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  • Author: Rodrigo Moreno-Reyes x
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Lucia Russo Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Padova, Italy
Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

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Thi Ngoc Huyen Nguyen Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

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Aglaia Kyrilli Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

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Martin Robin Department of Nuclear Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

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Pierre Bel Lassen Department of Urology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium

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Rodrigo Moreno-Reyes UMRS 1166 (Inserm), Paris, France

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Bernard Corvilain Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

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Objective: Endogenous subclinical hyperthyroidism (eSCH) is defined by subnormal serum thyroid-stimulating hormone (TSH) level. There is limited evidence of metabolic changes induced by eSCH. The aim of our work was to evaluate changes in BMI and lipid parameters after radioiodine treatment in patients with grade 1 (TSH: 0.1–0.39 mlU/L) and 2 (TSH <0.1 mlU/L) eSCH. Design: A retrospective study was performed on 74 patients with eSCH caused by benign autonomous nodular goiter which was treated with radioiodine. Methods: We assessed BMI, lipids parameters, and TSH after radioiodine therapy. The 12-month follow-up time point was used to compare the primary outcome variables. TSH was measured by the electrochemiluminescence method. Results: After radioiodine therapy, the absolute and relative increases in BMI at 12 months were significantly higher in the grade 2 group than in the grade 1 group (1.07 ± 0.27 kg/m<sup>2</sup> vs. 0.26 ± 0.15 kg/m<sup>2</sup>, respectively; p = 0.023 and 4.01 ± 0.98% vs. 1.01 ± 0.56%, respectively; p = 0.026). Compared to baseline, significant increases in the levels of total cholesterol and LDL were observed after treatment in the grade 2 eSCH group (16.7 ± 4.5 mg/dL p < 0.01 and 14.3 ± 4.1 mg/dL p < 0.01, respectively) but not in the grade 1 group. In a multivariate model, a negative correlation was observed between pretreatment TSH levels and absolute BMI gain (p < 0.01). Conclusions: After correction of eSCH, increases in BMI and LDL levels were observed only in patients with grade 2 eSCH. Pretreatment serum TSH was the main independent factor associated with BMI changes after radioiodine treatment.

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Aglaia Kyrilli Department of Endocrinology, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, Belgium

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Nunzia Tacelli Department of Radiology, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, Belgium

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Lucia Russo Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy

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Laetitia Lebrun Department of Pathology, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, Belgium

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Isabelle Salmon Department of Pathology, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, Belgium

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Gilles Russ Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France

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Rodrigo Moreno-Reyes Department of Nuclear Medicine, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik, Brussels, Belgium

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Bernard Corvilain Department of Endocrinology, Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, Belgium

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Objectives

The aim was to evaluate the clinical, ultrasound (US) and, when indicated, the cytological and histological characteristics of autonomously functioning thyroid nodules (AFTN) in consecutive patients.

Methods

A prospective, single-centre study was conducted between March 2018 and September 2021. In total, 901 consecutive patients were referred for thyroid workup and of 67 AFTN were evaluated. All enrolled patients underwent 99mTcO4 scintigraphy, additional 123I scintigraphy only in case of normal serum TSH, evaluation of thyroid function, US examination using European Thyroid Imaging and Reporting Data System (EU-TIRADS), and US-guided fine needle aspiration (FNA) cytology when indicated. All indeterminate FNA samples were subjected to DNA sequencing analysis.

Results

More than half of the evaluated patients with AFTN were euthyroid; median serum TSH was 0.41 (IQR: 0.03–0.97) mU/L. The median AFTN size measured by US was 27.0 (IQR: 21.1–35.0) mm. 28.4% of AFTN were classified as EU-TIRADS score 3 and 71.6% as EU-TIRADS score 4, indicating that the majority of AFTN had intermediate risk for malignancy according to US. Out of the 47 AFTN subjected to cytological evaluation, 24 (51%) yielded indeterminate FNA results. DNA sequencing revealed pathogenic TSHR and GNAS mutations in 60% of cases. No malignancy was detected at final histology in surgically excised AFTN (n = 12).

Conclusions

Of the 67 AFTN evaluated in this study, 50% presented with normal serum TSH, 70% displayed ultrasound features suggesting an intermediate malignancy risk and 50% of the AFTN submitted to cytology yielded indeterminate results. No malignant AFTN was detected.

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Rodrigo Moreno-Reyes R Moreno-Reyes, Department of Nuclear Medicine, Université Libre de Bruxelles, Bruxelles, 1050, Belgium

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Ulla Feldt-Rasmussen U Feldt-Rasmussen, Department of Endocrinology and Metabolism, University of Copenhagen, Kobenhavn, 1165, Denmark

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Agnieszka Piekiełko-Witkowska A Piekiełko-Witkowska, Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, 01-813, Poland

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Adriana Gaspar da Rocha A Gaspar da Rocha, Public Health Unit, University of Porto Institute of Molecular Pathology and Immunology, Porto, 4200-465, Portugal

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Corin Badiu C Badiu, National Institute of Endocrinology "C Davila" University of Medicine and Pharmacy, Bucharest, Romania

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Josef Koehrle J Koehrle, Institut für Experimentelle Endokrinologie, Berlin, Germany

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Leonidas Duntas L Duntas, Metabolism and Diabetes National Kapodistrian University of Athens, Athens, Greece

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Abstract

In 2022, the European Chemicals Agency (ECHA) made a statement concluding that iodine is an endocrine disruptor (ED). "We stress the fact that the ECHA opinion ECHA/BPC/357/2022 is based on their misguidedly zooming in on exclusively the biocidal products (e.g., hand disinfectants, disinfection of animals’ teats/udder, embalming fluids before cremation, etc.) that contain molecular iodine (I2), entirely neglecting [see the 2013 ECHA Regulation (EU) n°528/2012 describing iodine as being of “great importance for human health”. Clearly, the current sweeping and erroneous classification of “iodine” as an endocrine disruptor is ill-advised. We moreover call upon the scientific and medical community at large to use the accurate scientific nomenclature, i.e., iodide or iodate instead of “iodine” when referring to iodized salts and food prepared there with. Drugs, diagnostic agents, and synthetic chemicals containing the element iodine in the form of covalent bonds must be correctly labelled ‘’iodinated’’, if possible, using each time their distinctive and accurate chemical or pharmacological name.

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Rodrigo Moreno-Reyes Department of Nuclear Medicine, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium

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Ulla Feldt-Rasmussen Department of Endocrinology and Metabolism, University Hospital Rigshospitalet, and Faculty of Ηealth and Clinical Sciences, University of Copenhagen, Copenhagen, Denmark

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Agnieszka Piekiełko-Witkowska Centre of Postgraduate Medical Education, Centre of Translational Research, Department of Biochemistry and Molecular Biology, Warsaw, Poland: Basic Lead of the European Society of Endocrinology Focus Area on Thyroid

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Adriana Gaspar da Rocha Public Health Unit, ULS Baixo Mondego, Figueira da Foz, Portugal Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal Health Investigation and Innovation Institute (i3S), University of Porto, Porto, Portugal

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Corin Badiu National Institute of Endocrinology "C. Davila" University of Medicine and Pharmacy, Bucharest, Romania

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Josef Köhrle Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Experimentelle Endokrinologie, Berlin, Germany: Co-Lead of the European Society of Endocrinology Focus Area on Environmental Endocrinology

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Leonidas Duntas Evgenideion Hospital, Unit of Endocrinology, Metabolism and Diabetes, National Kapodistrian University of Athens, Athens, Greece

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Graphical abstract

Abstract

In 2022, the European Chemicals Agency (ECHA) made a statement concluding that iodine is an endocrine disruptor (ED). We stress the fact that the ECHA opinion ECHA/BPC/357/2022 is based on their misguidedly zooming in on exclusively the biocidal products (e.g. hand disinfectants, disinfection of animals’ teats/udder, embalming fluids before cremation) that contain molecular iodine (I2), entirely neglecting the 2013 ECHA Regulation (EU) no. 528/2012 describing iodine as being of ‘great importance for human health’. Clearly, the current sweeping and erroneous classification of ‘iodine’ as an endocrine disruptor is ill-advised. We moreover call upon the scientific and medical community at large to use the accurate scientific nomenclature, i.e. iodide or iodate instead of ‘iodine’ when referring to iodized salts and food prepared there with. Drugs, diagnostic agents, and synthetic chemicals containing the element iodine in the form of covalent bonds must be correctly labeled ‘iodinated’, if possible, using each time their distinctive and accurate chemical or pharmacological name.

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