Papers by Liliana Bergoglio
Arquivos Brasileiros De Endocrinologia E Metabologia, Jun 1, 2013
Introduction: Hypothyroidism has long been known for its effects on different organ systems, lead... more Introduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Results: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. Conclusions: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given.
Arquivos Brasileiros De Endocrinologia E Metabologia, Jun 1, 2013
Objective: To establish the frequency of U Tg (undetectable pre-ablation thyroglobulin) in TgAbne... more Objective: To establish the frequency of U Tg (undetectable pre-ablation thyroglobulin) in TgAbnegative patients and to evaluate the outcome in the follow-up. Subjects and methods: We retrospectively reviewed 335 patients' records. Twenty eight patients (9%) had U Tg. Mean follow--up was 42 ± 38 months. All subjects had undergone total thyroidectomy, and lymph nodes were positive in 13 (46%) patients. Tg and TgAb levels were measured 4 weeks after surgery by IMA technology in hypothyroid state. No evidence of disease (NED) status was defined as undetectable (< 1 ng/mL) stimulated Tg and negative Tg-Ab and/or negative WBS, together with normal imaging studies. Results: Seventeen patients (61%) were considered with NED. Four patients (14%) had persistent disease (mediastinum, n = 1, lung n = 2, unknown n = 1), and 7 (25%) had detectable TgAb by other method during their follow-up. Conclusions: U Tg levels usually is associated to a complete surgery. However, in a low percentage of patients, this may be related to false negative Tg or TgAb measurement.
Pediatric Research, Feb 1, 1997
The Journal of Clinical Endocrinology and Metabolism, Oct 1, 2005
Objectives: The presence of thyroglobulin (Tg) in needle washouts of fine needle aspiration biops... more Objectives: The presence of thyroglobulin (Tg) in needle washouts of fine needle aspiration biopsy (Tg-FNAB) in neck lymph nodes (LNs) suspected of metastasis has become a cornerstone in the followup of patients with papillary thyroid carcinoma (PTC). However, there are limited data regarding the measurement of anti-Tg antibodies in these washouts (TgAb-FNAB), and it is not clear whether these antibodies interfere with the assessment of Tg-FNAB or whether there are other factors that would more consistently justify the finding of low Tg-FNAB in metastatic LNs. Materials and methods: We investigated 232 FNAB samples obtained from suspicious neck LNs of 144 PTC patients. These samples were divided according to the patient's serum TgAb status: sTgAb-(n = 203 samples) and sTgAb+ (n = 29). The TgAb-FNAB levels were measured using two different assays. Tg-FNAB was also measured using two assays when low levels (< 10 ng/mL) were identified in the first assay of the metastatic LNs from the sTgAb+ samples. Results: The TgAb-FNAB results were negative in both assays in all samples. Low levels of Tg-FNAB were identified in 11/16 of the metastatic LNs of the sTgAb+ patients and 16/63 of the sTgAb-patients (p < 0.05) using assay 1. The measurement of the Tg-FNAB levels using assay 2 indicated additional metastases in 5 LNs of the sTgAb+ patients. Conclusions: Factors other than the presence of TgAb-FNAB may contribute to the higher number of metastatic LNs with undetectable Tg-FNAB in the sTgAb+ group. In addition, the measurement of Tg-FNAB using different assays was useful to enhance the diagnosis of metastatic LNs, particularly when cytological and Tg-FNAB results are discordant.
Revista Argentina de Endocrinología y Metabolismo, Dec 1, 2013
The syndrome of inappropriate secretion of TSH was the term originally coined to indicate two for... more The syndrome of inappropriate secretion of TSH was the term originally coined to indicate two forms of central hyperthyroidism, i.e. thyrotropin (TSH)-secreting pituitary adenomas (TSHomas) and resistance to thyroid hormone action (RTH). Both forms are characterized by high levels of free thyroxine (FT4) and free triiodothyronine (FT3) in the presence of measurable TSH concentrations, a biochemical picture which is in contrast to primary hyperthyroidism where TSH levels are always undetectable. Patients with TSHoma are clinically hyperthyroid, while RTH patients are generally euthyroid (so-called generalized RTH). However, in a minority of RTH thyrotoxic patients, features have been described with such individuals being deemed to have predominant central or pituitary resistance. Although incidence of inappropriate secretion of TSH is generally low, it is essential to rule out the likely causes of discordance in the TSH/T4 (thyroxine) relationship. The distinction between TSHoma and PRTH can be difficult since both conditions do not present significant differences in age, sex, gender or concentrations of TSH, FT4 and FT3. The failure to recognize them as different entities may have deleterious consequences, such as thyroid ablation in patients with central hyperthyroidism, or unnecessary pituitary surgery in those with PRTH. The objective of this review is to properly characterize them with a history of an affected first-degree relative, biochemical dynamic tests, pituitary imaging and genetic testing, according to what has been reported in international literature, and to analyze biochemical difficulties in choosing the best biochemical tools for that purpose, taking into account that no individual biochemical test can validate the differential diagnosis that must be based on a combination of: serum SUα, SUα/TSH ratio, TSH response to TRH, TSH response to suppression with LT3, and genetic analysis. Rev Argent Endocrinol Metab 50:253-264, 2013 No financial conflicts of interest exist.
Artículo de publicación ISIIntroduction: Hypothyroidism has long been known for its effects on di... more Artículo de publicación ISIIntroduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a...
Thyroid, 2007
Few reports have addressed normal serum thyroglobulin (Tg) values in newborns and infants. In the... more Few reports have addressed normal serum thyroglobulin (Tg) values in newborns and infants. In the present study, serum Tg was measured in 228 normal children (110 females and 118 males) aged from 3 to 180 days of life, all presenting normal age-related serum thyrotropin (thyroid-stimulating hormone [TSH]) values and negative anti-Tg and antithyroperoxidase antibodies. Serum Tg was measured by Radioimmunoassay (RIA) (two methods) and Immunometricassay (IMA) (three methods). Mean Tg values measured by the five methods exhibited among-method biases, although a significant positive correlation was observed. Serum Tg levels measured by the five methods showed a correlation with age, but not with TSH or gender. During the first days of life, relatively high mean Tg levels were observed, which progressively decreased until they reached a plateau. Therefore, with the aim of establishing reference values, the population was separated into two age groups: from 3 to 15 days of life (group A) and from 16 to 180 days of life (group B). Mean Tg concentration in group A was statistically higher than in group B. Tg centile distributions were calculated with the aim of establishing the normal levels of serum Tg for each method. We conclude that for a correct interpretation of serum Tg levels, the age and the methods used should be considered.
The Journal of Clinical Endocrinology & Metabolism, 2005
Context: Changes in thyroglobulin (Tg) and/or Tg antibody (TgAb) methods can disrupt the serial m... more Context: Changes in thyroglobulin (Tg) and/or Tg antibody (TgAb) methods can disrupt the serial monitoring of differentiated thyroid carcinoma (DTC) patients. Objective: This study compared Tg measurements made in TgAbnegative and TgAb-positive sera using four RIA and 10 immunometric assay (IMA) methods. Design: TgAb detection using a panel of 12 direct methods was contrasted with four Tg recovery tests. Sera from 110 normal euthyroid subjects (68 TgAb negative/42 TgAb positive) and 131 TgAbnegative DTC patients had Tg and/or TgAb analyses made by 10 laboratories in four countries. Euthyroid controls were used to compare Tg and TgAb ranges, sensitivities, and TgAb interference, whereas DTC patients were used to study Tg assay specificities, hook effects, and the influence of high Tg levels on TgAb measurements. Results: Tg methods had high between-method variability [47 Ϯ 3%
Endocrine Practice, 2011
Objective: Thyroid hormone, requiring adequate maternal iodine intake, is critical for neurodevel... more Objective: Thyroid hormone, requiring adequate maternal iodine intake, is critical for neurodevelopment in utero. Perchlorate decreases uptake of iodine into the thyroid gland by competitively inhibiting the sodium/iodide symporter (NIS). It is unclear whether environmental perchlorate exposure adversely affects thyroid function in first trimester pregnant women. Methods: Urinary iodine and perchlorate measurements and thyroid function tests were obtained in 134 pregnant women from Los Angeles, CA (mean ± SD 9.1 ± 2.2 weeks gestation) and 107 pregnant women from Córdoba, Argentina (mean 10.0 ± 2.0 weeks). Results: Median urinary iodine values were 144 μg/L in California and 130 μg/L in Argentina. Urinary perchlorate levels were detectable in all women: median (range) in California 7.8 (0.4-284) μg/L; and in Argentina 13.5 (1.1-676) μg/L. Serum thyroperoxidase antibodies (TPO Ab) were detectable in 16% of women from California and 17% of women from Argentina. Using Spearman rank correlation analyses, there was no association between urinary perchlorate concentrations and serum TSH, free T 4 index, or total T 3 values, including within the subset of women with urinary iodine values less than 100 μg/L. In multivariate analyses using the combined Argentina and California data sets adjusting for urinary iodine concentrations, urine creatinine, gestational age, and TPO Ab status, urine perchlorate was not a significant predictor of thyroid function. Conclusions: Low-level perchlorate exposure is ubiquitous, but is not associated with alteration in thyroid function tests among women in the first trimester of pregnancy.
AIDS, 2003
Objective: To describe the alterations in the bone metabolism of HIV-seropositive patients and ev... more Objective: To describe the alterations in the bone metabolism of HIV-seropositive patients and evaluate the effects of antiretroviral therapies. Design: Cross-sectional analytical study. Method and materials: A total of 142 subjects (113 male, 29 female), aged 20-45 years were divided into four groups: group A, 33 HIV-seropositive antiretroviral-naive patients; group B1, 36 HIV-seropositive patients on antiviral therapy for over 1 year, without protease inhibitors (PI); group B2, 42 HIV-seropositive patients on combined therapy containing PI for over 1 year; and group C, 15 healthy, HIV-seronegative subjects. Bone mineral density (BMD) were determined by dual energy X-ray absorptiometry in total body, lumbar spine and proximal femur; and evaluation of serum osteocalcin, D-pyridinoline, parathyroid hormone (THP), calcium and phosphate, and urine calcium. Results: BMD was significantly lower in HIV-seropositive patients in comparison with healthy controls, in all sites studied. However, no statistical differences were observed among all groups of HIV-infected patients, independently of the antiretroviral therapy. There was a significantly higher occurrence of osteopenia and osteoporosis in HIVinfected patients in comparison with controls (P , 0.0001), with no differences among treatment-naive patients and either of the treatment groups. Bone formation and resorption markers were similar among all studied groups. There was a significant correlation in all bone sites between time of infection and BMD (P , 0.02). Conclusions: BMD was significantly lower in HIV-seropositive patients in comparison with controls in lumbar spine, proximal femur and total body, without significant differences among treatment-naive patients and either of the treatment groups. Only time with HIV infection and not specific therapy was associated with BMD decreases.
Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it... more Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems Níveis indetectáveis de tireoglobulina pré-ablação em pacientes com câncer de tireoide: nem sempre é o que parece
Acta Bioquimica Clinica Latinoamericana, 2007
Guía de consenso para el diagnóstico y seguimiento de la enfermedad tiroidea 269
Revista Argentina de Endocrinología y Metabolismo, 2013
The syndrome of inappropriate secretion of TSH was the term originally coined to indicate two for... more The syndrome of inappropriate secretion of TSH was the term originally coined to indicate two forms of central hyperthyroidism, i.e. thyrotropin (TSH)-secreting pituitary adenomas (TSHomas) and resistance to thyroid hormone action (RTH). Both forms are characterized by high levels of free thyroxine (FT4) and free triiodothyronine (FT3) in the presence of measurable TSH concentrations, a biochemical picture which is in contrast to primary hyperthyroidism where TSH levels are always undetectable. Patients with TSHoma are clinically hyperthyroid, while RTH patients are generally euthyroid (so-called generalized RTH). However, in a minority of RTH thyrotoxic patients, features have been described with such individuals being deemed to have predominant central or pituitary resistance. Although incidence of inappropriate secretion of TSH is generally low, it is essential to rule out the likely causes of discordance in the TSH/T4 (thyroxine) relationship. The distinction between TSHoma and ...
Arquivos brasileiros de endocrinologia e metabologia
Hypothyroidism has long been known for its effects on different organ systems, leading to hypomet... more Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine,...
Acta Bioquimica Clinica Latinoamericana, 2007
Revista Argentina de Endocrinología y Metabolismo, 2016
Arquivos Brasileiros de Endocrinologia & Metabologia, 2013
OBJECTIVE: To establish the frequency of U Tg (undetectable pre-ablation thyroglobulin) in TgAb- ... more OBJECTIVE: To establish the frequency of U Tg (undetectable pre-ablation thyroglobulin) in TgAb- negative patients and to evaluate the outcome in the follow-up. SUBJECTS AND METHODS: We retrospectively reviewed 335 patients' records. Twenty eight patients (9%) had U Tg. Mean follow-up was 42 ± 38 months. All subjects had undergone total thyroidectomy, and lymph nodes were positive in 13 (46%) patients. Tg and TgAb levels were measured 4 weeks after surgery by IMA technology in hypothyroid state. No evidence of disease (NED) status was defined as undetectable (< 1 ng/mL) stimulated Tg and negative Tg-Ab and/or negative WBS, together with normal imaging studies. RESULTS: Seventeen patients (61%) were considered with NED. Four patients (14%) had persistent disease (mediastinum, n = 1, lung n = 2, unknown n = 1), and 7 (25%) had detectable TgAb by other method during their follow-up. CONCLUSIONS: U Tg levels usually is associated to a complete surgery. However, in a low percentag...
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Papers by Liliana Bergoglio