Daukšienė, Dalia

Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]

Background/Objectives: While it is known that Hashimoto’s thyroiditis (HT), goiter, thyroid nodules, and thyroid dysfunction may affect women’s reproductive health through hormonal and metabolic mechanisms, data are limited regarding the specific impacts on female sexual function. This study evaluated sexual function in women with thyroid disorders and examined its associations with thyroid function, age, menopausal status, and body mass index (BMI). Methods: A population-based survey was conducted in Kaunas, Lithuania, within the WHO MONICA framework. A random sample of 1569 women aged 25–69 years was included in the final analysis after applying the exclusion criteria. Anthropometric measurements were taken using standardized procedures, and the BMI was calculated. Sexual function was assessed using the 19-item Female Sexual Function Index (FSFI). Thyroid structure was evaluated by a team of trained physicians using ultrasound, while thyroid function was assessed via serum analysis (ELISA-based assays for TSH, fT4, and anti-TPO antibodies). Results: Of the 1569 women analyzed, 64.1% had sexual dysfunction (SD) (FSFI ≤ 26.55). Age and BMI showed significant negative correlations with all FSFI domains, with the strongest associations for arousal, lubrication, and total FSFI score (p < 0.01). SD was more prevalent among postmenopausal (43.6%) women than in premenopausal women (22.6%, p < 0.001) and increased with a higher BMI (p < 0.001). HT was found in 28.3% of participants. Compared with the reference group, women with HT were older, had higher BMI, higher TSH levels, and more hypothyroidism (p < 0.001). SD was more common in the HT group (71.7% vs. 64.2%, p < 0.001), with significantly lower lubrication and higher pain scores. In the multivariate analysis, only goiter remained an independent predictor of SD (p = 0.04). Conclusions: In conclusion, women with HT were older; had a higher BMI; and more frequently experienced SD, particularly reduced lubrication and increased pain, compared with the reference group. Although several thyroid conditions were associated with sexual dysfunction, only goiter remained an independent predictor after adjusting for age and BMI.

This study aimed to investigate the expression of microRNAs (miRNAs) -146b-3p, -221-5p, -222-3p, and -21a-3p and the methylation pattern of the thyroid-stimulating hormone receptor (TSHR) gene in blood plasma samples from papillary thyroid cancer (PTC) patients before and after thyroidectomy compared to healthy controls (HCs). This study included 103 participants, 46 PTC patients and 57 HCs, matched for gender and age. Significantly higher preoperative expression levels of miRNAs and TSHR methylation were determined in the PTC patients compared to HCs. Post-surgery, there was a notable decrease in these biomarkers. Elevated TSHR methylation was linked to larger tumor sizes and lymphovascular invasion, while increased miRNA-222-3p levels correlated with multifocality. Receiver operating characteristic (ROC) analysis showed AUCs below 0.8 for all candidate biomarkers. However, significant changes in the expression of all analyzed miRNAs and TSHR methylation levels indicate their potential to differentiate PTC patients from healthy individuals. These findings suggest that miRNAs and TSHR methylation levels may serve as candidate biomarkers for early diagnosis and monitoring of PTC, with the potential to distinguish PTC patients from healthy individuals. Further research is needed to validate these biomarkers for clinical application.

Algoritmas (lot. algorismus

Introduction: Endoscopic transaxillary gasless hemithyroidectomy (TAH) is one of several different hemithyroidectomy approaches. TAH has the advantage of better cosmesis compared to open surgery, although we have a lack of information about patient health-related quality of life (HRQOL) after TAH. Aim: To evaluate HRQOL after TAH. Material and methods: The prospective clinical study involved 40 patients who underwent TAH. Patient demographic and clinical data were collected. Patients completed the Short-Form 36 Health Survey (SF-36) before surgery, and at 1 and 6 months after surgery. Patients were followed up at an outpatient clinic for a check-up and postoperative evaluation. Patient HRQOL preoperative scores were compared with the general population. Results: All patients were female, with a median age of 32 years and median body mass index of 23 kg/m2. The overall complication rate was 12.5%. According to the SF-36, patient HRQOL 1 month after TAH decreased in role physical (RP) and bodily pain (BP) scores (p < 0.05). RP and BP scores reached the preoperative level 6 month safter surgery. Patients’ role emotional score 6 months after surgery was higher than before surgery (78.94 ±34.16vs. 93.38 ±19.24; p < 0.05). Role physical, general health, physical functioning and vitality scores were changed(p < 0.05) 1 month after surgery in patients with different pathological examination results, lobe weight, lobe volume and postoperative complications. Conclusions: Patient HRQOL scores are higher 6 months after TAH than before surgery. Thyroiditis in pathological examination, resected lobe weight and volume, postoperative complications have significance to postoperative HRQOL scores.

Introduction: Papillary thyroid carcinoma (PTC) is the most common thyroid cancer type. It carries a good prognosis. However, approximately ten percent of cases may present with metastatic disease at initial presentation. Fine needle aspiration biopsy cytology is still the gold standard for diagnosing PTC, but there is a technical limitation. That’s why minimally invasive diagnostic test is the subject of research in nowadays.Our objective: We aimed to explore the TSHR methylation level in PTC patient’s plasma samples and to compare with clinicopathological factors.Methods: Study included 68 patients with a histologically confirmed diagnosis of PTC treated at Hospital of Lithuanian University of Health Sciences, Kaunas clinics 2020 - 2021. Peripheral blood samples were collected from patients. DNA methylation level changes of TSHR were analyzed by quantitative methylation-sensitive polymerase chain reaction. The total tumor size was calculated as the sum of the diameters of all tumors in PTC multifocal cases. Statistical analyses were performed using SPSS 22.0 software (SPSS Inc., Chicago, IL, USA). The results were considered statistically significant at P< 0.05. Results: Average age at diagnosis was 48.19 ± 14.9 years, there were 8 male patients (11.8%) and 60 female patients (88.2%). We observed that TSHR concentration were significantly higher in PTC with greater tumor size (>2 cm) compared to lower (≤2 cm) tumor size (P< 0.001), lymph node metastasis (P=0.01), lymphovascular invasion (P=0.02), multifocality (P=0.013). A weak positive correlation between the concentration of TSHR with the total size of PTC tumors was found (P=0.09, r=0.315). However, there was no correlation between demographic characteristics and histopathological subtypes of PTC. Conclusion: This study analyzed associations between TSHR promoter methylation level and PTC clinicopathologic features. Our results indicate that TSHR promoter methylation may be useful parameter in assessing disease progression. Further studies are also warranted to expand upon our findings.

Introduction Papillary thyroid cancer (PTC) is the most common type of thyroid cancer (85%–90%). Today Fine needle aspiration biopsy (FNAB) is the diagnostic tool for the evaluation of thyroid nodules because of its accuracy and cost-effectiveness, but FNAB also has limitations, as it is quite challenging to take a biopsy from a small thyroid nodule moreover FNAB diagnosis is doubtful in up to 20% of cases.Therefore, non-invasive biomarkers of PTC are needed. Aim of the study To evaluate methylation level changes of the PTEN gene in FFPE tissue samples and peripheral blood plasma samples of PTC patients before and after surgery. Methods The study included 50 FFPE tissue samples from 25 patients and 68 patients plasma samples with a histologically confirmed diagnosis of PTC. Peripheral blood samples were collected before surgery and 4-6 weeks after surgery. Methylation level changes of the PTEN gene were analysed in plasma and FFPE tissue samples by quantitative methylation-sensitive polymerase chain reaction. Results Paired sample analysis showed statistically higher PTEN methylation levels in FFPE tumor tissue samples compared to non-cancerous tissue samples (PZ0,016). Plasma PTEN methylation levels were compared before and after PTC surgery. Significantly lower levels of PTEN methylation were found in samples collected after surgery compared to samples collected before surgery (PZ 0,031). Conclusion PTEN methylation level changes may be a promising minimal invasive biomarker in predicting PTC prognosis and diagnosing PTC.

Introduction Multifocality empirically is often treated as a risk factor for aggressive course of papillary thyroid carcinoma (PTC), encouraging aggressive treatments. However, inconsistency and even contradiction in a literature is present concerning the role of tumor multifocality in clinical outcomes of PTC. Therefore, the prognostic value of multifocality of PTC remains controversial, creating a difficulty in the current clinical management. Methods.We analyzed miR-146b, miR-21, miR-221, miR-21, and miR-181b in formalin fixed paraffin embedded PTC tissue samples of 312 individuals and evaluated their expression relationship with multifocality of a tumor. Results. Multifocality was observed in 68 (21,7%) of the PTC patients. Patients with multifocal lesions had significantly lower expression of miR-21 than those with unifocal (nZ224) lesions (P<0.011) in our study. MiR-146b, -221, -222, 181b expression did not statistically significantly differ between these groups. Conclusions Our results suggest that lower expression of miR-21 is related to multifocal lesions. Data from numerous other studies confirm that miR-21 is usually overexpressed in PTC associated with aggressive clinicopathological features. So,our findings of lower miR-21 expression let us to hypothesize, that multifocality might not be a risk factor of poor PTC prognosis.

Background and objectives. It is important to differentiate papillary thyroid cancer (PTC) from benign thyroid nodule early enough to avoid an advanced disease course. Therefore, the non-invasive biomarkers of PTC are needed. The aim of this study was to analyze a set of five miRNA molecules (miR-221, miR-222, miR-146b, miR-21, miR-181b) inplasma of patients with papillary thyroid cancer (PTC), nodular goiter (NG) and healthy controls (HC) and evaluate their diagnostic value for differentiation of PTC from NG and HC. Material (patients) and research method used. The expression of miRNAs was measured using qRT-PCR. Prospective PTC plasma miRNA expression (n=49) was compared with plasma miRNA in the HC group (n=57) and patients with NG (n=23). To evaluate the diagnostic value of circulating miR-146b, miR-222, miR21, miR-221 and miR-181b, ROC analysis was performed. Findings/results in sufficient details to support conclusions. After ROC analysis, all five miRNAs had statistically significant satisfactory or good diagnostic values to differentiate PTC patients from healthy controls. MiR-221 had the highest AUC of 0.792 (95% CI=0.708-0.877, with 73,5% sensitivity and 73.7% specificity at the cutoff value of 0.0104. [...].

Aim: We investigated whether a difference exists between TSHR, PTEN and RASSF1A methylation status in plasma of subjects with papillary thyroid cancer (PTC).Methods: Peripheral blood samples were collected from 68 patients with PTC and 86 healthy controls (HC). Thyroid cancer tissue and corresponding adjacent normal tissue methylation levels were analyzed. DNA methylation level changes in TSHR, PTEN and RASSF1A genes were analyzed by quantitative methylation-sensitive polymerase chain reaction.Results: We observed that the methylation level of TSHR was significantly higher in the thyroid cancer tissue compared to adjacent normal tissue (p = 0.040). TSHR methylation levels in the PTC group plasma samples were significantly higher compared to HC (p = 0.022). After surgery, PTC plasma samples showed lower TSHR and PTEN methylation levels compared to the levels before surgery (p = 0.003, p = 0.031, respectively). The TSHR methylation level was significantly higher in PTC with larger tumor size (>2 cm) (p < 0.001), and lymph node metastases (p = 0.01), lymphovascular invasion (p = 0.02) and multifocality (p = 0.013) 0ROC analysis revealed that the TSHR methylation level provides high accuracy in distinguishing PTC from HC (p = 0.022, AUC of 0.616).Conclusion: TSHR methylation in peripheral blood samples is expected to be a sensitive and specific minimally invasive tool for the diagnosis of PTC, especially in combination with other diagnostic means.