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Abstracts and short papers from the 5th Congress of the Polish Thyroid Association, Poznan, 3-5 September, 2015

2016; BioMed Central; Volume: 9; Issue: S1 Linguagem: Inglês

10.1186/s13044-016-0035-9

1756-6614

Leonard Wartofsky, P. P. A. Smyth, Josef Köhrle, Ryszard Anielski, Marian Słowiaczek, Paweł Orlicki, Rafał Czepczyński, Jacek Daroszewski, Alicja Hubalewska‐Dydejczyk, Aldona Kowalska, Maria Kurowska, Joanna Malicka, Anna Oszywa-Chabros, Agnieszka Zwolak, Jerzy S. Tarach, Krzysztof Lewandowski, Andrzej Lewiński, Anna Szeliga, A Czyźyk, Przemysław Niedzielski, Mirosław Mleczek, Adam Maciejewski, Anna Oczkowska, Jolanta Dorszewska, Katarzyna Łącka, Jerzy S. Tarach, Elżbieta Andrysiak­‍-Mamos, Elżbieta Sowińska­‍-Przepiera, Ewa Żochowska, Bartosz Kiedrowicz, Agnieszka Kaźmierczyk­‍-Puchalska, Anhelli Syrenicz, Katarzyna D. Arczewska, Joanna Drozdowska, Wanda Krasuska, Anna Stachurska, Grażyna Hoser, Mirosław Kiedrowski, Tomasz Stępień, Hilde Nilsen, Barbara Czarnocka, Karolina H. Czarnecka, Michał Kusiński, Agnieszka Nadel, Justyna Kiszałkiewicz, Daria Domańska, Monika Migdalska‐Sęk, Dorota Pastuszak‐Lewandoska, Ewa Nawrot, Krzysztof Kuzdak, Ewa Brzeziańska‐Lasota, Barbara Czarnocka, Anna Dąbrowska, Jolanta Kijek, Jerzy S. Tarach, Anna Torun-Jurkowska, Beata Chrapko, Anna Dąbrowska, Jerzy S. Tarach, Jolanta Kijek, Helena Jastrzębska, Magdalena Kochman, Ewa Szczepańska, Joanna Zgliczynska-Widlak, Agnieszka Samsel, Wojciech Zgliczyński, Roman Junik, Dariusz Kajdaniuk, Grzegorz Kamiński, Grzegorz Kamiński, Krzysztof Giejda, Małgorzata Karbownik‐Lewińska, Magdalena Marcinkowska, Jan Stępniak, Andrzej Lewiński, Monika Koziołek, Anna Sieradzka, Magdalena Lewandowska, Maria Stepaniuk, Bartosz Kiedrowicz, Julita Duda, Elżbieta Andrysiak­‍-Mamos, Anhelli Syrenicz, Monika Koziołek, Anna Sieradzka, Ewa Wentland-Kotwicka, Bartosz Kiedrowicz, Miłosz Parczewski, Maria Stepaniuk, Agnieszka Bińczak‐Kuleta, Andrzej Ciechanowicz, Elżbieta Andrysiak­‍-Mamos, Anhelli Syrenicz, Maria Kurowska, Joanna Malicka, Piotr Denew, Agnieszka Zwolak, Monika Lenart-Lipińska, Jerzy S. Tarach, Katarzyna Łącka, D Lapińska, Kosma Woliński, Magdalena Matysiak-Grześ, Aleksandra Klimowicz, Edyta Gurgul, Rafał Czepczyński, Maria Gryczyńska, Marek Ruchała, Hanna Mikoś, Marcin Mikoś, Barbara Rabska-Pietrzak, Marek Niedziela, Marek Ruchała, Ewelina Szczepanek‐Parulska, Magdalena Rudzińska, Joanna K. Ledwon, Kamila Karpińska, Maria Macios, Justyna Sikorska, Barbara Czarnocka, Małgorzata Rumińska, Ewelina Witkowska–Sędek, Beata Pyrżak, Nadia Sawicka‐Gutaj, Anna Sieradzka, Monika Koziołek, Magdalena Lewandowska, Ewa Wentland-Kotwicka, Marcin Machaj, Lilianna Osowicz-Korolonek, Jakub Pobłocki, Anhelli Syrenicz, Jerzy Sowiński, Nadia Sawicka‐Gutaj, Paulina Ziółkowska, Marek Ruchała, Ewelina Szczepanek‐Parulska, Bartłomiej Budny, Marek Ruchała, Małgorzata Trofimiuk–Müldner, Katarzyna Ziemnicka, Dorota Zozulińska‐Ziółkiewicz,

Thyroid Cancer Diagnosis and Treatment

Other presentations: short papers and extended abstractsA4 Short-stay surgical goitre treatment. Possibilities and conditionsRyszard Anielski1,2, Marian Slowiaczek1,, Pawel Orlicki1,2, 1Department of Short-stay Surgery, St. John Grande Hospital of Brothers Hospitallers, Cracow, Poland; 2Department of Catastrophe Medicine and Emergency Medicine, Chair of Anesthesiology and Intensive Care, Jagiellonian University, Medical College, Cracow, Poland Correspondence: Ryszard Anielski Background Operations have their recognised place in the treatment of goitre. The indications for operative treatment have been the same for many years. Advances in medicine and changes in surgical approach have both influenced the development of minimally invasive techniques. These have also affected the duration of hospital stay, shortening it significantly, and resulting in a reduction in the real financial costs of the medical services provided. Aims The aim of study was to evaluate the use of short-stay (one-day) surgery in patients with thyroid disorders requiring surgical treatment. Material and methods A prospective analysis was performed of two groups of operated patients with a variety of thyroid conditions. One group consisted of patients treated at the Short-stay Surgical Department of the St. John Grande Hospital of Brothers Hospitallers, in Cracow. The second consisted of the material of 500 patients operated on conventionally in the Department of Endocrine Surgery of the Third Chair of General Surgery, Jagiellonian University Medical College in Cracow by the same surgeons in the years 2007-2008. The groups of patients were then compared and analysed statistically. Statistical analysis involved comparing the groups with respect to specific diagnostic criteria, using the chi-square test and Fisher's exact test for categorized discrete variables, and the Mann-Whitney U and Kruskal-Wallis tests for continuous variables. The Student-t test was employed to calculate probability and confidence interval. Results Between 2010 and 2015, 102 operations for goitre were performed in the Department of Short-stay Surgery of the St. John Grande Hospital of Brothers Hospitallers, Cracow. The comparison group consisted of the material of 500 patients operated for thyroid disease in the Department of Endocrine Surgery JU CM (DEPT) in the years 2007 – 2008. The groups were similar with respect to age and sex. The duration of post-operative stay in the first group (HOSPITAL) was 1.9 days ± 0.3, as compared with 3.8 days ± 1.36 in the second group (DEPT) (p < 0.001) (Table 1).In assessing patients for potential short-stay surgery, those for overactive goitre were less frequently qualified than those with thyroid inflammation (p < 0.001). There were no significant differences in the other types of goitre (Table 2).We must note that the cancers were at a less advanced stage in patients operated for thyroid cancer under the short-stay regime, than those in the second group. The extent of the operation, and operative technique were similar between the two groups studied (Table 3).Complications arising were also compared, and these were less frequent in operative patients in the first (hospital) group (7.8% vs 17.8%) (p = 0.012). Conclusion Short-stay surgical treatment of thyroid conditions in specialist centres is possible and is as safe as conventional-term treatment, with no increase in the frequency of postoperative complications. Declarations Ethics approval and consent to participate No, becuase there is a retrospective analysis. Consent for publication Not applicable Availability of data and materials Available from the corresponding author on reasonable request. Competing interests The authors declare no conflict of interests. Funding Not applicable Authors' contributions R.Anielski: concept of the study, data collection and analysis, writing of the manuscriptM.Słowiaczek: data collection, writing of the manuscript, discussion and critical revision.P.Orlicki: data collection, substantive evaluation of the manuscript and discussion. Peer review This extended abstract underwent the journal’s standard peer review process for supplements.Table 1 (abstract A4). Population characteristicsFull size table Table 2 (abstract A4). Clinical diagnosis of patientsFull size table Table 3 (abstract A4). Type of surgical procedureFull size table A5 How to prepare the patient for radioiodine treatment?Rafal CzepczynskiDepartment of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, PolandRadioiodine therapy (RIT) is an important method of treatment of hyperthyroidism. Two different approaches to RIT are represented with regard to dosage of radioiodine (131I): individual dose calculation based on a detailed dosimetry and the administration of fixed doses of 131I aimed at the hypothyroidism as the final outcome. As shown by the statistics on huge numbers of patients followed for decades after RIT, even using meticulous calculation of the activity of therapeutic 131I, hypothyroidism is very common – it is found in approx. 30% of patients with toxic nodular goitre and even in 80% of patients with Graves' disease. The risk of hypothyroidism increases with each passing year after RIT at a rate of approximately 3-5% per year.RIT effect depends on many unmodifiable factors, for example thyroid mass, clinical form of hyperthyroidism, hormonal status etc. Several studies have demonstrated reduced efficacy of RIT in patients with lower TSH concentrations, higher thyroxine concentrations and higher TRAb titres. There is, however, a number of factors that can be modified to obtain a better result of RIT. The efficacy of RIT is primarily dependent on the kinetics of iodine in the thyroid gland. It can be followed using dosimetric measurements. A spot measurement of thyroid iodine uptake after 24 h (IU24) may not reflect the actual exposure of the gland to beta radiation. High values of IU24 are associated with poorer treatment effect, as these patients present a rapid iodine turnover and 131I is retained in the thyroid for a relatively short time. Iodine kinetics can be improved by low-iodine diet. Reducing the supply of iodine by the reduction of food intake based on fish, seafood and marine plants, as well as dairy products (milk, cheese) for 1-2 weeks, can increase the uptake of iodine by 20-30%. Longer elimination of iodine is not recommended because of possible side effects, e.g. hyponatremia. In the case of very low IU24 values, lithium salts can improve the effect of RIT. Although lithium is not responsible for the increase of iodine uptake by the thyroid gland, it does increase the retention time of iodine in the thyroid. The use of approx. 1 g of lithium carbonate per day for 5-14 days resulted in an increase of absorbed dose and a reduction of cases with the therapy failure. More and more often rhTSH is used to stimulate iodine uptake. A single injection of rhTSH causes usually 2-4-fold increase in the 131I uptake. Due to stimulation of the thyroid hormone release, this method is mainly used in the treatment of non-toxic nodular goitre. Stimulation with rhTSH frequently causes side effects like pain at the base of the neck and temporary increase of the thyroid volume.Antithyroid drugs used before, during and after RIT adversely affect the final outcome of the treatment (number of patients achieving euthyroid or hypothyroid status after RIT is lower). This is connected with their impact on iodine uptake, their immunomodulatory action and radioprotective effect in the thyrocyte. This effect is more pronounced in the case of propylthiouracil than methimazole. Therefore, while preparing the patient to RIT, following expert recommendations should be followed: refrain from the use of these drugs in case of slight hyperthyroidism, in more severe cases prefer methimazole over PTU and withdraw the drug for 2-7 days (methimazole) or 2-3 weeks (propylthiouracil) before RIT. If necessary, an antithyroid drug can be resumed after RIT, optimally approx. 1 week after the administration of 131I.Corticosteroids, amiodarone and iodine contrast agents should be named among the drugs that adversely affect the effect of RIT. Through their cytoprotective and immunosuppressive effect, corticosteroids reduce the radiosensitivity of the thyroid cells. Therefore, for the prevention of Graves orbitopathy, corticosteroids should be introduced a few days after RIT. Although the contrast agents contain large amounts of iodine (approx. 30 g of organic iodine and 5 mg of iodide in an average dose), urinary iodine excretion returns to normal as early as after 1-2 months after injection. Amiodarone treatment is regarded as an absolute contraindication to RIT. However, as demonstrated by retrospective studies in our centre, RIT used in an experimental setting in such patients even at very low IU24 led to normalization of amiodarone-induced hyperthyroidism in a few months.RIT often leads to hypothyroidism. Nevertheless, in accordance with the ALARA rule, we should strive to achieve a therapeutic effect using the lowest possible radionuclide activity. Thus, taking the factors described above into account while preparing the patient to RIT will allow to optimize the treatment effect and to reduce the exposure of the patient and the environment (including ourselves) to ionizing radiation. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials Not applicable Competing interests The author declares no conflict of interests. Funding Not applicable Peer review This short paper underwent the journal’s standard peer review process for supplements.A6 Management of mild thyroid orbitopathyJacek DaroszewskiDepartment of Endocrinology, Diabetes and Isotope Therapy, Medical University, Wroclaw, PolandThyroid orbitopathy (TO), the most frequent extrathyroidal manifestation of Graves’ disease (GD) occurs in approximately 2 per 10 000 population per year and in 25%–60% of patients with GD in clinically relevant form. Progression of mild to moderate-to-severe TO may occur in up to 15% of subjects and no predictors are available to predict worsening at a first clinical examination. Therefore the management of mild TO and prevention of the aggravation is one of the most common problem in practical endocrinology.Mild TO is usually diagnosed basing on soft tissue involvement (conjunctival and eyelid oedema and congestion) and proptosis < 3 mm above the upper limit. However it must be noted, that eye muscle involvement may be often underestimated due to low sensitivity of generally used motility tests. Despite often discrete manifestations at clinical examination diplopia is the principal symptom influencing patients’ quality of life (QoL) and his work ability. Moreover, as subjective factor as the impact of symptoms on patient’s everyday life and work must be considered. Therefore in big proportion of patient the grading of TO and a subsequent decision on implementation the immunosuppressive treatment is based on patient’s self-assessment.Strict metabolic control with the avoidance of hypothyroidism is a principal element of the treatment of thyrotoxicosis in GD patients. Changes in thyroid status may negatively influence TO. Therefore, evaluation of thyroid function ought to be frequent (every 6–8 weeks or even more often) during the first phases of treatment (or after changing the daily dose of the ATD) and periodical (every 3–4 months) thereafter.Treatment methods for hyperthyroidism [ATDs, radioiodine (RAI), thyroidectomy] per se seem to be capable to affect the course of TO and the choice of method is still a challenging dilemma. Randomized trials showed that TO grew more often after RAI than after thyroidectomy or ATDs .The influence of RAI on TO are uncertain, due to the limited number of controlled studies. Steroid prophylaxis is recommended in patients on RAI treatment, if mild and active TO pre-exists. Because TO may also appear for the first time after RAI treatment, it is generally worth wide to consider the pros and cons of steroid use also in GD patients with risk factors as male gander, age > 60 yrs, smoking and high TRab titre. Steroid prophylaxis can be performed with very low doses of prednisone (0.2 mg/kg body weight), given 1 day after RAI therapy, gradually tapered down and stopped after 6 weeks. In subject with risk factors for the RAI-associated TO progression, doubled both doses of prednisone and time of treatment should be implemented.Tabaco smoking markedly increases the risk of developing TO and aggravate it is course. Smokers are 4-fold more prone to develop eye symptoms and as much as 27-times more often experience the severe stage. Smokers respond less well to treatment with steroids or radiotherapy then non-smokers (15% vs. 85%). The efficacy of helping patients stop smoking is very low: opportunistic advice from doctor only 2%. Therefore all GD patient should be honestly informed about the risk and nicotine replacement therapy may be considered.GD subjects are at high risk of dry eye symptom due to mechanical factors, hormonal disturbance, autoimmunological process and side effects of commonly used drugs. Orbital discomfort (at rest or with gaze) must be distinguished from ocular surface irritation from exposure. It may be also hypothesized the inflammation at the eye surface via proinflammatory cytokines may induce inflammation in retrobulbar space. Therefore all subjects with OT and may be the majority of GD patients, should be advised to consistently use local measures. Artificial tear drops or gels (administered 4-6 times daily – in the morning, by meals and at bed time) and lubricant ointments prior to slipping can reduce surface symptoms and improve quality of life. The use of preservative-free drops can help to avoid allergic reactions, epithelial toxicity and conjunctival inflammation by preservatives and particularly benzalkonium chloride.Non-ophthalmologists often forget, that such simple solutions can have a significant impact on TO symptoms.Antioxidant therapy in TO has been used for ca. 30 years but reported results are extremely divergent. Hoverer randomized, placebo control study conducted by EUGOGO showed selenium (but not pentoxyfylline) treatment within 6 months induced significant improvement in eye status and QoL during 12 month follow up. Therefore selenium supplementation (200 μg daily) is recommended for patients with mild TO and may be advised for GD subjects free of TO but with risk factors. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials Not applicable Competing interests The author declares no conflict of interests. Funding Not applicable Peer review This short paper underwent the journal’s standard peer review process for supplements.A7 Management of the subclinical hypothyroidism (SH) in pregnancy – are the current guidelines expected to be changed?Alicja Hubalewska-DydejczykChair and Department of Endocrinology, Jagiellonian University, Medical College, Cracow, PolandThyroid dysfunctions in pregnancy are relatively common and they have a negative impact on the health of the mother and her offspring. The physiological changes during pregnancy influence the thyroid function, thus the existing guidelines recommend the necessity to prepare the trimester-specific thyroid hormone reference ranges for each medical centre and analytical method used. In case of a lack of such TSH reference ranges the following ones are generally accepted: I trim: 0.1-2.5 mU/L, II and III trim. 0.2-3.0 (ATA, ES) – 3.5 mU/L (ETA).While discussing the thyroid illness in pregnant women, it has to be underlined that despite the well-informed guidelines and expert work there are areas of substantial uncertainty. Among others the most important questions are: how to define the SH during pregnancy, can the maternal SH adversely affect the foetus and the mother and how to assess/balance the risk and benefit of any intervention. The endpoint of the clinical studies are the pregnancy complications and foetal cognitive development as possible, well-known hypothyroidism-related disturbances. The dilemmas in relation to the normal TSH reference range followed by the SH definition in pregnancy result from the differences caused by variations in assays, population-specific factors such as ethnicity, dietary habits, iodine status, BMI. These dilemmas can also be caused by the fact that the even slight abnormalities in thyroid function are potentially unfavourable factors associated with child outcome. Maternal thyroid hormones (TH) are the only source of TH for foetus especially in the first half of pregnancy.What is normal? – this is the most frequent question. According to the International Federation of Clinical Chemistry the reference intervals have to be based on the 2.5th and 97.5th percentile of the respective population with an optimal iodine intake in case of thyroid hormone ranges assessment. In meta-analysis based on the 14 well-performed studies (in which TSH and FT4 were calculated in accordance with the international guidelines and the sufficient number of pregnant women with negative thyroid antibodies were enrolled to the studies), Medici et al. [1] showed that there are essential differences in upper TSH reference value during early pregnancy worldwide and in 90% of cases TSH upper limit value exceeds the recommended TSH level (2.63-4.68 mU/L). The results of the Generation R study [2], a large cohort study, suggest that the diagnosis of the SH should be undertaken when TSH >4.04 mU/l and normal FT4 (10.4-22.0 pmol/L). Bestwick et al. [3] suggest using multiple of the median (MoM) values to overcome the limitation connected with TSH and TH assessment during pregnancy. TSH and FT4 (MoMs) significantly reduced the difference between UK and Italian samples compared with conventional units, which were also confirmed by Medici et al. in the above, cited work in different populations [1].In the face of the above facts, there are critical questions whether our pregnant women are treated in euthyroidism and whether the treatment of the euthyroid pregnant women has a negative effect on pregnancy course and foetus.There are some new clinical data confirming that even subclinical thyroid dysfunction in pregnancy increases the risk of mother and child adverse outcomes. Among others, Liu et al. [4], in prospective cohort study of 3315 women screened, showed that the women with SCH were at an increased risk of miscarriage between four and eight gestational weeks but statistical significance was achieved only if TSH ≥5.22 mU/L. Women with a combination of SCH and TAI were found to were at the highest risk of miscarriage and, for that, at earlier gestational ages.In conclusion, it should be stated, that the current available data concerning the upper TSH limit value in pregnancy, safe for mother and her offspring, could probably be higher than previously thought. It requires further clinical studies, however, thyroid related research in pregnant population is difficult to conduct. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials Not applicable Competing interests The author declares no conflict of interests. Funding Not applicable Peer review This short paper underwent the journal’s standard peer review process for supplements. References 1. Medici M, Korevaar TI, Visser WE, Visser TJ, Peeters RP. Thyroid function in pregnancy: what is normal? Clinical Chem. 2015;61:704-713.2. Medici M, de Rijke YB, Peeters RP, Visser W, de Muinck Keizer-Schrama SM, Jaddoe VV, Hofman A, Hooijkaas H, Steegers EA, Tiemeier H, Bongers-Schokking JJ, Visser TJ. Maternal early pregnancy and newborn thyroid hormone parameters: the Generation R study. J Clin Endocrinol Metab. 2012;97:646-652.3. Bestwick JP, John R, Maina A, Guaraldo V, Joomun M, Wald NJ, Lazarus JH. Thyroid stimulating hormone and free thyroxine in pregnancy: expressing concentrations as multiples of the median (MoMs). Clin Chim Acta 2014;430:33-37.4. Liu H, Shan Z, Li C, Mao J, Xie X, Wang W, Fan C, Wang H, Zhang H, Han C, Wang X, Liu X, Fan Y, Bao S, Teng W. Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study. Thyroid 2014; 24:1642-1649.A8 Delayed risk stratification as the indicator of treatment and follow-up in thyroid cancer patientsAldona KowalskaEndocrinology Department, Holycross Cancer Centre, Kielce, PolandThere has been a dynamic increase in detectability of differentiated thyroid cancer (DTC) in recent years. This increase is mainly due to detection of small foci of papillary carcinoma, which is characterized by very good prognosis. Increased morbidity does not result in increased mortality. Currently the management of the DTC patient dictates a lifelong oncologic surveillance due to recurrences or distant metastases observed even many years after the onset of the disease. Diagnostics and treatment can be a significant burden for the patients. Thyroid surgery involves the risk of hypoparathyroidism and damage of the recurrent laryngeal nerve. The frequency of surgical complications depends on surgeon's experience and scope of the surgery. The risk of postsurgical hypoparathyroidism significantly increases with the central compartment lymph node dissection and when the surgery is performed by an inexperienced surgeon (less than 10 surgeries a year). Another burden for the patient is using the 131I therapy. It has been indicated that using an isotope with the activity above 100 mCi increases the risk of leukaemia. Another danger is the increased risk of salivary gland cancer or fertility impairment. The way to avoid the above complications is using the 131I with possibly lowest activity and stimulating the 131I uptake with recombinant TSH instead of LT4 withdrawal. It has also been indicated that using Thyrogen decreases the 131I radiotoxicity by 30-50%, while maintaining the high effectiveness of ablation. Discontinuation of the 131I therapy is also essential in groups of very low recurrence risk, where benefits of such therapy have not been indicated. The usage of suppressive LT4 doses increases the risk of atrial fibrillation and has an influence on bone mineral density decrease in postmenopausal women. Periodic oncologic follow-up which include stimulated Tg measurement or a whole–body scan, what is further associated with physical and psychological burden. Adjusting the treatment and monitoring the disease is necessary in case of poor disease outcome. There are ongoing studies on several risk stratification systems. Seventh edition of the TNM system according to AJCC/UICC is commonly used. This system correlates very well with the risk of fatal outcome, however, it does not allow a good differentiation of high risk recurrent/persistent disease patients. Using the system is recommended worldwide, as it allows keeping the epidemiological registers and monitoring the changes in DTC epidemiology. Stratification systems recommended by ATA and ETA are also used to assess the risk of disease recurrence, taking into account assessment of the histological type and surgical radicality of the procedure. In 2015, new ATA recommendations advise taking into account the number and extent of the lymph node involvement (>5 and the size of metastasis in a node >0.2 cm and clinically identified nodes) as factors which affect the prognosis. Other factors which affect the prognosis are the degree of the extrathyroidal extension (microscopic or extensive) and the degree of vascular invasion in follicular thyroid cancer. Attempts are being made to use molecular factors (BRAF, TERT) as prognostic elements, but the data concerning this subject is inconclusive. In 2010, Tuttle et al. suggested a delayed risk stratification system (DRS), applied 2 years after finishing the initial treatment. The system assumes effectiveness of the therapy as a predictor. Patients, who respond very well to the treatment (Tg/LT4 < 0.2, Tg/stimulated 1.0, Tg/stimulated >10.0, increasing anti-Tg serum) or structurally persistent (disease seen in imaging and physical examinations) constitute the high-risk group. The group with ambiguous response is composed of patients with serum Tg/stimulated >2.0 < 10, stable or decreasing anti-Tg levels, nonspecific changes in imaging. Studies carried out by several teams confirm high effectiveness of the above stratification system in predicting the outcome. It is recommended to use the delayed risk stratification system to personalize the LT4 treatment by adjusting the suppression level to the risk as well as by modifying the intensity and method of the oncologic follow-up. Using the DRS system will allow many patients to avoid negative outcomes of the LT4 suppressive therapy as well as mentally and physically burdensome periodic follow-up of possible disease remission. At the same time, it will bring significant savings for the health care budget. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials Not applicable Competing interests The author declares no conflict of interests. Funding Not applicable Peer review This short paper underwent the journal’s standard peer review process for supplements.A9 Influence of vitamin D3 deficiency on body mass and TSH level in patients with Hashimoto’s thyroiditisMaria Kurowska, Joanna Malicka, Anna Oszywa-Chabros, Agnieszka Zwolak, Jerzy S. TarachChair and Department of Endocrinology, Medical University of Lublin, Lublin, Poland Correspondence: Jerzy S. Tarach Background One billion people worldwide are characterized by vitamin D deficiency. Vitamin D deficiency is also prevalent in subjects with Hashimoto`s thyroiditis. It was proved that serum 25(OH)D levels in these patients are lower than in healthy individuals. This observation suggests that vitamin D deficiency may play an important role in the development of thyroiditis. Several clinical trials have shown that supplementation of vitamin D may reduce the incidence of rheumatoid arthritis, multiple sclerosis and type 1 diabetes. In experimental studies it was proved that 1,25(OH)2D3 may prevent Hashimoto`s disease, however the mechanisms of this impact has so far not been explained. It was also reported that administration of vitamin D together with anti-thyroid drugs or thyroid hormones suppresses the autoimmune reaction and reduces serum levels of thyroid autoantibodies. The discovery of the presence of vitamin D receptors in the thyroid gland probably indicates that vitamin D plays a role in regulation of thyroid function. The association of hypothyroidism with higher body mass is commonly known. Also the state of vitamin D supply is inversely correlated with obesity. Aims To determine whether there is a correlation between the concentration of 25(OH)D3, body weight and TSH level in patients with Hashimoto's thyroiditis. Materials and methods Covered 65 patients [55 F; 10 M] aged 20-86 years [mean 50.5 ± 20.3], hospitalized in our department between 2013-2015. Analysis of clinical picture and laboratory studies. Serum TSH levels were measured with CLIA and 25(OH)D3 with ECLIA assays. Results Vitamin D3 deficiency 30 ng/mL]. Depending on the concentration of 25(OH)D3 the patients were divided into 4 groups: group 1 covered 10 people [6 F; 4 M] with 25(OH)D3 concentration >30 ng/mL [average value 41.2 ± 9.2]; group 2 – 10 patients [9 F; 1 M] with 25(OH)D3 level between 20 and 30 ng/mL [average 22.5 ± 2.6]; group 3 – 22 people [20 F; 2 M] with 25(OH)D3 value between 10-20 ng/mL [mean 14.4 ± 2.8]; group 4 – 23 patients [19 F; 4 M] with 25(OH)D3 concentration <10 ng/mL [mean 6.8 ± 1.9]. BMI for groups 1 to 4 was respectively: 25.0 ± 5.6 kg/m2; 23.5 ± 4.4 kg/m2; 27.1 ± 6.1 kg/m2 and 27.6 ± 4.9 kg/m2. BMI in groups 3 and 4 was significantly higher (p <0.001) than in group 1. Mean TSH levels were respectively: in group 1 – 1.4 ± 1.4 [range from 0.1 to 3.9] mIU/L; in group 2 – 1.5 ± 1.2 [0.1-4.2] mIU/L; in group 3 – 10.4 ± 22.9 [0.1-87.0] mIU/L; in group 4 – 3.6 ± 4.8 [0.73-19.3] mIU/L. TSH levels differed between group 1 and group 4 statistically significantly [p < 0.001]. Additionally, all patients were divided into two major groups: group 1 = 20 people [15 F; 5 M] with 25(OH)D3 > 20 ng/mL and group 2 = 45 patients [40 F; 5 M] with 25(OH)D3 < 20 ng/mL. Average 25(OH)D3 concentrations were respectively: 31.84 ± 11.65 ng/mL in group 1 and 11.05 ± 4.52 ng/mL in group 2 (p < 0.001), TSH levels: 1.47 ± 1.31 mIU/L and 6.9 ± 16.5 mIU/L (p < 0.001), and BMI: 24.27 ± 5.15 kg/m2 and 27.37 ± 5.48 kg/m2 (p < 0.001). The age of patients in both groups was respectively: 41.55 ± 19.24 and 54.69 ± 5.48 years (p < 0.001). Conclusions Patients with Hashimoto's thyroiditis and 25(OH)D3 concentrations below 20 ng/mL are characterized by higher body weight and higher TSH levels. Our results suggest that vitamin D3 supplementation may have a positive effect on the proper control of hypothyroidism and body weight in patients with Hashimoto's disease. Declarations Authors' contributions MK, JST: study conceived and designed, manuscript composition, critical revision and supervision. JM, AOC, AZ took part in the care of the