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Background: Although there are studies regarding the efficacy of OK-432 sclerotherapy on thyroglossal duct cyst (TDC), its effects on surgical procedure following this therapy have not been properly described. Objectives: The present study aimed to delineate the prognostic factors of OK-432 sclerotherapy in patients with TDC and investigate its influence on subsequent surgical procedure and the histological characteristics in patients with poor response to OK-432 sclerotherapy. Material and methods: We conducted a retrospective analysis of the medical records of 20 TDC patients treated with OK-432 sclerotherapy. Results: Of the 20 patients, OK-432 sclerotherapy was effective in 5 patients (25.0%). OK-432 showed a lower effective rate in multilocular cysts (9.1%) than in unilocular cysts (44.4%), although not significantly. Five cases were treated with surgery following OK-432 sclerotherapy. There was no significant difference in the operating time and the amount of bleeding between patients with and without OK-432 sclerotherapy. From the results of the histological examination of the cyst wall, two cases had stratified squamous epithelium and two cases showed the absence of lymphocyte infiltration. Conclusion and significance: OK-432 sclerotherapy is an acceptable initial treatment for TDC, especially in unilocular cysts, because of lack of influence on surgical procedure. [ABSTRACT FROM AUTHOR]

Hirsutism is the excessive growth of terminal hair in a typical male pattern in a female. It is often a sign of excessive androgen levels. Although many conditions can lead to hirsutism, polycystic ovary syndrome and idiopathic hyperandrogenism account for more than 85% of cases. Less common causes include idiopathic hirsutism, nonclassic congenital adrenal hyperplasia, androgen-secreting tumors, medications, hyperprolactinemia, thyroid disorders, and Cushing syndrome. Women with an abnormal hirsutism score based on the Ferriman-Gallwey scoring system should be evaluated for elevated androgen levels. Women with rapid onset of hirsutism over a few months or signs of virilization are at high risk of having an androgen-secreting tumor. Hirsutism may be treated with pharmacologic agents and/or hair removal. Recommended pharmacologic therapies include combined oral contraceptives, finasteride, spironolactone, and topical eflornithine. Because of the length of the hair growth cycle, therapies should be tried for at least six months before switching treatments. Hair removal methods such as shaving, waxing, and plucking may be effective, but their effects are temporary. Photoepilation and electrolysis are somewhat effective for long-term hair removal but are expensive. [ABSTRACT FROM AUTHOR]

Patients with PTEN hamartoma tumor syndrome (PHTS) are at increased risk of developing benign and malignant tumors, including thyroid carcinoma. Benign thyroid lesions and single cases of thyroid carcinoma have been reported in children with PHTS. We conducted a retrospective, single-centered study including children and adolescents with a molecularly proven diagnosis of PTEN. Our cohort consists of 16 patients, with a mean age at diagnosis PHTS of 5.7 years. Twelve of 16 cases exhibited thyroid abnormalities (75%). In seven patients, thyroid abnormalities were already present at first ultrasound screening, in five cases they occurred during follow-up. Eight patients underwent thyroidectomy. Histopathology included nodular goiter, follicular adenoma, papillary microcarcinoma in a boy of six and follicular carcinoma in a girl of 13 years. Two patients had autoimmune thyroid disease.Conclusion: Thyroid disease is common in children with PHTS. Physicians caring for patients with early thyroid abnormalities and additional syndromal features should be aware of PHTS as a potentially underlying disorder. Ultrasound screening should be performed immediately after diagnosis of PHTS and repeated yearly or more frequently. Because of possible early cancer development, we recommend early surgical intervention in the form of total thyroidectomy in cases of suspicious ultrasound findings. What is Known: • PHTS patients are at high risk of developing benign and malignant tumors. • Individual cases of thyroid carcinoma in children have been reported. What is New: • Thyroid disease is even more common in children with PHTS (75%) than previously expected. • Frequently thyroid disease is the first organ pathology requiring diagnostic workup and therefore children with PHTS should be examined for thyroid disease right after diagnosis and receive follow-up on a regular basis throughout life. [ABSTRACT FROM AUTHOR]

Background: The new Bethesda system for reporting thyroid cytopathology (TBSRTC) was a major step towards standardization, reproducibility and clarity of communication in thyroid fine needle aspiration cytology (FNAC). This system is used worldwide, including in Thailand, and the Department of Pathology at Rajavithi Hospital has been using this system for three years. Objective: To evaluate the Bethesda system for reporting thyroid cytopathology at Rajavithi Hospital and assess the malignancy risk and diagnostic accuracy of thyroid FNAC. Material and Method: The author retrospectively reanalyzed the thyroid FNAC reports for three years (January 2013 to December 2015). The reports were reclassified into each Bethesda system classes, and the malignancy risks for each category were calculated and compared with the follow-up histopathology reports. The statistical parameters of diagnostic accuracy for FNAC were also analyzed. Results: A final total of 13,371 reports were included as follows: non-diagnostic/unsatisfactory (ND/UNS) 32.2%; benign 46.9%; atypical follicular lesion of undetermined significance (AFLUS) 4.8%; follicular neoplasm or suspicious for follicular neoplasm (FN/SFN) 7.8%; suspicious for malignancy (SM) 4.4%; and malignant 3.9%. The rates of malignancy reported on 358 cases with follow-up histopathology were ND/UNS, 22.1%; benign, 2.8%; AFLUS, 46.2%; FN/SFN, 37.3%; SM 74.3%; and malignant 90.0%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC were 74.7%, 90.3%, 81.5%, 86.2% and 84.6%, respectively. Conclusion: The thyroid FNAC interpretation, using the Bethesda system in routine service allowed a more specific cytological diagnosis. The distribution of cases using the Bethesda categories differed from previous studies, but the malignancy rate of ND/UNS and AFLUS case were higher, the overall accuracy rate was similar with high yield. The universal Bethesda classification is a useful application for general practice in institutes without specialist pathologists and may decrease interlaboratory disagreements and variability. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the frequency of echogenic foci with comet-tail artifact in histologically proven thyroid nodules, and to determine the types of echogenic foci with comet-tail artifact that are associated with malignancy. We retrospectively analyzed the sonographic findings of echogenic foci with comet-tail artifact, present in thyroid nodules in 63 patients who underwent surgery for thyroid nodules at our institution between January 2016 and September 2016. The sonographic findings (appearance and background of echogenic foci, shape of comet-tail artifact) in benign and malignant nodules were compared. Seventy-one (7.4%) nodules with ultrasound finding of echogenic foci with comet-tail artifact were encountered in 962 thyroid nodules of 556 patients; 25 of these were benign, and 46 were malignant. Among the echogenic foci with comet-tail artifact categories, those (11/11, 100%) freely distributed in cystic components were all in benign nodules, whereas those (48/67, 71.6%) any part of echogenic foci or comet-tail artifact associated with solid components, were more common in malignant nodules (P < 0.001). There was no statistically significant difference in the appearance of echogenic foci and the shape of comet-tail between the benign and malignant nodules (P = 0.139, P = 0.626, respectively). Echogenic foci with comet-tail artifact freely distributed in cystic component may predict a benign nodule; those associated with solid components cannot be considered a benign finding. [ABSTRACT FROM AUTHOR]

The recently published guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on interventional ultrasound (INVUS)-guided procedures summarize the intended interdisciplinary and multiprofessional approach. Herewith, we report on recommendations for interventional procedures for diagnosis and treatment of the thyroid gland. [ABSTRACT FROM AUTHOR]

PURPOSE: Thyroid-associated orbitopathy (TAO), a clinical manifestation of Graves' disease, is an autoimmune disorder of the orbital and periorbital tissue. Data on the epidemiology and clinical presentation of TAO in Africa are generally scarce and unavailable in Ghana. We investigated the epidemiology and clinical features of TAO among patients with thyroid disorders attending the Korle Bu Teaching Hospital, Accra. SUBJECTS AND METHODS: This was a descriptive cross-sectional study of patients diagnosed with thyroid disorders which was conducted at the endocrine and orbital clinics of the Korle Bu Teaching Hospital. Diagnosis was based on clinical features and confirmed by a thyroid function test. Data collected and analyzed included demography, systemic and ocular features of thyroid disorder, and thyroid function tests. RESULTS: Of the 194 patients with thyroid disorders recruited, 117 (60.30%) had TAO. The mean age was 45.22 years (standard deviation: 13.90). The male:female ratio was 1:4.45. The most common ocular symptoms were "bulging eyes" (76/65.00%) and "puffy eyelid" (62/53.00%), and the common signs were eyelid retraction (97/82.91%) and proptosis (80/68.38%). Mild TAO was diagnosed in 64.96% of patients with only 6.84% having the severe form. The outcomes of the thyroid function test, thyroid disorder, and severity of TAO did not record any statistically significant differences. CONCLUSIONS: The epidemiology is similar to those reported from other parts of the world, but the ocular presentation seems to be milder than in Caucasians. [ABSTRACT FROM AUTHOR]

Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Overt thyroid disease is associated with a wide range of adverse obstetric and child development outcomes. An increasing number of studies now indicate that milder forms of thyroid dysfunction are also associated with these adverse pregnancy outcomes. The definitions of both overt and subclinical thyroid dysfunction have changed considerably over the past few years, as new data indicate that the commonly used fixed upper limits of 2.5 mU/l or 3.0 mU/l for thyroid-stimulating hormone (TSH) are too low to define an abnormal thyroid function. Furthermore, some studies now show that the reference ranges are not necessarily the best cut-off for identifying pregnancies at high risk of adverse outcomes. In addition, data suggest that thyroid peroxidase autoantibody positivity and high or low concentrations of human chorionic gonadotropin seem to have a more prominent role in the interpretation of thyroid dysfunction than previously thought. Data on the effects of thyroid disease treatment are lacking, but some studies indicate that clinicians should be aware of the potential for overtreatment with levothyroxine. Here, we put studies from the past decade on reference ranges for TSH, determinants of thyroid dysfunction, risks of adverse outcomes and options for treatment into perspective. In addition, we provide an overview of the current views on thyroid physiology during pregnancy and discuss strategies to identify high-risk individuals who might benefit from levothyroxine treatment. [ABSTRACT FROM AUTHOR]

A specialized dose rate measurement device that was designed for monitoring the thyroid dose of children and adults after reactor accidents was tested. In measurements with neck phantoms and a human patient, the device was found to be capable of measuring the required low dose rates, even within increased ambient radiation. It is suitable for the application in emergency care centers. [ABSTRACT FROM AUTHOR]

Background: Thyroglobulin measurement with fine-needle aspiration (Tg-FNA) is a sensitive method for detecting metastatic papillary thyroid carcinoma (PTC). However, the diagnostic threshold is not well established and the influence of the thyroid gland on the cutoff value is also controversial. In this study, patients were classified into two groups according to the presence or absence of thyroid tissue, to determine an appropriate cutoff value for clinical practice.Methods: Patients with a history of thyroid nodules or surgery for PTC and with enlarged cervical lymph nodes on an FNA examination were enrolled for Tg-FNA detection.Results: One hundred ninety-six lymph nodes (189 patients) were included: 100 from preoperative patients, 49 from patients treated with partial thyroid ablation, and 47 from patients with total thyroid ablation. In 149 lymph nodes from patient with thyroids, the cutoff value for Tg-FNA was 55.99 ng/mL (sensitivity, 95.1%; specificity, 100%), whereas in 47 lymph nodes from patients without a thyroid, it was 9.71 ng/mL (sensitivity, 96.7%; specificity, 100%). Thus, the cutoff value for Tg-FNA was higher in patients with thyroids than in patients without thyroids.Conclusions: The cutoff value for Tg-FNA is influenced by residual thyroid tissue, and a higher cutoff value is recommended for patients with thyroids than for patients without thyroids. [ABSTRACT FROM AUTHOR]

Agranulocytosis is a rare but serious complication of antithyroid drug therapy, and an up-to-date understanding of this topic is important. Both direct toxicity and immune-mediated responses have been described as possible mechanisms. Some major susceptibility loci have recently been identified, which may lead the diagnosis of agranulocytosis into a genomic era. Onset is acute and patients present with symptoms and signs of infection together with high fever. Clinical suspicion is pivotal and should prompt blood sampling. An absolute neutrophil count of <500/μl in the presence of antithyroid drugs establishes the diagnosis. The causative drug should immediately be stopped to prevent further damage. Treatment includes broad-spectrum antibiotics and granulocyte-colony stimulation factor in selected patients. Later, patients will need definitive treatment for hyperthyroidism, usually with radioactive iodine or surgery. The best way to avoid the mortality associated with antithyroid drug-induced agranulocytosis is patient education. [ABSTRACT FROM AUTHOR]

Introduction: Medication changes involving levothyroxine-either dose titrations or switching formulations-occur frequently in patients with erratic thyroid-stimulating hormone (TSH) levels and persistent hypothyroid symptoms. We investigated whether switching patients from levothyroxine tablets to a gel cap formulation of levothyroxine might reduce dose adjustments and improve tolerability and efficacy outcomes. Objectives: Primary study objectives included quantifying the percentage of patients achieving TSH levels within a pre-specified range, median dose changes experienced, and the percentage of patients with improved hypothyroid symptom control after switching from levothyroxine tablets to levothyroxine gel caps. Methods: A retrospective medical chart review was conducted among 99 randomly selected hypothyroid patients who were switched from a tablet to a gel cap formulation of levothyroxine. Patients were required to have been on levothyroxine monotherapy for ≥1 year prior to the medication switch. Data was collected for 6 months pre-switch and up to 6 months post-switch. Results: Of the 99 patients studied, the majority (51.5%) experienced no documented change in TSH status after the switch ( P < 0.0001). However, there was a decrease in the mean number of dose changes experienced (1.61 ± 0.96 vs. 0.73 ± 0.96; P < 0.0001). Improved hypothyroid symptom control was reported among 61.6% of patients (61 of 99; P < 0.0001). Conclusion: The results of CONTROL Switch support a strategy of switching patients who may experience tolerability or efficacy problems with standard levothyroxine tablets to the levothyroxine gel cap formulation. [ABSTRACT FROM AUTHOR]

The impact of thyroid dysfunction in subclinical ranges on metabolic syndrome (MetS) is not well known. The aim of the present study is to evaluate the association of thyroid dysfunction with MetS and its components. In the cross-sectional population-based Tehran Thyroid Study, out of 5 786 randomly selected participants, aged ≥ 20 years, subjects with thyroid nodules and cancer or any severe systemic disease, those who were pregnant and those using thyroid medication were excluded, leaving 5 422 subjects to be investigated. Body weight, waist circumference, and blood pressure were measured. Fasting blood glucose and concentrations of lipids and lipoproteins, free T4, and TSH were assayed. Mean age of the participants was 40.3 ± 14.4 of whom 101 (2 %) had overt hypothyroidism, 294 (5 %) subclinical hypothyroidism, 82 (2 %) overt hyperthyroidism, and 178 (3 %) had subclinical hyperthyroidism; 1 704 (32 %) had MetS. Clinically hypothyroid subjects had the highest prevalence of MetS (41.6 %), abdominal obesity (45 %), and hypertriglyceridemia (58 %) compared to other groups (p < 0.05). Significant odds ratio for prevalent MetS was observed only in clinically hypothyroid men [OR: 2.9, 95 % CI: 1.04, 8.4, p = 0.04]. In women, the association between overt hypothyroidism and MetS was marginally significant only in the crude model [OR: 0.068, 95 % CI (0.97-2.42), p = 0.06]. There was higher risk of Mets in subclinically hypothyroid subjects, aged > 50. Overt and subclinical hyperthyroidism had significantly higher odds of hyperglycemia in men and women after full adjustment for age, smoking, and BMI. Overt hypothyroidism and subclinical hypothyroidism especially in the elderly could be associated with MetS. Hyperthyroidism may induce hyperglycemia. [ABSTRACT FROM AUTHOR]

Thyroid fine-needle aspiration (FNA) biopsy has been widely accepted as an accurate and cost-effective tool in the management of thyroid nodules. To avoid unnecessary FNAs and provide appropriate management, patient evaluation should be based on a multidisciplinary approach. For this purpose, the Thyroid Imaging Reporting and Data System (TI-RADS) and strain elastography (SE) were proposed as tools for the risk assessment of malignancy in thyroid nodules. The aim of the present study was to analyze the utility of TI-RADS system and SE, along with FNA, and prospectively evaluate 369 consecutive patients referred for FNA of a thyroid nodule. TI-RADS was tested against The Bethesda System for Reporting Thyroid Cytopathology to determine whether there was an agreement between the two classification systems; statistically, some agreement was observed. Medians of the maximum SE values (E-max) were obtained for benign and malignant FNA results and found to be 1.97 [interquartile range (IQR): 1.87] and 2.8 (IQR: 3.42), respectively (P=0.004). The number of studies investigating the utility of TI-RADS and SE along with TBSRCT is currently limited. Our study demonstrated that a multidisciplinary approach with the use of TI-RADS and SE may mildly improve the management of thyroid nodules. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate and compare the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of thyroid lesions with the final histopathologic diagnosis in the surgical specimens. Materials and Methods: A retrospective study was performed over an 11-year-period at Sultan Qaboos University Hospital, Sultanate of Oman. The records of all patients who had undergone FNAC and subsequent surgery for thyroid cancer were included. Cytological diagnosis was classified into five categories: Unsatisfactory, benign, papillary carcinoma, undifferentiated thyroid carcinoma, and suspicious for malignancy. Histopathological diagnosis was classified into two categories: Papillary carcinoma and other thyroid carcinomas. Results: A total of 1460 cases of FNAC thyroid were retrieved. Female to male ratio was 6.3:1, and the mean age was 43.4 years. There were 20 papillary carcinomas, two undifferentiated thyroid carcinomas, and 118 suspicious for malignancy representing 9.6% of all cases. Of these 140 FNAC cases, subsequent histopathologic diagnosis found in only 95 cases. Papillary carcinoma was seen in 83.16% followed by follicular and medullary types with a rate of 12.6% and 2.1%, respectively. Conclusion: The findings of this study showed that FNAC is a sensitive method for the diagnosis of thyroid lesion if cytological yield is adequate and papillary carcinoma is the most common type of thyroid cancer in our institution. [ABSTRACT FROM AUTHOR]

Background First-trimester care of maternal thyroid dysfunction has previously been shown to be poor. This study evaluates early management of thyroid dysfunction in pregnancy in Australia. Methods Patients reviewed by the Obstetric Medicine team for thyroid dysfunction from 1 January 2012 to 30 June 2013 were included. Data were collected on gestation at referral from the patient’s general practitioner to the antenatal clinic, information provided in the referral letter, thyroid function tests and thyroid medications. Results Eighty-five women were included in the study. At the time of general practitioner referral to antenatal services, 19% of women with preexisting thyroid disease had no thyroid function tested. Forty-three percent had an abnormal thyroid-stimulating hormone defined as being outside the laboratory-specific pregnancy reference range if available, or outside the level of 0.1–2.5 mIu/L in the first trimester, 0.2–3.0 mIu/L in the second trimester and 0.3–3.0 mIu/L in the third trimester. Only 21% of women increased their thyroxine dose prior to their first antenatal clinic review. Conclusion This study highlights that a significant proportion of women with known thyroid disease either have untested thyroid function in the first trimester or a thyroid-stimulating hormone outside of levels recommended by guidelines. [ABSTRACT FROM AUTHOR]

Background: The risks of thyroid dysfunction after iodinated contrast media exposure in patients with euthyroid nodular goiter are largely unknown. Methods: This observational, retrospective cohort study included a random selection of one million people in Taiwan. All patients with iodinated contrast media exposure during this study period were selected. Patients with euthyroid nodular goiter were identified as cases, while patients without thyroid nodule were selected as controls. We followed these patients until the first event of thyroid dysfunction including hyperthyroidism or hypothyroidism after iodinated contrast media exposure. Results: A total of 334 cases and 2672 matched controls were selected in this study. The mean age of cases and controls were 58.6 and 58.4 years old, and mean follow-up durations were 2.1 and 2 years respectively. After adjustment, patients with euthyroid nodular goiter had a higher risk of thyroid dysfunction (hazard ratio 5.43, [confidence interval (CI) 3.01-9.80]) compared with controls after iodinated contrast media exposure. In the subgroup analysis, the risks of hyperthyroidism and hypothyroidism in cases compared with controls were 5.77 [CI 2.64-12.62] and 4.95 [CI 2.15-11.40] respectively. Half of the euthyroid nodular goiter cases developed thyroid dysfunction within one year after iodinated contrast media exposure. Interestingly, all thyroid-related comorbidities and drug prescriptions did not increase the risk of thyroid dysfunction. Conclusions: Presence of euthyroid nodular goiter was associated with higher risk of thyroid dysfunction including hyperthyroidism and hypothyroidism after iodinated contrast media exposure. [ABSTRACT FROM AUTHOR]

Thyroid disease is common, and the prevalence is rising. Traditional diagnosis and monitoring relies on thyroid stimulating hormone (TSH) levels. This does not always result in symptomatic improvement in hypothyroid symptoms, to the disappointment of both patients and physicians. A non-traditional therapeutic approach would include evaluation of GI function as well as a dietary history and micronutrient evaluation. This approach also includes assessment of thyroid peroxidase (TPO) antibodies, T3, T4, and reverse T3 levels, and in some cases may require specific T3 supplementation in addition to standard T4 therapy. Both high and low TSH levels on treatment are associated with particular medical risks. In the case of high TSH this is primarily cardiac, whereas for low TSH it is predominantly bone health. This article discusses these important clinical issues in more detail, with some practical tips especially for an approach to the "non-responders" to the current traditional therapeutic approach. [ABSTRACT FROM AUTHOR]

Once diabetes is excluded, thyroid gland diseases form the main bulk of endocrine problems that the practicing physician encounters in their clinical practice. As patients with thyroid gland dysfunction may present with varied symptoms of different severity levels, physicians often have to identify such patients, so that appropriate treatment for thyroid disorders can be instituted at the earliest to prevent potential future complications. The current review will cover the evaluation and interpretation of thyroid function tests in the diagnosis of thyroid disorders. [ABSTRACT FROM AUTHOR]

Objective The prognosis of Graves' disease (GD) varies among patients. However, the immune pathogenesis of refractory GD is still unknown. The aim of this study was to explore the cytokine expression profile associated with refractory GD. Methods Preliminary cytokine protein microarray screening was performed to detect differentially expressed cytokines in the plasma of four patients with refractory GD and four patients with stable GD. Some differentially expressed cytokines were then validated in plasma by enzyme-linked immunosorbent assay (ELISA) and in peripheral blood mononuclear cells (PBMCs) by quantitative real-time polymerase chain reaction (qRT-PCR) on another independent set of samples. Results We found that 21 cytokines were differentially expressed between patients with intractable GD and those in remission, including 18 upregulated and 3 downregulated cytokines with a fold change >1·30 and <0·77, respectively. Intractability-related elevation of three cytokines (IL-4, IL-6 and IL-10) was validated by ELISA in plasma on another GD cohort with 30 patients in recurrence and 14 in remission ( t-test, P = 0·035, 0·033 and 0·041, respectively). Furthermore, mRNA expression of IL-4, IL-6 and IL-10 in PBMCs, detected by qRT-PCR, was significantly elevated in patients with refractory GD compared with those in remission ( P = 0·039, 0·047 and 0·042, respectively). Conclusion The severity of GD is associated with the aberrant expression and secretion of several cytokines that may serve as potential biomarkers and predictors for disease prognosis. Targeting these cytokines or their receptors may also lead to a novel therapeutic intervention for GD. [ABSTRACT FROM AUTHOR]

The article discusses diseases that are considered as mental constructs or oversimplifications. Topics cited include the diagnosis of acute respiratory distress syndrome, characterization and diagnosis of ventilator-associated pneumonia and ventilator-associated tracheobronchitis and uncertainty on the relative adrenal insufficiency syndrome.

Background: Total thyroidectomy is increasingly used as a surgical approach for many thyroid conditions. Subsequently, postoperative hypocalcaemia is observed with increasing frequency, often resulting in prolonged hospital stay, increased use of resources, reduced quality of life and delayed return to work. The administration of vitamin D is essential in the therapy of postoperative hypocalcaemia; calcitriol is most commonly used. What has not been examined so far is whether and how routine preoperative vitamin D prophylaxis using calcitriol can help to prevent postoperative hypocalcaemia. This study evaluates routine preoperative calcitriol prophylaxis for all patients who are to undergo a total thyroidectomy, compared with the current standard of post-treatment, i.e., selective vitamin D treatment for patients with postoperative hypocalcaemia.Methods/design: This clinical observational (minimal interventional clinical trial) trial is a multicentre, prospective, randomized superiority trial with an adaptive design. Datasets will be pseudonymized for analysis. Patients will be randomly allocated (1:1) to the intervention and the control groups. The only intervention is 0.5 μg calcitriol orally twice a day for 3 days prior to surgery. For the primary endpoint measure (number of patients with hypocalcaemia), hypocalcaemia is defined as serum calcium of less than 2.1 mmol/l on any day during the postoperative course; this measure will be analyzed using a Chi-square test comparing the two groups. Secondary endpoint measures, such as number of days to discharge, quality of life, and economic parameters will also be analyzed.Discussion: By virtue of the direct comparison of clinically and economically relevant endpoints, the efficacy as well as efficiency of preoperative calcitriol prophylaxis of hypocalcaemia will be clarified. These results should be available 24 months after the first patient has been enrolled. The results will be used to inform a revised practice parameter guideline of whether or not to recommend preoperative calcitriol for all patients in whom total thyroidectomy is planned.Trial Registration: Deutsches Register Klinischer Studien, DRKS00005615 (Feb.12.2016). [ABSTRACT FROM AUTHOR]

Background: Management of thyroid diseases during pregnancy requires special considerations because maternal thyroid diseases can have adverse effects on both pregnancy and fetus. Universal screening for thyroid diseases in pregnant women is not currently supported by studies with high evidence whereas guidelines have been released for individuals at high risk, although controversies are still in debate. Iodine prophylaxis should be performed systematically to women during pregnancy.Materials and Methods: An electronic search of PubMed/Medline and EMBASE concerning thyroid diseases and pregnancy have been conducted over the past 20 years and summarized.Results: Data regarding prevention and treatment of thyroid diseases during pregnancy are reported from analysis of the literature.Conclusions: As thyroid dysfunction may cause profound impact on mother's and fetus's health, implementation by strict application of clinico-diagnostic flowchart and recommendations is of paramount importance when dealing with thyroid diseases during pregnant state. [ABSTRACT FROM AUTHOR]

Background In humans, measurement of serum thyroid-stimulating hormone ( TSH) concentration is commonly used as a first-line discriminatory test of thyroid function. Recent reports indicate that canine TSH ( cTSH) assays can be used to measure feline TSH and results can help diagnose or exclude hyperthyroidism. Objectives To investigate the usefulness of cTSH measurements as a diagnostic test for cats with hyperthyroidism. Animals Nine hundred and seventeen cats with untreated hyperthyroidism, 32 euthyroid cats suspected of having hyperthyroidism, and 131 clinically normal cats. Methods Prospective study. Cats referred to the Animal Endocrine Clinic for suspected hyperthyroidism were evaluated with serum T4, T3, free T4 ( fT4), and TSH concentrations. Thyroid scintigraphy was used as the gold standard to confirm or exclude hyperthyroidism. Results Median serum TSH concentration in the hyperthyroid cats (<0.03 ng/ mL) was significantly ( P < .001) lower than concentrations in clinically normal cats (0.05 ng/ mL) or euthyroid cats with suspected thyroid disease (0.06 ng/ mL). Only 18 (2.0%) hyperthyroid cats had measurable TSH concentrations (≥0.03 ng/ mL), whereas 114 (69.9%) of the 163 euthyroid cats had detectable concentrations. Combining serum TSH with T4 or fT4 concentrations lowered the test sensitivity of TSH from 98.0 to 97.0%, but markedly increased overall test specificity (from 69.9 to 98.8%). Conclusions and Clinical Importance Serum TSH concentrations are suppressed in 98% of hyperthyroid cats, but concentrations are measurable in a few cats with mild-to-moderate hyperthyroidism. Measurement of serum TSH represents a highly sensitive but poorly specific test for diagnosis of hyperthyroidism and is best measured in combination with T4 and fT4. [ABSTRACT FROM AUTHOR]

Background: In 2004, the U.S. Preventive Services Task Force found insufficient evidence to recommend thyroid screening. Purpose: To update the 2004 U.S. Preventive Services Task Force review on the benefits and harms of screening and treatment of subclinical and undiagnosed overt hypothyroidism and hyperthyroidism in adults without goiter or thyroid nodules. Data Sources: MEDLINE and Cochrane databases through July 2014. Study Selection: Randomized, controlled trials and observational studies of screening and treatment. Data Extraction: One investigator abstracted data, and a second investigator confirmed; 2 investigators independently assessed study quality. Data Synthesis: No study directly assessed benefits and harms of screening versus no screening. For subclinical hypothyroidism (based on thyroid-stimulating hormone levels of 4.1 to 11.0 mIU/ L), 1 fair-quality cohort study found that treatment of subclinical hypothyroidism was associated with decreased risk for coronary heart disease events versus no treatment. No study found that treatment was associated with improved quality of life, cognitive function, blood pressure, or body mass index versus no treatment. Effects of treatment versus no treatment showed potential beneficial effects on lipid levels, but effects were inconsistent, not statistically significant in most studies, and of uncertain clinical significance (difference, -0.7 to 0 mmol/L [-28 to 0 mg/dL] for total cholesterol levels and -0.6 to 0.1 mmol/L [-22 to 2 mg/dL] for low-density lipoprotein cholesterol levels). Treatment harms were poorly studied and sparsely reported. Two poor-quality studies evaluated treatment of subclinical hyperthyroidism but examined intermediate outcomes. No study evaluated treatment versus no treatment of screen-detected, undiagnosed overt thyroid dysfunction. Limitation: English-language articles only, no treatment study performed in the United States, and small trials with short duration that used different dosage protocols. Conclusion: More research is needed to determine the clinical benefits associated with thyroid screening. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the diagnostic performance of quantitative histogram parameters using real-time tissue elastography (RTE) in the diagnosis of patients with diffuse thyroid disease. One hundred and sixteen patients (mean age, 43.7 ± 10.97 y) who had undergone pre-operative staging ultrasonography and RTE were included. For each patient, 11 parameters were obtained from RTE images, from which the "elastic index" was calculated. Diagnostic performance of the elastic index and that of the 11 parameters on RTE were calculated and compared. Of the 116 patients, 31 had diffuse thyroid disease and 85 had normal thyroid parenchyma. Area under the receiver operating characteristic curve (Az) of MEAN (average relative value) elasticity was high (0.737), without significant differences from other elasticity values. Diagnostic performance of the elastic index was higher than the MEAN, Az = 0.753, without significance (p = 0.802). In conclusion, RTE using the elastic index was found to have good diagnostic performance and may be useful in the diagnosis and management of patients with diffuse thyroid disease. [ABSTRACT FROM AUTHOR]

A wide range of morphological and developmental variations of thyroid gland like hypoplasia, ectopic thyroid tissue, hemiagenesis or agenesis of thyroid gland has been reported. Out of these agenesis of the thyroid isthmus is a very rare congenital anomaly. Thyroid isthmus agenesis does not manifest clinical symptoms, and it can be confused with other thyroid pathologies. Also the presence of levator glandulae thyroideae and its anatomical variations gain importance in the pathologies which are related to thyroid gland and their treatment modalities. We hereby, report the absence of isthmus and presence of levator glandulae thyroideae and pyramidal lobe in a middle aged male cadaver. The present case report is an attempt to highlight the implications of variation of thyroid gland from diagnostic, phylogenetic and functional perspectives. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to compare the diagnostic values of thyroid ultrasound (US) and neck computed tomography (CT) in incidentally detecting diffuse thyroid disease (DTD). A single radiologist made US and CT diagnoses of incidentally detected DTD in 130 consecutive patients before thyroidectomy for various malignancies. Histopathologic examinations confirmed normal thyroid (n = 80), Hashimoto thyroiditis (n = 20), non-Hashimoto lymphocytic thyroiditis (n = 28) and diffuse hyperplasia (n = 2). Receiver operating characteristic curves revealed that the best diagnostic indices of both imaging methods were achieved on the basis of two or more abnormal imaging findings. The sensitivity, specificity and accuracy of US and CT in incidentally detecting DTD by this classification were 72% and 72%, 87.5% and 91.3% and 81.5% and 83.8%, respectively. Thyroid US and neck CT have similar diagnostic values for differentiating incidental DTD from normal thyroid. [Copyright &y& Elsevier]

Thyroid dysfunction and treatment follow up require accurate measurement of thyroid hormones. Most thyroid disease is treated on an outpatient basis; thus, assays have to be rapid and cost effective for optimal patient care. There are no rapid or point-of-care thyroid tests yet available, which could replace centralized automated thyroid testing. With the high population of thyroid dysfunction, it is important for thyroid assays to be available widely and locally. Immunoassays are most commonly used due to their ease and availability, but are limited in their accuracy. MS assays are much more specific, but are laborious with a high machine cost. Many hospitals may not be able to afford the machines and lack technical expertise. Sensitivity, specificity and standardization issues still result in substantial differences between various tests currently used for this population. To address these issues, new performance standards are being established by the professional organizations and technological advancements are being undertaken by instrument manufacturers. Automation solution is provided by various manufacturers and offers a choice for the hospital labs to select a platform which helps in their workflow and other chemistry testing. This has also resulted in decentralization and easy access to the thyroid testing. Even with these advancements, it is understandably confusing for clinicians to choose an assay for various clinical scenarios (20). As it becomes more available and standardized, LC-MS will continue to demonstrate its superiority to immunoassay. [ABSTRACT FROM AUTHOR]

Abstract: This article is dedicated to present a MRI (magnetic resonance imaging) based three-dimensional finite element modeling on the thermal manifestations relating to the pathophysiology of thyroid gland. An efficient approach for identifying the metabolic dysfunctions of thyroid has also been demonstrated through tracking the localized non-uniform thermal distribution or enhanced dynamic imaging. The temperature features over the skin surface and thyroid domain have been characterized using the numerical simulation and experimental measurement which will help better interpret the thermal physiological mechanisms of the thyroid under steady-state or water-cooling condition. Further, parametric simulations on the hypermetabolism symptoms of hyperthyroidism and thermal effects within thyroid domain caused by varying breathing airflow in the trachea and blood-flow in artery and vein were performed. It was disclosed that among all the parameters, the airflow volume has the largest effect on the total heat flux of thyroid surface. However, thermal contributions caused by varying the breathing frequency and blood-flow velocity are negligibly small. The present study suggests a generalized way for simulating the close to reality physiological behavior or process of human thyroid, which is of significance for disease diagnosis and treatment planning. [Copyright &y& Elsevier]

Purpose: Osteoprotegerin (OPG) is a soluble decoy receptor for the receptor activator of nuclear factor kappaB ligand, thereby inhibiting bone resorption. In this study, we aimed to evaluate plasma OPG levels in patients with thyroid dysfunctions and determine whether its levels change after restoration of euthyroidism. Material and Method: OPG levels were studied at the time of diagnosis and after the restoration of euthyroidism at least for 8 weeks in patients diagnosed with overt thyrotoxicosis and hypothyroidism. Results: Seventeen hypothyroid, 17 thyrotoxic patients and 17 age-, sex- and body mass index-matched healthy controls were analyzed. Mean basal plasma OPG levels were 5.42±2.66, 5.04±1.62 and 5.24±0.93 pmol/l in thyrotoxic, hypothyroid and healthy controls, respectively (p=0.844). After restoration of euthyroidism, OPG was 5.52±2.37 pmol/l in thyrotoxic and 4.33±1.37 pmol/l in hypothyroid patients, indicating no significant difference compared to baseline values (p=0.846 and p=0.109, respectively). We also did not observe any correlation between basal OPG levels and basal thyrotropin and thyroid hormone levels. Discussion: Thyroid dysfunctions seem to affect bone functions by mechanisms other than OPG, however, more clinical studies with larger sample sizes are needed to clarify the underlying mechanisms of thyroid dysfunction-related changes in bone metabolism. [ABSTRACT FROM AUTHOR]

Objective:We present a case of large, symptomatic lingual thyroid which was successfully and safely removed via a transoral approach, using the da Vinci robotic system, in an academic medical centre in Singapore.Case report:A 17-year-old female adolescent presented with a large lingual thyroid causing upper airway obstruction. She underwent robotic, minimally invasive, transoral resection using the da Vinci system. Post-operative recovery was uneventful; she was able to commence oral feeding almost immediately, and was discharged from hospital on the fourth post-operative day.Conclusion:It is surgically feasible and safe to undertake transoral robotic resection of a large lingual thyroid. This approach may allow faster recovery and shorter hospitalisation for patients. Surgical safety requires a full understanding of the intralingual neurovascular anatomy. [ABSTRACT FROM PUBLISHER]

Subclinical thyroid dysfunction (STD) represents a condition of slight thyroid hormone excess or deficiency, which may be associated with important adverse effects. This review will focus on the natural history, diagnosis and management of subclinical thyroid dysfunction. Since STD is only detected as a thyroid stimulating hormone (TSH) abnormality, it is essential to exclude transient causes of abnormal serum TSH before treating this disorder. Treatment of subclinical hyperthyroidism (SHyper) is recommended in elderly patients with undetectable serum TSH for the increased risk of atrial fibrillation, osteoporosis and bone fractures and for the higher risk of progression to overt disease. Treatment of subclinical hypothyroidism should be considered in patients with serum TSH above 10 mU/L for the increased risk of progression to overt hypothyroidism and the increased risk of coronary heart disease and heart failure events, which have been documented in patients with TSH increase above 10 mU/L. About 75% of patients with STD have mild dysfunction. The mild form of STD (low but detectable serum TSH in SHyper and mild increased serum TSH between 5 and 9 mU/L in SHypo is associated with a minor risk of disease progression to overt dysfunction. The best treatment for STD remains controversial. Treatment of the mild form of STD should be considered after evaluating the patients’ age, the adverse risk factors, the potential beneficial effects of treating this disorder and any underlying co-morbidities. Mild SHypo should be treated in infertile and pregnant women. [ABSTRACT FROM AUTHOR]

Several questions and answers related to diagnosis and treatment for thyroid diseases including a question on thyroid disorders' contribution to thyroid dysfunction, another on symptoms commonly experienced by patients and a question on therapies recommended.

Postpartum thyroiditis is a potentially destructive lymphocytic thyroiditis occurring in approximately 8% of the pregnant population, making it the most common endocrine disorder associated with pregnancy. This autoimmune thyroid disorder is precipitated by the postpartum immunological rebound that follows the partial immunosuppression of pregnancy, in individuals already at risk of autoimmune thyroid disease. The manifestations of postpartum thyroiditis are usually not present at the six-week postpartum visit and thus it is important that all physicians be aware of the risks, presentation and intervention required for this common disorder. Postpartum thyroiditis is a strong predictor of future thyroid health and it is essential that women with a history of postpartum thyroiditis be screened regularly, especially prior to a future pregnancy. Selenium supplementation has recently been identified as a potential means to prevent postpartum thyroiditis in women at risk but further studies are required before recommendations for its use can be made. [ABSTRACT FROM AUTHOR]

Summary: Lingual thyroid presenting as persistent cough and subclinical hypothyroidism is a rare presentation but recognition is nevertheless important. We present one such case and its successful management. [Copyright &y& Elsevier]

A 60-year-old woman presented with a neck mass and underwent fine needle aspiration of a left thyroid nodule. During this time, she had been injected with hCG for weight loss. Soon after, she developed rapid diffuse thyroid growth with pain. She was ultimately diagnosed with thyrotoxicosis due to postaspiration subacute thyroiditis and subsequently became hypothyroid. This condition is rare in the nonpregnant state in noncystic nodules with a smaller needle gauge approach. The incidence of thyroid nodule discovery and evaluation is increasing. As more procedures are undertaken, understanding of potential complications is important. This case highlights potential complications of thyroid fine needle aspiration including diffuse thyroid swelling and thyroiditis. The role of hCG injections is speculated to have potentially stimulated thyroid follicular epithelium via cross-reactivity with the TSH receptor and contributed to the acute inflammatory response after fine needle aspiration. [ABSTRACT FROM AUTHOR]

Objectives Radioactive iodine (131I) therapy is increasingly viewed as a safe and effective treatment for paediatric and adolescent hyperthyroidism. Our objective was to estimate treatment response and its predictors and describe current referral practices for 131I therapy. Design Retrospective study. Patients One hundred and thirty-one children 30 days–21 years old with laboratory evidence of hyperthyroidism, seen in an academic paediatric and adolescent endocrinology practice. Measurements Rate of referral, indications for 131I, predictors of poor treatment response. Results Thirty-eight of 102 patients with persistent hyperthyroidism (37%) received 131I (160 μCi/g thyroid tissue/131I uptake), as did an additional 10 patients initially evaluated by adult thyroidologists. Primary indications were intolerance to (29%) or poor control on (19%) antithyroid drugs, patient preference (50%) and unknown (2%). Of 48 patients treated with 131I, 89% and 11% became hypothyroid after one and two 131I doses, respectively. The goal of 131I therapy was attainment of hypothyroidism. ‘Poor treatment response’ (seen in 27%) was defined as requirement for a second 131I dose or failure to achieve hypothyroidism after 6 months. Predictors of poor treatment response included: previous use of antithyroid drugs (37% vs. 0%, P = 0·02), ophthalmopathy (58% vs. 8%, P = 0·002), and an interval of ≥12 months from diagnosis to 131I (50% vs. 10%, P = 0·003). A very elevated free T4 tended to be more prevalent in those with poor response. Conclusions In children and adolescents with hyperthyroidism, high rates of success after 131I are achievable. Use of antithyroid drugs, pre-existing eye disease and prolonged time to 131I may confer relative resistance to 131I. [ABSTRACT FROM AUTHOR]

Aims: To evaluate therapy and dose adjustments in patients with congenital hypothyroidism (CH), longitudinally followed up until 16 years old, according to aetiology, Beclard’s nuclei presence, and thyroxine (T4) level at diagnosis. Methods:L-T4/kg/day and dose change ratio (CR) were assessed in 74 CH patients. Results: The dose was statistically larger in athyreosis than in dyshormonogenesis (1–10 and beyond 14 years) and in ectopy (2, 15, 16 years). The ectopic children required statistically larger L-T4/kg than the dyshormonogenetic ones (3–7 years). The L-T4/kg/day was increased, not statistically, in patients or with T4 <30 nmol/l or without Beclard’s nuclei at diagnosis. The CR progressively dropped after the 6th month at each attendance, without any difference in terms of aetiology, T4 level at diagnosis, or Beclard’s nuclei. The total CR was greater (significantly) in patients without Beclard’s nuclei, and (not significantly) in those with T4 <30 nmol/l at diagnosis or with agenesia. Conclusion: The L-T4 dose in CH is highly affected by the aetiology. The CR is higher in patients with delayed bone maturation at diagnosis. We suggest that these latter patients need blood tests more frequently to obtain a proper titration of the therapy. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Thyrotoxic hypokalemic periodic paralysis (TPP) is a disorder leading to hypokalemia and muscle weakness. It mainly affects the Asian population, and it is rare in the Balkan and Caucasian people. We describe a case of a 34 year-old male presenting with TPP. To our knowledge, this case is the third Turkish patient diagnosed as TPP in the English medical literature. He was admitted to the Emergency Department (ED) with generalized weakness. Initial laboratory analysis showed that serum potassium was 1.6 mmol/L. His serum potassium was normalized after intravenous administration of potassium chloride (KCl) of 80 mmol over 4 h and 40 mg of propranolol administered orally, and then his generalized weakness was recovered. Thyrotoxicosis was treated with propyithiouracil and propranolol. [ABSTRACT FROM AUTHOR]

The expression of lactoferrin (LF), ceruloplasmin (CP) and secretory component (SC) in various thyroid diseases was investigated using an immunohistochemical method. LF is an iron-binding protein overexpressed in certain human adenocarcinomas. CP is implicated in carcinogenesis and SC is part of the local immune defense system. Sections of 15 follicular adenomas, 5 follicular carcinomas (FC), 16 papillary carcinomas (PC), 15 goitres and 2 cases of lymphocytic thyroiditis were re-examined and investigated immunohistologically by a streptavidin-biotin method. A positive immunostain reaction for CP and LF was observed in all cases of PC and FC. A positive immunostain reaction for SC was observed in 13/16 cases of PC and 4/5 cases of FC. A negative immunostain reaction for CP, LF and SC was observed in medullary cancers, in follicular adenomas and in the cases with goitre. We conclude that the immunostain expression of LF, CP and SC is a valuable diagnostic aid in the differential diagnosis between benign and malignant thyroid tumors. The expression of SC indicates the presence of a local immunodefensive system. [ABSTRACT FROM AUTHOR]

Thyroid hemiagenesis is a rare congenital anomaly in which one lobe of thyroid gland fails to develop. It is much rarer in males. There is a higher incidence of associated thyroid disorders in patients with thyroid hemiagenesis; therefore early and prompt diagnosis is important for children. We present the ultrasonographic and scintigraphic findings of thyroid hemiagenesis in an eight-year-old-boy. On ultrasonography (US), left lobe of the thyroid gland could not be demonstrated and the right lobe showed minimal hyperplasia. Its echogenicity was normal and no nodule was seen. On thyroid scintigraphy, left lobe of thyroid gland or any ectopic thyroid tissue could not be demonstrated, while the right lobe showed minimal hyperplasia. Without performing any invasive procedure, we enrolled the child in a follow-up program with the guidance of US and scintigraphy, which were effective both in making the final diagnosis of thyroid hemiagenesis and in evaluating the current status of the present thyroid tissue. In conclusion, if only one thyroid lobe is detected in a pediatric case initially with US or scintigraphy, the diagnosis of thyroid hemiagenesis should be suggested and, before any unnecessary or invasive attempt, the other complementary method (scintigraphy/US) should be performed. [ABSTRACT FROM AUTHOR]

Brucellosis is a zoonotic disease, especially in endemic regions all over the world, it is a common infectious disease. However, brucellosis borne thyroid gland infection is quite rare. The purpose of this study is to draw attention to the thyroid abscess borne due to brucella, which also show an unusual clinical graphic. Within this study we aim to represent a case with thyroid abscess dominated Brucella spp. [ABSTRACT FROM AUTHOR]

Researches the use of thyroid-stimulating hormone in screening for thyroid dysfunction, examining whether screening should focus on detecting subclinical thyroid dysfunction. Examination of guidelines on screening for thyroid dysfunction, published by the American College of Physicians; Description of methodologies used in this research; Statistical data on screening for thyroid dysfunction; Number of persons benefiting from the detection of thyroid dysfunction.

Objective: To review the optimal use of sensitive assays for thyroid-stimulating hormone (TSH) by clinicians.Methods: The available literature pertinent to the clinical application of sensitive TSH testing was identified through a systematic MEDLINE search and reviewed. Selection of materials for inclusion was based on clinical validity of the data and relevance to the study question.Synopsis: Sensitive TSH assays have contributed greatly to our basic knowledge of thyroid physiology and are a powerful clinical tool in the diagnosis and treatment of thyroid disease. The clinical applicability of these assays, as is our understanding of their appropriate use, is rapidly expanding. Based upon the best evidence and current understanding of thyroid physiology, strategies are presented for appropriate use of sensitive TSH assays in healthy outpatients, in patients who are likely to have a disturbed hypothalmic-pituitary-thyroid axis, and in patients on levothyroxane therapy.Conclusions: Although many clinical questions regarding the use of sensitive TSH assays remain to be studied, it has emerged as a powerful tool for the diagnosis and management of thyroid disease. Optimal use of sensitive TSH assays requires an understanding of TSH physiology and measurement, coupled with appropriate application and interpretation in specific clinical settings. [ABSTRACT FROM AUTHOR]

This JAMA Guidelines Synopsis summarizes the 2017 American Thyroid Association guidelines on diagnosis and management of thyroid disease during pregnancy and the postpartum period. [ABSTRACT FROM AUTHOR]

We encountered a patient who presented with neck swelling, difficulty in swallowing, voice change along with systemic features such as evening rise of temperature, chronic cough and weight loss. Ultrasonography of the thyroid gland revealed two cystic swellings. An ultrasound guided fine needle aspiration cytology was suggestive of tubercular abscess. The patient responded well to antigravity aspiration of the swellings and antitubercular treatment. [ABSTRACT FROM AUTHOR]

The article discusses guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Topics include higher risk for developing type 2 diabetes mellitus (T2D)with selenium (Se); treatment of thyroid peroxidase antibody (TPOAb)-positive women during pregnancy; and risk of developing gestational diabetes mellitus (GDM) with serum selenoprotein concentrations.