Objective: Increased resting heart rate (RHR) is a typical sign of thyrotoxicosis. RHR may therefore serve as a monitoring tool, but longitudinal data on continuous measures of RHR and thyroid hormones are sparse. We evaluated the association between continuously monitored RHR and thyroid function tests in Graves’ disease (GD). Design: This is a double-center, prospective, longitudinal cohort study in 30 patients with GD on antithyroid drug treatment. Participants were followed up with monthly study visits over six months at two hospitals in Graz, Austria. Methods: Free thyroxine (fT4) and free triiodothyronine (fT3) were measured at each study visit. Participants were encouraged to continuously wear a wristband activity tracker (Fitbit Charge 6) to assess RHR. Associations of RHR (mean value over ten days) with thyroid hormones were determined by generalized estimating equation analyses. Results: From September 2024 to November 2025, we enrolled 30 participants (24 women, mean (SD) age of 40.7 (14.6) years) and performed 176 study visits. Thyrotoxicosis was present in 24 participants (80%) at baseline. One SD increase in RHR of 8.8 beats per minute was associated with fT4 (beta = 0.856, 95% CI: 0.641–1.071, P < 0.001), fT3 (beta = 0.836, 95% CI: 0.620–1.051, P < 0.001), and thyrotoxicosis (odds ratio: 5.134, 95% CI: 2.192–12.025, P < 0.001), respectively. Conclusion: RHR assessed by a wearable device is strongly associated with thyroid hormones in GD. Further trials are required to evaluate whether RHR is useful to guide timing of thyroid function tests during antithyroid drug treatment and for GD diagnostics.

The Choosing Wisely Initiative (CWI) was founded in 2012 and aims to reduce unnecessary healthcare to promote the common good. The Austrian Society for Endocrinology and Metabolism (& Ouml;GES) and the Institute of General Practice and Evidence-Based Health Services Research at the Medical University of Graz released five Choosing Wisely recommendations in the field of endocrinology. The recommendations presented and discussed in this article are the following: 1. "Thyroid nodules patients should not be treated with L-thyroxine except in selected cases." 2. "Avoid excess bone mineral density testing: intervals less than two years are rarely necessary." 3. "Don't prescribe testosterone therapy to older men except in confirmed cases of hypogonadism." 4. "Don't routinely test for anti-thyroid peroxidase antibodies (TPO-Ab)."5. "Do not routinely request/perform thyroid ultrasound in subjects without signs and/or symptoms of thyroid disease and not belonging to risk groups for thyroid cancer and limit the indication and execution of fine-needle aspirations on low-risk nodules." Resources unnecessarily consumed in one area of the healthcare system are lacking in others, which is why it is an important ethical responsibility, for the common good, to minimize unnecessary overdiagnosis and overtreatment.

In July 2025, the Endocrine Society published a new guideline on primary aldosteronism (PA), which is summarized and discussed in this article along with pragmatic guidance for its implementation in clinical routine. This guideline suggests screening for PA in all (!) patients with arterial hypertension. The determination of aldosterone and renin, as well as the aldosterone to renin ratio (ARR), remains the recommended screening test for PA. These laboratory measurements can be performed with any ongoing medication as part of a no medication withdrawal strategy to facilitate a wide screening to reduce the enormous underdiagnosis of PA. Confirmatory tests such as the saline infusion test are rarely required. The further management of patients with a positive screening test is guided by individual patient characteristics, but at any stage of PA diagnostics, medical PA therapy with a mineralocorticoid receptor antagonist (MRA), preferentially spironolactone, can be initiated. Beyond improvements of blood pressure and potassium, an increase in renin from baseline is now also a therapeutic target for MRA therapy. In addition to computed tomography (CT), adrenal venous sampling (AVS) is still highly recommended for subtype classification, though there is also evidence supporting a solely CT-based procedure. The dichotomous subtype classification into unilateral versus bilateral aldosterone secretion, that is, PHA types with preferentially surgical versus medical therapy, has recently been questioned by histopathologic, genetic, and clinical data. Various drugs such as nonsteroidal MRA and aldosterone synthase inhibitors, positive data on successful treatment of PA with radiofrequency ablation, and nuclear imaging methods (e.g,. 11C-Metomidate PET-CT and 68Ga-Pentixafor PET-CT) that perform as least as good as AVS, are currently emerging options for the care of PA patients.

Background/objectivesVitamin K and D co-treatment may have additive effects on bone and cardiovascular health and is frequently used as an over-the-counter supplement. The primary aim of this study was to assess whether the effect of vitamin D supplementation on bone turnover markers and cardiovascular parameters is modified according to vitamin K status at baseline (i.e., serum levels of vitamin K1, MK4 and MK7).MethodsThis is a post-hoc analysis of a randomized controlled vitamin D supplementation (2,800 international units daily for 8 weeks) trial in 200 participants. We measured vitamin K1, MK4 and MK7 by means of the currently available gold standard liquid chromatography tandem mass spectrometric and analysed cardiovascular and bone markers (including 24-h systolic and diastolic blood pressure, glucose and lipid parameters as well as osteocalcin, beta-crosslaps, and procollagen type 1 N-terminal propeptide). The main aim was to analyze whether pre-intervention vitamin K status (moderator) influenced the effects of vitamin D supplementation on outcome measures of bone and cardiovascular health after the intervention (moderation analyses). We also investigated whether vitamin D supplementation effects vitamin K status and whether vitamin K measures correlated with the outcome parameters.ResultsModeration analyses showed no significant interaction between vitamin K status and the intervention (vitamin D supplementation/placebo) on cardiovascular or bone parameters. We observed no treatment effect of vitamin D on vitamin K status. In exploratory analyses, parameters of vitamin K status correlated only weakly and inconsistently with some bone and cardiovascular parameters.ConclusionThe data from this post-hoc analysis do not provide evidence for the assumption that vitamin K status modifies or enhances effects of vitamin D supplementation on cardiovascular or bone parameters. These findings are in line with current guidelines, which do not routinely recommend vitamin K and D co-treatment in patients with osteoporosis. However, further trials are needed to evaluate the potential benefits of vitamin K supplementation and its combination with vitamin D.

Adrenal incidentalomas are detected in about 1.4-7% of adults in CT or MRI scans. In all adrenal incidentalomas >= 1 cm, the risk of malignancy must be assessed and biochemical workup performed, including a 1 mg dexamethasone suppression test. In the case of post-dexamethasone serum cortisol levels >50 nmol/l (>1.8 mu g/dl), adrenocorticotropic hormone (ACTH) independency, and lack of typical signs of Cushing's syndrome, mild autonomous cortisol secretion (MACS) is diagnosed. Patients with MACS have a reduced quality of life as well as a higher risk of sleep disturbances, psychiatric comorbidities, and bone fractures. Above all, however, affected patients have an increased cardiovascular risk due to the development of diabetes, arterial hypertension, and dyslipidemia; they thus have higher cardiovascular mortality rates. Without accompanying comorbidities, a conservative treatment approach is feasible with annual follow-up evaluation of blood pressure, HbA1c, low-(LDL) and high-density lipoprotein (HDL) cholesterol, triglycerides, and bodyweight. Patients with unilateral adenomas and potentially cortisol-associated comorbidities that are progressive, difficult to control, associated with inadequate-for-age end organ damage, or are multiple should be referred for adrenalectomy. About 50% of patients develop adrenal insufficiency postoperatively, which is why biochemical testing of cortisol and/or ACTH stimulation is necessary. Until adrenal insufficiency has been excluded, cortisol replacement with hydrocortisone is paramount. If adrenal insufficiency is confirmed, continuation of cortisol replacement and regular endocrine follow-up until recovery of the pituitary-adrenal axis are warranted.

Adrenale Inzidentalome werden bei ca. 1,4–7

Objective One of the most severe endocrine side effects of immune checkpoint inhibitors (ICI) is hypophysitis leading to adrenal insufficiency. Recovery is rare, although it has been reported after high-dose glucocorticoid treatment. This is the first randomised study to evaluate whether hormonal recovery differs in patients treated with high-dose glucocorticoids versus glucocorticoid replacement therapy.Design/Methods In this single-centre, open, randomised controlled study, patients with ICI associated hypophysitis were randomised 1:1 to high-dose glucocorticoid treatment (1 mg/kg of prednisolone for two weeks, followed by tapering until week 7 and a switch to hydrocortisone 20 mg total daily dose in week 8) or glucocorticoid replacement therapy (hydrocortisone 20 mg total daily dose) over 8 weeks. The primary outcome was the frequency of hormonal axes recovery.Results Between 17th April 2019 and 16th September 2022, 18 out of the 20 randomised patients finished the trial; eight completed high-dose, 10 glucocorticoid replacement. Nine patients presented with hyponatraemia, two had typical changes on MRI, 12 had isolated adrenal insufficiency, and six had an additional hormone deficiency. None of the patients in neither group experienced a recovery in adrenal function. One patient in each group showed amelioration of hypogonadism. There was a significant, unfavourable treatment effect of high-dose treatment on HbA1c (mean treatment effect 5.16, 95% confidence interval 0.31 to 10.02, p = 0.039).Conclusions High-dose glucocorticoid treatment was not effective in restoring adrenal function and leads to adverse effects on glucose metabolism. We therefore do not recommend its use for the treatment of ICI associated hypophysitis, except for compressive symptoms.

Die Choosing-Wisely-Initiative wurde im Jahr 2012 gegründet und verfolgt das Ziel, eine Überversorgung in der Medizin zu reduzieren, um so das Allgemeinwohl zu fördern. Die Österreichische Gesellschaft für Endokrinologie und Stoffwechsel (ÖGES) hat in Zusammenarbeit mit dem Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung der Medizinischen Universität Graz fünf Choosing-Wisely-Empfehlungen auf dem Gebiet der Endokrinologie veröffentlicht, die in diesem Artikel vorgestellt und diskutiert werden. Diese Empfehlungen lauten wie folgt: 1. „Keine Behandlung mit L‑Thyroxin bei Knoten in der Schilddrüse, außer in ausgewählten Fällen.“ 2. „Zu häufige Knochendichtemessungen vermeiden: Intervalle von weniger als 2 Jahren sind selten notwendig.“ 3. „Keine Testosterontherapie bei älteren Männern außer in Fällen mit nachgewiesenem Hypogonadismus.“ 4. „Kein routinemäßiges Testen auf TPO-Antikörper.“ 5. „Keine routinemäßige Schilddrüsensonographie ohne Anzeichen/Symptome einer Schilddrüsenerkrankung, außer bei Risikopersonen für Schilddrüsenkrebs. Bei Knoten mit geringem Risiko die Indikation/Durchführung von Feinnadelaspirationen einschränken.“ Ressourcen, die in einem Bereich des Gesundheitssystems unnötig verbraucht werden, fehlen in anderen Bereichen, weswegen es eine wichtige ethische Verantwortung ist, zum Wohle der Allgemeinheit eine unnötige Überdiagnostik und Übertherapie zu minimieren.

Im Juli 2025 hat die Endocrine Society eine neue Guideline bezüglich des primären Hyperaldosteronismus (PHA) veröffentlicht, die in diesem Artikel kurz zusammengefasst und diskutiert wird inklusive pragmatischer Hinweise zur Implementierung in die klinische Routine. Es wird in dieser Guideline ein Screening auf einen PHA bei allen (!) Patienten mit arteriellem Hypertonus empfohlen. Die Bestimmung von Aldosteron und Renin sowie der Aldosteron-zu-Renin-Ratio (ARR) ist nach wie vor der empfohlene Screeningtest. Diese Laborbestimmungen können unter jeglicher Medikation, auch ohne Medikamentenumstellungen, erfolgen, wodurch ein breiteres Screening des aktuell massiv unterdiagnostizierten PHA ermöglicht werden soll. Bestätigungstests wie z. B. der Kochsalzbelastungstest sind jedoch kaum mehr notwendig. Bei einem positiven Screeningtest wird das weitere Vorgehen von individuellen Patientencharakteristika abhängig gemacht, wobei in jedem Stadium der Diagnostik die Entscheidung zu einer medikamentösen PHA-Therapie mit vorzugsweise dem Mineralokortikoidrezeptor-Antagonisten (MRA) Spironolacton getroffen werden kann. Neben einer Verbesserung des Blutdrucks und Kaliumspiegels wird nun auch ein Reninanstieg unter MRA-Medikation als Therapieziel definiert. Zusätzlich zur Computertomographie wird zur Subtypenklassifizierung nach wie vor das Nebennierenvenensampling stark propagiert, wobei es auch Evidenz für ein rein CT-Befund-basiertes Vorgehen gibt. Die dichotome Subtypenklassifizierung in einseitige versus beidseitige Aldosteronhypersekretion bzw. operativ versus medikamentös zu therapierenden PHA wird durch histopathologische, genetische und klinische Daten zunehmend in Frage gestellt. Neue medikamentöse Therapieoptionen wie nichtsteroidale MRA und Aldosteronsynthase-Inhibitoren, positive Daten zur erfolgreichen Radiofrequenzablation als Therapiemöglichkeit des PHA und nuklearmedizinische Methoden in der Diagnostik (z. B. 11C‑Metomidate-PET-CT und 68Ga-Pentixafor-PET-CT), die zumindest so gut wie ein Nebennierenvenensampling sind, eröffnen aktuell auch weitere Möglichkeiten für die Betreuung von Patienten mit PHA.

MicroRNAs (miRNAs) are single-stranded, non-coding RNAs that regulate mRNA expression on a post-transcriptional level. Observational studies suggest an association of serum miRNAs and polycystic ovary syndrome (PCOS), a common heterogeneous endocrinopathy characterized by hyperandrogenism (HA), oligo- or amenorrhea (OM) and polycystic ovaries. It is not known whether these miRNA profiles also differ between PCOS phenotypes. In this pilot study, we compared serum expression profiles between the four PCOS phenotypes (A–D) and analyzed them both in PCOS (all phenotypes) and in phenotypes with HA by quantitative-real-time PCR (qRT-PCR). The serum expression of miR-23a-3p was upregulated in phenotype B (n = 10) and discriminated it from phenotypes A (n = 11), C (n = 11) and D (n = 11, AUC = 0.837; 95%CI, 0.706–0.968; p = 0.006). The expression of miR-424-5p was downregulated in phenotype C (n = 11) and discriminated it from phenotypes A, B and D (AUC = 0.801; 95%CI, 0.591–1.000; p = 0.007). MiR-93-5p expression was downregulated in women with PCOS (all phenotypes, n = 42) compared to controls (n = 8; p = 0.042). Phenotypes with HA (A, B, C; n = 32) did not show differences in the analyzed expression pattern. Our data provide new insights into phenotype-specific miRNA alterations in the serum of women with PCOS. Understanding the differential hormonal and miRNA profiles across PCOS phenotypes is important to improve the pathophysiological understanding of PCOS heterogeneity.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Circulating calcitriol may contribute to the risk of cardiovascular disease (CVD), but its regulation in patients with CVD is poorly characterized. We therefore aimed to assess determinants of circulating calcitriol in these patients. We analyzed 2183 independent samples from a large cohort of patients scheduled for coronary angiography and 1727 independent samples from different other cohorts from patients with a wide range of CVDs, including heart transplant candidates, to quantify the association of different parameters with circulating calcitriol. We performed univariable and multivariable linear regression analyses using the mathematical function that fitted best with circulating calcitriol. In the multivariable analysis of the large single cohort, nine parameters remained significant, explaining 30.0% (32.4% after exclusion of 22 potential outliers) of the variation in circulating calcitriol (r=0.548). Log-transformed 25-hydroxyvitamin D [25(OH)D] and log-transformed glomerular filtration rate were the strongest predictors, explaining 17.6% and 6.6%, respectively, of the variation in calcitriol. In the analysis of the combined other cohorts, including heart transplant candidates, the multivariable model explained a total of 42.6% (46.1% after exclusion of 21 potential outliers) of the variation in calcitriol (r=0.653) with log-transformed fibroblast growth factor-23 and log-transformed 25(OH)D explaining 29.0% and 6.2%, respectively. Circulating 25(OH)D was positively and FGF-23 inversely associated with circulating calcitriol. Although significant, PTH was only a weak predictor of calcitriol in both analyses (<2.5%). In patients with CVD, FGF-23 and 25(OH)D are important independent determinants of circulating calcitriol. The relative importance of these two parameters may vary according to CVD severity. Future studies should focus on the clinical importance of regulating circulating calcitriol by different parameters.

Purpose Surgical therapy represents the first-line treatment for endogenous Cushing’s syndrome (CS). While postoperative glucocorticoid replacement is mandatory after surgical remission, the role of perioperative glucocorticoid therapy is unclear. Methods We recruited patients with central or adrenal CS in whom curative surgery was planned and patients who underwent pituitary surgery for other reasons than CS as a control group. Patients did not receive any perioperative glucocorticoids until the morning of the first postoperative day. We performed blood samplings in the morning of surgery, immediately after surgery, in the evening of the day of surgery, and in the morning of the first and third postoperative day before any morning glucocorticoid intake. We continued clinical and biochemical monitoring during the following outpatient care. Results We recruited 12 patients with CS (seven with central CS, five with adrenal CS) and six patients without CS. In patients with CS, serum cortisol concentrations <5.0 µg/dL (<138 nmol/L) were detected in the morning of the first and third postoperative day in four (33%) and six (50%) patients, respectively. Morning serum cortisol concentrations on the third postoperative day were significantly lower when compared to preoperative measurements (8.5 ± 7.6 µg/dL vs. 19.9 ± 8.9 µg/dL [235 ± 210 nmol/L vs. 549 ± 246 nmol/L], p = 0.023). No patient developed clinical or biochemical signs associated with hypocortisolism. During follow-up, we first observed serum cortisol concentrations >5.0 µg/dL (>138 nmol/L) after 129 ± 97 days and glucocorticoids were discontinued after 402 ± 243 days. Patients without CS did not require glucocorticoid replacement at any time. Conclusion Perioperative glucocorticoid replacement may be unnecessary in patients with central or adrenal CS undergoing curative surgery as first-line treatment.

Denosumab is a potent antiresorptive medication, commonly used in the treatment of osteoporosis, as well as in a variety of other diseases. Potential adverse rebound effects after its cessation include a loss in bone mineral density and an increased risk of osteoporotic fractures. Hypercalcemia is a less frequently reported rebound phenomenon after denosumab discontinuation, that may pose a diagnostic challenge to physicians as a rare non-parathyroid hormone (PTH) dependent cause of hypercalcemia. In our case, a 47-year-old male presented with rebound hypercalcemia after denosumab cessation during follow-up after surgical treatment for parathyroid carcinoma. This non-PTH-dependent hypercalcemia resolved after re-initiation of denosumab. We performed a systematic literature review on rebound hypercalcemia after denosumab cessation and identified 52 individual patient cases. Children appear to be more prone to developing rebound hypercalcemia, which could be attributed to their higher baseline bone turnover, underlying conditions, or denosumab dosage regimens. In most cases, patients initially presented with acute and often severe symptoms of hypercalcemia that occur from 1.75 to 9 months after denosumab cessation (4 to 9 months in adults). Most effective treatment approaches to sufficiently decrease serum calcium levels were bisphosphonates or re-administration of denosumab. A watch and wait strategy may be sufficient in asymptomatic cases, which are less common and probably underdiagnosed. Subsequent antiresorptive treatment after denosumab cessation, which is a common practice in osteoporosis treatment, may reduce the risk of rebound hypercalcemia. As denosumab is a frequently used drug in patients with advanced malignant diseases and rebound hypercalcemia with low PTH levels may raise the suspicion for skeletal metastases, awareness of this rebound effect may be for particular relevance in such settings.

Background We aimed to evaluate the effectiveness of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations in previously SARS-CoV-2-infected adults in the general population of Austria during the Delta wave and with extended follow-up.Methods In a nationwide retrospective cohort study, we calculated age-, sex-, and nursing home residency-adjusted Cox proportional hazard ratios (HRs) of coronavirus disease 2019 (COVID-19) deaths, SARS-CoV-2 infections, and non-COVID-19 deaths from 1 October to 31 December 2021, and secondarily with extended follow-up to 30 June 2022. Relative vaccine effectiveness (rVE) is rVE = (1 - HR) x 100.Results Among 494 646 previously infected adults, 169 543 had received 2 vaccine doses, 133 567 had received 1 dose, and 190 275 were unvaccinated at baseline. We recorded 17 COVID-19 deaths (6 vaccinated, 11 unvaccinated) and 8209 SARS-CoV-2 infections. Absolute risk of COVID-19 deaths was 0.003%. rVE estimates for COVID-19 deaths and reinfections exceeded 75% until the end of 2021 but decreased substantially with extended follow-up. The risk of non-COVID-19 death was lower in those vaccinated versus unvaccinated.Conclusions First and second SARS-CoV-2 vaccine doses appear effective in the short-term, but with diminishing effectiveness over time. The extremely low COVID-19 mortality, regardless of vaccination, indicates strong protection of previous infection against COVID-19 death. Lower non-COVID-19 mortality in the vaccinated population might suggest a healthy vaccinee bias.

Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of ACTH-independent Cushing syndrome (CS), presenting diagnostic challenges due to its rarity and its difficult clinical differentiation from other causes of CS. Here, we report the case of a 22-year-old female who developed classical symptoms of hypercortisolism including progressive weight gain, moon facies, and various skin manifestations. Despite biochemical screening confirming ACTH-independent CS, imaging modalities including computed tomography and magnetic resonance imaging showed normal adrenal gland morphology, complicating the localization of cortisol hypersecretion. Subsequent nuclear imaging methods were not indicative of ectopic cortisol production until adrenal vein sampling (AVS) conclusively identified the adrenal glands as the only possible source of cortisol hypersecretion. Eventually, bilateral adrenalectomy led to a significant improvement in symptoms. Pathological examination confirmed the diagnosis of PPNAD, and genetic testing revealed a mutation in the PRKAR1A gene associated with the Carney complex. This case highlights the importance of considering rare etiologies in hypercortisolism diagnosis and describes their challenging diagnostic workup and the utility of AVS in localizing cortisol hypersecretion in PPNAD patients.

Circulating 25-hydroxyvitamin D (25(OH)D) is the generally accepted indicator of vitamin D status. Since hydroxylation of 25(OH)D to 24-25-dihydroxyvitamin D (24,25(OH)2D) is the first step of its catabolism, it has been suggested that a low 24,25(OH)D level and a low vitamin D metabolite ratio (VMR), i.e., 24,25(OH)2D divided by 25(OH)D, may indicate high vitamin D requirements and provide additional diagnostic information beyond serum 25(OH)D. We, therefore, evaluated whether the classification of “functional vitamin D deficiency”, i.e., 25(OH)D below 50 nmol/L, 24,25(OH)2D below 3 nmol/L and a VMR of less than 4%, identifies individuals who benefit from vitamin D supplementation. In participants of the Styrian Vitamin D Hypertension trial, a randomized controlled trial (RCT) in 200 hypertensive patients with serum 25(OH)D below 75 nmol/L, who received either 2.800 international units of vitamin D per day or placebo over 8 weeks, 51 participants had functional vitamin D deficiency. In these individuals, there was no treatment effect of vitamin D supplementation on various parameters of bone metabolism and cardiovascular risk except for a significant effect on parathyroid hormone (PTH) and expected changes in vitamin D metabolites. In conclusion, a low vitamin D metabolite profile did not identify individuals who significantly benefit from vitamin D supplementation with regard to bone markers and cardiovascular risk factors. The clinical significance of functional vitamin D deficiency requires further evaluation in large vitamin D RCTs.

Zusammenfassung Im Rahmen dieses Reviews sollen sowohl die klinische Unterscheidung einer Hyperthyreose von einer Thyreotoxikose anderer Ursache als auch neue Therapien bei Morbus Basedow diskutiert werden. Als Thyreotoxikose wird jegliches Krankheitsbild bezeichnet, das sich durch einen Exzess an Schilddrüsenhormonen auszeichnet. Obwohl die Begriffe Thyreotoxikose und Hyperthyreose in der Klinik oft synonym verwendet werden, sollte der Begriff der Hyperthyreose streng genommen nur für Ursachen einer Thyreotoxikose verwendet werden, die durch exzessive Hormonproduktion in der Schilddrüse entstehen. Die Unterscheidung einer Hyperthyreose von einer Thyreotoxikose anderer Ursache macht im klinischen Alltag insbesondere deshalb Sinn, weil aufgrund der verschiedenen Ätiologie auch unterschiedliche Therapien notwendig sind. Dies ist in vielen Fällen durch eine Bestimmung der TSH-Rezeptor-Antikörper oder eine Schilddrüsenszintigraphie möglich, in besonderen Fällen lässt sich aber auch dadurch kein eindeutiges Ergebnis erzielen bzw. sind diese Untersuchungen manchmal nicht durchführbar (z. B. Szintigraphie bei Schwangeren). Dafür existieren mit der Berechnung der fT3/fT4-Ratio sowie der Messung des Blutflusses in den Schilddrüsenarterien einfache Tools, die die Differenzierung in der Klinik erleichtern können. Da sich die Therapie des Morbus Basedow in den letzten 70 Jahren nicht wesentlich verändert hat und teilweise mit Komplikationen wie Rezidiven oder einer permanenten Hypothyreose vergesellschaftet ist, besteht ein Bedarf nach neuen Behandlungsalternativen. Diesbezüglich sind derzeit Therapien in Evaluierung, die die Funktion der B‑Zellen modulieren und somit eine Reduktion der TSH-Rezeptor-Antikörper bewirken sollen. Zudem sind mehrere Therapieansätze in Entwicklung, welche die Signalkaskade nach Aktivierung des TSH-Rezeptors blockieren sollen.

INTRODUCTION:Evidence is limited on the effectiveness of a fourth vaccine dose against coronavirus disease 2019 (COVID-19) in populations with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We estimated the risk of COVID-19 deaths and SARS-CoV-2 infections according to vaccination status in previously infected individuals in Austria. METHODS:This is a nationwide retrospective observational study. We calculated age and gender adjusted Cox proportional hazard ratios (HRs) of COVID-19 deaths (primary outcome) and SARS-CoV-2 infections (secondary outcome) from 1 November to 31 December 2022, primarily comparing individuals with four versus three vaccine doses. Relative vaccine effectiveness (rVE) was calculated as (1-HR) X 100. RESULTS:Among 3,986,312 previously infected individuals, 281,291 (7,1%) had four and 1,545,242 (38.8%) had three vaccinations at baseline. We recorded 69 COVID-19 deaths and 89,056 SARS-CoV-2 infections. rVE for four versus three vaccine doses was -24% (95% CI: -120 to 30) against COVID-19 deaths, and 17% (95% CI: 14-19) against SARS-CoV-2 infections. This latter effect rapidly diminished over time and infection risk with four vaccinations was higher compared to less vaccinated individuals during extended follow-up until June 2023. Adjusted HR (95% CI) for all-cause mortality for four versus three vaccinations was 0.79 (0.74-0.85). DISCUSSION:In previously infected individuals, a fourth vaccination was not associated with COVID-19 death risk, but with transiently reduced risk of SARS-CoV-2 infections and reversal of this effect in longer follow-up. All-cause mortality data suggest healthy vaccinee bias.

Currently, only a few theoretical support systems exist for the treatment of hyperthyroidism. They are typically not practically applicable and solely focus on Graves’ disease. The recently developed DigiThy software framework can be used to assist physicians for methimazole dose titration during the treatment of Graves’ disease. In this study, a pool of 60 virtual patients was created to compare physicians’ individual treatment approaches by 8 different physicians and students (including three colleagues, unexperienced with care of Graves’ disease) with the decision support system DigiThy in terms of already defined performance indices. These indices are used to assess the deviation of FT4 from the reference range throughout the treatment. The computer aided treatment algorithms outperformed the usual care approach according to different prespecified criteria for treatment success. Two out of the three unexperienced colleagues improved their treatment success over time, i.e. with more patients treated. In conclusion, our findings suggest that the DigiThy software may be a useful tool for use as a decision support system in routine care of patients with Graves’ disease, while also serving as an effective training tool for the education of physicians. Randomized controlled studies are required before implementation of DigiThy in daily clinical practice.