Editorial Famacosalud.com
Advances in the approach to thyroid eye disease (TOD) point towards personalized treatments, as highlighted at the 66th Congress of the Spanish Society of Endocrinology and Nutrition (SEEN), an event recently held in Granada. EOT is an autoimmune inflammatory process of the orbital connective tissue that leads to extensive remodeling of the same and entails the appearance of sequelae at the ophthalmic and orbital level. Most of the symptoms of this condition appear in the first 18 months from the onset of hyperthyroidism in Graves’ disease and, to a lesser extent, are also associated with hypothyroidism or normal thyroid function.
In the opinion of Dr. Mariola Méndez Muros, member of the SEEN Thyroid Area and co-director of the Thyroid Orbitopathy Reference Unit at the Virgen Macarena University Hospital (Seville), endocrinologists play a key role in early diagnosis, prevention, initial treatment and selection of patients who require referral to specialized care. Likewise, ophthalmologists are essential in the management of thyroid eye disease, since they must always participate in the care of moderate to severe EOT and EOT with visual risk.
(from left to right): Dr. Cristina Álvarez Escolá, president of the Congress Program Committee and head of the Endocrinology and Nutrition Service at the La Paz University Hospital (Madrid); Dr. Ignacio Bernabéu, president of the SEEN, and Dr. Martín López de la Torre, president of the Local Program Committee of the congressional meeting
Fuente: SEEN / BERBĒS
Dry eyes and tearing, double vision or diplopia, photophobia…
For Dr. Antonio Manuel Garrido Hermosilla, member of the Thyroid Area of the SEEN and co-director of the Andalusian Reference Unit (UPRA) for Graves’ Orbitopathy in the Ophthalmology Service of the Virgen Macarena University Hospital, it is essential to move towards individualization of treatment based on the clinical, analytical and radiological characteristics of the patient and the possibility of combining biological therapies in the future.
In this sense, Dr. Méndez Muros states that “the development of different novel therapies reflects a direction towards personalized treatment of Graves’ disease. There is a wide variety of treatments available, aimed at different therapeutic targets, with differences in effectiveness depending on the predominance of congestive symptoms or the predominance of proptosis or diplopia.” According to Méndez Muros, these drugs are capable of modifying the natural history of the disease if the indication and time of use within the evolution of EOT is appropriate, taking into account the safety profile of each of them and the baseline characteristics of the patient.
EOT can cause vision changes such as dry eye and tearing, double vision or diplopia, photophobia (extreme sensitivity to light), decreased visual acuity, alterations in the visual field and color perception, and even loss of vision due to compression of the optic nerve or ulceration of the cornea.
For her part, Dr. Silvia Wengrowicz, a physician at the CDT Barcelona and member of the SEEN Thyroid Area, states that these alterations, together with the deterioration in appearance (wider, bulging eyes, red and swollen eyes and eyelids, or deviated eyes) and eye pain, have a great impact on the quality of life, which greatly affects the daily activities of people with this condition. pathology.
Logo of the SEEN meeting
Fuente: congresoseen2025.com
Although there is no cure for EOT, current immunomodulatory treatments can improve symptoms, as well as reduce inflammatory activity and sequelae, “but they do not eliminate the autoimmune basis of thyroid eye disease or guarantee the total absence of relapses,” he specifies.
Equitable access to AI to address diabetes
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In addition to EOT, many other topics have logically been addressed at the meeting of specialists in Endocrinology and Nutrition. For example: “Artificial Intelligence (AI) is like having an expert ‘co-pilot’ accompanying the patient and the healthcare professional. In the field of diabetes, through AI you can predict drops or increases in glucose before they occur, adjust the insulin dose more precisely and even detect complications such as diabetic retinopathy several years in advance.” This is highlighted by Antonio Martínez, Full Professor at the Polytechnic University of Valencia and researcher at the ITACA Institute.
In Martínez’s opinion, we find ourselves “in a unique moment: digitalization, precision medicine and AI are converging.” Furthermore, Spain has a competitive advantage thanks to the anticipation in the regulation of the use of health data and the investment that has been made by the Ministry of Health to integrate data from supplier platforms, especially real-time continuous glucose monitoring systems (rtMCG). Finally, he argues that the real challenge today is to guarantee access for health professionals to all the available tools (Artificial Intelligence) so that any person with diabetes, regardless of the autonomous community in which they reside, can benefit from them in their daily lives.
Artificial Intelligence: a new era of nutrition during pregnancy
Dr. Ana Cantón, head of the Clinical Nutrition Section of the Endocrinology and Nutrition Service of the University Hospital Complex of Santiago de Compostela (La Coruña) and member of the Nutrition Area of the SEEN, maintains that, during pregnancy, women can experience “an increase in fat-free mass, mainly due to the increase in plasma volume, together with a gain in maternal fat.” For this reason, he adds, it is essential to know how these changes are distributed, also in a predictive way: “some parameters of maternal body composition could help identify patients with a higher risk of developing complications such as gestational diabetes or preeclampsia, which allows for early detection of these alterations and a more targeted intervention in risk groups.”
In this scenario, super-advanced technologies have become new allies when it comes to monitoring changes during pregnancy, when applied to imaging techniques such as computed tomography (CT) and ultrasound. “Thanks to AI, it is possible to quickly and objectively measure muscle mass and quality, as well as body fat, reducing variability between observers and offering much more reliable data than classic methods such as the Body Mass Index (BMI),” says Dr. Fiorella Palmas, member of the SEEN Nutrition Area.
Author: AzurPro
Fuente: depositphotos.com
Thus, with regard to AI applied to CT, in recent years models for automatic segmentation capable of analyzing images in seconds have been validated, which has brought the technique closer to clinical practice and has promoted the possibility of extracting nutritional and prognostic information without the need for additional tests. In the case of ultrasound, tools have also been developed that allow the automation of measurements and the assessment of muscle quality through gray scale analysis.
90% of three-year-old children and obesity
On the other hand, Dr. Gilberto Pérez López, endocrinologist and pediatrician and member of the SEEN Obesity Area, warns that obesity is the most common chronic disease in adolescents and is associated with a high risk of persistence into adulthood: “from diagnosis, it must be treated intensively and is one of the most complex and difficult situations that a pediatrician can face.” Furthermore, it is a progressive and recurring disease that has no cure: 90% of three-year-old children with obesity will become overweight or severely overweight adolescents and the majority of adolescents living with obesity (80%) will have this pathology as adults.
In Spain, the PASOS study has shown that in adolescents (>12 years) the prevalence of severe excess weight is 8.2% (of which 0.9% had severe obesity). Risk factors in adolescence include genetic, environmental, lifestyle, and social influences. “Adolescents who spend two hours or more in their free time in front of a screen have a greater risk of being overweight or obese,” warns the expert, also within the framework of the SEEN meeting.
Trans people have a higher cardiovascular risk
Autor/a: Bain
Fuente: depositphotos.com
“Gender-affirming hormone therapy will modify the oncological risk of (transgender) people, since a trans* woman is more likely to suffer from breast cancer than a ‘cis’** man, although she has a lower risk of suffering from prostate cancer than a cis man.” This is stated by Dr. María Miguélez, specialist at the Gender Identity Unit of the Gregorio Marañón University Hospital (Madrid) and member of the Gónada, Identity and Sexual Differentiation Group of the SEEN.
*trans woman: a person who, having been assigned the male gender at birth, has a female gender identity
**cisgender: individual who identifies with his or her biological sex
In Congress, doctors have also analyzed the cardiovascular risk of trans people, since most studies show that they have a greater possibility of developing an alteration of this type. “They have a greater risk of suffering a myocardial infarction, a stroke or a venous thrombosis than cis people. There is a greater cardiovascular risk, but analyzing mortality, there is no increase in trans men and perhaps a slight increase in trans women,” says Dr. Marian Obiol, gynecologist at the Fuente de San Luis Sexual and Reproductive Health Unit within the Department of Health Hospital Universitario Doctor Peset and collaborator of the Valencia Gender Identity Unit -Doctor Peset (Valencia).
However, the gynecologist specifies that this increase in cardiovascular danger “is not exclusively due to hormonal treatment, but there are also other non-hormonal factors, such as the stress of belonging to a sexual minority, poorer mental health and the greater prevalence of obesity and smoking, which worsen cardiovascular health.”
SEEN 75th Anniversary Celebration
This year’s 2025 edition of the congress event has been very special, since the SEEN celebrated its 75th Anniversary as a scientific organization. “When our society was founded, in 1950, Endocrinology and Nutrition was a very recently created specialty and focused on thyroid pathology, diabetes and some rare pituitary pathology,” comments Dr. Ignacio Bernabéu, president of said entity. But today, it is a specialty of a systemic nature: endocrine alterations can affect all organs and systems of the body. Furthermore, endocrine and nutritional disorders are extraordinarily common (for example, obesity, diabetes or malnutrition) and can generate serious cardio-cerebrovascular, oncological and metabolic complications that generate large healthcare costs and seriously affect quality of life and survival.
Technological advances, molecular biology, new bioinformatic procedures, new drugs and new treatment guidelines have significantly improved care in all areas of the specialty: in diabetes mellitus (automatic glucose detection and continuous insulin infusion systems, GLP-1 analogues), in tumors and endocrine cancer (thyroid, adrenal, etc.), in ailments congenital metabolic diseases, rare hereditary diseases, in bone and mineral metabolism pathology, in the knowledge of endocrine disruptors and, especially, in the field of metabolic conditions.
Inauguration of the 75th Anniversary commemorative tent
Fuente: SEEN / BERBĒS
There has also been great progress in clinical hospital and home nutrition. Nutritional support shortens hospital stay, avoids complications and improves the prognosis of the underlying disease.
