Far-Reaching Thyroid Expertise

Monday, January 25, 2016

Researcher leading changes in understanding and care 

By Delia O’Hara

Antonio Bianco, MD, a leading expert on the thyroid gland, came to Rush University Medical Center two years ago to lead the creation of a comprehensive destination thyroid program combining top clinical and basic research with diagnostic, medical and surgical capabilities.

You could say he hit the ground running. In the past couple of years, Bianco has relocated his laboratory from Miami, published a number of influential studies and co-chaired an American Thyroid Association task force that created new guidelines for the treatment of hypothyroidism.

His work touches many. Roughly 10 million people in the United States alone have hypothyroidism, a clinical condition resulting from the failure of the thyroid to produce enough of two critical hormones, known as T4 and T3. Over time, untreated hypothyroidism can cause significant health problems, such as cognitive dysfunction, infertility, cardiac disease and slowed metabolism.

Fortunately, effective treatment for hypothyroidism exists. Unfortunately, it’s not fully effective for everyone. The overwhelming majority of people with hypothyroidism can live a normal life thanks to a synthetic medicine known as levothyroxine, but complaints that the drug hasn’t helped everyone “have been a very hot topic” in recent years, Bianco says.

“The quality of life has been poor for about 15 percent of patients, but until recently the medical community has played down the significance of the unhappiness of those patients, who often go from one doctor to another seeking relief,” he elaborates. More recently, patients themselves, and their advocates, “put pressure on the medical community to recognize the issue and study new, better treatments.”

A tale of two hormones

Bianco has helped produce the knowledge that could lead to such improved treatments. He and his team at Rush have led an international effort that provides a better understanding of what happens when hypothyroid patients are treated with levothyroxine, a synthetic version of the thyroid hormone thyroxine, which also is known as L-T4.

Using hypothyroid rats, the team observed that normalization of thyroid action in the parts of the body where it is especially important — the brain, the liver and the skeletal muscles — occurred only when treatment with L-T4 was combined with another thyroid hormone, triiodothyronine, or L-T3. Normal individuals can transform T4 into the more active hormone T3 on their own, but patients treated with levothyroxine alone may not produce enough T3 to function well. Bianco’s team concluded that this deficiency is the likely cause of those residual symptoms in some patients.

This topic has intrigued scientists all over the world. A previous study performed in the United Kingdom showed that patients with a common genetic mutation in the enzyme that does the work of transforming T4 to T3 preferred the combination therapy to L-T4 alone.

“It turns out that not all hypothyroid patients are the same,” Bianco says. The enzyme mutation might play a role in how well patients do when treated with L-T4 alone, or in combination with L-T3.

The task force co-chaired by Bianco to update guidelines for the American Thyroid Association was particularly sensitive to these and other new observations. “It was a major advance,” Bianco says, while also noting that more studies and better treatments still are needed.

Going where the science is

The thyroid’s complexities have fascinated Bianco ever since he was a medical student in his native Brazil. Located at the base of the front of the neck, the thyroid plays an outsize role in our well-being, affecting growth, metabolism, cardiovascular and muscle-skeletal functions, and the development and function of our brains. Yet while it’s hard-working and dependable, the thyroid is vulnerable, too. 

While some people have too much thyroid hormone in their systems, worldwide, most thyroid disease is caused by inadequate iodine in the diet. In the United States and most developed countries, where iodine supplementation is added to table salt, the leading type of thyroid disease is hypothyroidism, most often caused by Hashimoto’s disease, an autoimmune condition that knocks out the gland.

Bianco was born and raised in Sao Paulo, where he did his medical and clinical training, and took the first steps as a physician scientist in the thyroid field by earning a PhD in human physiology at the University of Sao Paulo.      

“My interest in thyroid research started in medical school,” he says. “I shadowed a graduate student working on the thyroid with laboratory rats. I started looking at how different types of nutrients affect the thyroid, and I never stopped.”

Bianco moved to the United States about 16 years ago. “As a scientist, you have to go where the science is,” he says, and he had found himself traveling more and more while he lived in Brazil.

He has served as chief of the Thyroid Section at Brigham and Women’s Hospital, a Harvard Medical School teaching hospital, and chief of the Division of Endocrinology at the University of Miami Leonard M. Miller School of Medicine. Now he serves as Rush Medical College’s vice dean for clinical affairs and president of Rush University Medical Group, a multidisciplinary group of more than 500 physicians.  

His lab has been federally funded for thyroid studies during his entire career, and he has a distinguished service record with the American Thyroid Association. Bianco chaired and participated in major task-force and program organizing committees beofre ultimately being elected the association’s president for 2015-16.

He credits much of his success to the dedication of his collaborators, including more than 40 graduate students and post-doctoral fellows who have spent years in his laboratory learning about thyroid hormone metabolism and action. Their work has been recognized in the form of hundreds of publications, lectures across the United States and around the world, awards, membership in prestigious societies and dozens of successful careers in academic medicine.

“Working with students and fellows keeps you on your toes,” Bianco says.