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Thyroid disorders are common in older people and cause significant morbidity. There may be fewer symptoms at presentation and increased susceptibility to adverse events, making diagnosis and management more challenging. The approach to management of thyroid disorders in older people differs from that for younger individuals. Factors that need to be considered include frailty, concurrent illness, polypharmacy, drug–drug interactions, and target organ sensitivity to treatment. This review discusses the clinical presentation, pathophysiology, and management of thyroid disorders and the effects of medications on thyroid function in older people. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) of the thyroid gland is extremely rare, even in areas where the prevalence of TB is very high. Only a few such cases have been reported in the literature. The clinical course may resemble toxic goiter or acute thyroiditis. We report the case of a 23-year-old male who presented with painless swelling of the thyroid gland associated with mild fever and weight loss. On ultrasound neck, a large echogenic solid lesion was seen. Fine-needle aspiration cytology was suggestive of colloid goiter, but histopathology study suggested TB of the thyroid gland along with colloid goiter. We report this case to emphasize that TB of the thyroid gland, although rare, should be kept in the differential diagnosis of thyroid nodules, especially in countries such as India which are endemic for TB. [ABSTRACT FROM AUTHOR]

Thyroglossal duct cyst (TDC) is the most common congenital anomaly of the neck. The thyroglossal duct is an embryological structure which connects the base of the tongue to the thyroid gland, which when fails to obliterate results in this anomaly. The incidence of this anomaly is approximately 7%, representing about 75% of the congenital masses of the neck. This cystic lesion is usually mobile and nontender in nature and usually presents with respiratory distress in infants. A lingual TDC is the rarest form of a TDC, and differs from a classical thyroglossal cyst totally in presentation and management. We present here a rare case of 2-month infant presenting with respiratory distress due to lingual TDC extending up to the suprathyroid region. [ABSTRACT FROM AUTHOR]

Thyroid acropachy is a rare manifestation of autoimmune thyroid disease with characteristic imaging findings. Clinically, it is almost always associated with thyroid ophthalmopathy and dermopathy. It presents as nail clubbing and swelling of the digits and toes. Especially, symmetrical swelling of the hands and feet as well as clubbing of the nails may require differential diagnosis with many hepatic, pulmonary, renal and even rheumatologic diseases. Radiologically, soft-tissue swelling and periosteal new bone formations are particularly significant. We present a 22-year-old female with Graves' disease who presented with bilateral swelling of the hands and feet and was diagnosed with thyroid acropachy following clinical and radiological evaluations. [ABSTRACT FROM AUTHOR]

Background: Subclinical thyroid dysfunction - abnormal serum thyrotrophin (thyroid-stimulating hormone; TSH) concentrations with normal free thyroxine (FT4) is common in older people. It remains unclear whether individuals with subclinical serum status experience an increased symptom profile.Aim: To compare the prevalence of those symptoms typically associated with overt thyroid dysfunction in older individuals with a subclinical and euthyroid serum profile.Design and Setting: Cross-sectional study, nested within the Birmingham Elderly Thyroid Study (BETS); from 19 UK general practices.Method: Adults living in a community setting (aged ≥65 years), without overt thyroid dysfunction or associated treatment, self-reported the presence or absence of 18 symptoms (while serum result naïve). Serum concentrations of TSH and FT4 were measured to establish thyroid status.Results: A total of 2870 individuals were screened: 2703 (94%) were categorised as euthyroid (normal), 29 (1%) subclinically hyperthyroid, and 138 (5%) subclinically hypothyroid. Symptoms were common in all groups. No significant differences in the prevalence of individual symptoms were observed between the euthyroid and subclinically hypothyroid groups nor in comparison with the subclinically hyperthyroid group. Multivariate logistic regression analysis failed to reveal an association between individual or multiple symptoms and subclinical status.Conclusion: Findings suggest that subclinical thyroid dysfunction does not confer a symptom burden in older individuals and support adherence to guidelines in the non-treatment of subclinical thyroid dysfunction. GPs may use the findings to reassure older people presenting with symptoms that subclinical thyroid dysfunction is an unlikely explanation. The presence of persistently abnormal TSH concentrations may be linked to long-term risks of cardiovascular disease, especially atrial fibrillation, but whether this should prompt treatment and whether such treatment alters vascular outcomes is unknown. [ABSTRACT FROM AUTHOR]

Screening is intended to detect thyroid dysfunction in asymptomatic patients in order to prevent adverse consequences of untreated thyroid dysfunction.[13] Screening is done by performing a blood test for TSH. To make its recommendation, the task force considered evidence from systematic reviews on the benefits and harms of screening for asymptomatic thyroid dysfunction, treatment of asymptomatic thyroid dysfunction, and patient values and preferences. These recommendations do not apply to patients with previously diagnosed thyroid disease or thyroid surgery; exposure to medications known to affect thyroid function; exposure to thyroid radioiodine therapy, or radiotherapy to the head or neck area; or pituitary or hypothalamic diseases. These recommendations do not apply to patients with previously diagnosed thyroid disease or thyroid surgery; exposure to medications known to affect thyroid function (e.g., lithium, amiodarone); exposure to thyroid radioiodine therapy, or radiotherapy to the head or neck area; or pituitary or hypothalamic diseases. [Extracted from the article]

* Context.--Familial adenomatous polyposis (FAP) is a rare genetic disorder with autosomal dominant inheritance, defined by numerous adenomatous polyps, which inevitably progress to colorectal carcinoma unless detected and managed early. Greater than 70% of patients with this syndrome also develop extraintestinal manifestations, such as multiple osteomas, dental abnormalities, and a variety of other lesions located throughout the body. These manifestations have historically been subcategorized as Gardner syndrome, Turcot syndrome, or gastric adenocarcinoma and proximal polyposis of the stomach. Recent studies, however, correlate the severity of gastrointestinal disease and the prominence of extraintestinal findings to specific mutations within the adenomatous polyposis coli gene (APC), supporting a spectrum of disease as opposed to subcategorization. Advances in immunohistochemical and molecular techniques shed new light on the origin, classification, and progression risk of different entities associated with FAP. Objective.--To provide a comprehensive clinicopathologic review of neoplastic and nonneoplastic entities associated with FAP syndrome, with emphasis on recent developments in immunohistochemical and molecular profiles of extraintestinal manifestations in the thyroid, skin, soft tissue, bone, central nervous system, liver, and pancreas, and the subsequent changes in classification schemes and risk stratification. Data Sources.--This review will be based on peerreviewed literature and the authors' experiences. Conclusions.--In this review we will provide an update on the clinicopathologic manifestations, immunohistochemical profiles, molecular features, and prognosis of entities seen in FAP, with a focus on routine recognition and appropriate workup of extraintestinal manifestations. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 12-year-old Japanese girl who was identified as a proband in Japan in a national mass screening for congenital hypothyroidism. Topics discussed include familial dysalbuminemic hyperthyroxinemia characterized by hyperthyroxinemia without thyrotoxicosis, the importance of free thyroid hormone concentration in the blood, and differential diagnosis for hyperthyroxinemia without thyrotoxicosis.

Background: We sought to evaluate left atrial (LA) and right atrial (RA) phasic function and deformation in the subclinical hyperthyroidism (SCH) using two- and three-echocardiographic (2DE and 3DE) methods. Methods: We included 45 untreated women with SCH and 45 healthy women who underwent comprehensive 2DE and 3DE examination. Results: Total and passive LA emptying fractions (EF) were decreased, whereas active EF was increased among the SCH participants. RA total EFs were similar between the controls and the SCH subjects; passive EF was reduced; and active EF was amplified in the SCH group. TSH correlated with 2DE LA passive and active EFs, 3DE LA total, passive and active EFs, as well as 2DE LA positive longitudinal strain. Additionally, TSH correlated with 2DE RA passive and active EFs, 3DE LA and RA passive EF, 2DE LA and RA positive longitudinal strain. However, after adjustment for the parameters of left and right ventricular diastolic function and structure, the TSH level remained associated only with LA conduit and booster pump functions, as well as RA pump function. Conclusion: Biatrial phasic function evaluated by 2DE and 3DE is significantly impaired in the SCH subjects. TSH level correlates with LA and RA conduit and pump functions. [ABSTRACT FROM AUTHOR]

The thyroid gland was assessed by ultrasound in healthy euthyroid mixed-breed medium size dogs in different age groups. The objective was to verify ultrasonographic imaging patterns in these groups, as well as to identify possi-ble changes in imaging features resulting from ageing. Thirty dogs - 10 young (<1 year), 10 adult and 10 elderly - without clinical signs or history of thyroid gland disease with complete blood count and thyroid function tests within the reference values were evaluated. Each thyroid lobe was examined by ultrasound for shape, size, echogenicity and echotexture. The analysis of echogenicity and echotexture was made by histogram. Thyroid volume was estimated by the equation for ellipsoid (length x width x height) π/6. The thyroid volume of the young dogs in this study had a tendency to be higher than in adult dogs (P = 0.068) and older dogs (P = 0.120). The height of the thyroid lobe in the longitudinal plane was significantly higher (P = 0.026) in young dogs com-pared with the other dogs. The echotexture and echogenicity had no significant differences between groups, but the echogenicity was greater in older dogs. The results point out that ultrasound imaging of the thyroid volume is influenced by age in euthyroid dogs. [ABSTRACT FROM AUTHOR]

The thyroid is the first endocrine gland to form during embryogenesis. At this stage, incomplete or anomalous migration of thyroid tissue causes ectopic localization of the gland. Submandibular ectopic thyroid tissue with a coexisting normally located thyroid gland is extremely rare. In this case aimed to present the findings of the 65-years-old female patient who is bilateral subtotal thyroidectomy operation performed for multinodular goiter of 12 years ago. Case, painless mass in the right submandibular and infrahyoid region for 6 months was admitted to our clinic with complaints. Result of contrast-enhanced neck computed tomography, ultrasound-guided fine-needle aspiration biopsy and thyroid scintigraphy were found of functional residual thyroid tissue in the normal localization as well as 2×3 cm mass in the submandibular area and 1×2 cm mass lesion in the infrahyoid region. The patient referred to excisional biopsy. Normal thyroid foilicules and no evidence of malignancy were found in specimen pathologically. Postoperative foliow-up of thyroid function tests were normal. [ABSTRACT FROM AUTHOR]

The article discusses abnormalities in Thyroid function tests (TFTs) that help in diagnosis of primary thyroid disorders as well as secondary or central thyroid disorders. The review discusses hypothyroidism and states that on finding an "abnormal" TFT, the physician recommends parents the referral to a pediatric endocrinologist. This review provides pediatricians with guidelines that will help them distinguish between variants of normal from true thyroid pathology.

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]

Ectopic thyroid is an uncommon condition defined as the presence of thyroid tissue at a site other than the pretracheal area. When the process of embryologic migration is disturbed, aberrant thyroid tissue may appear. In most cases, ectopic thyroid is located along the embryologic descent path of migration as either a lingual thyroid or a thyroglossal duct cyst. In rare cases, aberrant migration can result in lateral ectopic thyroid tissue. Approximately 1 to 3% of all ectopic thyroids are located in the lateral neck. Ectopic tissue frequently represents the only presence of thyroid tissue; a second site of orthotopic or ectopic thyroid tissue is found in other cases. The presentation of ectopic thyroid as a lateral mass should be differentiated from metastatic thyroid cancer; other differential diagnoses include a submandibular tumor, branchial cleft cyst, carotid body tumor, and lymphadenopathy of various etiologies. In addition to the history and physical examination, the workup for a patient with a submandibular mass suspicious for ectopic thyroid should include (1) technetium-99m or iodine-131 scintigraphy, (2) ultrasonography and either computed tomography or magnetic resonance imaging, (3) fine-needle aspiration biopsy, and (4) thyroid function testing. No treatment is required for asymptomatic patients with normal thyroid function and cytology, but hypothyroid patients should be placed on thyroid hormone replacement therapy. Most cases are diagnosed postoperatively. Surgical treatment of ectopic thyroid should be considered when a malignancy is suspected or diagnosed, when the patient is symptomatic, or when thyroid suppression therapy fails. [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.

We evaluated the preoperative serum thyrotropin (TSH) levels in 386 patients operated on for nodular thyroid disease (NTD). TSH levels for cases with final benign disease and differentiated thyroid carcinoma (DTC) were compared. No evidence of cancer was detected in 310 patients (80.3%), whereas malignancy was present in 76 cases (19.7%). Mean TSH concentration was 1.36 ± 1.62 mU/L in benign patients and 2.08±2.1 in cases with malignant lesions (P = 0.0013). The group of malignancy was subdivided in papillary thyroid carcinoma (PTMC) versus thyroid cancer of larger size (TCLS). Mean TSH was 1.71 ± 1.52 in PTMC and 2.42 ± 2.5 in TCLS. Significant differences were found when all groups (benign, PTMC and TCLS) were compared (P < 0.001). However, pairwise comparisons between them showed that differences were only significant between benign and TCLS groups (P < 0.01). In conclusion, TSH levels were higher in patients with a final diagnosis of DTC. Moreover, it appears that there exists an increment in tumor size as a function of increment in the TSH level. [ABSTRACT FROM AUTHOR]

Abstract: Background: In cases of thyroid diseases, many of the symptoms arise on the skin. In this study, we aimed to detect and compare the skin findings and accompanying dermatoses of patients with thyroid diseases. Materials and methods: 220 patients with thyroid diseases, who did not have any medical cure, and 90 healthy individuals as a control group attended our study. All of the cases were examined, and the skin findings and/or dermatoses were recorded. The skin findings in the patients and the control group were compared statistically. Results: Among 220 cases, in 125 (56.8%) skin findings were detected. The most frequently observed skin findings were chronic urticaria (6.8%), vitiligo (6.8%), diffuse alopecia (6%), acne vulgaris (5%) and acne rosacea (3.6%). No significant difference was detected statistically between the patients and control group in terms of skin findings. When compared for the presence of each dermatosis, chronic urticaria, vitiligo and pruritus were found to be significantly higher in the patient group with thyroid diseases than in the control group. In terms of the presence of skin findings, no statistical difference was detected between autoimmune hyperthyroidism and non-autoimmune hyperthyroidism, between autoimmune hypothyroidism and non-autoimmune hypothyroidism, or between autoimmune euthyroidism and non-autoimmune euthyroidism. Chronic urticaria, vitiligo, and diffuse alopecia were found to be significantly higher in patients with autoimmune thyroid diseases than in the control group. Vitiligo and diffuse alopecia were found to be higher in autoimmune hyperthyroidism patients than in the control group. Vitiligo was found to be significantly higher in autoimmune hypothyroidism patients than in the control group. Conclusion: To our knowledge, no report investigating the skin findings among thyroid diseases exists in literature. We believe this study would provide data for further studies. [Copyright &y& Elsevier]

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Background: The definition of the type of thyroid dysgenesis in congenital hypothyroidism (CH), ectopy, or athyreosis is important for monitoring patients and for genetic investigations. We have recently encountered infants who in spite of undetectable Technetium uptake on scintigraphy had biochemical results making athyreosis unlikely.Objective: To reevaluate the utility of plasma thyroglobulin (Tg) in this clinical context using new sensitive Tg assays.Subjects and Methods: Plasma Tg was retrospectively determined by two immunoassay systems on specimens obtained at diagnosis in 31 hypothyroid infants with thyroid dysgenesis.Results: Scintigraphy led to the diagnosis of ectopy in 19 infants and of athyreosis in 12. Seven (58%) of the infants classified as athyreotic by scintigraphy had detectable plasma Tg (>0.2 μg/l), indicating that they had functional thyroid tissue.Conclusions: An undetectable plasma Tg should be documented to validate a scintigraphic diagnosis of athyreosis. Conversely, when plasma Tg is undetectable, scintigraphy could be avoided. [Copyright &y& Elsevier]

The article presents information about the cutaneous manifestation of thyroid glands. The thyroglossal duct cyst is the most common congenital cystic abnormality of the neck, accounting for 70% of such lesions. Although they are usually observed in the first decade life, they may appear in adulthood as a complication or surgery. Malignancies develop in less than 1 percent of thyroglossal duct cysts. Moreover, to date, there have been 22 cases of metastatic thyroid cancer to the skin. Lesions may be solitary or multiple, they usually present after the diagnosis of thyroid cancer has manifested itself by thyromegaly of internal metastases.

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]

Thyrotoxic hypokalemic periodic paralysis is a rare complication of thyrotoxicosis. This clinic condition is often encountered in Asian populations and male gender while thyrotoxicosis is frequently seen in women. The escape of potassium into cell is the mechanism responsible for this disease and its etiology is not completely known. Thyroid hormones, carbohydrate rich diet, alcohol consumption and excessive exercise are regarded as the precipitating factors. This clinical picture is generally difficult to define at first attack. Here, we report a forty-two-year-old male patient with Basedow- Graves disease who was diagnosed as having thyrotoxic hypokalemic periodic paralysis during the first paralytic attack. His symptoms improved after potassium replacement and treatment with beta-blocker and antithyroid drugs. The permanent cure was achieved with radioactive iodine ablation therapy. [ABSTRACT FROM AUTHOR]

A lingual thyroid is a mass of ectopic thyroid tissue located in the midline of the base of the tongue. Its estimated prevalence ranges from 1 in 3,000 to 1 in 10,000 population. We report the interesting case of a 28-year-old woman who presented with a primary papillary carcinoma in a lingual thyroid and a histologically normal thyroid gland. To the best of our knowledge, this case probably represents only the second reported case of a follicular variant of a papillary carcinoma arising in a lingual thyroid. [ABSTRACT FROM AUTHOR]

The article presents a case study of two female patient presented with essential hypertension (HTN). It describes the role of primary hyperaldosteronism (PHA) in secondary HTN with symptoms that are nonspecific. The two HTN patients were diagnosed with Conn’s syndrome in primary care as the potentially curable cause of HTN.

The article presents a case study of a 53-year-old man with history of Graves' disease and progressive skin changes, patients have a orbital decompression surgery and treatment with radioiodine, and mentions that the patient have manifestation of autoimmune thyroid disease.

Acute suppurative thyroiditis (ST) is caused by infection of the thyroid gland. Abscess formation in acute ST is a rare, but potentially life-threatening condition. Most patients with acute ST have predisposing conditions. Herein, we report a 24-year-old female who presented on the fifth postpartum day with severe dysphagia, fever, chills, and sore throat. Thyroid hormone levels were consistent with thyrotoxicosis. Based on the clinical, radiological and laboratory findings, ST and abscess caused by Peptostreptococcus was diagnosed. The patient was successfully treated with appropriate antibiotics and ultrasound-guided abscess drainage. Turk Jem 2015; 19: 67-68 [ABSTRACT FROM AUTHOR]

The article focuses on thyroid hemiagenesis, a rare congenital anomaly detected during imaging for other conditions. An overview is provided concerning the thyroid rudiment. Two cases are described involving a 48-year-old man who presented for a workup of an apparent palpable mass on the right side of the neck and a 25-year-old woman with pharyngitis and difficulty in opening her mouth and swallowing. Most common pathologies are identified to be hyperthyroidism, hypothyroidism and goiter.

In this article the author discusses diagnosis and treatment of central hypothyroidism (CH), which is a rare cause of hypothyroidism with varied clinical symptoms. He explores the study by Koulouri and colleagues which suggests that the levels of free thyroxine (FT4) about 16 picomoles per liter (pmol/l) may show an appropriate target in treated patients with CH. He notes that levothyroxine (LT4) replacement therapy might be optimal by fulfilling the associated conditions.

The article argues that tumors that occur in the thyroid gland as a result of lymph or vascular spread from distant sites are considered to represent metastatic disease rather than a direct extension of a primary from an adjacent organ. Although a thyroid gland mass may be the presenting clinical sign, it is more often the underlying thyroid gland disease that prompts clinical evaluation. Immunohistochemistry analysis will help with the separation between primary and metastatic tumors.

Peak expiratory flow measurement would give an objective assessment of tracheal stenosis by demonstrating extrathoracic airways obstruction. Primary thyroid lymphoma is an uncommon disease representing 5% of all thyroid neoplasms and the majority are due to non-Hodgkin's lymphoma. Though it is widely accepted that the vast majority of thyroid lymphomas occur with the background of autoimmune Hashimoto's thyroiditis, its presence has been reported as varying from 22%-100% and is by no means sufficient to establish a diagnosis. In recent years the recognition of mucosa associated lymphoid tissue (MALT) has drawn new attention to the pathogenesis of primary lymphomas of thyroid. MALT lymphomas are also known to transform into high grade lymphomas.

The article presents a case study of a 28-year old man with painless swelling of the neck for two years. No complaints from the benignant lesions for a long time because of the slow growth. The cyst was then removed after it was diagnosed by an advanced radiological examination. The article discusses epidermal inclusion cyst and its treatment.

Presents the case of a 39-year old anesthestist who was experiencing increased hair loss. Description of the patient's symptoms and condition; Medical examination of the patient; Diagnosis of chronic hypothyroidism; Treatment with thryoxine.