Revista Colombiana de Endocrinología, Diabetes & Metabolismo

Integrating evidence, consensus, and real-world practice in thyroid eye disease: A collaborative research agenda from Colombia

Natalia Aristizábal-Henao — 2026-04-10

Thyroid eye disease (TED), also known as Graves’ orbitopathy, represents a paradigmatic clinical challenge within the spectrum of rare autoimmune diseases. Its relatively low incidence in moderate-to-severe forms, marked clinical heterogeneity, and the complexity of therapeutic decision-making limit the generation of robust and broadly applicable evidence across healthcare settings. In this context, the development of structured, context-adapted, and progressively integrated scientific tools becomes a priority.

This work is the result of a sustained collaborative effort among members of the Colombian Association of Endocrinology, Diabetes, and Metabolism (ACE, by its Spanish acronym), together with ophthalmologists and endocrinologists, aimed at strengthening the scientific framework available for the study and management of TED in our setting. Importantly, this initiative does not represent an isolated academic product, but rather forms part of a structured research strategy that integrates evidence synthesis, formal consensus, and real-world data generation.

As a foundational step, the group conducted a comprehensive systematic review that synthesizes the current therapeutic landscape for active moderate-to-severe TED. This work consolidates available evidence on glucocorticoids, biologic therapies, and immunosuppressive agents, confirming consistent patterns—such as the central role of intravenous glucocorticoids—while also identifying areas of uncertainty, particularly regarding the comparative effectiveness of emerging therapies. Moreover, it highlights key limitations in the field, including heterogeneity in reported outcomes, the lack of head-to-head trials, and the underrepresentation of Latin American populations.

Gestational hypothyroidism, diagnostic and therapeutic update: Narrative review

Franklin Espitia de la Hoz — 2026-03-04

Background: Gestational hypothyroidism is associated with pregnancy complications and fetal developmental delays.

Purpose: to describe the diagnostic and therapeutic guidelines for gestational hypothyroidism.

Materials and methods: A search of scientific literature was conducted in various electronic databases (Medline, EBSCO, Embase, and others) using free and standardized search terms. Adequacy of certainty was assessed for each publication and for supporting evidence, which was summarized narratively.

Results: Eighty-eight articles were included. Hypothyroidism is the most common thyroid disorder in pregnancy; it is associated with adverse gestational outcomes and fetal brain damage. During pregnancy, laboratory tests of thyroid function (thyroxine, triiodothyronine, thyroid-stimulating hormone/TSH) should be interpreted in relation to gestational age. The presence of antithyroid antibodies confirms the diagnosis of autoimmune thyroid disease. Pregnant women with clinical hypothyroidism are treated with levothyroxine, with appropriate monitoring, to maintain TSH levels at the defined level for the trimester and avoid over- or undertreatment.

Conclusions: Gestational hypothyroidism is a potentially dangerous condition for the mother-child relationship and is easily diagnosed. Effective and safe treatment is currently available, which requires consensual decision-making, with the goal of considering the risks and benefits of the treatment for both the pregnant woman and the fetus.

Prevalence and risk factors associated with diabetic foot at Erasmo Meoz University Hospital, Cúcuta, Colombia, in 2020

Juan Andrés Galvis Sanabria — 2026-04-10

Background: Diabetes mellitus (DM) is a chronic disease whose poor metabolic control can lead to severe complications, such as diabetic foot, which represents one of the main causes of morbidity, disability, and lower-limb amputations among these patients.

Objective: To determine the prevalence and risk factors associated with diabetic foot lesions in patients diagnosed with diabetes mellitus treated at the Erasmo Meoz University Hospital (HUEM, by its Spanish acronym) during 2020.

Methodology: An analytical, observational, cross-sectional, retrospective study was conducted using a database of 527 patients diagnosed with DM who were treated at HUEM during 2020. Sociodemographic, anthropometric, clinical, and lifestyle-related variables were analyzed.

Results: The prevalence of diabetes mellitus at HUEM was 0.052%. Significant differences were observed in clinical and sociodemographic variables between patients who underwent amputation and those who did not. A significant association was found between amputation and neuropathy (adjusted odds ratio [aOR] = 23.47; 95% confidence interval [CI] = 6.22–85.39), vasculopathy (aOR = 12.98; 95% CI = 2.68–62.85), and retinopathy (aOR = 2.58; 95% CI = 1.15–5.80). In contrast, the presence of ulcers did not show a significant association with amputation (aOR: = 0.56; p = 0.43).

Conclusions: Neuropathy and vasculopathy are key predictors of lower-limb amputation in patients with diabetic foot. These findings highlight the need for public health policies tailored to the regional context to improve care and reduce the incidence of amputations among patients with diabetes.

Reference interval of thyroid stimulating hormone and free t4, in pregnant women in a sample of the Colombian population

Myriam Vanessa Rueda Galvis — 2026-02-27

Background: Pregnancy induces multiple hormonal changes in the thyroid axis, potentially leading to hormonal disorders associated with adverse maternal-fetal outcomes. International associations recommend normal TSH levels between 0.1 and 4 mIU/L; however, these values may vary depending on ethnicity, geographic location, and iodine sufficiency, among other factors.

Purpose: To determine the reference intervals for TSH and free T4 in pregnant Colombian women.

Materials and methods: A cross-sectional observational study was conducted using records from 729 Colombian pregnant women with concurrent measurements of ?-hCG, TSH, and free T4. Women with a history of thyroid disease, thyroid hormone replacement therapy, or positive a-TPO antibodies were excluded. Reference intervals were calculated following CLSI/IFCC C28-A3 (Nov 2008) recommendations for the first and second/third trimesters of pregnancy.

Results: The median age of the study population was 32.3 years (SD 5.58). The reference intervals obtained were: First trimester: TSH 0.37-4.84 mIU/L; free T4 0.64-1.11 ng/dL; Second and third trimesters: TSH 0.33-4.56 mIU/L; free T4 0.60-1.12 ng/dL. No significant differences were found between trimesters.

Conclusions: This is the first study to establish reference intervals for TSH and free T4 in pregnant women in Colombia. The values found are higher than those recommended by international guidelines, suggesting a potential overdiagnosis and unnecessary treatment of hypothyroidism in this population.

Experience with Cushing's disease at San José Hospital: A case series from 2010 to 2023

Sebastián Camilo Tabares Rodríguez — 2026-04-08

Introduction: Cushing's disease is a rare disorder characterized by pituitary overproduction of adrenocorticotropic hormone (ACTH), which leads to chronic and sustained exposure to endogenous corticosteroids.

Objective: The objective of this study was to characterize a series of Cushing's disease cases at San José Hospital in Bogotá.

Methodology: A descriptive study of patients with pituitary neuroendocrine tumors and associated Cushing's disease treated in the Endocrinology Department of San José Hospital (Bogotá, Colombia) between 2010 and 2023.

Results: A total of 12 cases of ACTH-producing pituitary tumors were identified. Eleven of these were women, with a mean age of 39.5 years at diagnosis. A total of 54.5% (n=6) of the cases were microadenomas, and the main documented symptoms were centripetal obesity (58.3%), violaceous striae (58.3%), and steroid acne (58.3%). All patients underwent surgery, and 7 (58%) required additional therapy for biochemical control, including reoperation (n = 3; 42%), radiotherapy (n = 4; 57%), somatostatin analogues (n = 5; 71%), and ketoconazole (n = 2; 28%).

Conclusions: The clinical and paraclinical presentation of this entity is similar among the different populations studied and the one in our study; however, the overall disease remission rate is relatively lower compared with that reported for the general international population.

Adrenal insufficiency secondary to glucocorticoid use: Case report

Doly Pantoja Guerrero — 2026-02-26

Background: Secondary Cushing’s syndrome due to chronic use of exogenous corticosteroids is an endocrine disorder caused by prolonged exposure to these drugs, which are commonly used to treat various inflammatory and autoimmune diseases. One of its most serious complications is secondary adrenal insufficiency, which can occur following corticosteroid withdrawal syndrome (CWS). This syndrome arises when glucocorticoids are abruptly discontinued, leading to suppression of the hypothalamic-pituitary-adrenal (HPA) axis and, consequently, an acute reduction in endogenous cortisol production, potentially triggering an adrenal crisis.

Purpose: Provide information on the risks associated with the indiscriminate use of corticosteroids, their adverse health effects due to prolonged use, and the consequences of abruptly discontinuing these medications.

Case presentation: A patient who used glucocorticoids for a long time to manage chronic pain, subsequently developed exogenous Cushing's syndrome. After abrupt discontinuation of these medications, suppression of the HPA axis was evident and, consequently, AI.

Discussion and conclusion: It is estimated that Cushing’s syndrome due to exogenous corticosteroid use accounts for 70-90% of cases. Abrupt withdrawal of these drugs may lead to adrenal crisis secondary to corticosteroid withdrawal syndrome. In Colombia, the easy availability of glucocorticoids favors their inappropriate use; therefore, diagnosis should rely on a thorough medical history and laboratory evaluation when clinically suspected.

Macro-TSH: A hidden challenge in hypothyroidism management

Silvana Jiménez-Salazar — 2026-01-30

Background: Immunoassays used to evaluate thyroid function can be affected by interferences such as macrothyrotropin (macro-TSH), a form of Thyrotropin (TSH) bound to anti-TSH antibodies. Although biologically inactive, it can lead to overdiagnosis of subclinical hypothyroidism and complicate levothyroxine management.

Case presentation: A 32-year-old woman with postoperative hypothyroidism after total thyroidectomy for Graves’ disease. While on levothyroxine 150 mcg/day, she presented with persistently elevated TSH (>100 mIU/L) without symptoms and with normal free T4. Malabsorption was ruled out using a pseudomalabsorption test. Given the biochemical discrepancy, polyethylene glycol (PEG) precipitation showed a recovery of 2.45%, suggesting macro-TSH. The absence of gel filtration chromatography (GFC) prevented confirmation. Treatment was maintained without adjustment, with follow-up of free T4 and PEG-diluted TSH.

Discussion and conclusion: Macro-TSH is an uncommon cause of elevated TSH (prevalence 0.6-1.6%). It can mimic subclinical hypothyroidism, leading to therapeutic errors. It should be suspected in cases of elevated TSH with normal thyroid hormone levels and absence of symptoms. The polyethylene glycol precipitation test is useful for screening but, whenever possible, should be confirmed with gel filtration chromatography.

It can be concluded that considering macro-TSH in unexplained TSH elevations helps prevent overtreatment and optimizes clinical management.

Elevated TSH levels due to the use of multivitamins with biotin during pregnancy

Angélica María González Clavijo — 2026-02-12

Background: The use of vitamin supplements that include biotin during pregnancy can interfere with immunoassays based on the streptavidin/biotin system, causing falsely elevated or decreased results for various hormones, depending on the assay format.

Purpose: To present a clinical case in which biotin supplementation during pregnancy caused significant interference in TSH measurement, generating falsely elevated values.

Case presentation: A 29-year-old woman with a history of total thyroidectomy for papillary thyroid cancer had adequate suppression goals until she became pregnant. Despite multiple increases in levothyroxine dose, she did not achieve them. Given a levothyroxine dose greater than 2,50 µg/kg/day and the onset of clinical symptoms consistent with thyrotoxicosis, the possibility of analytical interference secondary to the use of prenatal multivitamins containing biotin in the immunoassay used for TSH quantification was raised. These supplements were discontinued 72 hours before the next follow-up, which demonstrated a significant decrease in levels.

Discussion and conclusion: Biotin interference in noncompetitive immunoassays often results in falsely low TSH levels; however, at very high concentrations—such as those resulting from megadoses of prenatal supplements—it can produce the opposite effect. Streptavidin saturation and the formation of unstable complexes alter the kinetics of the assay, generating an increased light signal and falsely elevated TSH values.

Biotin consumption can interfere with TSH measurement in immunoassays, generating falsely high or low results, leading to the administration of inappropriate and potentially harmful treatments for patients.

Latent autoimmune diabetes in adults (LADA): A narrative review

Néstor Andrés Díaz — 2026-03-31

Context: Latent autoimmune diabetes in adults (LADA) is a form of diabetes with clinical, immunological, and pathophysiological features that overlap with type 1 and type 2 diabetes. Its diagnosis is often delayed or misclassified as type 2 diabetes, which can negatively affect patient outcomes.

Objective: To describe the diagnostic criteria, clinical phenotypes, associated complications, and current therapeutic options in patients with LADA.

Methodology: A narrative review was conducted based on a non-systematic collection of the available scientific literature. Databases such as PubMed and Scopus were consulted, selecting relevant observational studies, clinical trials, reviews, and expert consensus documents. Articles in English and Spanish were included, without applying additional formal inclusion criteria or methodological assessment.

Results: The review highlights the proposed diagnostic criteria, clinical phenotypes based on autoantibody titers, and their associations with metabolic and autoimmune characteristics. Microvascular and macrovascular complications are discussed, along with current therapeutic strategies aimed at preserving beta-cell function.

Conclusions: LADA is an underdiagnosed condition that requires clinical suspicion and autoantibody testing in adults with recent-onset diabetes. Early identification can prevent inappropriate treatments and enable interventions that may preserve pancreatic function and improve long-term outcomes.

Antonio Ucrós Cuéllar and the development of Endocrinology in Colombia

Agaph Stella Acosta Prada — 2026-04-10

Introduction: This article examines the life and work of Dr. Antonio Ucrós Cuéllar (1919–2005), a key figure in the development of endocrinology in Colombia. His role in the institutionalization of the specialty, his commitment to medical education, and his contributions to scientific knowledge and public health are highlighted.

Contents: The paper outlines the main milestones of his academic training in Colombia and Spain, including his specialization under distinguished European mentors. Upon returning to Colombia, his foundational contributions are analyzed, particularly the creation of the first endocrinology service at the San José Hospital and his leadership in the consolidation of the then-called Colombian Society of Endocrinology. His participation in research on endemic goiter and his contribution to the implementation of mandatory salt iodization policies in Colombia are examined. Additionally, his work on growth and development, his promotion of nuclear medicine and clinical laboratory practices, and his role in training multiple generations of physicians are discussed. Finally, his editorial, academic, and institutional contributions, as well as his humanistic approach to medical practice, are emphasized.

Conclusions: The career of Dr. Antonio Ucrós Cuéllar represents a cornerstone in the consolidation of endocrinology in Colombia. His scientific, academic, and institutional legacy reflects a comprehensive vision of medicine, integrating research, teaching, clinical practice, and public health. His influence endures in the training of specialists, health policies, and the national endocrinological tradition.

Consensus-based recommendations for the medical management of moderate-to-severe thyroid eye disease using the RAND/UCLA Appropriateness Method

María Del S. Cabarcas-Solano — 2026-03-31

Background: Thyroid eye disease (TED) is the most common extrathyroidal manifestation of Graves’ disease and a major cause of morbidity. Management of active, moderate-to-severe thyroid eye disease remains challenging due to clinical heterogeneity, a variable response to glucocorticoids, and an evolving evidence base for alternative therapies. Although international guidelines provide general recommendations, uncertainty persists regarding the role of biologics, immunosuppressants, and local interventions.

Objective: To assess the appropriateness and necessity of medical therapies for active, moderate-to-severe thyroid eye disease using the RAND/UCLA Appropriateness Method, integrating systematic evidence with expert consensus.

Methods: A systematic review of randomized trials, meta-analyses, systematic reviews, and observational studies was conducted following PRISMA standards. A multidisciplinary panel (n=10) rated 14 clinical scenarios across 238 intervention–scenario pairs in three rounds using a 9-point scale. Appropriateness was defined by median scores and the interpercentile range; necessity was evaluated for appropriate interventions according to RAND/UCLA criteria.

Results: Intravenous glucocorticoids were consistently rated as necessary as a first-line therapy. Teprotumumab and tocilizumab were considered appropriate in multiple scenarios, with teprotumumab frequently meeting necessity criteria. Mycophenolate was appropriate but not necessary, reflecting concerns about the robustness of the evidence and its modest efficacy. Rituximab was rated conservatively due to heterogeneous evidence and safety concerns, including dysthyroid optic neuropathy. Local therapies, such as periocular triamcinolone and botulinum toxin, were appropriate in several scenarios and necessary in selected cases.

Conclusions: Intravenous glucocorticoids remain the cornerstone of TED management. This consensus clarifies the role of emerging therapies and provides context-specific recommendations that complement existing guidelines.

New horizons in the understanding of metabolic dysfunction-associated fatty liver disease

Juan Felipe Morantes Rubiano — 2026-04-08

Context: The transition from the term nonalcoholic fatty liver disease (NAFLD) to metabolic dysfunction–associated steatotic liver disease (MASLD/MAFLD) highlights its multisystem nature and its close association with cardiometabolic risk factors such as obesity and type 2 diabetes.

Objective: To analyze recent advances in the pathophysiology, diagnosis, and treatment of metabolic dysfunction–associated steatotic liver disease.

Methodology: Narrative review of the scientific literature focusing on pathophysiological mechanisms, current diagnostic tools, and emerging therapeutic strategies.

Results: The pathogenesis involves complex processes including lipotoxicity, insulin resistance, gut dysbiosis, and genetic factors. Current diagnostic approaches prioritize noninvasive methods for fibrosis assessment, such as the FIB-4 index and elastography, reserving liver biopsy for selected cases. Regarding treatment, lifestyle modification and weight loss of 7% to 10% remain the cornerstone of management. Pharmacological therapies such as pioglitazone and vitamin E have established evidence. Emerging therapies, including glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide), have demonstrated efficacy in resolving steatohepatitis and improving fibrosis. Other promising agents include resmetirom, lanifibranor, and tirzepatide.

Conclusions: Recognizing this condition as an integrated metabolic disease enables a more precise diagnostic approach and supports the development of personalized therapies aimed at reducing hepatic steatosis and mitigating cardiovascular risk, the leading cause of mortality in these patients.