Publication of march 2025

  • 19e Congrès UCLouvain d’Endocrino-Diabétologie

 

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19e Congrès UCLouvain d’Endocrino-Diabétologie

Management of type 2 diabetes in the era of blood glucose sensors

Blood glucose sensors for continuous interstitial glucose monitoring are reimbursed in Belgium for certain categories of type 2 diabetics treated with basal-prandial insulin regimens under the Diabetes Convention. They provide a better assessment of glycemic exposure, allowing finer tuning of insulin doses and adjustment of non-insulin glucose-lowering medications. As with type 1 diabetes, their use requires reevaluation of dietary practices and guided dietary counseling based on ambulatory measurements as a result of improved assessment of glycemic exposure, including postprandial excursions and nocturnal glucose.

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19e Congrès UCLouvain d’Endocrino-Diabétologie

Optimizing antihyperglycemic therapy in elderly people living...

Type 2 diabetes treatment in older adults presents a clinical challenge due to a benefit-risk balance that is increasingly compromised by ageing and comorbidities. This review explores the concepts of overtreatment and deprescribing of glucose-lowering treatments, which are essential for optimizing the management of this heterogeneous population. Beyond highlighting their relevance, it underlines current knowledge gaps and the need for further research to develop a more individualized, effective, and safe therapeutic approach for older adults living with type 2 diabetes.

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19e Congrès UCLouvain d’Endocrino-Diabétologie

Thyroid and Female Subfertility

Severe thyroid dysfunction can lead to subfertility via different pathways like altered menstruations, changes in reproductive hormone levels and through a direct impact on the ovaries. Fertility problems may persist even after thyroid function normalization, and require surgery and/or an assisted reproductive technology (ART). Several studies showed that women with polycystic ovarian syndrome and idiopathic subfertility have a higher prevalence of thyroid autoimmunity (TAI) compared with fertile women or women with other subfertility causes.

Prior to ART treatment, ovarian stimulation (OS) is performed, leading to high estradiol levels, in turn potentially resulting in (subclinical) hypothyroidism in women with TAI, requiring thyroid hormone supplements (LT4) before pregnancy. Women with (subclinical) hypothyroidism prior to OS and treated with LT4 should target a serum TSH level <2.5mIU/L.

In meta-analyses including women with TSH levels >4.0mIU//L, LT4 increased live birth rates, but this was not the case in euthyroid women with TAI. However, the use of intracytoplasmic sperm injection seems to be promising in those women. 

Based on the above-mentioned reasons, routinely screening for thyroid disorders in women of subfertile couples is strongly advised.

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19e Congrès UCLouvain d’Endocrino-Diabétologie

“Is there still a place for scintigraphy in the assessment of...

Thyroid nodules are a very common issue in the adult population. Thyroid scintigraphy is the only method available to assess the functional characteristics of thyroid nodules. Hyperfunctional nodules, also known as hot or autonomous nodules, are characterized by an increased isotope uptake compared to the adjacent thyroid parenchyma. They present activating somatic mutations in the TSHR and GNAS genes, are rarely malignant, and their prevalence increases in iodine-deficient regions. Cytological examination of these nodules frequently shows indeterminate results, which can lead to unnecessary therapeutic procedures.

Although recommendations limit scintigraphy use to thyroid nodule assessment in cases of low serum TSH, many European studies have shown that a subnormal TSH level does not effectively exclude the presence of a hyperfunctional nodule. In our prospective study conducted between 2018 and 2021, among the 67 hyperfunctional nodules evaluated, 50% of patients presented with normal serum TSH levels, 70% had a EU-TIRADS 4 ultrasound score suggesting an intermediate malignancy risk, and 50% of the nodules submitted to cytology yielded indeterminate results. No malignancy was detected upon histological examination of the hyperfunctional nodules submitted to surgical excision. 

Scintigraphy may still be relevant in the initial assessment of thyroid nodules in selected populations, namely patients with a TSH level <2mU/L in regions with past or current iodine deficiency, in order to avoid unnecessary diagnostic and surgical procedures.

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19e Congrès UCLouvain d’Endocrino-Diabétologie

Thyroid nodules in children: Clinical approach and management

Thyroid nodules in children, although relatively rare, have become more frequently diagnosed due to progress in imaging techniques, such as ultrasound. These nodules can either be benign or malignant, with a significant difference in prognosis. This article reviews the clinical, diagnostic, and therapeutic aspects of thyroid nodules in children, emphasizing the importance of a careful and individualized approach. The clinical evaluation includes consideration of risk factors such as radiation exposure and family history, along with physical signs like nodule palpability and lymphadenopathy. Ultrasound is the primary diagnostic tool, with high-frequency probes (≥12MHz) providing detailed information on nodule size, structure, and suspicious features. The TIRADS classification system is used to stratify malignancy risk, guiding decisions regarding biopsy or monitoring. Fine needle aspiration (FNA) is recommended for nodules with suspicious ultrasound features and has a sensitivity of 86-100% and specificity of 65-98.5%. If FNA results are inconclusive, further imaging and FNA procedures are indicated. Regular follow-up is essential, with a new ultrasound recommended every 6 to 12 months. Malignant cases require surgery and ongoing clinical monitoring. The article also highlights the management guidelines by the American Thyroid Association for pediatric thyroid nodules and differentiated thyroid cancer.

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Neurology

Introduction of the p-tau217 blood test in Belgium: a major...

Alzheimer’s disease is characterized by the accumulation of amyloid plaques and neurofibrillary tangles of tau protein. Current biomarkers measured by imaging or in the cerebrospinal fluid have improved diagnosis, but these methods remain costly and/or invasive. Blood biomarkers, particularly p-tau217, are attracting increasing interest. A study conducted by IoNS (UCLouvain) validated the plasma p-tau217 assay in more than 200 patients, showing an average increase of 450% in patients with amyloidopathy, with a sensitivity of 95% and a specificity of 94% to distinguish patients with amyloidopathy and tauopathy from those without. This test is reserved for patients with objective cognitive impairment and is not intended for mass screening, as there is currently no preventive treatment. It is essential to account for potential confounding factors (renal insufficiency, stroke, recent head trauma). Finally, p-tau217 could help identify patients eligible for new treatments in the pipeline for approval in the near future, such as lecanemab.

 

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STOPP/START.v2

The tool STOPP / START.v2 allows evaluation of drug treatments prescribed to patients age 65 and older.

 

This tool, designed for all care settings, stimulates thinking and challenging medication taken by patients, especially drugs forcardiovascular and nervous system.

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