PRESERVATION OF CELL TYPE
Differentiated thyroid cancer represents most (90%-95%) types of thyroid cancer and includes papillary, follicular, and Hürthle cell carcinomas (HCCs) (6). Cellular differentiation is a central aspect in the histopathologic classification for thyroid follicular epithelial cell-derived cancers and refers to the process by which a cell becomes specialized to perform a specific function. Differentiated thyroid cancers maintain the characteristics and behavior of normal follicular epithelial cells in thyroid tissue. These cells retain many of the physiologic functions of thyroid cells, including thyroid-stimulating hormone (TSH, also called thyrotropin) stimulation of growth, iodine uptake (expression of sodium iodine symporter), and thyroid hormone production (9). Differentiated thyroid cancers maintain radioactive iodine (RAI) avidity, which permits the use of RAI scintigraphy and treatment as part of the disease management strategy. As a general rule, differentiated cancers tend to be less aggressive than undifferentiated cancers (9).
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- PCOS Weight Loss Medication By Christine Traxler, MD Medically Reviewed by Kim Langdon, MD on 07.16.23 Polycystic ovary syndrome (PCOS) is a complex metabolic disorder seen in up to 12% of women of reproductive age. While the name suggests it results in cysts on your ovaries, you don’t have to actually have cysts to have this disorder. Some of the more common symptoms of PCOS include menstrual irregularities, insulin resistance, weight gain, excess facial and body hair, mood dysfunction, acne, and infertility. When you combine excess weight with high blood sugar, you risk complications like diabetes, heart disease, and certain hormone-sensitive cancers. Among women trying to manage the disorder, the biggest challenge is fighting weight gain with PCOS. Weight gain around the midsection—sometimes referred to as PCOS belly—is often due to the combination of male hormone dominance and insulin resistance. Weight loss is important to managing PCOS because even a small amount of weight loss (around 5% to 10% of your total weight) can have a significant impact on symptoms and outcome. You may be wondering if medications like those we have been hearing so much about lately could help someone with PCOS lose weight. The answer is yes. Medications used for weight loss in other situations may also benefit those with PCOS and obesity. Some options include Orlistat, metformin, and semaglutide (brands Ozempic and Wegovy). They act in different ways to improve weight loss. Many are specifically recommended for those who have type 2 diabetes. This guide goes over the medications you can consider if you want to lose weight with PCOS. Learn how the medications work and the side effects you may experience if your doctor prescribes them for you. Medications that can help with PCOS weight loss Some women with PCOS can lose weight using only diet and exercise. In many cases, weight loss can be achieved by eating food with fewer calories and burning them through increased activity. Others have metabolic issues like low thyroid function and insulin resistance that negatively impact their ability to lose weight. If you’re having difficulty losing weight with PCOS, you may want to talk to your doctor about taking medications to help you lose weight. Your doctor is the best resource for deciding which, if any, of these medications are appropriate for your unique condition. This list will hopefully help you collaborate with your doctor by explaining how they work. It is not intended to provide you with medical advice but, instead, to educate you regarding what’s out there and why they help some individuals with PCOS and obesity. Metformin Metformin is a commonly used drug for diabetes and prediabetes. When it was studied in the prevention of diabetes, researchers noted that those who took the drug steadily prevented diabetes by 31%. In addition, users of metformin lost about 3.5% of their body weight and kept it off. The fat loss was more often located around the midsection. Metformin acts to reduce the risk of diabetes by blocking the production of excess glucose in the liver. When it does this, less insulin is released by the pancreas. In addition, it reduces appetite and changes the gut microbiome to promote enhanced weight loss. The major side effects of metformin are nausea, diarrhea, and bloating, which may also transiently affect appetite. It may cause some foods to taste different, too. Researchers have noted that you would need to remain on the drug long-term to reap the maximum benefits. Weight gain after stopping metformin is entirely possible. Take Control of PCOS by Partnering With a Dietitian 90% of Zaya Care patients pay $0 for one-on-one counseling with a Registered Dietitan >> Find Your Match Acarbose (Precose) Acarbose is an antidiabetic drug that prevents glucose absorption by blocking the enzymes responsible for bringing glucose into the bloodstream from the gut. The drug itself doesn’t get absorbed into your system to a great degree. By blocking sugar uptake, acarbose lowers blood sugar and insulin levels. Acarbose has been found to reduce triglycerides and lower the risk of diabetic complications. Those who take it have reduced weight compared to those taking a placebo. In one study, the BMI was reduced from 30 (obesity) to an average of around 23 (normal). The main side effects of acarbose are flatulence and diarrhea. This occurs because there is excess food that doesn’t get absorbed by the gut, particularly carbohydrates. Like most of these medications, stopping the medicine may mean that you’ll gain the weight back. Orlistat (Alli or Xenical) Orlistat has been used for several years to reduce weight in individuals with or without diabetes. It is not an antidiabetic agent but instead inhibits a pancreatic enzyme called lipase. It prevents the absorption of dietary fat. Other nutrients are easily absorbed without change. Years of use of the drug from the time it was placed on the market in 1999 indicate that it does promote a modest weight loss among those who use it regularly. Only about four to six pounds of excess weight are lost in most individuals but, for some, it can improve the risk of obesity complications. The main side effects are greasy stools and diarrhea, but they tend to pass within a few weeks in most users. Rarely, the drug can cause kidney stones or an inflamed pancreas. Tizepatide (Mounjaro) Tizepatide (Mounjaro) is a drug acting in two ways to combat diabetes. It mimics the GIP hormone (glucose-dependent insulinotropic peptide) and also acts on the GLP-1 (glucagon-like peptide-1) receptors. The result is a reduced amount of glucose sugar entering the body from the GI tract. By lowering blood sugar, insulin levels are reduced. For those with obesity, Tizepatide lowers body weight by up to 20% of your original weight. Lipid metabolism is also improved. Appetite can be suppressed and, for those with diabetes, blood sugar is reduced. Mounjaro must be injected into the soft tissue of your body (often under the skin of the abdomen or thigh) every week. Side effects can include nausea or abdominal pain. Diarrhea or constipation may occur as well. It is also extremely expensive if your insurance won’t cover it. >> Read more: Mounjaro diet plan: Best foods to eat & which to avoid Liraglutide (Victoza or Saxenda) Liraglutide is an injectable drug that acts as a GLP-1 agonist. When you take it, it can promote insulin secretion, slow gastric emptying, and suppress your appetite. It is believed that this is how weight loss is achieved. It also improves diabetic control in those who have diabetes or prediabetes. Liraglutide must be injected regularly to be effective. Most doctors begin prescribing a low dose injected daily to see how well you tolerate it. Side effects are mostly gastrointestinal in nature (nausea, stomach pains, constipation, or diarrhea). Individuals using this drug lose about 10 to 11 pounds on average, mostly because they aren’t hungry. Low blood sugar does not happen as long as other diabetic drugs aren’t taken at the same time; however, those with high blood sugar have improved blood sugar numbers. >> Read more: Saxenda diet plan: Best foods to eat & which to avoid Semaglutide (Ozempic or Wegovy) There are two drugs marketed under the generic name of semaglutide. They are the same drug; however, Ozempic is prescribed for diabetes, while Wegovy has been approved for weight loss. Other than the semantics, these GLP-1 receptor agonists are the same drug. Both are injected; however, some take the drug daily and others take it once per week. Like all of these GLP-1 receptor agonists, the side effects include nausea, abdominal pain, bloating, and diarrhea or constipation. They act to reduce your appetite and slow the emptying of your GI tract. On average, it takes around 6 months to lose 11% of your weight on Ozempic, but it varies from person to person. Note that Ozempic typically isn’t covered by insurance unless it’s prescribed for diabetes. Wegovy, on the other hand, can be prescribed for weight loss and is covered by many insurance plans. You can learn more about what the research says about using Ozempic for PCOS here. >> Read more: Ozempic diet plan: Best foods to eat & which to avoidWhy am I not losing weight on Ozempic?Cost of Wegovy with & without insurance Phentermine-Topiramate Phentermine-topiramate is a combination drug used for short-term weight loss. It is an oral pill that combines phentermine (a stimulant) and topiramate (often used as an anticonvulsant). The drug has the potential for abuse because the phentermine is similar to amphetamine, so few doctors prescribe it. It is an oral pill that suppresses your appetite. This results in weight loss that varies by person. It is only recommended for 12 weeks or less and may increase heart rate or cause nervousness in some individuals. In women of reproductive age, it can cause birth defects if a pregnancy occurs. >> Find a PCOS nutritionist who accepts your insurance How insulin resistance from PCOS causes weight gain Why would drugs used for diabetes help weight loss? Much of this question is answered by understanding the impact of insulin resistance on weight. Insulin resistance is the underlying problem among most with type 2 diabetes. When sugar enters the body, insulin is produced to put it into the cells. If you are resistant to the effects of insulin, the sugar remains in the bloodstream, unable to enter and nourish the cells of your body. This excess, unused energy is put into the fat cells as fatty acids. PCOS and insulin resistance go hand-in-hand. If you have PCOS, you almost certainly have insulin resistance. The drugs most often effective in weight loss are those that also lower blood sugar and improve your sensitivity to insulin. Once you lose some weight, you will naturally improve insulin resistance because less fat means your insulin will work better—even if you stop taking weight loss medication. >> Read more: Supplements that may help with PCOS weight loss How a nutritionist can help with PCOS weight gain Losing weight is never a matter of just taking a pill or injecting yourself with a drug. It often takes increased physical activity and better eating habits to lose weight and keep it off. Unless you need the drugs for type 2 diabetes, you may decide to stop taking them after losing enough weight. A PCOS nutritionist can help in so many ways. PCOS nutritionists are trained in nutrition and the intricacies of managing PCOS through nutrition. Your PCOS nutritionist can evaluate your goals and current situation. They can make food recommendations and help you create a PCOS diet plan that will work at any stage in the weight loss process. While they cannot prescribe medications, a PCOS nutritionist can help you determine how diet and exercise can work with weight loss medication to influence your weight. They can also help you cope with the side effects of medications like nausea and constipation through changes to your meal plan. A nutritionist specializing in women’s health issues like PCOS can follow your progress, helping you succeed through individual attention and personalized recommendations so you can achieve your health-related goals. Take Control of PCOS by Partnering With a Dietitian 90% of Zaya Care patients pay $0 for one-on-one counseling with a Registered Dietitan >> Find Your Match By Christine Traxler, MD Christine Traxler MD is a family physician, lifelong writer, and author with a special interest in mental health, women’s healthcare, and the physical after-effects of psychological trauma. As a contributing writer and editor for numerous organizations, she brings a holistic focus to her work that emphasizes healing and wellness through daily self-care, connecting with others, and setting stepwise goals toward achieving more balanced and authentic lives.
Poorly differentiated thyroid cancer (PDTC) was at one time considered a variant of differentiated thyroid cancer; however, the World Health Organization began recognizing it as a distinct pathologic entity in 2004 because the clinical and histologic features occupy an intermediate position between differentiated thyroid cancer and undifferentiated thyroid cancer (10-13). PDTC occurs de novo; however, there is a theory that PDTC may also transform from differentiated thyroid cancers through the accumulation of genetic abnormalities (11,14). This theory is supported by the frequent cooccurrence of PDTC and differentiated thyroid cancer in the same tumor specimen and the overlap of genetic mutations (11). When PDTC and well-differentiated thyroid cancer are present in the same tissue sample, it is important to note the presence of PDTC, as prognosis and treatment strategies may be guided by the PDTC component (10). Given that PDTCs are often resistant to RAI therapy, these cancers present a therapeutic challenge (11,12). Outcome statistics for PDTCs are worse than for differentiated thyroid cancers. In PDTCs, approximately 50% of patients survive after 10 y, whereas in differentiated thyroid cancers, particularly papillary thyroid carcinoma (PTC), 95% of patients survive after 10 y (13).
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Undifferentiated thyroid cancer includes anaplastic thyroid carcinoma (ATC), a very rare form of thyroid carcinoma accounting for less than 1% of all thyroid carcinomas (15). Undifferentiated thyroid cancer may occur de novo or may transform from a previously differentiated thyroid cancer (more commonly PTC, but also follicular thyroid carcinoma [FTC] and PDTC) (12,14). A signature attribute of many advanced tumors is cellular dedifferentiation, whereby cancerous cells maintain little to no resemblance to the normal cells from which the cancer originated. In the context of thyroid cancer, loss of RAI avidity most commonly develops from cellular dedifferentiation, resulting in the impairment of the sodium iodine symporter function (14,15). Loss of iodine avidity excludes the use of RAI scintigraphy and treatment. As thyroid cancer cells dedifferentiate, their glucose metabolism increases, allowing for evaluation with 18F-FDG PET/CT (16). Overall outcomes and survival statistics are poor for undifferentiated thyroid cancer, with a mean survival of 0.5 y after diagnosis (15).
Figure 1 illustrates the cellular differentiation stage for follicular epithelial cell-derived thyroid carcinomas and how it relates to radioiodine scintigraphy/treatment and overall prognosis.
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This post was last modified on Tháng mười một 20, 2024 1:14 sáng