Keywords Hashimoto's thyroiditis; TBII; Graves hyperthyroidism; TSH receptor antibodies; autoimmune conversion

Objective: The objective of this study was to assess changes in body composition, with a specific focus on fat mass (FM) and fat-free mass (FFM), in obese adults with type 2 diabetes (T2D) treated with once-weekly (OW) subcutaneous (s.c.) semaglutide. Methods: This was a single-center, 12-month, real-world, ambispective study (6-month prospective and 6-month retrospective). Body composition parameters were assessed via segmental multifrequency bioelectrical impedance analysis (SMF-BIA). Results: A total of 117 patients with DM2, with a median age of 56 years, a median HbA1c level of 9.4%, and a median body weight of 102.5 kg, were included in the study. The median body weight, body fat mass, and visceral fat significantly decreased at 6 months, with values of −9.3, −7.5, and −1.8 kg, respectively. There were further reductions from 6 to 12 months, albeit at a slower rate. The median skeletal muscle mass significantly decreased at 6 months (−1.2 kg), although no further significant reductions were observed at 12 months. Conclusions: OW s.c. semaglutide for 12 months significantly improved body composition parameters, mainly at the expense of fat mass loss, with the preservation of skeletal muscle mass. These changes are clinically meaningful, since they impact general metabolic health and are associated with improvements in metabolic control and clinical parameters associated with renal and CV risks, as well as presumable improvements in quality of life.

Phantom hCG refers to persistent mild elevations of hCG, leading physicians to unnecessary treatments whereas neither a true hCG nor a trophoblastic disease is present. We report the case of a 23-year-old woman with persistent low levels of serum hCG detected one month after miscarriage. As choriocarcinoma was suspected, a chemotherapy trial of methotrexate was prescribed, without any hCG reduction. Subsequently, laparoscopy ruled out a trophoblastic residue and the patient was referred to the Endocrine Unit for further investigations. While low levels of hCG were still detected in serum, no hCG was detected in the urine. In addition, when serum was processed in a HBT tube for revealing heterophilic antibodies, hCG was no longer detected. Such finding indicated the presence of phantom hCG due to heterophilic mouse antibodies interaction. This case raises the need of clinico-biological discussion to avoid inappropriate therapeutic decisions. Based on this case experience and after review of the literature, we suggest that current gynecological protocols for the diagnosis and treatment of trophoblastic disease should consider the inclusion of urinary hCG and/or a test for serum heterophilic antibodies when appropriate.

Purpose: To extend a prior real-world analysis (DARWIN-T2D) of patients with type 2 diabetes initiating dapagliflozin in Italy, Greece, and Spain by evaluating changes in glycemic and extra-glycemic endpoints after initiation of dapagliflozin. Patients and Methods: The association among demographic/clinical characteristics and the change in glycemic and extraglycemic effectiveness endpoints during the observation period was assayed using a mixed effects model. Results: A total of 1438 (860 males; 59.8%) patients were evaluated; patients were followed for a mean of 5.6 months. At baseline, 93.4% and 61.9% of patients were on concomitant metformin and insulin, respectively. A significant mean decrease in HbA1c from 8.7% to 7.5% was observed. The mixed model used also revealed several associations between different glycemic and laboratory parameters and patient characteristics at baseline; insulin use was significantly associated with lower HbA1c. Patients with BMI ≥ 30 kg/m² experienced greater weight loss than those with BMI < 30 kg/m². A consistent glucose-lowering effect of dapagliflozin was seen in all subgroups of patients, including those with stage 2 renal impairment and cardiovascular disease. Conclusion: The present analysis confirms the efficacy of dapagliflozin in diversified real-world settings with broadly similar effects on HbA1c across countries and baseline characteristics.

La nutrición parenteral en domicilio (NPD) es una técnica que ha permitido la supervivencia en la comunidad de aquellos pacientes con enfermedades graves resultantes en un fallo intestinal que hacía imposible su nutrición por otros métodos. Esta está indicada si existe un fallo intestinal documentado (entendido como la reducción de la función intestinal al mínimo hasta el punto de que se requiere suplementación intravenosa para mantener la salud y/o el crecimiento) con imposibilidad para la nutrición exclusiva por vía oral/enteral, posibilidad de manejo del enfermo en el domicilio y que no exista una expectativa corta de supervivencia, teniendo en cuenta la calidad de vida del paciente, el entorno familiar y la capacidad del paciente y/o de sus cuidadores de entrenamiento para la terapia de NPD. En los problemas de salud poco prevalentes, como es el fallo intestinal, en los cuales la evidencia científi ca disponible es de baja calidad, los documentos de consenso/expertos aportan valor en la toma de decisiones. Se suma a ello que la NPD es un proceso muy complejo y, a pesar de que existe una amplia experiencia en su aplicación e incluso guías de práctica clínica, en la práctica diaria se plantean incertidumbres acerca de su conveniencia, utilidad, uso racional y costes asociados. Por este motivo se ha realizado este documento de consenso, utilizando el método GRADE, con el que pretendemos defi nir nuestra posición con respecto al uso actual de la NPD en nuestro país y dar respuesta a una serie de preguntas que generan controversia en relación a este tratamiento.