientia supplementum (2012)

2019 Volume 111, Page(s) 55–84

Abstract: Thyroid hormone (TH) action is crucial for the development of several tissues.A number of syndromes are associated with reduced responsiveness to thyroid hormones, expanding the original definition of thyroid hormone resistance, firstly described by ... ...

Abstract	Thyroid hormone (TH) action is crucial for the development of several tissues.A number of syndromes are associated with reduced responsiveness to thyroid hormones, expanding the original definition of thyroid hormone resistance, firstly described by Refetoff and collaborators in 1967, which is characterized by elevated circulating levels of T4 and T3 with measurable serum TSH concentrations, as a consequence of mutations of thyroid hormone receptor beta (TRβ), recently named as RTHβ. More recently, another form of insensitivity to TH has been identified due to mutations in the thyroid hormone receptor alpha (TRα), named RTHα. In this chapter we will focus the discussion on the phenotype of RTHβ and RTHα. These diseases share the same pathogenic mechanism caused by dominant negative mutations in TH receptor genes that reduce T3 binding or affect the recruitment of cofactors. As a consequence, thyroid hormone actions are impaired at the tissue level. The phenotypic manifestations of RTHβ and RTHα are to some extent correlated with the degree of disruption and the tissue distribution of the TRs being characterized by variable coexistence of hypothyroid or thyrotoxic manifestations in RTHβ or by a congenital hypothyroid features in RTHα despite normal TSH and borderline low free T4.
MeSH term(s)	Humans ; Phenotype ; Thyroid Hormone Receptors alpha/genetics ; Thyroid Hormone Receptors beta/genetics ; Thyroid Hormone Resistance Syndrome/genetics ; Thyroid Hormones/blood
Chemical Substances	Thyroid Hormone Receptors alpha ; Thyroid Hormone Receptors beta ; Thyroid Hormones
Language	English
Publishing date	2019-10-04
Publishing country	Switzerland
Document type	Journal Article ; Review
ISSN	1664-431X
ISSN	1664-431X
DOI	10.1007/978-3-030-25905-1_5
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Article: Challenging diagnosis of resistance to thyroid hormone in a patient with COVID-19, pituitary microadenoma and unusual response to octreotide long-acting release test.

Petolicchio, Cristian / Brasili, Sara / Gay, Stefano / Cocchiara, Francesco / Campi, Irene / Persani, Luca / Vera, Lara / Ferone, Diego / Gatto, Federico

Endocrinology, diabetes & metabolism case reports

2024 Volume 2024, Issue 2

Abstract: Summary: The resistance to thyroid hormone syndrome (RTHβ) occurs uncommonly and requires a high level of clinical suspicion and specific investigations to reach a precise diagnosis and to avoid unnecessary and potentially harmful therapies. We report a ...

Abstract	Summary: The resistance to thyroid hormone syndrome (RTHβ) occurs uncommonly and requires a high level of clinical suspicion and specific investigations to reach a precise diagnosis and to avoid unnecessary and potentially harmful therapies. We report a case of a young male patient referred to our unit for SARS-CoV-2 infection and atrial fibrillation with elevated thyroid hormones and non-suppressed thyroid-stimulating hormone (TSH), for which antithyroid therapy was prescribed. A mood disorder was reported in the medical history. The family history was unknown as the patient was adopted. Thyroid-specific antibodies were undetectable, and thyroid ultrasound revealed a normal thyroid gland without nodules. After the resolution of SARS-CoV-2 infection, the diagnostic workup continued, and the pituitary MRI revealed a small area ascribable to a microadenoma. Due to atrial fibrillation, the execution of the T3 test was contraindicated. The octreotide long-acting release (LAR) test showed an initial reduction of free thyroid hormones levels at first administration, which was consistent with the presence of a TSH-secreting pituitary tumour, although an escape from the response was observed after the following two injections of octreotide LAR. Indeed, the genetic investigation revealed a variant in heterozygosity of the THRβ gene (Pro453Ser), thus leading to an RTHβ diagnosis, and, therefore, medical treatment with triiodothyroacetic acid was initiated. After 2 years from the SARS-CoV-2 infection, the patient continues the follow-up at our outpatient clinic, and no other medical interventions are needed. Learning points: RTHβ is a rare genetic syndrome characterised by discrepant thyroid function tests and by a dissociation between the observed hormone levels and the expected patient signs and symptoms. Features of thyroid hormone deficiency in TR-ß dependent tissues (pituitary gland, hypothalamus, liver and neurosensitive epithelia), as well as thyroid hormone excess in TR-α-dependent tissues (heart, bone, skeletal muscle and brain), may coexist in the same individual. Clinical pictures can be different even when the same variant occurs, suggesting that other genetic and/or epigenetic factors may play a role in determining the patient's phenotype. Differentiating RTHβ from a TSH-secreting pituitary tumour is very difficult, especially when a concomitant pituitary adenoma is detected during diagnostic workup. The injection of long-acting somatostatin analogues can help differentiate the two conditions, but it is important to detect any interference in the dosage of thyroid hormones to avoid an incorrect diagnosis. Genetic testing is fundamental to prevent unnecessary and potentially harmful therapies. Medical treatment with triiodothyroacetic acid was demonstrated to be effective in reducing thyroid hormone excess and controlling symptoms.
Language	English
Publishing date	2024-04-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2785530-2
ISSN	2052-0573
ISSN	2052-0573
DOI	10.1530/EDM-23-0146
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Article ; Online: Fetal cell microchimerism and susceptibility to COVID-19 disease in women.

Cirello, Valentina / Lugaresi, Marina / Manzo, Alessandro / Balla, Eva / Fratianni, Gerardina / Solari, Francesca / Persani, Luca / Fugazzola, Laura / Campi, Irene

Infection

2023 Volume 51, Issue 4, Page(s) 1071–1078

Abstract: Purpose: The clinical outcome of COVID-19 disease is worse in males, and the reasons of this gender disparity are currently unclear, though evidences point to a combination of biological and gender-specific factors. A phenomenon unique to the female ... ...

Abstract	Purpose: The clinical outcome of COVID-19 disease is worse in males, and the reasons of this gender disparity are currently unclear, though evidences point to a combination of biological and gender-specific factors. A phenomenon unique to the female gender is the fetal cell microchimerism (FCM), defined as the presence of fetal microchimeric cells in maternal organs and in the circulation for years after delivery and usually evaluated by assessing the presence of male cells or DNA in a woman. In the present case-control study, we aimed to evaluate the possible effect of pregnancy and related FCM on the susceptibility to SARS-CoV-2 infection and on the clinical course and outcome of COVID-19. Methods: One hundred twenty-three women with a previous male pregnancy, comprising 63 COVID-19 cases and 60 healthy controls were enrolled. The presence of blood male DNA was assessed by the amplification of the Y-chromosome specific gene SRY. Results: The prevalence of male DNA of presumed fetal origin was significantly higher in healthy controls than in COVID-19 cases (70 vs 44.4%, P = 0.0044; OR 0.3429, 95% CI 0.1631-0.7207, P = 0.0047). Among women affected with COVID-19, the presence of male FCM did not significantly influence the severity of the disease, though the 8 deceased women studied were all FCM negative. Conclusion: This is the first case-control study reporting the prevalence of FCM in COVID-19 and healthy women. Overall, our data seem to suggest a role for FCM in the protection towards the SARS-CoV-2 infection with a possible positive impact on clinical outcome.
MeSH term(s)	Pregnancy ; Humans ; Male ; Female ; COVID-19/epidemiology ; Chimerism ; Case-Control Studies ; SARS-CoV-2 ; DNA
Chemical Substances	DNA (9007-49-2)
Language	English
Publishing date	2023-03-01
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	185104-4
ISSN	1439-0973 ; 0300-8126 ; 0173-2129
ISSN (online)	1439-0973
ISSN	0300-8126 ; 0173-2129
DOI	10.1007/s15010-023-02006-x
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Zs.A 881: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Correction: Fetal cell microchimerism and susceptibility to COVID-19 disease in women.

Cirello, Valentina / Lugaresi, Marina / Manzo, Alessandro / Balla, Eva / Fratianni, Gerardina / Solari, Francesca / Persani, Luca / Fugazzola, Laura / Campi, Irene

Infection

2023 Volume 51, Issue 4, Page(s) 1079

Language	English
Publishing date	2023-05-11
Publishing country	Germany
Document type	Published Erratum
ZDB-ID	185104-4
ISSN	1439-0973 ; 0300-8126 ; 0173-2129
ISSN (online)	1439-0973
ISSN	0300-8126 ; 0173-2129
DOI	10.1007/s15010-023-02037-4
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Zs.A 881: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Severe Graves' Orbitopathy occurring in a patient with thyroid hemiagenesis.

Meringolo, Domenico / Campi, Irene / Costante, Giuseppe

Endocrine

2018 Volume 62, Issue 2, Page(s) 490–491

MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Autoantibodies/blood ; Autoantigens/immunology ; Female ; Graves Disease/complications ; Graves Disease/diagnosis ; Graves Disease/drug therapy ; Graves Ophthalmopathy/complications ; Graves Ophthalmopathy/diagnosis ; Graves Ophthalmopathy/drug therapy ; Humans ; Hypothyroidism/drug therapy ; Hypothyroidism/etiology ; Immunoglobulins, Thyroid-Stimulating/blood ; Iodide Peroxidase/immunology ; Iron-Binding Proteins/immunology ; Magnetic Resonance Imaging ; Middle Aged ; Thyroid Dysgenesis/complications ; Thyroid Dysgenesis/diagnosis ; Thyroid Dysgenesis/immunology ; Thyrotropin/blood ; Thyroxine/therapeutic use ; Ultrasonography
Chemical Substances	Adrenal Cortex Hormones ; Autoantibodies ; Autoantigens ; Immunoglobulins, Thyroid-Stimulating ; Iron-Binding Proteins ; thyrotropin-binding inhibitory immunoglobulin ; Thyrotropin (9002-71-5) ; TPO protein, human (EC 1.11.1.7) ; Iodide Peroxidase (EC 1.11.1.8) ; Thyroxine (Q51BO43MG4)
Language	English
Publishing date	2018-07-09
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1194484-5
ISSN	1559-0100 ; 1355-008X ; 0969-711X
ISSN (online)	1559-0100
ISSN	1355-008X ; 0969-711X
DOI	10.1007/s12020-018-1662-9
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Zs.A 3884: Show issues

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Article ; Online: Impact of thyroid function screening in a large cohort of patients admitted to an emergency department.

Campi, Irene / Perego, Giovanni Battista / Ravogli, Antonella / Santafede, Francesca / Sileo, Federica / Dubini, Antonella / Parati, Gianfranco / Persani, Luca / Fugazzola, Laura

Internal and emergency medicine

2022 Volume 17, Issue 8, Page(s) 2379–2389

Abstract: Background: Thyroid dysfunctions are highly prevalent and can worsen underlying cardiopathies, but despite that the routine screening of thyroid function in the Emergency Department (ED) setting is not generally recommended.: Objective: To understand ...

Abstract	Background: Thyroid dysfunctions are highly prevalent and can worsen underlying cardiopathies, but despite that the routine screening of thyroid function in the Emergency Department (ED) setting is not generally recommended. Objective: To understand if staff training and implementation of rapid TSH screening (rTSH) could improve the management of patients arrived in the ED. Specifically, we aimed at evaluating the prevalence of undiagnosed thyroid diseases among ED patients; the effects of educational meetings in the clinical decision-making process; the usefulness of rTSH, in terms of variation of either the clinical work out or the existing treatment. Design: Retrospective case-control study of 9227 patients managed in the ED of an academic institution. rTSH was routinely available for all patients, who were divided into rTSH-YES and rTSH-NO groups. Results: We included 4243 and 4984 patients in the rTSH-YES and rTSH-NO group, respectively. Trained personnel uncovered a high prevalence of undiagnosed thyroid dysfunction (7%). The diagnosis in the ED of heart failure, history of thyroid diseases, contrast media/amiodarone administration and female gender were independently associated with an increased likelihood to have thyroid dysfunction. The rTSH improved the clinical outcome by (a) appropriate treatment of an underlying clinical condition causing ED entrance, (b) appropriate prophylaxis in patients requiring contrast media, (c) uncovering incorrect treatments, with 60% of patients on levothyroxine requiring a dose reduction. Conclusions: The rTSH in the ED revealed a high prevalence of untreated thyroid disorders with a major impact on following interventions. The training of a multidisciplinary team is crucial in driving the correct decision-making process.
MeSH term(s)	Humans ; Female ; Retrospective Studies ; Case-Control Studies ; Contrast Media ; Thyrotropin ; Thyroid Diseases/complications ; Thyroid Diseases/diagnosis ; Thyroid Diseases/epidemiology ; Emergency Service, Hospital
Chemical Substances	Contrast Media ; Thyrotropin (9002-71-5)
Language	English
Publishing date	2022-08-25
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2454173-4
ISSN	1970-9366 ; 1828-0447
ISSN (online)	1970-9366
ISSN	1828-0447
DOI	10.1007/s11739-022-03071-0
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