E Gandossi

Università degli Studi di Brescia, Brescia, Lombardy, Italy

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Publications (33)66.89 Total impact

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    ABSTRACT: The majority of clinicians suggest that enteral feedings should be held 1-2 h prior to and after L-T4 administration despite lack of data for continuous enteral nutrition. The aim of this study was to: (1) compare the thyroid hormonal profile in patients submitted to L-T4 treatment in tablets or liquid formulation with an enteral feeding tube; (2) evaluate the nursing compliance with the two different formulations. 20 euthyroid patients submitted to total laryngectomy and thyroidectomy consecutively started L-T4 treatment in tablets (Group T) or in liquid formulation (Group L) with enteral feeding tube the day after surgery. Tablets were crushed before administration and enteral feeding was stopped for 30 min before and after L-T4 treatment, whereas liquid formulation was placed into the nasoenteric tube immediately. A questionnaire about the preparation and administration of thyroxine replacement therapy was given to the nurses. No difference of TSH, fT4 and fT3 before and after L-T4 treatment was observed among patients of Group L. A slightly serum TSH increase was observed in Group T, but not reaching statistical significance (2.50 ± 1.18 vs 2.94 ± 1.22 mUI/L), whereas no difference in fT4 and fT3 levels was found. Preparation and administration of liquid L-T4 was considered excellent by 12/13 nurses, whereas tablet formulation was considered poor by 10/13. Our data showed that liquid L-T4 formulation can be administered directly through feeding tube with no need for an empty stomach, with a significant improvement in therapy preparation and administration by nurses.
    Journal of endocrinological investigation 05/2014; · 1.65 Impact Factor
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    ABSTRACT: Purpose Recent evidences suggest that, despite the large use of levothyroxine (L-T4), up to 40% of patients are over-treated developing sub-clinical hyperthyroidism. We compared TSH, fT4 and fT3 serum levels of elderly patients in treatment with liquid and tablet L-T4 formulations over a period of time of five years. Subjects Patients were recruited by searching the database of those treated and followed at the Thyroid Unit of the University of Brescia. Results Two hundred and ninety-nine patients (251 females, 48 males) were treated with L-T4 in tablet form (group T) and 118 subjects (107 female, 11 male) with liquid LT4 (group L). The two groups were super-imposable by age, median L-T4 dosage, TSH, fT4 and fT3 values. A slightly but not significantly higher BMI value was observed among patients of group L over those of group T (26.9 ± 2.9 vs. 26.4 ± 2.1 kg/cm2, respectively). During five years of LT-4 treatment, sub-clinical or over-hypothyroidism was found in 13 (4.3%) and 3 (2.5%) patients of group T and group L (P = 0.335), whereas, subclinical or clinical hyperthyroidism was significantly more frequent among patients of group T than those of group L [69 (23%) vs. 5 (4.2%) patients, (P = 0.0001)]. Logistic regression analysis showed that only the Tablets were associated with the risk of developing subclinical or hyperthyroidism [OR 2·354 (1·136–4·827), P = 0.021]. Conclusions We show a greater stability in the thyroid profile of hypothyroid elderly patients in treatment with liquid thyroxine as opposed to those being treated by tablet formulation over five years of follow-up.
    European geriatric medicine 01/2014; · 0.63 Impact Factor
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    ABSTRACT: Levothyroxine (L-T4) treatment with coffee, or with water followed by coffee within a few minutes, results in poor TSH response in many patients. Thyroxine is worldwide suitable in tablets form but novel formulations in soft gel capsule or liquid formulation are now available. We fortuitously observed an euthyroid patient who wrongly assumed liquid L-T4 with coffee at breakfast: after changing the assumption thirty minutes before breakfast, no change of TSH, fT4 and fT3 was observed. Once the first patient was identified, we identified additional stable euthyroid patients who assumed liquid L-T4 with coffee. Patients were recruited by searching our "thyroid patients" database. All patients on liquid L-T4 treatment were contacted by phone to find out if L-T4 was taken at breakfast. We identified fifty-four patients that were submitted to TSH, fT4 and fT3 evaluation, with the following indication to assume the same dosage of L-T4 half hour before breakfast. We checked again their TSH, fT4 and fT3 values, 3 and 6 months later. No significative difference of thyroid hormonal values was observed between patients who assumed L-T4 at breakfast and after 3 and 6 months of its assumption half hour before breakfast [TSH : 2.5±1.1 vs 2.5±1.1 and 2.4±1.1 (mIU/L), respectively], [fT4: 12.4±2.4 vs 12.5±2.4 and 12.3±2.1 (pg/mL), respectively] and [fT3: 3.4±0.6 vs 3.4±0.6 and 3.3±0.5 (pg/mL), respectively]. Oral liquid L-T4 could remove the problem of L-T4 malabsorption by coffee observed with traditional tablets formulations.
    European Journal of Endocrinology 10/2013; · 3.14 Impact Factor
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    ABSTRACT: High resolution ultrasonography features have also been described as having a useful supporting role in the diagnosis of subacute granulomatous thyroiditis (ST), and images are generally characterized by heterogeneous hypoechoic areas of the affected tissue with lack of flow on color Doppler US. To determine the sonographic features of subacute granulomatous thyroiditis. We reviewed the medical records of patients referred at the Endocrine and Metabolic Unit of our Institution between January 2010 and December 2011. A total of 7520 patients were evaluated in our department between January 2010 and December 2011. Among them, 22 (0.3%) patients had a diagnosis of ST (19 women and 3 men, 45.4 ± 9.7 year; range, 33-62 years). Ultrasound examination showed bilateral ST in 64% of patients. Thyroid volume was 13.2 ± 7.7 mL, without difference if ST was unilateral (13.2 ± 7.1 mL) or bilateral (13.9 ± 8.3 mL). On grayscale US, heterogeneous diffusely or focally marked hypoechoic areas, like "lava flow", were found in all the lesions. Our data confirm the high sensitivity of US in the diagnosis of ST: diffuse hypoechoic and confluent areas with the characteristic features like "lava flow".
    Acta Radiologica 08/2013; · 1.33 Impact Factor
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    ABSTRACT: Drug malabsorption is a potential concern after bariatric surgery. We present four case reports of hypothyroid patients who were well replaced with thyroxine tablets to euthyroid thyrotropin (TSH) levels prior to Roux-en-Y gastric bypass surgery. These patients developed elevated TSH levels after the surgery, the TSH responded reversibly to switching from treatment with oral tablets to a liquid formulation.
    Obesity Surgery 07/2013; · 3.10 Impact Factor
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    ABSTRACT: Objectives- The aim of this study was to evaluate the predictive value of sonography and sonographic elastography in thyroid nodules with nondiagnostic cytologic findings. Methods- The study included 101 patients (74 female, mean age ± SD, 55 ± 11 years [range, 27-70 years]; and 27 male, mean age, 62 ± 9 years [range, 42-72 years]) who had at least 1 nodule with nondiagnostic cytologic findings at two different fine-needle aspiration cytologic evaluations and with an indication for hemi or total thyroidectomy for clinical suspicion of malignancy, nodule size, or the occurrence of a coexisting nodule with cytologic findings suspicious for malignancy. All of the patients underwent sonography and elastography 2 months after the second fine-needle aspiration and before surgery. The elastogram was matched with an elasticity color scale and classified as follows: score 1, nodules with high elasticity (soft); score 2, nodules with indeterminate elasticity; and score 3, nodules with low elasticity (hard). Results- A total of 135 nodules (93.7%) were hyperplastic; 15 (9.4%) were papillary carcinomas; and 9 (6.3%) were follicular adenomas. The association of scores 2 and 3 identified 12 of 15 thyroid cancers (sensitivity, 80.0%; specificity, 93.7%; positive predictive value, 57.1%; negative predictive value, 97.8%; and accuracy, 92.4%), whereas the association of conventional sonographic features plus scores 2 and 3 identified all of the cancers (specificity, 70.8%; positive predictive value, 26.3%; negative predictive value, 100%; and accuracy, 73.6%). Conclusions- Our data suggest that elastography could be a promising tool in the management of nodules that are nondiagnostic at cytologic evaluation, reducing unnecessary surgery.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 11/2012; 31(11):1777-82. · 1.40 Impact Factor
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    ABSTRACT: The European Thyroid Association (ETA) and the American Thyroid Association (ATA) guidelines identify subgroups of patients affected by thyroid carcinoma in whom, due to a low risk of recurrence, radioiodine ablation is not indicated. These patients are referred to as "very low-risk" according to the ETA consensus and "low-risk" patients according to the ATA guidelines. The recommended post-surgical follow-up of these patients is based upon periodical measurements of serum thyroglobulin (Tg) on levothyroxine therapy and neck ultrasound (US). To evaluate the usefulness of recombinant human (rh)-TSH Tg test and its repetition 2-3 yr afterwards in very low-risk patients. We consecutively enrolled 32 patients with undetectable anti-Tg antibodies. Basal serum Tg levels was undetectable in all patients. Following rhTSH serum Tg remained undetectable in 23 (71.9%) patients (UP) and was >1.0 ng/ml in 9 (DP). US and whole body scan, revealed lymph node metastasis in 4/9 DP patients. A second rhTSH stimulation test (36.9±3.5 months later) was performed in all UP and in 5 DP patients without proven recurrences. All the UP and 4/5 formerly DP patients showed undetectable Tg stimulation. Our results suggest that rhTSH Tg test may be helpful in very low-risk patients, given its ability to differentiate those who may be considered "free of disease" from those who require further investigation and treatment. Repeated rhTSH Tg tests may be indicated only in patients with detectable serum Tg at prior stimulation testing.
    Journal of endocrinological investigation 11/2011; 35(5):459-63. · 1.65 Impact Factor
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    ABSTRACT: BACKGROUND: Thyroglobulin measurement in the washout of the needle used in fine-needle aspiration cytology (FNAC) has been proposed for the early detection of lymph node metastasis both in patients with or without serum thyroglobulin antibodies; however, up to now, there have been no reports that recombinant human thyrotropin (rhTSH) stimulation modifies thyroglobulin measurement in lymph node aspirates. METHODS: We described, after rhTSH stimulation, the switching from undetectable to detectable levels of thyroglobulin in fine-needle aspiration fluid from a suspected metastatic lymph node in 2 patients. RESULTS: We hypothesized that thyroglobulin levels in the lymph node increased after rhTSH stimulation. The excess thyroglobulin saturates all thyroglobulin antibody binding sites and becomes detectable, explaining why it was undetectable when TSH was suppressed. CONCLUSION: On the basis of our experience, we suggest submitting to thyroglobulin measurement in the washout of the needle used in FNAC all patients with detectable serum thyroglobulin antibody after rhTSH stimulation. © 2011 Wiley Periodicals, Inc. Head Neck, 2011.
    Head & Neck 06/2011; · 2.83 Impact Factor
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    ABSTRACT: A relevant biological role of circulating endothelial progenitor cells (EPC) was recently demonstrated. EPC are generated in the bone marrow, and interact with damaged endothelium, restoring the integrity of the monolayer. Therefore, aim of the present study was to evaluate EPC in the blood of patients with untreated Graves' hyperthyroidism (GD), in whom an increased oxidative stress was observed. Twenty-three patients with untreated active GD and 18 matched normal controls (NC) were included in the study. Circulating EPC were isolated from peripheral blood. Mononuclear cells were cultured with endothelial basal medium supplemented with EGM SingleQuots, and were identified by positive double staining after 7 days in culture. Circulating levels of C reactive protein, total antioxidant power, interleukin (IL)-6, IL- 18, monocyte chemoattractant protein-1, tumor necrosis facotr- α, soluble vascular cell adhesion molecule (VCAM) and intracellular adhesion molecule were evaluated by enzymelinked immunosorbent assay kit. EPC number was also evaluated in a subgroup of GD patients after restoration of euthyroidism. Systolic blood pressure resulted increased in GD patients compared with control subjects whereas diastolic blood pressure was not significantly different. Patients with GD showed an increase in circulating levels of IL-18 and VCAM-1 and a reduction of total antioxidant power (p<0.05) compared to NC. Moreover, a reduced number of EPC was observed in patients with GD compared to NC (p<0.05) which turned to NC values after restoring euthyroidism. Patients with GD showed a reduction in the physiological protective mechanisms against endothelial damage, probably induced by increased inflammation and oxidative stress.
    Journal of endocrinological investigation 05/2011; 34(5):335-9. · 1.65 Impact Factor
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    ABSTRACT: To assess the interplay between metformin treatment and thyroid function in type 2 diabetic patients. The acute and long-term effects of metformin on thyroid axis hormones were assessed in diabetic patients with primary hypothyroidism who were either untreated or treated with levothyroxine (L-T4), as well as in diabetic patients with normal thyroid function. No acute changes were found in 11 patients with treated hypothyroidism. After 1 year of metformin administration, a significant thyrotropin (TSH) decrease (P < 0.001) was observed in diabetic subjects with hypothyroidism who were either treated (n = 29; from 2.37 +/- 1.17 to 1.41 +/- 1.21 mIU/l) or untreated (n = 18; 4.5 +/- 0.37 vs. 2.93 +/- 1.48) with L-T4, but not in 54 euthyroid subjects. No significant change in free T4 (FT4) was observed in any group. Metformin administration influences TSH without change of FT4 in patients with type 2 diabetes and concomitant hypothyroidism. The need for reevaluation of thyroid function in these patients within 6-12 months after starting metformin is indicated.
    Diabetes care 06/2009; 32(9):1589-90. · 7.74 Impact Factor
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    ABSTRACT: Ultrasound-guided fine needle aspiration cytology (US-FNAC) represents the most effective test available to distinguish between benign and malignant thyroid nodules. The major limit is the rate of inadequate specimens which generates a much higher cost. The aim of the present study was to evaluate whether the adoption of stylet needles may result in a significant improvement of diagnostic performance in a large, unselected series of nodules. 1468 nodules were submitted to US-FNAC by two different 25-gauge needles: a traditional hollow needle (Ns) or a stylet needle (Ys). Cytological specimens were evaluated in blind conditions by the same cytopathologist. Ys was associated to a significant reduction of non-diagnostic specimens (2.8% vs 9.1% by Ns, respectively, P < 0.001). Logistic regression analysis taking into account sex, age, needle type, nodule size, multiplicity and structure predictor of successful sampling [odds ratio 3.6 (95.0% CN 2.0-6.4), P < 0.001]. The cost analysis comparing the adoption of the two types of needle evidenced that the cost per adequate specimen was consistently less for Ys than for Ns (euro 78.87 vs euro 90.76). Our data showed that the adoption of a stylet needle significantly improves diagnostic performance, reducing by about 14% the expenditure per diagnostic procedure. Therefore, we suggest that stylet needles should be widely adopted to perform US-FNAC of thyroid procedures.
    Southern medical journal 04/2009; 102(5):498-501. · 0.92 Impact Factor
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    ABSTRACT: Riedel's thyroiditis (RT) is a rare form of infiltrative and inflammatory disease of the thyroid, first described by Bernard Riedel in 1896. The concurrent presence of RT and other thyroid diseases has been reported, but, the association of RT with Hashimoto's thyroiditis and acute thyroiditis has not yet been reported. We present a case of concurrent Riedel's, Hashimoto's and acute thyroiditis that occurred in a 45-year-old patient.
    Case Reports in Medicine 02/2009; 2009:535974.
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    ABSTRACT: Surgery is the treatment of choice for symptomatic primary hyperparathyroidism; unlikely few patients do not meet established surgical criteria or have comorbid conditions that prohibit surgery. In these subjects, medical therapy alone offers little hope for a sustained long normocalcemic period. However percutaneous ethanol injection (PEI) may represent an alternative therapeutic procedure. It is currently in use for the treatment of secondary or tertiary hyperparathyroidism, however, few studies or case reports suggest it for the treatment of primary hyperparathyroidism. Moreover, little information is available about the long-term follow-up, where incomplete necrosis or the spreading of ethanol in the surrounding tissues is often reported. We believe that many of the side effects could be correlated to procedure itself. Taking these experiences into account, we have reasoned that in order to limit these side effects, we had to modify the standard PEI procedure. We reported this preliminary experience describing our modified PEI procedure.
    QJM: monthly journal of the Association of Physicians 06/2008; 101(8):657-62. · 2.36 Impact Factor
  • Clinical Radiology 05/2008; 63(4):483-4. · 1.66 Impact Factor
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    ABSTRACT: As a consequence of increasing application of ultrasound technology, the detection of asymptomatic thyroid nodules has generally increased. In fact, ultrasound epidemiological studies report that two third of subjects have at least a thyroid nodule, instead of 4-7% detected by clinicians. These evidences suggest the need of a rational approach to the thyroid nodule ''epidemia''. The question of whether clinically unapparent thyroid lesions should be assessed by cytology is still unresolved and, moreover, the clinical significance of nonpalpable (diameter <10 mm) thyroid carcinoma is still a matter of discussion. Aim of this work is to delineate a rational approach to thyroid nodules, taking in account literature data, the most recent guidelines and our clinical experience.
    Minerva endocrinologica 03/2008; 33(1):15-25. · 1.40 Impact Factor
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    ABSTRACT: Ultrasound fine needle aspiration cytology (US-FNAC) represents the most effective test available to distinguish between benign and malignant thyroid nodules, with an accuracy approaching 95%. The major limit of this procedure it is the rate of inadequate specimens which is reported to be from 10% to 31%. Also because cost considerations have always been important and have recently become even more relevant for clinical guidelines in many countries, it is desirable to limit the number of inadequate samples. Recently, we have shown that the use of stylet needles greatly reduces inadequate cytological specimens in thyroid nodules with an intranodular vascular pattern. With the aim to improve our previous results, we have extended our procedure to all thyroid solid nodules. Between February 2004 and March 2006, 312 consecutive patients with thyroid nodule without intranodular vascular pattern at color-Doppler evaluation were enrolled in this prospective study. US-FNAC was performed by two different 25 gauge needles (Neolus [Ns] and Yale Spinal [YS]), and the two procedures were performed in alternate sequence on consecutive patients. Adequate specimens were observed in 145 (92.9%) and 153 (98%) nodules respectively investigated by Ns and in YS (p<0.005). The total cost to obtain a cytological diagnosis by Ns was of euro 12210.2 (156+12 repeated US-FNAC), whereas it was of euro 12449.7 by YS (156+3 repeated US-FNAC). Our data suggest that spinal needles are associated with a low proportion of inadequate FNAC, without increase of total direct cost, considering also the number of FNAC repetitions needed; therefore, their routine use could be taken into account.
    Journal of endocrinological investigation 01/2008; 31(1):25-8. · 1.65 Impact Factor
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    ABSTRACT: Little information is available concerning the possible antiproliferative effects of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) on the thyroid gland. We have hypothesized that the antiproliferative effects of statins observed in thyroid cell lines in vitro may have a clinical counterpart that could be detected by investigating the prevalence and size of thyroid nodules in patients on long-term treatment with statins. We retrospectively evaluated 135 dyslipidaemic patients receiving statin therapy continuously for at least 5 years, and 137 controls. All the subjects were submitted to ultrasound investigation of the thyroid gland, to establish prevalence, number and volume of thyroid nodules. Subjects treated with statins showed markedly lower prevalence of thyroid nodules (36.3%vs. 67.9%, P < 0.001), as well as reduced number and smaller total volume of lesions, as compared to the control group. A logistic regression analysis, taking into account age, sex, risk factors for the development of thyroid nodules and concomitant drug treatment, revealed that treatment with statins remained the only important predictor of the presence of thyroid nodules [odds ratio (OR) 0.312, 95% confidence interval (CI) 0.156-0.625, P < 0.001] besides risk factors. Our data provide the first circumstantial evidence of an association between HMG-CoA reductase inhibitor treatment and reduced prevalence, number and volume of thyroid nodules. This finding may be explained by an antiproliferative and/or pro-apoptotic effect of long-term statin treatment on thyroid cells, in vivo.
    Clinical Endocrinology 01/2008; 68(1):16-21. · 3.40 Impact Factor
  • World Journal of Surgery 12/2007; 31(11):2269. · 2.23 Impact Factor
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    ABSTRACT: In most trials, at least 30-60% of patients with Graves' disease treated with antithyroid drugs relapse within 2 years after therapy withdrawal. At present, there are no prognostic parameters available early in treatment to indicate patients likely to achieve long-term remission. Because thyrotropin receptor autoantibodies (TRAb) are specific for Graves' disease, we evaluated the ability of their levels and of their rate of change to predict long-term prognosis. In our study 216 consecutive patients with newly diagnosed Graves' disease started a therapy with methimazole. Patients were treated until they achieved euthyroidism and TRAb were measured at 6-month intervals throughout a follow up of 120 months. Our study demonstrated that at the onset of hyperthyroidism patients' age, sex, fT4 levels and goiter size had no prognostic value in predicting long-term prognosis (respectively p = 0.79; p = 0.98; p = 0.83; p = 0.89). On the contrary, at the time of diagnosis TRAb titer was a good predictor of the final outcome (p<0.001); a titer equal to (or) more than 46.5 UI/L could identify patients who had never achieved long-term remission with a sensitivity of 52% and a specificity of 78%. Also fall rate of TRAb at 6 months of follow up and after therapy withdrawal were useful to predict the final outcome (p<0.001). At 6 months of follow up the time of therapy withdrawal, a decrease of TRAb lower than 52.3% or even its increase could identify patients who had never achieved permanent remission with a sensitivity of 55% and a specificity of 79.1%. No single parameter among TRAb, satisfactory identified a sub-set of patients who achieved long remission. Accordingly to our data, the best result in predicting long term remission is probably given by the presence of at least one of the two features evaluated at 6 months (TRAb titer and/or percentage of TRAb fall rate), with a sensitivity of 63% and specificity of 88%. TRAb titers evaluated both at the onset of hyperthyroidism that at 6 months of therapy or their rate of fall at 6 months and at ATD withdrawal are predictors of outcome. However, the presence of at least one, between titers of TRAb or their rate of fall at six months, resulted to be the best predictor of remission with the higher sensitivity and specificity.
    Endocrine Journal 12/2007; 54(5):713-20. · 2.23 Impact Factor
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    ABSTRACT: To evaluate whether a preliminary aspiration (ASP) of the cystic component and/or using spinal needles in complex thyroid nodules (CTN) could improve the adequacy of cytological sampling. Between January 2004 and December 2006, 386 consecutive patients with CTN were enrolled in this prospective investigation. Ultrasound (US) fine needle aspiration cytology (FNAC) of the solid component of the nodule (one nodule per patient) was performed using two different 25 gauge needles, with (Yale Spinal, YS) or without (Neolus, NS) a stylet, in alternate sequence on consecutive patients. In addition, a subgroup of patients presenting larger cystic component (approximately 50%) was submitted to total aspiration of the cystic component (ASP+) or not submitted (ASP-) before US-FNAC, in alternate sequence within each needle type group. All the samplings were performed by a single endocrinologist. Adequate specimens were observed in 163 (84.5%) and 183 (94.8%) nodules investigated by NS and YS respectively. Sampling with the stylet needle was associated with an overall significant reduction of non-diagnostic specimens (15.5% vs 5.2% by NS and YS respectively, P < 0.001). The favourable result obtained with YS was independent from preliminary aspiration of the cystic component (ASP+: 14.8% vs 5.7% by NS and YS; ASP-: 16.2% vs 4.8%, not significant). A logistic regression analysis, taking into account nodule size and presence of intranodal vascularity at eco-colour evaluation of the solid component, confirmed that needle type was the only significant predictor of successful sampling (odds ratio 3.6 (95% confidence interval 1.7-7.6), P < 0.001). Our data show that adopting stylet needles to perform FNAC in CTN may significantly improve the percentage of adequate sampling. On the other hand, preliminary aspiration of CTN with large cystic component does not add any advantage.
    European Journal of Endocrinology 10/2007; 157(4):529-32. · 3.14 Impact Factor