Background: Women of reproductive age with differentiated thyroid cancer (DTC) often need to receive radioactive iodine (RAI) treatment after surgery. In contrast to the well documented effect of RAI on testicular function, the potential negative effects of this treatment on ovarian reserve have been largely dismissed. The objective of this pilot study was to examine the possibility that RAI treatment is deleterious to the ovarian reserve by prospectively measuring the concentration of anti-Müllerian hormone (AMH) after this treatment. Methods: Thirty premenopausal women (aged 34 years, range 20-45) with a new diagnosis of DTC scheduled to undergo RAI ablation were recruited for this study. All of them had TNM stage 1 disease (T1-3, N0 or N1, M0), and were scheduled to receive RAI doses ranging from 30-150 mCi. AMH was measured at baseline, and 3, 6, 9 and 12 months after the administration of RAI. Results: Of the 30 women, only 24 returned after the baseline assessment. RAI treatment resulted in a significant decrease in AMH concentrations at 3 months, from 3.252.75 to 1.91.74 ng/ml, P<0.0001. Only partial recovery was subsequently documented, 82% of subjects had final values below baseline levels, such that at one year serum AMH was still 32% lower than prior to treatment (2.361.88 ng/ml, P35) subjects were significantly more likely to experience a marked AMH reduction at 3 months (63.7±18.5% vs 33.1± 29.2%, P=0.01). The only predictor of recovery after 1 year was the extent of AMH decrease at 3 months: the lower the decline, the higher the chances for recovery. Conclusions: RAI in DTC has a rapid and profound effect on ovarian reserve with only a partial recovery potential. In an era of declining human fertility, RAI should be carefully planned in women of reproductive age. AMH measurement could be used as a tool in this decision-making process.

Purpose: Chronic gender-affirming hormone therapy (GAHT) with sublingual estradiol (SLE) has not been studied. We aimed to compare GAHT with SLE only, to combined oral (CO) estradiol and cyproterone acetate, in treatment-naive trans women. Methods: Twenty-two trans women enrolled into either the CO arm or the SLE-only arm (0.5 mg four times daily) in this 6-month prospective study. Anthropometric and laboratory variables were collected at baseline and 3 and 6 months. At the study beginning and end, body composition was measured by dual-energy X-ray absorptiometry and bioelectrical impedance, and gender dysphoria, sexual desire, and function were assessed by validated questionnaires. Results: Subjects in the SLE were older, 26.3±5.8 years versus 20.1±2.3 years, p=0.006. All anthropometric, body composition, and laboratory variables were identical at baseline. Although dysphoria appeared greater, and sexual function lower at baseline in the CO group, this canceled out after age adjustment. Both treatments induced similar biochemical and hormonal changes. Creatinine, hemoglobin and cholesterol decreased significantly, while testosterone was suppressed to the same level in both groups: 3.22 [1.47–5.0] nmol/L in the SLE group and 2.41 [0.55–8.5] nmol/L in the CO, p=0.65. Significant changes in body composition toward a more feminine body were noted in both groups. Dysphoria did not significantly improve in either group, while sexual desire and function decreased at six months in both, p<0.001. Conclusions: Both treatments achieved similar clinical changes. At this stage, SLE, which repeatedly induces alarming excursions of serum estradiol throughout the day, appears to offer no advantage over the CO approach.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by progressive loss of motor neurons, but non-motor manifestations including autonomic dysfunction have been reported. To better understand the autonomic involvement in ALS we measured blood pressure (BP) changes. We evaluated blood pressure (BP) in a transgenic (TG) SOD1-G93A mouse model of ALS. BP was recorded in awake mice from six to 19 weeks of age by the tail-cuff method. TG mice (n =15) had significantly elevated BP compared to their wild-type (WT) siblings (n =14) even prior to the clinical appearance of motor dysfunction (at age 10–11 weeks, p =0.026). BP gradually decreased in TG mice but not in WT mice from age 10–11 weeks until the advanced stages of the disease (p for trend <0.002). The results indicate impairment of cardiovascular control in this ALS model.