Greek – Chinese Symposium: Science in the time of COVID-19

Natural disasters and diseases have always been an integral part of human history. The instinct for survival was the ever-present trigger for researches and discoveries, as humans were forced to deal with Nature’s phenomena.

The proportional relationship between human comprehension and natural phenomena, led to the development and advancement of Science and Technology. As Science comprises the observation, study and research of Nature, Technology comprises the support, application and implementation of scientific discoveries and conclusions. They are interrelated and indispensable to humanity’s existence.

The COVID-19 pandemic led to an overload of scientific researches, studies and publications, to such extent that the data flow and information are overwhelming for the human mind. Scientists around the world search for solutions and ways to deal with this new threat to humankind.

We organized the online Symposium “Science in the Time of COVID-19”, on the 27th of June, at 15:30, inviting Chinese and Greek scientists to share experiences, observations, acquired knowledge, studies and researches, regarding the pandemic COVID-19 recent developments.

Additionally, the symposium will cover prospects for breakthroughs and pathways, through which artificial intelligence, genetics and clinical research will surpass potential limitations of approaches and methods employed by states, when dealing with such threats to humankind.

Biomedical research: lessons from the last decade’s crisis and austerity-stricken small countries for the current COVID-19-related crisis

The 2007–2008 economic crash has had long-lasting effects on Greece’s biomedical research landscape. It has exposed a gap in support for countries that are classified as high income but are living under austerity measures. A new model is needed for optimal utilization of the intellectual and natural resources that such countries can offer to improve the global research landscape.

Many countries were afflicted by the most recent decade-long financial crisis and its accompanying austerity measures. In Greece, Spain, Portugal and other countries, funding scarcity has greatly impeded the performance of expensive biomedical research in particular1. This field was particularly hit because the crisis took place while there was, at the same period, an explosion of costly, resource-expensive studies of biological pathways, precision medicine, big-data science, super-resolution imaging, robotics and high-throughput experimental technologies.

There are several long-standing programs that support research in low- and middle-income countries. For instance, such countries could benefit from the Research4Life programs AGORA, Hinari, OARE, ARDI and GOALI, or they could be entitled to request waivers for full tuition fees for their graduate students in leading foreign academic institutions. These countries face fundamental difficulties of their own, and such programs are sorely needed. In contrast, when small, high-income, developed countries are stricken by decreases in their gross domestic product, they cannot benefit from the developmental policies and remedial programs available to developing countries. Therefore, they could be fairly described as ‘research resource–poor countries’.

Read More —> nature.com

 

STRESS EXPERT GEORGE CHROUSOS ON HOW TO LIVE WELL AND BE HAPPY

THIS EMINENT PHYSICIAN AND SCHOLAR ADVOCATES THE PURSUIT OF EUDAIMONIA, A STATE OF HAPPINESS FOUNDED ON SELF-CONTROL, REFLECTION AND GENEROSITY OF SPIRIT.

Οnce, as a small child growing up in Patra, George Chrousos came very close to dying and was saved by the family doctor who made a house call to treat him. It was the late 1950s and, playing with some boys in the neighborhood, he had suffered a bad cut on his face from an old German bayonet. Infection set in and, if he hadn’t been treated promptly with penicillin, a drug newly introduced to Greece, he might well not be alive today. He tells me this as we talk almost six decades later at Aghia Sofia Children’s Hospital in Athens, Greece’s biggest university hospital pediatric clinic, which he headed until just a few months ago.

George Chrousos is a professor of pediatrics and endocrinology, and has held the UNESCO Chair for Adolescent Medicine since 2010. Before returning to Greece in 2001, he was the director of the Pediatric and Reproductive Endocrinology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) in Bethesda, Maryland, and a professor of pediatrics, physiology and biophysics at Georgetown University, Washington, DC.

He has received worldwide recognition for his research on the physiological and molecular mechanisms of stress, and on the diseases of the hypothalamic-pituitary-adrenal axis (HPA). According to both the Institute of Scientific Information and Google Scholar, which measure the number of searches for scientific articles and publications, he is the most cited clinical pediatrician or endocrinologist in the world and is listed among the 100 most-cited scientists worldwide.

After so many years of international recognition in the field of science, and having now permanently returned to Greece, do you feel that your Greek background played a role in your successful career path?

I consider myself as a Greek citizen of the world, and the US as my scientific homeland. As a Greek, I have always had a keen passion for philosophy and history, and I relate everything I read to medicine. When I began to focus on stress, I wanted to study its history in other, older societies at the same time. In 2011, I was appointed to the Kluge Chair in Technology and Society at the Library of Congress in Washington, where I discovered and collected a vast bibliography on the subject.

I discovered that the need to find a cure for stress has been very prominent since the beginning of the history of humankind. In the ancient Greek and Roman world, three philosophical currents for stress management were developed, by the Stoics, the Sceptics and the Epicureans, who even went as far as to speak about a “cure for the soul.” The psychotherapy we use today for cases of stress, anxiety or depression is called cognitive-behavioral therapy, and it has its roots in the philosophical schools of ancient Greece.

What are the findings of your research regarding stress management?

Exercise, a diet of high nutritional value, a regular daily routine, and good sleep are among the sine qua non. It’s far easier to enjoy a good psychological state if you’ve slept well! Beyond this, studies have shown that stress can be managed more effectively by those who have a more philosophical outlook on life. Do you know who lives more than 100 years? Those who can control their baser instincts and regulate their emotions. In the past few years, we’ve studied more than 450 centenarians in the Attica region.

On average, they were never overweight, hadn’t suffered bouts of clinical depression, ate a healthy diet and led lives of impressive regularity. Several of them had seen their children predecease them. Yet they’d say stoically, “What can you do? It was God’s will to take them.” Human beings are the only creatures to have developed a formidably complex prefrontal cortex, which can exert control over instincts, impulses and emotions, stimulate hope and assist in the attainment of a sense of well-being, of a lasting state of happiness.

Can someone train their brain to feel better?

Of course. As human beings, we can harness the systems of our brain that control stress and the emotions by means of philosophy, psychotherapy, meditation or prayer. All religions, irrespective of how dissimilar they may seem, inherently contain the necessary “ingredients” conducive to a better and happier life. Isn’t Buddhism a way of managing stress? Isn’t meditation and prayer the monks’ way of doing the same? Doesn’t Sufist mysticism claim to do the same for Muslims?

We could become a hub for the study and teaching of wellbeing, more specifically of eudaimonia, a Greek word, both in its original sense as defined by Aristotle, and in its current usage in modern English.

Have you arrived at a conclusion as to what constitutes happiness?

Aristotle said that in order to be happy, one must be good. Plato and Epicurus used to say that happiness (eudaimonia) could only be achieved by following a path of virtue and wisdom. One must have attained a certain maturity, gained a certain amount of experience and wisdom, and have the ability to regulate one’s emotive side and one’s instincts. You need to feel a sense of contentment that in your life you’ve tried your best to give to those around you. I personally believe that Epicurus had reached the highest point of human wisdom. Nietzsche used to say that we haven’t progressed a single step beyond Epicurus.

The link between mind and body and its effect on health is being studied at medical institutions everywhere. Does Greece have something to contribute to the world community today as regards this issue?

Greece can and does still contribute quite a lot. First of all, Greece carries out and often generates more scientific research than what would normally correspond to its population. One of the new postgraduate programs that we have introduced revolves around the science of stress and the promotion of health through a knowledge of the basic principles of biology. I’m surprised that there isn’t a comparable postgraduate module anywhere else in the world, and I’m currently in discussion with the University of Oxford regarding the possibility of setting up a similar program there.

Greece was and still is a beacon of philosophy and well-being. We could become a hub for the study and teaching of wellbeing, more specifically of eudaimonia, both in its original sense as defined by Aristotle, and in its current usage in modern English. We possess the right climate, conditions and environment, the necessary human resources, and a spectacular quotient of history. As Epicurus used to argue, we only get to live once. He entreated us to enjoy this one time. And by enjoyment, he did not mean food or sex, especially given how frugal he was in his own lifestyle – he only ate bread and olives, and, very occasionally, cheese. It is perfectly clear that he meant the kind of eudaimonia, the kind of happiness and pleasure, that can be achieved by developing good habits and by following the path of a virtuous life. True happiness comes from the meaning that life can hold for each of us, a meaning that we must each seek for ourselves.

How does one discover the meaning of one’s life?

It requires a lot of searching and self-reflection. We each have our own, different meaning. Yet we all have the responsibility to seek our life’s true meaning. And, of course, the act of giving to others is in itself the very meaning of life. A doctor has no need for any other kind of meaning in life, in my view, except for the substantial contribution to his fellow human beings that he can make through his profession. Bertrand Russell used to say that scientists and artists were the happiest people. Why? Because the pursuit of truth and the practice of the arts are by themselves contributions to our fellow human beings.

Have you yourself discovered the meaning of life?

Yes, I’ve found the meaning of my own life. I like to study and investigate the evolution and development of human beings, and to use this knowledge in order to help my fellow men.

Why did you decide to return to Greece after such a long and successful professional career and a comfortable private life in the US?

I like Greece and I’m Greek. The world here is vibrant. There’s a certain polymorphy and diversity, a distinct sense of humor and a feeling of solidarity. I do, of course, go back to the US often, not only to carry out scientific research and to teach, but also because two of my daughters and my grandchildren live there.

As a scientist, which factor do you think played the most significant role in your own development? Heredity or the environment in which you grew up?

I do believe that heredity was good in my case. But I also had an exceptional mother, who gave me her attention from very early on. She taught me how to read and write when I was three years old, and she inspired in me a love for books and knowledge. I read constantly and continue to learn even today.

Plato used to say that the virtues of education should be cultivated in children first of all. We know today that our brains begin to develop synapses, that is to say nerve circuits, very rapidly during the last three months of pregnancy, a process that reaches its peak at around the time of a child’s second year of life; that children have an already developed “moral intelligence” at four; and that most of the higher functions of the brain have been fully developed by the age of five. The conclusion is that if we wish to influence our society towards a more positive state of things, we need to start from a very early stage. Besides, there are socioeconomic studies that prove that a healthy pregnancy and a good early years education yield more benefits to society than school and post-secondary education.

 

The polycystic ovary syndrome

The polycystic ovary syndrome – Not just a disorder caused by an imbalance of reproductive hormones

The polycystic ovary syndrome (PCOS), the most common endocrinopathy in women of reproductive age (5-8% of women), was first described in 1935 by Stein and Leventhal. Seventy-five years later, it’s known as an heterogeneous endocrine and metabolic disorder of unknown etiology. Many medical research projects are carried out due to the frequent clinical heterogeneity as well as its long-term metabolic and cardiovascular effects.

Polycystic ovary syndrome is a clinical diagnosis that has at least two of the following three characteristics:

  1. Chronic anaphylaxis (which manifests itself in case of amenorrhea or postmenopause, ie less than six cycles over a year).
  2. Biochemical hyperandrogenemia (increase of androgen levels in blood) or hyperandrogenism (clinical hyperandrogenemia without similar biochemical findings)
  3. Polycystic ovarian morphology during ultrasound scan

An important condition for the correct diagnosis of PCOS is to exclude the presence of any other endocrine disorder and / or the use of drugs that can cause anovulation and clinical or biochemical hyperandrogenemia.

The aetiopathogenesis of PCOS has not yet been clarified, although there are several theories about its causes. The most important are ovarian and adrenal function disorder, insulin resistance and compensatory hyperinsulinemia, Gonadotropin-releasing hormone (GnRH) and  luteinizing hormone (LH) and three of them cause androgen excess. In case of the familial appearance of the syndrome, sometimes we found a positive family history of PCOS in our patient.

As mentioned above at the diagnosis characteristics, patients usually visit us if they has symptoms such as menstrual disorders (heavy periods or irregular frequent bleeding / absence of menstruation), infertility, hirsutism, androgenetic alopecia, acne. The recognition of the syndrome in its complete clinical expression has no pathognomonic signs and its phenotypic heterogeneity is a diagnostic challenge. Here, the assessment of the patient by an Endocrinologist plays an important role in ensuring that the medical history, objective examination and appropriate examinations make the right diagnosis and hence correct and personalized treatment.

As far as the patient’s therapeutic approach is concerned, it is important to bear in mind that PCOS is primarily a reproductive and metabolic disorder. 30-75% of women with PCOS are obese and in most cases have an abdominal body fat distribution, which is beneficial for well-known to all of us metabolic syndrome. Also in overweight and obese premenopausal women, the prevalence of PCOS is four times higher than in the general population. Women with PCOS and the absence of menstruation (obese and no) have an increased risk of Type 2 diabetes, which is even higher when obesity and family history of diabetes occur. In addition, PCOS is accompanied by a risk of high cholesterol, while postmenopausal women with PCOS have a high blood pressure levels.

In summary, the multisystemic clinical expression of PCOS implies a multidimensional therapeutic approach, and here, besides personalized medication, a change of a lifestyle, by adapting a right nutrition and physical activity, plays also an important role.

THYROID NODULE

The thyroid gland is located in the anterior neck; it is a butterfly-shaped organ that is usually visible on inspection. It produces hormones, triiodothyronine (T3) and thyroxine (T4), which mostly controls how your body uses energy (metabolism). The thyroid is controlled by a gland located in the brain, the pituitary gland, which produces thyroid-stimulating hormone (TSH) to stimulate secretion of thyroid hormones (T4, T3). These two glands works together very closely and any functional thyroid disorder influences inversely the production of TSH.

Thyroid nodules are round or oval-shaped of thyroid tissue usually of different structure relative to the rest of the parenchyma. Thyroid nodules are common in the general population, especially in recent years thanks to the extensive use of ultrasound. The factors that can cause the creation of the nodules vary, while about 95% of them are benign.

 

DIAGNOSIS

There are different diagnostic tools that help determine whether a nodule is benign or cancerous and therefore to find the best treatment options (surgical removal, monitoring or other treatment). The diagnostic approach is not always the same for all patients.

If one or more nodules are detected during a physical examination (palpation) or during a carotid ultrasound (triplex), cervical CT/MRI  scan in other cases, your doctor should refer you to an Endocrinologist for more specific examinations:

  • All patients should undergo hormone test to evaluate thyroid function. In some patients, thyroid antibodies may also be required.
  • Thyroid ultrasound to evaluate the dimensions and morphology of the nodule, the presence of other nodules, the parenchymal echotexture and the evaluation of the cervical lymph nodes.
  • If there is no disorder in thyroid function, then, depending on the ultrasound and / or nodal size, as well as the individual and / or family history, it may require immediate puncture, under ultrasound guidance, to analyze the cells of the nodule.

If the hormone test shows hyperfunction (TSH production is at lower levels or suppressed) then we should do first a thyroid scintigraphy to see if it is a hot nodule (use of radiopharmaceuticals) or a cold nodule (without the use of radiopharmaceuticals). In the latter case, if most of the cold nodes are benign, a further investigation with a puncture is required for a cytology (see above). Hot nodules should not be punctured because it is rare to be cancerous.

– In case of hypothyroidism (abnormally high TSH levels) and if a patient needs a thyroxine replacement therapy, the investigation of nodules should be performed as thyroid function is normalized.

In some cases, the Endocrinologist may request calcitonin measurement, which is high in patients with a type of a thyroid cancer, a medullary thyroid carcinoma. Moderately elevated levels of calcitonin may also be detected in other benign thyroid diseases or other disorders, where a patient need a further investigation.

TREATMENT

In case of hyperfunctioning nodule/warm nodule the treatment may be done from the mouth to suppress a thyroid hormone synthesis, surgical removal or treatment with radioactive iodine. Choosing an appropriate treatment depends on the age of the patient, the characteristics of the nodule and the presence of other nodules, contraindications between various treatment methods, as well as the preferences of a patient.

If a puncture is necessary as a first choice or after a scintigraphy because the nodule is cold, the therapeutic approach depends on the results of the cytology test.

In some cases, the material is not sufficient for an exact cytologic evaluation and so a puncture procedure should be repeated.

  • In a small percentage (10%) cytology provides unclear results, a so-called “gray zone” results. In this case, the therapeutic option may be surgical removal, repetitive puncture and / or close monitoring depending on the age of the patient, the presence of comorbidities as well as factors that increase suspicion of malignancy (clinical, ultrasound, individual and / or family history)
  • In cases of benign cytology, the patient needs continuous monitoring of the nodule. If, over time, the characteristics of the nodule change, then it should be necessary to repeat the puncture. Nodules of a large size (> 3-4 cm), even if they are benign, especially with compressive symptoms on the throat, should be removed with a surgical intervention.
  • The nodules that are cytologically malignant or suspected for malignancy require surgical intervention. In these cases, it is advisable before the surgery to check out the cervical lymph nodes using an ultrasound scan by an experienced radiologist, in order the surgeon to have all the required information. In some cases, post-operative care with the radioactive iodine may be necessary to counteract the remaining benign but also malignant cells in order to better monitor the patient.

It is important to know that a small percentage (about 5%) of all thyroid nodules are malignant and that thyroid cancer, in most cases, has high survival rates.

A brief description of thyroxine suppression therapy for the treatment of benign and cystic nodules. Nowadays, according to the latest global data, thyroxine suppression therapy is not recommended because it does not reduce all the nodules and if it reduces, the amount is not big enough to justify the use of the treatment which is maybe harmful (heart arrhythmia, osteoporosis) especially among older patients.

Cystic nodules, usually benign lesions of the thyroid parenchyma, need simple monitoring. However, it they are large and symptomatic, an evacuative puncture is carried out in the first stage. Unfortunately, most of the time they recur so the best treatment, excepting contraindications, is their surgical removal.

PRACTICAL WEIGHT LOSS TIPS

Increased body weight predisposes to type 2 diabetes. Weight reduction and the maintenance of a healthy weight is a key component of diabetes management, either type 1 or type 2. In many cases of type 2 diabetes, losing just 5 -10% of body weight can improve blood sugar numbers and lipids as well as a blood pressure. It is important to understand that the goal is not to cut quickly the quantity of food in order to lose weight but to consume smaller quantities following a weight-management program and improving your eating habits. So cutting calories can lead to weight loss.

  • Consume daily the same amount of calories.
  • Eat your meal at the dining table, without watching a TV or magazines.
  • Make sure there is a vegetable salad on the table and start your meal with it.
  • Eat low-fat foods, avoid fried food and add a small amount of olive oil to your meal.
  • If you are hungry and cannot wait until your next meal, eat a green salad without oil.
  • Drink plenty of water throughout the day. Avoid alcohol; it contains many calories.
  • Keep your refrigerator empty rather than full. Avoid nuts, biscuits and sweets.
  • Always leave some food on your plate, put a small portion or use a smaller plate.
  • Do not forget about physical activity. Exercise daily, e.g. one hour walking, gardening etc.
  • Frequent visits to your doctor or dietitian will help you with your efforts.

 

Insulin and Nutrition

When insulin is the main part of therapy then you need to eat at regular times and amounts. It is very important to be properly trained for this, so you should contact your health care team (dietician).

DIABETES AND PHYSICAL EXERCISE

The exercise in general:

  • Improves the insulin sensitivity 
  • It’s helpful for weight loss and maintaining weight loss
  • Improves muscle strength
  • Improves bone density and strength
  • Reduces blood pressure
  • Protects the heart and blood vessels by increasing the “good” and reducing the “bad” cholesterol
  • Improves blood circulation and reduces the risk of cardiovascular disease
  • Increases the energy level
  • Helps relax and relieve anxiety

 

Exercise is essential for management of type 2 diabetes. It not only helps control blood glucose but also improves physical fitness and reduces the risk of cardiovascular disease.

 

Which types of exercise are recommended for people with diabetes

Any activity that increases your heart rate and keeps it, improves your aerobic capacity. Aerobic exercise helps prevent type 2 diabetes and in general, improves glucose control in people with diabetes. Apart from these, it boosts overall mood and fight anxiety. You do not feel anxious when walking or swimming. According to the latest research, resistance training such as weight exercises also can lead to better blood glucose control and the result is similar with this of anti-diabetic drugs. In addition, they improve muscle strength and mass, reduce fat, improve mood and self-confidence.

It is GOOD to exercise three to four times a week, 30 minutes a day. Exercise every day is ideal. A good exercise program includes 5 to 10-minute warm-up, at least 15-30 minutes of continuous aerobic exercise (fast walking or cycling) and 5-minute relaxation at the end. Add to this program muscular strength or resistance exercises 2 to 3 times a week.

However, you need to be careful! Do not forget to track your glucose prior to, during and after exercise. This recording will reveal how your body responds to exercise and will help you to avoid dangerous blood sugar fluctuations. The effect of exercise is the same either for people with diabetes or without diabetes. Under normal circumstances, insulin is released from the beta cells in the pancreas when blood glucose levels increase, for example after eating. Insulin is necessary for the use of glucose by the liver and muscles, which can cause lower blood sugar levels. When exercising, the body needs extra energy (in the form of glucose) for the muscles. For short bursts, such as a quick run to catch the bus, the muscles and liver release stores of glucose for fuel. With continued moderate exercising, though, your muscles take up glucose at almost 20 times the normal rate. This lowers blood glucose levels. In people who do not use insulin or anti-diabetic drugs, insulin levels is lower and thus the risk of hypoglycemia is reduced. In addition, in people with diabetes, intense exercise CAN transiently increase glucose sugar levels. That is why if you have diabetes you should definitely control your blood sugar levels after exercise.

 

Before exercise: check your blood sugar

Before starting any exercise program, you should consult your doctor, especially if you had previously reduced physical activity. Ask your doctor which activities and the duration of exercise are relevant and if any change in your medication is required. If you use insulin or drugs that can cause hypoglycemia, monitor your blood sugar 30 minutes before exercise and just before exercise. This will help you understand if your glucose level is stable, rising or falling and if exercise is safe for you.

 

Recognize hypoglycemia symptoms

During exercise, you should avoid hypoglycemia. During prolonged exercise, check your blood sugar every 30 minutes, especially if you start a new exercise program or if you change the exercise intensity or duration. It seems difficult when practicing in the open air or taking part in organized sports. However, it is necessary at least until you realize that your body responds to changes in an exercise program.

 

Stop exercising if:

  • The sugar is below 70 mg / dL
  • You feel scared, nervous or confused
  • -Take or drink something to raise your blood sugar levels (15-20 grams of carbohydrates), such as: Two to five glucose tablets, half a glass (125 ml) juice, half a glass of carbonated sugar drink, five or six candies with sugar
  • Check your sugar again in 15 minutes. If it is still low, consume the same food or drink with sugar and check it again in 15 minutes. Repeat these steps until your blood glucose is at least 70 mg/dL. You can continue the exercise if blood sugar levels are normal.

 

After an exercise: Check your blood sugar again

Check your blood sugar immediately after exercise and several times over the next few hours. An exercise depleted glucogen stores in the muscles and the liver. As your body replaces these stores, it takes the sugar from the blood. The more intent is an exercise, the greater is the effect on the blood sugar levels. Hypoglycemia can occur even many hours after exercise.

 

Exercise tips

  • To reduce the risk of hypoglycemia, people with diabetes should follow structured exercise and dietary program, and take medication at the same time each day.
  • An extended or very intense exercise can cause the production of adrenaline and other hormones that antagonize the effect of insulin and may increase blood sugar levels. If you follow an extended or very intense exercise (which lasts for several hours), it may be necessary to alter the insulin / antidiabetic tablet medication in your diet. Consult your doctor.
  • Be careful when you exercise while your medication has the greatest effect. Depending on the time of exercise, it may be necessary to reduce the dose of basal or nutritional insulin. Your doctor will give you the appropriate instructions.
  • Better to exercise with someone who knows that you has diabetes and what to do in case of hypoglycemia.
  • It is useful to have an ID with you with the details on your disorders and medications.
  • Measure the sugar before, during and after exercise and always have a snack with carbohydrates (fruit, juice) in case of hypoglycemia.
  • Ask your doctor what is the best type of exercise for you. Some complications of diabetes, such as advanced retinopathy or neuropathy, can make some exercises dangerous for you. Your doctor will make you a test to estimate your heart’s response to the exercise.
  • Do not start exercising if you have type 1 diabetes and your blood sugar is over 250 mg / dL and you have ketone bodies in your blood because you probably have insulin deficiency and exercise will increase even more sugar levels. Take fluids, adjust the dose of insulin and contact your doctor.
  • Start slowly and then gradually increase the intensity and duration. Choose an activity that you enjoy.  If you enjoy an exercise, it will become a lifestyle. If you need to lose some weight, a water aerobics is a good idea. Other choices are cycling or swimming. Put on comfortable shoes and take care of your feet. Drink water before, during and after exercise to avoid dehydration. Do not ignore the pain! Stop exercising if you feel an excessive pain in the muscles and joints.

If you pair regular exercise with a well-balanced diet and the medication, you are on a right way to achieve an optimal regulation of blood glucose level as well as to avoid chronic complications of diabetes.

Hyperthyroidism

Hyperthyroidism occurs when your thyroid gland becomes overactive and produces more thyroid hormones than you need. This leads to an increased rate of metabolism and the appearance of various symptoms, which, depending on the condition severity, are more or less perceptible to the patient.

What is the thyroid gland?

 The thyroid gland is located in the anterior neck; it is a butterfly-shaped organ that is usually visible on inspection. It produces hormones, triiodothyronine (T3) and thyroxine (T4), which mostly controls how your body uses energy (metabolism). The thyroid is controlled by a gland located in the brain, the pituitary gland, which produces thyroid-stimulating hormone (TSH) to stimulate secretion of thyroid hormones (T4, T3). These two glands works together very closely and any functional thyroid disorder influences inversely the production of TSH.

What causes hyperthyroidism ?

  1. Graves’s disease. It is the most common cause of an overactive thyroid, especially in women of reproductive age (ages 20-40). It can occur at any age in men and women. As an autoimmune disease, ie our immune system produces an antibody that stimulates our thyroid, it may co-exist with other autoimmune diseases in the same patient (Crohn’s Disease, rheumatoid arthritis, celiac disease, type 1 diabetes, etc.). Also, as it is usually observed in autoimmune diseases, there is a family predisposition. Some patients may have eye problems (thyroid ophthalmopathy or Graves’ ophthalmopathy) with exophthalmia, dry eye syndrome, swelling, diplopia and loss of vision in the most severe forms. Smoking is one of the risk factors for the appearance and worsening of ophthalmopathy.
  2. One or more thyroid nodules that can become autonomous over the years, producing more thyroid hormones and thus causing hyperthyroidism. That is what Endocrinologists call toxic adenoma or toxic multinodular goiter, which can be detected by scan as “hot nodules”.
  3. In cases where hyperthyroidism is caused by inflammation and destruction of parenchyma, autoimmune etiology (postpartum thyroiditis) or potential viral etiology, usually after respiratory failure (hypoxia).
  4. Medications: amiodarone, interferon, lithium
  5. Excessive dosage of thyroxine

What are the symptoms of Hyperthyroidism?

  1. Weight loss with normal or increased appetite
  2. Tachycardia and even heart arrhythmia
  3. Leakage of stool
  4. Anxiety, irritability, sleeping difficulty
  5. Shaky hands, sweating, heat intolerance
  6. Fatigue, weakness
  7. Menstrual disorders

Diagnosis

Blood test help determine the diagnosis: TSH, Ft4, T3 (Ft3) and visualization by scintigraphy. It may also be necessary to measure antibodies (TSI, anti-TPO & anti-TG) and thyroid ultrasound with triplex to control the inferior thyroid artery.

Treatment

There are three choices

  1. Antithyroid Drugs
  2. Radioiodine
  3. Surgery

The age, severity, cause of hyperthyroidism and the patient’s preference play a role in choosing the right treatment.

Medication

There are two categories of drugs used in the treatment of hyperthyroidism.

Antithyroids such as metamazole (unimazole), carbimazole (Thyrostat) and propylthiouracil (prothuril), which reduce the excessive production of thyroid hormones. We usually prefer the first two because of fewer side effects, excepting the first trimester of pregnancy it is preferred to use propylthiouracil.

Antipyretics are prescribed: a) for a short time to make the patient euthyroid prior to surgery or radioactive iodine (usually in the second case the drugs should be discontinued a few days prior to iodine administration to increase the intake of the radiopharmaceutical and to make possible a thyroid destruction). b) for a longer period (1-2 years) as in Graves Disease in order to achieve to achieve a  therapeutic treatment (usually 30% up to 50-60% of patients in milder forms of the disease). After a discontinuation, there is a risk of relapse even after long-term sobriety. That is why we need to proceed to one of the two permanent treatment methods, thyroidectomy or radioactive iodine. All anti-thyroid medicines can cause side effects that your doctor should tell you and regularly measure some biochemical markers. During antithyroid medication, thyroid function should be checked, at least every 1-2 months.

Beta-blockers (mostly propranolol) are the second category of drugs, are prescribed in order to relieve symptoms (tachycardia, tremor, irritation) by gradually lowering the dose until the control of hyperthyroidism is achieved.

 

Radioactive iodine

Radioactive iodine is used in liquid form or in a capsule and can destroy the thyroid parenchyma, usually within 6-18 weeks. In people with severe symptoms, older patients and those with heart diseases, as previously mentioned, an antithyroid medication should be preceded, which will be interrupted a few days before a treatment. Most patients after radioactive iodine become hypothyroid and they should take a lifelong thyroxine therapy. On the other hand, 10-20% of the patients may need a second dose to see a result of a treatement, usually those with more severe hyperthyroidism and a large thyroid gland. Some patients with Graves’ disease, especially smokers, may experience a worsening of ophthalmopathy after a radioactive iodine. Patients that received a radioiodine should avoid close contact with children and pregnant women for 3 to 7 days after a treatment. A therapy is contraindicated during breastfeeding and pregnancy, while women of childbearing age should be delay any pregnancy for at least 6 months or more, after a radioactive iodine.

 

Thyroidectomy 

Suggested as the first option

  • To patients with large goiters (a large thyroid gland) with tracheal compression.
  • Abnormal antithyroid treatment due to serious side effects
  • The presence of suspected malignant thyroid nodules
  • Patient preference

After a surgery, the patient needs to pass regular thyroid function and blood calcium tests. When optimum tests’ results are achieved, monitoring is done 1-2 times a year. Patients should be aware that usually after a surgery a lifelong thyroxine replacement therapy is required.