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NPs play a pivotal role in caring for pregnant people. This article provides an overview of gestational and postpartum thyroid disorders, including their assessment, management, and indications for referral. The goal of this article is to help providers better assess and manage thyroid disorders during pregnancy and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Pregnant women are more susceptible to iron deficiency (ID), and it can lead to several maternal and perinatal adverse effects. There are some published data on the effect of ID on thyroid function, but none of the studies were conducted in sub-Saharan African countries including Sudan. This study was conducted to investigate association between ID (ferritin < 15 µg/L) and thyroid functions [thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4)] among Sudanese women in the first trimester of pregnancy. Method: A cross-sectional study was conducted in Saad Abuelela Maternity Hospital, Sudan. Obstetric/sociodemographic characteristics were gathered through questionnaires. Hemoglobin, serum ferritin, TSH, FT3, and FT4 were measured in all pregnant women. Continuous variables were compared with either independent sample t-test if they were normally distributed, or with Mann–Whitney U- test if they were not-normally distributed. Spearman correlations were performed between the continuous variables. Results: In total, 127 pregnant women with mean [standard deviation (SD)] age of 27.0 (5.5) years and gestational age of 10.5 (3.0) weeks, respectively, were enrolled in this study. Forty-seven (37.0%) of these 127 women had ID. While the median [interquartile range (IQR)] of the parity, TSH, and FT3 were not different between women with ID and women without ID, the median (IQR) of FT4 was significantly lower in women with ID compared with women without ID [1.020 (0.910‒1.120) vs. 1.095 (0.990‒1.217) pmol, P = 0.014]. Serum ferritin was inversely correlated with FT3, (r = -0.225, P = 0.011). There was no significant correlation between serum ferritin, TSH, and FT4. Conclusions: Iron deficiency was common during the first trimester of pregnancy and was associated with thyroid dysfunctions. Therefore, ID should be evaluated to avoid thyroid dysfunction. [ABSTRACT FROM AUTHOR]

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]

Differential diagnosis is important for clinical management of cases with thyroid diseases. We aimed to find the most useful diagnostic panel including immunohistochemistry markers and BRAF 600E mutation for papillary thyroid carcinoma. The study included 99 papillary thyroid carcinoma, 95 benign thyroid disease and 6 well differentiated tumour of uncertain malignant potential cases. Three groups were compared for immunohistochemistry marker expressions (CK19, Gal-3, HBME-1, p63, CD56). Diagnostic contribution of BRAF V600E mutation and its relationship with the immunohistochemistry and prognostic parameters were evaluated. CK19, Gal-3, HBME-1 and p63 positivity and loss of CD56 expression were significantly higher in papillary thyroid carcinoma than in benign thyroid disease. Gal-3 was the most useful marker to differentiate both papillary thyroid carcinoma and well-differentiated tumour of uncertain malignant potential cases from benign thyroid disease. CK19&HBME-1 and CK19&-Gal-3 dual panels had the highest sensitivities and high specificities for distinguishing papillary thyroid carcinoma from benign thyroid disease. Moreover, CK19&Gal-3 dual panel had the highest sensitivity and specificity to distinguish well-differentiated tumour of uncertain malignant potential from benign thyroid disease. In addition, CK19&Gal-3&HBME-1 was the most sensitive triple panel in differentiating both papillary thyroid carcinoma and well-differentiated tumour of uncertain malignant potential cases from benign thyroid disease. When combined with immunohistochemistry markers, the BRAF V600E reduced sensitivities and increased specificities towards malignancy, and it was not associated with prognostic parameters except for histological subtypes. [ABSTRACT FROM AUTHOR]

Introduction: Fine needle aspiration (FNA) is recognized worldwide as the primary diagnostic method for evaluating thyroid nodules. Samples collected by FNA can be spread directly onto slides, prepared for cell blocks, or processed as liquid-based cytology. Advocates of the traditional smear technique emphasize that background material such as colloid, cell sequencing characteristics in cell clusters, and cellularity is important in cytological diagnosis. They state that these properties are not observed in liquid-based liquids. Liquid-based cytology techniques aim to provide standardized slides of homogeneous cellular smears with well-preserved cell morphology, producing more precise visualization, shorter interpretation time, and more reproducible results. This study aimed to investigate and compare the diagnostic performance of liquid-based thyroid FNA samples prepared with SurePath and Cytospin over the last 6 years. Methods: Patients who underwent ultrasound-guided FNA between January 2015 and December 2021 were included in the study. Cytology reports, pathology reports, and demographic information of the patients were collected from the Hospital Information Management System. The programs "SPSS for Windows 21" and "MedCalc Diagnostic Test Evaluation Calculator" were used for data analysis. Chi-square tests were used in crosstab analysis. The Kolmogorov-Smirnov two-sample test, two proportions test, and the confidence interval tests were used to analyze the variables of the methods. P <.05 was considered statistically significant. Results: The study population comprised 4,855 patients, 83.8% female and 16.2% male. There were no statistical differences in age and gender distribution in the population of both methods. Nondiagnostic outcome rates were 11.2% for SurePath and 12.8% for Cytospin. Sensitivity, specificity, and accuracy values for SurePath and Cytospin methods were determined as 58.57%, 98.28%, and 91.12% and 79.07%, 96.88%, and 94.03%, respectively. Conclusion: In our study, although the qualitative analytical results were slightly in favor of the cytospin method, we think both ways can be used safely, especially in hospitals where the clinics performing sampling activities are variable and many, as well as in pathology laboratories where the workload is intense. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the differences in hemogram parameters, especially in inflammatory markers and perinatal and neonatal outcomes of pregnant women with thyroid disease, and to examine the effects of these differences on pregnancy outcomes. Material and Methods: The data of 80 pregnant women diagnosed with thyroid disease according to the American Thyroid Association (ATA) criteria at the first admission between 2016 and 2019 and 100 pregnant women whose thyroid hormone levels were within the normal reference range were retrospectively analyzed. Obstetric outcomes such as type and time of delivery, and the presence of additional disease during pregnancy, and neonatal outcomes such as weight, gender, and Apgar score at birth were compared. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), white blood cell (WBC) count, and hemoglobin (Hb) and mean platelet volume (MPV) values, which are accepted as inflammation markers, were also compared between groups. Results: There was no significant difference between hypothyroid and hyperthyroid pregnant women in terms of Hb (p=0.319) and PLR (p=0.341) values. Third-trimester WBC (p=0.015) values were higher and MPV (p=0.007) values were lower in the hypothyroid pregnant women compared to the control group. The highest NLR (p=0.005) value was observed in the hypothyroid group. Comorbidities were found to be 27.4% (n=20) in the hypothyroid group, 14.3% (n=1) in the hyperthyroid group, and 1.0% (n=1) in the control group (p<0.001). Conclusion: Pregnant women with thyroid disease may have differences in hemogram parameters, especially in inflammatory markers, and these differences may affect pregnancy outcomes. [ABSTRACT FROM AUTHOR]

The article presents answers to a clinical quiz about faltering growth and sleepiness on peritoneal dialysis.

Objective We evaluated the intraday changes of thyroid function biomarkers in healthy subjects to help clinicians diagnose thyroid diseases in appropriate timing. Methods Blood samples were collected from 31 subjects at 0:00, 4:00, 8:00, 12:00, 16:00 and 20:00 on the sampling day and analyzed for thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free T3 (FT3), and free T4 (FT4). The intraday concentration changes were analyzed using Friedman's 2-way analysis of variance by ranks. Results The concentrations of TSH, T3, T4, FT3, and FT4 in males were significantly higher than those in females (P  < .01). The obvious peak circadian rhythm of TSH was observed at 0:00 AM with gradual decline thereafter, whereas other biomarkers showed no rhythmic changes. Conclusion Sex differences should be considered in interpreting thyroid function tests. It is important to select the sampling time according to the clinician's diagnostic needs, especially at night when TSH secretion peaks. [ABSTRACT FROM AUTHOR]

Background: Ethanol ablation for the treatment of thyroid cysts has been well documented in the literature as a safe, effective treatment option in the elective setting. This study demonstrates the use of ethanol ablation in the emergency setting. Methods: Three patients presenting with airway-threatening compressive symptoms secondary to a thyroid cyst were treated with ethanol ablation within 24 hours of presentation to hospital. Results: All patients had symptom resolution at a median of nine months follow up post procedure. Sixty-six per cent of patients required only one treatment. There was a median of 100 per cent radiological resolution of the cystic component. The median Glasgow Benefit Inventory score was +27.7, similar to that for tonsillectomy. Conclusion: Ethanol ablation is a safe, cost-effective and efficient treatment option for thyroid cysts in the acute setting. [ABSTRACT FROM AUTHOR]

Objective. Patients with nonfunctioning pituitary adenoma (NFPA) can present with different types of thyroid disorders, which are easily misdiagnosed or missed and can even result in serious clinical consequences. This study was to summarize the different types of thyroid disorders in patients with NFPA with the aim of providing references for the diagnosis and treatment of such patients. Materials and Methods. The data of pituitary adenoma (PA) patients who underwent surgical treatment at Xuanwu Hospital, Capital Medical University, from 2017 to 2021 were retrospectively analyzed, and NFPA patients with preoperative thyroid disorders were screened out to analyze their imaging, endocrine, treatment, and prognosis data. Also, thyroid disorders were classified to summarize diagnostic methods and treatment principles for different types of thyroid disorders. Results. A total of 399 NFPA patients were included in this study, of which 67 (16.8%) had thyroid disorders before surgery. Fifty-four patients had (13.5%) central hypothyroidism (CH) caused by NFPA and were treated with levothyroxine (L-T4) supplementation before and after operation. Eleven patients (2.8%) had primary hypothyroidism and were treated with L-T4 during the perioperative period, and long-term treatment of primary hypothyroidism was provided after surgery. Two NFPA patients (0.5%) were combined with primary hyperthyroidism and treated with medication for primary hyperthyroidism after tumor resection. Conclusion. Thyroid disorders are relatively common in patients with NFPA, but are difficult to be diagnosed due to their different types. CH is the most common type of thyroid disorder, which requires aggressive L-T4 supplementation during the preoperative period. The primary disease of the thyroid gland is easily missed when NFPA is combined with primary hypothyroidism or primary hyperthyroidism, and the thyroid function test results require to be analyzed carefully for continued treatment for thyroid disease after resection of the NFPA. [ABSTRACT FROM AUTHOR]

Background: It is difficult to detect optic nerve changes in patients with thyroid-associated ophthalmopathy (TAO) before the development of optic neuropathy. Purpose: To detect changes in the intraorbital segment of the optic nerve in patients with TAO using diffusion tensor imaging (DTI) and determine any correlations with disease severity. Material and Methods: A total of 74 participants (17 normal, 22 mild, and 35 moderate-severe TAO) were organized to be given 3-T DTI to measure fractional anisotropy (FA) and mean diffusivity (MD) for the orbital segments of their optic nerves. All underwent ophthalmological examinations for visual acuity, intraocular pressure, exophthalmos, and fundoscopy, and were assessed based on the Clinical Activity Score (CAS). Univariate analysis of variance and Pearson's correlation coefficients were carried out. Results: Patients with moderate-to-severe TAO had significantly lower FA values and higher MD values (P < 0.05). FA values were negatively correlated with CAS but had no obvious correlations with the degree of exophthalmos. MD values had no obvious correlations with CAS or the degree of exophthalmos. Conclusion: DTI parameters of the intraorbital optic nerves were significantly altered in moderate-to-severe patients before onset of clinical optic nerve dysfunction and may, therefore, be used as an imaging biomarker for assessing the disease. [ABSTRACT FROM AUTHOR]

The article presents the discussion on revised recommendations for celiac disease (CD) screening and biopsy including consideration of a serology-based diagnostic approach. Topics include expanded section on skin disorders showing continuous glucose monitoring (CGM)-related and insulin pump-related skin issues; and screening for thyroid disease by measurement of TSH, anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies.

Objective: Data about the impact of Cushing's syndrome (CS) on thyroid is scarce. We aimed to identify the prevalence of thyroid diseases in patients with CS. Patients and Methods: Nineteen patients with CS and 40 healthy participants were included in the study. All patients were tested for free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), anti-thyroglobulin (anti-Tg), and antithyroid peroxidase (anti-TPO) levels, and thyroid ultrasonography (US). Results: Overt hypothyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism was evident in 5.3%, 5.3%, and 21.1% of patients with CS; and 2.5%, 7.5%, and 15% of healthy subjects, respectively. fT3 and fT4 levels were lower in patients with CS. None of the patients with CS and 27.5% of the control group had autoimmune thyroid disease (AITD), which was demonstrated by both US findings and anti-TPO positivity (P=0.01). Frequency of thyroid nodule was 52.6% and 52.5% in patients with CS and controls, respectively (P=0.99). Conclusion: The prevalence of thyroid dysfunction, nodular thyroid disease, and goiter is comparable to healthy population. However, AITD is less prevalent among patients with CS. Although, hypercortisolism has an impact on hypothalamic-hypophyseal-thyroid axis, its clinical implication does not seem to be significant. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the characteristics of incidental findings (IFs) on computed tomography (CT) scans of trauma admissions, examine associations between IFs and gender and age-groups, and discuss the management strategies. Methods: The CT reports were retrospectively reviewed to evaluate IFs. Cases were divided into five age-groups (0--19, 20--39, 40--59, 60--79, ≥ 80). IFs were classified as "Group 1": congenital anomalies that do not require further investigation, nondegenerative/minor degenerative findings; "Group 2": findings that do not require immediate intervention, require outpatient follow-up/in case of symptoms; and "Group 3": findings that require immediate intervention/further investigation. Results: There were 2385 CT scans and 1802 incidental findings (IFs) in 783 trauma cases. CT scans with IFs constituted 50.2%. The percentage of IFs was 75.6% in males and 24.4% in females, and they occurred in 4.8%, 27.6%, 44.3%, 20.9%, and 2.4% of age groups 1 to 5, respectively. Group 1 had 34.6%, group 2 had 54.6%, and group 3 had 10.8% IFs. There was not any significant association between the classification and gender or age-groups. In terms of organs, IFs of the thyroid and gall bladder & bile ducts were significantly higher among females (P = 0.044 and P < 0.001, respectively), while IFs in the head & neck region were significantly higher in males (P < 0.001). Incidental findings in the kidney, liver, adrenal gland, and vascular structures differed significantly across age-groups (P < 0.05). Conclusion: There were no significant relationships between the classification of IFs and gender or age-groups. However, the distribution of IFs was significantly associated with gender and age-groups in terms of organs. Healthcare professionals should consider this relationship when following up and treating patients. [ABSTRACT FROM AUTHOR]

Objective: To study whether maternal thyroid disease in pregnancy is associated with pubertal timing in sons and daughters.Design: Cohort study.Setting: National birth cohort and health registers.Patient(s): A total of 15,763 mothers and children from the Danish National Birth Cohort and its Puberty Cohort.Intervention(s): Register-based and self-reported information on maternal thyroid diseases during pregnancy (hyperthyroidism, hypothyroidism, benign goiter, or no thyroid disease [reference group]).Main Outcome Measure(s): The adjusted mean age difference (months) at attaining several self-reported pubertal milestones collected every 6 months using an interval-censored regression and the average difference in age at attaining all pubertal milestones using the Huber-White robust variance estimation (primary outcome).Result(s): Sons of mothers with hyperthyroidism had earlier pubertal development (average difference, -2.9 [95% confidence interval (CI), -5.0 to -0.7] months) than unexposed sons. Maternal hypothyroidism was not associated with pubertal development in sons (average difference, -1.2 [95% CI, -5.1 to 2.7] months). We observed nonstatistically significant indications of earlier pubertal development in sons of mothers with benign goiter (average difference, -1.9 [95% CI, -4.6 to 0.9] months). Maternal thyroid disease was not associated with pubertal development in daughters (average difference (months), hyperthyroidism, -0.8 [95% CI, -2.8 to 1.2]; hypothyroidism, 0.3 [95% CI, -3.1 to 3.8]; and benign goiter, 0.7 [95% CI, -2.0 to 3.4]).Conclusion(s): We found indications of earlier pubertal development in sons of mothers with hyperthyroidism. More research is needed to further investigate the observed sex-specific association. [ABSTRACT FROM AUTHOR]

Fine-needle aspiration cytology is considered the gold standard screening test in the evaluation of a thyroid nodule. We studied whether cell block cytology can be used in addition to conventional smears for the evaluation of tissue from fine-needle aspirations or fluid aspirations and also compared it with histopathological diagnosis. Aims: The primary aim of this study was to know the utility of cell blocks in the diagnosis of thyroid lesions. Settings and Design: This was a prospective observational study conducted from June 2018 to September 2020 at a tertiary Care Hospital in Eastern India. Ethical approval was obtained from the Ethics Committee of the institution. Patients above 18 years who presented with goiter were included in the study. Thirty patients were enrolled in the study after informed consent. Methods and Material: Smears prepared from the aspirates were stained with Leishman-Giemsa (LG) and Pap stain. The remnant from the needle hub was transferred to a sterile container. Cell blocks were prepared from the remnants. Smears were scored based on cell obscuration by blood, cellularity, cell degeneration, and cell architecture. The results were compared with histopathology. Statistical Analysis Used: Data were recorded using Microsoft Excel. Descriptive statistics, frequency, and proportion were used to describe demographic variables. Results: The majority of the patients (23.3%) were in their third decade of life, followed by 16.7% of the patients in their fourth and fifth decades. The patient age ranged from 25 to 80 years, with a mean age of 50.83 years and a standard deviation of 16.72. The largest number of patients were females accounting for 80% (24/30) of the total participants. The majority of the patients (36.7%) (11/30) had thyroid gland enlargement for a period of 15 days to three months. 14% of the participants were not able to recall its duration. The majority (60%) (18/30) had left lobe lesions, followed by 33.3% (10/30) who had right lobe lesions, and 6.7% (2/30) who had bilateral lobe swelling. The mean size of the lesion was 2.84 cm. 50% were found to be Bethesda II lesions, while 13.3% were Bethesda IV, and 36.7% were found to be Bethesda VI lesions. The cell block score (7) was found to be better compared to Fine Needle Aspiration Cytology (FNAC) (4.7). Tissue Coagulum Clot and Clot Scrape methods were found to yield better results compared to the Cytocentrifuge method. The P value was found to be significant (<0.001). Conclusions: Cell blocks were found to improve the cell morphology compared to FNAC alone and can be used as an adjunct to FNAC in the diagnosis of various thyroid lesions. [ABSTRACT FROM AUTHOR]

There are many thyroid diseases affecting people all over the world. Many diseases affect the thyroid gland, like hypothyroidism, hyperthyroidism, and thyroid cancer. Thyroid inefficiency can cause severe symptoms in patients. Effective classification and machine learning play a significant role in the timely detection of thyroid diseases. This timely classification will indeed affect the timely treatment of the patients. Automatic and precise thyroid nodule detection in ultrasound pictures is critical for reducing effort and radiologists' mistake rate. Medical images have evolved into one of the most valuable and consistent data sources for machine learning generation. In this paper, various machine learning algorithms like decision tree, random forest algorithm, KNN, and artificial neural networks on the dataset create a comparative analysis to better predict the disease based on parameters established from the dataset. Also, the dataset has been manipulated for accurate prediction for the classification. The classification was performed on both the sampled and unsampled datasets for better comparison of the dataset. After dataset manipulation, we obtained the highest accuracy for the random forest algorithm, equal to 94.8% accuracy and 91% specificity. [ABSTRACT FROM AUTHOR]

Background & Aims: Thyroid disorders including hypothyroidism and hyperthyroidism are common condition in the world and the right diagnosis and treatment are important. Now a days screening for thyroid dysfunction recommend only in a specific situation, thus unnecessary tests could have undesirable outcomes such as improper sampling and costs related to long-term follow-up which could affect patients and health system. (5-10. Except for cases of inappropriate doing thyroid function tests, it should be noted that TSH measurement alone has a high sensitivity for the initial investigation and diagnosis of thyroid diseases (7, 10) so, in context of abnormal TSH it is necessary to measure other thyroid hormones. It is worth mentioning that in the case of hospitalized patients, thyroid laboratory disorders are more common without the presence of thyroid gland homeostasis disorder (11), which shows the necessity of paying more attention to the target population in requested examinations. Therefore, according to the importance of the subject, the present study investigated the request patterns of thyroid function tests and the logical cases of their request in Tehran's Firouzgar Hospital affiliated to Iran University of Medical Sciences, during the second 6 months of 2017. In this cross-sectional study, 484 inpatients for whom each of the Thyroid function tests was requested selected as a sample by census and included in the study. The samples included in the study were evaluated by clinical evaluation and history taking with the aim of finding the indications for thyroid test request, and if it is possible to diagnose thyroid function disorders in the next stage of the requested tests in terms of compliance with the algorithms and instructions The existing one was checked. Finally, if the laboratory tests lead to the final diagnosis, the proportionality of the requested functional test with the final diagnosis is checked. Methods: In this study, the definition of essential thyroid tests included the patients who have a known thyroid disease based on previous history or hospital records and clinical examinations, or there is a high clinical suspicion for their thyroid disease, it is reasonable to perform TSH & T4 & T3RU or TSH & FT4 tests. SPSS version 24 software was used for statistical analysis of data. Results: The average age of the participants in the study was 54.2 years with a standard deviation of 17 years and 59.4% were female. In total requested tests the most patients 101 (20.7%) were hospitalized in the neurology department and the least patients 2 (0.4%) were from the toxicology ward. Out of a total of 488 patients for whom thyroid tests were requested, only 259 patients were found to have a specific reason for requesting these types of tests based on the clinical records, history or clinical examination, and 99 patients (38.2%) were hypothyroid. TSH was requested for 477 patients, and the mean TSH was 3.583. Out of a total of 69 patients whose treatment status changed, 27 patients (39.1%) had an increase in the treatment dose. The most patients whom TSH was requested without indication, most cases (26.3%) were admitted to the neurology department. The most common pattern of requesting thyroid tests in people participating in our study was the combination of TSH, T3, T4. In this study, 69 patients out of 488 patients for whom thyroid tests were performed treatment was changed. Out of 194 patients who had a logical reason to request thyroid tests based on their previous history of thyroid diseases or current examination and history, only 54 patients, equivalent to 27.83%, have undergone treatment change. Conclusion: The purpose of this study was to examine the patterns of requests for thyroid function tests and to determine the logical cases of their requests in Firozgar Hospital in a period of 6 months. Considering that hypothyroidism and hyperthyroidism have a significant prevalence in the world and also due to the high prevalence of iodine deficiency in our country, thyroid diseases are also common. Since the symptoms of thyroid diseases are mostly nonspecific and shared with other diseases, it is better to avoid unnecessary sampling and related problems, including high cost, the need for long follow-up and the patient's and family's concern about the results. As a result of the tests, the measurement of thyroid function tests should be used only in reasonable cases and with a suitable pattern. There is no need to check thyroid tests in all hospitalized patients who are unrelated to thyroid diseases. In general, it seems that the measurement of thyroid tests in logical cases and with the correct pattern has positive results for the patient and health system. In the current study, thyroid tests were requested for 488 patients, compared to the study of Small et al., it can be said that the sample size of our study was slightly smaller than that study. (11) About 60% of the studied patients were women, which can indicate that thyroid tests are more common in women than in men, regardless of whether the request is reasonable or unreasonable. In terms of average age, it can be stated that thyroid tests are performed at different ages of people, although the average age in this study was 54 years, but a wide standard deviation of 17 years was also observed among patients. Regarding the frequency of unnecessary requests, T3 with 99.2%, TSH with 60.6%, and T4 with 59.4%, T3RU with 59%, and Anti TPO Ab with 38% had the highest to lowest amount respectively. It should be noted that all requests for fT3 and fT4 tests were unnecessary. In our study, the most number of cases for whom thyroid tests were requested were hospitalized in the departments of neurology, endocrinology, neurosurgery, and neurology ICU, respectively. It seems that this amount can be reduced if endocrinologists are consulted about the indication of requesting thyroid tests. The most common request patterns for thyroid function tests were TSH&T4&T3 with 69.87% and TSH&T4 with 15.57% respectively. In the study of Roti et al., the most common requested pattern with 56% was the combination of TSH, T3, T4, and for this reason, the two studies are similar (10). was requested, 27.83% of them had a change in their treatment procedure, which is higher compared to the study of Mr. Small et al., where only 2% of patients had a change in treatment (11). In our study, among the patients whose test results were in favor of changing the treatment or starting of thyroid medication or increasing the dose of drugs was the most common case with 39.1%. In this study, among patients who had a history of thyroid problems, TSH and T4 tests were reported as the most frequently performed tests among these people. In general, based on the obtained results, it seems that requesting all thyroid indicators at the same time is a common finding. It can also be added that the unusual patterns of requesting thyroid function tests, multiple cases of requesting thyroid function tests, and the non-optimal contractual TSH threshold level cause unnecessary requests for thyroid function tests. One of the most important limitations of this type of study is that the algorithms and instructions are different in different field of medicine and the way of requesting thyroid function tests may be different between two medical specialties. Another limitation of this study is the lack of sufficient previous studies. One of the final suggestions can be the point that cases of inappropriate requests for thyroid hormones in free hormones are taken at the same time as taking total hormone levels, which are the most suitable places for intervention to reduce cases of inappropriate requests for thyroid function tests. It is also suggested that studies with a larger sample size and a longer follow-up period be conducted in the future. [ABSTRACT FROM AUTHOR]

Background: Considering the changes in thyroid physiology associated with pregnancy and poor outcomes related to abnormal maternal thyroid function, international guidelines recommend using population-based trimester-specific reference intervals (RIs) for thyroid testing. If these RIs are not available in the laboratory, implementing recommended fixed cut-off values globally is still controversial. To address this issue, we aimed to establish appropriate RI of thyroid-stimulating hormone (TSH) in pregnant Turkish women for our laboratory and compare the prevalence of thyroid dysfunction based on the established and recommended criteria.Methods: Of 2638 pregnant women, 1777 women followed in the obstetric outpatient were enrolled in the reference interval study after applying exclusion criteria related to medical and prenatal history. A retrospective study was conducted by collecting data from July 2016 to March 2019. Serum TSH was measured by UniCel DxI 800 Immunoassay System (Beckman Coulter Inc., Brea, CA, USA). The study design relied on two approaches in order to classify pregnant women: trimester-specific and subgroup-specific; the latter involved dividing each trimester into two subgroups: T1a, T1b, T2a, T2b, T3a, T3b. The lower and upper limits of the RIs were derived by the parametric method after normalizing the data distribution using the modified Box-Cox power transformation method.Results: The lowest TSH value was detected at 8-12 weeks in early pregnancy, and the median value of TSH in the T1b subgroup was significantly lower than the T1a subgroup (P < 0.05). TSH levels showed a gradual trend of increase along with the pregnancy and increased significantly in the T2a, T2b, and T3b subgroups compared to the preceding subgroups (P < 0.05). Compared to the diagnostic criteria recommended by American Thyroid Association (ATA), the prevalence of thyroid dysfunction was significantly different from the established trimester- and subgroup-specific RIs throughout the pregnancy (P < 0.001).Conclusions: We conclude that establishing gestation- and laboratory-specific RIs, especially for TSH, is essential for diagnosing thyroid disorders in pregnancy, and the recommended universal cut-off values, which may contribute to the risk of a misdiagnosis or a missed diagnosis, should be taken with caution in the clinical setting. However, regarding the fluctuation of thyroid function tests throughout pregnancy, trimester-specific RIs are insufficient, and implementing split phases is required. [ABSTRACT FROM AUTHOR]

Background Previous studies have posited that an association exists between thyroid function and the heart and vasculature. It remains unclear, however, whether longitudinal trends in thyroid function contribute to the development of atherosclerosis. We conducted a cohort study to examine the association of longitudinal trends in thyroid function with incident carotid atherosclerosis (CA) in middle-aged and older euthyroid subjects. Methods This cohort study's participants were recruited from the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study in Tianjin, China. Free triiodothyronine (FT3), thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured using chemiluminescence immunoassay. CA was assessed using carotid ultrasonography. Thyroid function and ultrasonography were assessed yearly during follow-up. Multivariable Cox proportional hazards regression models were used to assess the association between thyroid function and incident CA. Results A total of 3,181 participants were enrolled in the cohort study. Within 7,762 person-years of follow-up, 944 participants developed CA, the incidence rate of CA was 122 per 1,000 person-years. The fully adjusted hazards ratios (95% confidence interval) of CA for per 1-unit increase in changes of FT3, FT4 and TSH were 1.34(1.22–1.47), 1.22(1.19–1.26) and 0.92 (0.77–1.09) (P  < 0.0001, <0.0001 and = 0.32, respectively), respectively. Similar significant associations between mean levels of FT3 and FT4 and incident CA were observed. However, baseline thyroid function was not associated with incident CA. Conclusions These findings suggest that higher mean levels and higher values of changes in thyroid hormones were associated with a higher risk of incident CA in middle-aged and older euthyroid subjects. [ABSTRACT FROM AUTHOR]

The thyroid gland is a major regulator of cellular metabolism and influences numerous physiological processes including growth and development, thermogenesis, lipid and carbohydrate metabolism, heart rate, reproduction, and cognitive function1. The thyroid gland secretes the thyroid hormones, T4 (thyroxine) and T3 (triiodothyronine), that impact almost every cell and organ in the body. Due to these widespread effects, thyroid dysfunction is associated with various non-specific symptoms, which often leads to a delayed or misdiagnosis of thyroid disease. [ABSTRACT FROM AUTHOR]

Background: Published data show that thyroid function laboratory tests are often ordered inappropriately in the acute care setting, which leads to unnecessary costs and inappropriate therapy decisions. Pilot data at our institution indicated that approximately two-thirds of the thyroid-stimulating hormone (TSH) laboratories were unnecessary, correlating to a potential cost avoidance of more than $20,000 annually. The purpose of this study was to improve the appropriateness of thyroid function test ordering with a multipronged initiative. Methodology : This controlled, single-center, before and after study included inpatients or emergency department (ED) patients at Wake Forest Baptist Medical Center who were at least 18 years of age and had a TSH level ordered during the study period. Patients with a history of thyroid cancer were excluded. The initiative included an electronic ordering intervention, direct education of providers (medical residents, attendings, and clinical pharmacists), and distribution of pocket information cards with appropriate ordering criteria. The primary outcome was the number and percentage of inappropriate TSH tests ordered before and after implementing the 3 interventions. Secondary outcomes included cost savings, inappropriate changes in thyroid therapy based on improperly ordered tests, and the number of free T4 lab tests ordered on patients with a TSH within the therapeutic range. Results : All 3 interventions were implemented, except for education of ED residents and faculty, who chose to forgo the direct education component. Inappropriate ordering of TSH levels decreased from 63 to 50 (13% reduction, P =.062) after implementation. Inappropriate TSH ordering decreased across all services, except in the ED. Inappropriate Free T4 orders decreased from 191 to 133 (30% reduction, P =.01). There were no therapy changes based on inappropriate TSH orders. Extrapolated annual cost savings were approximately $6,000. Conclusion : This multipronged interprofessional collaborative quality improvement initiative was associated with a nonstatistically significant reduction in inappropriate TSH orders, statistically significant reduction in inappropriate free T4 orders, and cost savings. There was a reduction in inappropriate ordering across all services except the ED, which may have been due the ED not participating in the direct education component of the initiative. [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]

The article describes the case of a 70-year-old male diagnosed with primary tuberculosis (TB) of the thyroid gland. The patient presented with a large fluctuating right neck mass present for the previous 4 months. Topics covered include the findings of the contrast enhanced compute tomography of the neck, the treatment given to the patient and the variability of the presentation of the primary thyroid TB.

Many of the people now a days are suffering with thyroid disorder. Hence, the earlier detection of thyroid becomes very important in medical field to cure the patient.The detection methods are based on pattern recognition, machine learning and data mining. Thyroid disorder was caused by the imbalanced state of thyroid hormones, and is of two types, they are over production (hyperthyroidism) and less production (hypothyroidism). In this paper we applied machine learning models on the hypothyroid dataset taken from the UCI data repository to partially fulfill the detection of thyroid disorder. The experimental results have shown that, the proposed model willgive the good results [ABSTRACT FROM AUTHOR]

Objective: Thyroglossal duct cysts (TGDCs) are relatively common congenital midline neck masses that are treated with surgical excision. Traditionally these are removed along with any associated tract and the central portion of the hyoid bone through an anterior neck incision. Some patients with TGDCs want to avoid an external neck scar. Methods: We describe the details of a transoral endoscopic vestibular excision of a TGDC and the associated hyoid bone in an adolescent patient. Results: This novel approach was successful and there were no complications. Conclusion: We propose that cervical TGDCs can be safely and completely removed with this approach in appropriately selected patients while avoiding a neck scar. [ABSTRACT FROM AUTHOR]

Thyroglossal cyst is the most common congenital neck anomaly in children with equal sex incidence, but papillary carcinoma of the thyroglossal cyst in children is rare with only 10 cases reported so far. Even in adults, the incidence of malignancy in the thyroglossal cyst is only 1%. Most cases are diagnosed following surgery on histopathological examination; there is no consensus on the management owing to this rarity and indolent but unpredictable behavior of thyroid cancers. Here, we present one such rare case. [ABSTRACT FROM AUTHOR]

Background: Basedow's disease and Hashimoto's thyroiditis are autoimmune thyroid disorders and usually diagnosed with elevation of serum autoimmune antibodies. Thyrotropin receptor antibodies (TRAb) and/or thyroid-stimulating antibody (TSAb) are usually used for diagnosis of Basedow's disease, and thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb) are for diagnosis of Hashimoto's thyroiditis. However, it is difficult to diagnose a subject as Basedow's disease with associated features of Hashimoto's thyroiditis only with elevation of such autoimmune antibodies. Case presentation: A 44-year-old woman with 5-year history of Basedow's disease underwent a total thyroidectomy. She did not have a goiter. TRAb, TSAb, TPOAg and TgAb were all positive before a total thyroidectomy. In histopathological macroscopic examination, diffuse hyperplasia of the thyroid gland was observed. Furthermore, in histopathological microscopic examination, both characteristics of Basedow's disease and Hashimoto's thyroiditis were observed. After a total thyroidectomy, titers of all thyroid-associated autoimmune antibodies were markedly reduced. Conclusion: Herein, we report a subject with Basedow's disease without a goiter whose TPOAb and TgAb were relatively high at the onset of Basedow's disease. In addition, interestingly, the histopathological findings of this subject showed direct signs of Basedow's disease and Hashimoto's thyroiditis in the same thyroid gland. Considering from such findings, she seemed to have Basedow's disease with associated features of Hashimoto's thyroiditis. In conclusion, we should bear in mind the possibility of Basedow's disease with associated features of Hashimoto's thyroiditis in subjects with Basedow's disease, particularly when TPOAb and TgAb as well as TRAb and TSAb are positive. [ABSTRACT FROM AUTHOR]

Objective: Studies examining changes in thyroid function in the course of chronic liver disease have mostly been conducted in adults. The aim of this study was to investigate thyroid dysfunction in children with chronic liver diseases. Methods: Between 2005 and 2018, patients aged up to 18 years of age, diagnosed with chronic liver disease and had thyroid function test results available were included. Anthropometric characteristics, liver and thyroid function results were collected and analyzed. Results: The study included 107 (53 female; 49.5%) patients aged between one month and 18 years-old. Of the 107 patients, 96 (89.7%) had normal thyroid function results, seven (6.5%) had subclinical hypothyroidism (SH) and four (3.7%) had euthyroid sick syndrome. Of the patients with SH, one (14.2%) had glycogen storage diasease, one (14.2%) had biliary atresia, one (14.2%) had undiagnosed cholestatic liver disease, one (14.2%) had Alagille syndrome, one (14.2%) had idiopatic hepatitis, one (14.2%) had progressive familial intra-hepatic cholestasis and one (14.2%) had congenital hepatic fibrosis. Spearman correlation analysis showed a negative correlation between free tri-iodothyronine and direct bilirubin (r=-0.329, p=0.027). Conclusion: In conclusion, euthyroid sick syndrome or SH may affect up to 10% of children with chronic liver diseases. It is suggested that thyroid function should be evaluated in cases of pediatric chronic liver disease at diagnosis and during follow-up. Moreover, this study is the first to show a negative correlation between free T3 levels and direct bilirubin, suggesting a possible association between liver disease severity and thyroid function. [ABSTRACT FROM AUTHOR]

Objective: Thyroglossal duct cysts are the most common congenital neck mass. They typically present as a painless midline neck mass in a child or young adult, but may also present later in adulthood when the cyst becomes symptomatic. Thyroglossal duct cysts are most commonly located inferior to the hyoid bone in close relation with the thyrohyoid membrane. Very rarely, they may extend intralaryngeal, occupy the posterior hyoid space, and present with dysphonia and/or dysphagia. To our knowledge, this is the 24th reported case in the literature. Methods: Case report with a comprehensive review of the literature. Results: The patient was a 43-year-old male experiencing dysphonia and dysphagia following a motor vehicle accident. He was subsequently found to have a large thyroglossal duct cyst with endolaryngeal extension that was previously asymptomatic and undiagnosed. He underwent successful surgical excision which resulted in resolution of symptoms. Conclusion: This is the first reported case of a thyroglossal duct cyst in the posterior hyoid space with endolaryngeal extension being diagnosed following a traumatic event. This case illustrates the need to consider thyroglossal duct cyst in the differential diagnosis when working up a post-traumatic intralaryngeal neck mass. A secondary educational objective in this case is to be diligent to consider and rule out laryngeal fracture in the case of a neck mass presenting after trauma as they can easily be missed and present with many overlapping symptoms. [ABSTRACT FROM AUTHOR]

Introduction. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a significant step to standardize the reporting of thyroid fine needle aspiration (FNA). It has high predictive value, reproducibility, and improved clinical significance. Aim. The study was aimed to evaluate the diagnostic utility and reproducibility of "TBSRTC" at our institute. Methods and Material. The study included 646 thyroid FNAs which were reviewed by three pathologists and classified according to TBSRTC. Cytohistological correlation was done for 100 cases with surgical follow-up and the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and risk of malignancy (ROM) were calculated. The interobserver variation among three pathologists was also assessed. Results. The distribution of cases in various TBSRTC categories is as follows: I—nondiagnostic 13.8%, II—benign 75.9%, III—atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) 1.2%, IV—follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN) 3.7%, V—suspicious for malignancy (SM) 2.6%, and VI—malignant 2.8%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy are 72.4%, 94.3%, 84%, 89.2%, and 87.9%, respectively. The ROM of various TBSRTC categories were II—8.5%; III—66.7%; IV—63.6%; and V and VI—100%. Cohen's Weighted Kappa score was 0.99 which indicates almost perfect agreement among the three pathologists. Conclusions. Our study substantiates greater reproducibility among pathologists using TBSRTC to arrive at a precise diagnosis with an added advantage of predicting the risk of malignancy which enables the clinician to plan for follow-up or surgery and also the extent of surgery. [ABSTRACT FROM AUTHOR]

Background: An accurate measurement of serum thyroid stimulating hormone (TSH) is crucial for a thyroid disorder diagnosis and management. We compared the values of TSH between three automated immunoassays with aims to provide insights into variations in TSH levels that are important for a clinical decision: 2.50 mIU/L, 4.00 mIU/L and 10.00 mIU/L.Methods: We measured TSH with three different fully automated immunoassays: Abbott (Architect ci8200), Siemens (ADVIA Centaur XP) and Roche (Cobas e411). Serum was collected from 110 patients between August 2018 and January 2019. The results were compared using the Passing-Bablok regression method. Additionally, linear regression coefficients were calculated after logarithmic transformation of data.Results: Although all three regression coefficients were high (r2 > 0.98), the slopes from Passing-Bablok plots for the correlation of Abbott with either Roche or Siemens were merely 0.66 and 0.73, respectively. The slope for the correlation of Roche and Siemens was 1.11. Consecutively, the results obtained by the Roche and Siemens methods were proportionally higher than those obtained by the Abbott method (38% and 52%, respectively) at all measured ranges.Conclusions: Although immunoassays correlated among themselves, they cannot achieve the same values for clinical decisions for hypothyroidism (clinical requirements). Clinicians should be conscious of these limitations. A harmonisation of the methods is needed to meet clinical requirements and to enable appropriate clinical decisions in cases of hypothyroidism.Likewise, we suggest the introduction of borderline and high risk values of TSH for hypothyroidism depending on immunoassays to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

Aim: Vaspin is an insulin-sensitive adipokine secreted from visceral fat tissue, and belongs to the serine protease inhibitor family. The relationship between vaspin level and coronary artery disease is not known yet. We aimed to investigate the relationship between serum vaspin levels and degree of vessel involvement in coronary angiography in patients with stable angina pectoris. Methods: The patients were chosen from those who had coronary angiography with the diagnosis of stable angina pectoris. Patients with previously diagnosed chronic heart disease, chronic liver disease, renal failure, thyroid dysfunction and any systemic infectious or malignant disease, patients receiving immunosupressive treatment and those who did not give informed consent were excluded from the study. Serum vaspin measurements were performed using an East Biopharm enzyme-linked immunoassay (ELISA) kit using the sandwich ELISA method. For determination of the severity of coronary lesions, the modified Gensini score was used. Results: Eighty-eight patients [34 female (38.6%) and 54 male (91.4%)] were included in the study. Vaspin levels were similar in male (1.17±1.54 ng/L) and female (1.09±1.23 ng/L) patients (p=0.46). There was no correlation between vaspin levels and the number of vessels involved (p=0.75). Vaspin levels were similar in diabetic and nondiabetic patients. Conclusion: Vaspin may not be a sensitive marker of the degree of vascular lesions in patients with stable angina pectoris. The underlying cause is probably lack of significant changes in inflammatory cascade and oxidative stress in the involved group of patients. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the prevalence of thyroid disease (TD) in untreated CD patients and to evaluate the effect of gender and age on its prevalence. Background: Celiac disease (CD) is a form of intestinal malabsorption syndrome which is closely related to endocrine disorders, especially autoimmune thyroid disease and diabetes. The prevalence of TD is possibly high among patients with CD which necessitates the need for screening for TD among them. Methods: This comparative cross-sectional study was conducted on 288 consecutive untreated patients with CD (mean age, 27.9±14) and 250 controls (mean age, 29.01±13.15) referred for endoscopy in a hospital located in Iran. Thyroid function was evaluated by measuring T3, T4, and TSH levels using ELISA technique, and testing anti-thyroperoxidase (anti-TPO) antibodies through electrochemiluminescence method. Data analysis was conducted in SPSS v.22 software using descriptive statistics and chi-squared test. Results: Thyroid disease prevalence was 4-fold higher in patients than in controls (13.6% vs. 3.2%, p<0.05). Hypothyroidism was diagnosed in 30 patients and 7 controls, while hyperthyroidism was observed in 9 patients and in one control. Chi-squared test results reported a significant difference in TD prevalence between patients and controls based on gender and age (p<0.05). In both groups, women were significantly more affected than men, and the TD prevalence was higher in younger patients compared to adults. Conclusion: There was a strong association between thyroid dysfunction and CD. In this regard, it is necessary to screen patients for TD. [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.--The College of American Pathologists periodically surveys laboratories to determine changes in cytopathology practices. We report the results of a 2016 survey concerning thyroid fine-needle aspiration (FNA). Objective.--To provide a cross-sectional survey of thyroid cytology practices in 2016. Design.--In 2016, a survey was sent to 2013 laboratories participating in the College of American Pathologists Non-Gynecologic Cytology Education Program (NGC-A) requesting data from 2015-2016 on several topics relating to thyroid FNA. Results.--A total of 878 laboratories (43.6% of 2013) replied to the survey. Radiologists performed the most thyroid FNA procedures in most laboratories (70%; 529 of 756), followed by endocrinologists (18.7%; 141 of 756), and most of these were performed under ultrasound guidance (92.1%; 699 of 759). A total of 32.6% of respondents (251 of 769) provided feedback on unsatisfactory rates for nonpathology providers who performed FNA. Intraprocedural adequacy assessment was primarily performed by attending pathologists (77.4%; 490 of 633) or cytotechnologists (28.4%; 180 of 633). Most laboratories used the Bethesda System for Reporting Thyroid Cytopathology (89.8%; 701 of 781) and performed molecular testing based on clinician request (68.1%; 184 of 270) rather than FNA diagnosis. Correlation of thyroid excisions with prior cytology results most often occurred retrospectively (38.4%; 283 of 737) and was used for pathologist interpretive quality assurance purposes. Conclusions.--These survey results offer a snapshot of national thyroid FNA cytology practices in 2016 and indicate that standardized cytology terminology is commonly used; pathologists perform most immediate adequacy assessments for thyroid FNA; laboratories use correlation statistics to evaluate pathologists' performance; and molecular tests are increasingly requested for indeterminate interpretations, but reflex molecular testing is rare. [ABSTRACT FROM AUTHOR]

* 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 pituitary hormone, thyrotropin (TSH), is regarded as the primary biomarker for evaluating thyroid function and is useful in guiding treatment with levothyroxine for patients with hypothyroidism. The amplified response of TSH to slight changes in thyroid hormone levels provides a large and easily measured signal in the routine care setting. Laboratories provide reference ranges with upper and lower cutoffs for TSH to define normal thyroid function. The upper limit of the range, used to diagnose subclinical (mild) hypothyroidism, is itself a matter for debate, with authoritative guidelines recommending treatment to within the lower half of the range. Concomitant diseases, medications, supplements, age, gender, ethnicity, iodine status, time of day, time of year, autoantibodies, heterophilic antibodies, smoking, and other factors influence the level of TSH, or the performance of current TSH assays. The long-term prognostic implications of small deviations of TSH from the reference range are unclear. Correction of TSH to within the reference range does not always bring thyroid and other biomarkers into range and will not always resolve the patient's symptoms. Overt hypothyroidism requires intervention with levothyroxine. It remains important that physicians managing a patient with symptoms suggestive of thyroid disease consider all of the patient's relevant disease, lifestyle, and other factors before intervening on the basis of a marginally raised TSH level alone. Finally, these limitations of TSH testing mitigate against screening the population for the undoubtedly substantial prevalence of undiagnosed thyroid disease, until appropriately designed randomised trials have quantified the benefits and harms from this approach. [ABSTRACT FROM AUTHOR]

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]

Even though most thyroid subjects are undiagnosed due to nonspecific symptoms, universal screening for thyroid disease is not recommended for the general population. In this study, our motive is to showcase the early appearance of thyroid autoantibody, anti-TPO, prior to the onset of thyroid hormone disruption; hence the addition of anti-TPO in conjunction with traditional thyroid markers TSH and FT4 would aid to reduce the long-term morbidity and associated health concerns. Here, a total of 4581 subjects were tested multiple times for TSH, FT4, anti-TPO, and anti-Tg and followed up for 2 years. We streamlined our subjects into two groups, A1 (euthyroid at first visit, but converted to subclinical/overt hypothyroidism in follow-up visits) and A2 (euthyroid at first visit, but converted to hyperthyroidism in follow-up visits). According to our results, 73% of hypothyroid subjects (from group A1) and 68.6% of hyperthyroid subjects (from group A2) had anti-TPO 252 (±33) and 277 (±151) days prior to the onset of the thyroid dysfunction, respectively. Both subclinical/overt hypothyroidism and hyperthyroidism showed a significantly higher percentage of subjects who had anti-TPO prior to the onset of thyroid dysfunction compared to the combined control group. However, there was no significant difference in the subjects who had anti-Tg earlier than the control group. Further assessment showed that only anti-TPO could be used as a standalone marker but not anti-Tg. Our results showcase that anti-TPO appear prior to the onset of thyroid hormone dysfunction; hence testing anti-TPO in conjunction with TSH would greatly aid to identify potentially risk individuals and prevent long-term morbidity. [ABSTRACT FROM AUTHOR]

Gallbladder mucocele formation is an emerging disease in dogs characterized by increased secretion of condensed granules of gel-forming mucin by the gallbladder epithelium and formation of an abnormally thick mucus that can culminate in obstruction of the bile duct or rupture of the gallbladder. The disease is associated with a high morbidity and mortality and its pathogenesis is unknown. Affected dogs have a significantly increased likelihood of concurrent diagnosis of hyperadrenocorticism, hypothyroidism, and hyperlipidemia. Whether these endocrinopathies represent coincidental primary disease processes that exacerbate gallbladder mucocele formation in predisposed dogs or reflect a concurrent disruption of endocrine and lipid metabolism is unclear. In this study, we investigated a hypothesis that dogs with gallbladder mucocele formation would have a high prevalence of occult and atypical abnormalities in adrenal cortical and thyroid gland function that would suggest the presence of endocrine disruption and provide deeper insight into disease pathogenesis. We performed a case-control study of dogs with and without ultrasonographic diagnosis of gallbladder mucocele formation and profiled adrenal cortical function using a quantitative mass spectrometry-based assay of serum adrenal-origin steroids before and after administration of synthetic cosyntropin. We simultaneously profiled serum thyroid hormone concentrations and evaluated iodine sufficiency by measurement of urine iodine:creatinine ratios (UICR). The studies were complemented by histological examination of archival thyroid tissue and measurements of thyroid gland organic iodine from dogs with gallbladder mucocele formation and control dogs. Dogs with gallbladder mucocele formation demonstrated an exaggerated cortisol response to adrenal stimulation with cosyntropin. A prevalence of 10% of dogs with gallbladder mucocele formation met laboratory-based criteria for suspect or definitive diagnosis of hyperadrenocorticism. A significantly greater number of dogs with gallbladder mucocele formation had basal serum dehydroepiandrosterone (DHEAS) increases compared to control dogs. A high percentage of dogs with gallbladder mucocele formation (26%) met laboratory-based criteria for diagnosis of hypothyroidism, but lacked detection of anti-thyroglobulin antibodies. Dogs with gallbladder mucocele formation had significantly higher UICRs than control dogs. Examination of thyroid tissue from an unrelated group of dogs with gallbladder mucocele formation did not demonstrate histological evidence of thyroiditis or significant differences in content of organic iodine. These findings suggest that dogs with gallbladder mucocele formation have a greater capacity for cortisol synthesis and pinpoint DHEAS elevations as a potential clue to the underlying pathogenesis of the disease. A high prevalence of thyroid dysfunction with absent evidence for autoimmune thyroiditis suggest a disrupted thyroid hormone metabolism in dogs with gallbladder mucocele formation although an influence of non-thyroidal illness cannot be excluded. High UICR in dogs with gallbladder mucocele formation is of undetermined significance, but of interest for further study. [ABSTRACT FROM AUTHOR]

Standardization programs for thyroid hormones have revealed bias between immunochemical methods and the reference method ED-ID-LC/MS. Lack of standardization between methods, suboptimal reference intervals and replacement of serum with plasma may compromise the capability of the immunochemical thyroid methods to diagnose thyroid disease. To accommodate the demand for faster turn-around times for laboratory replies, we replaced serum with plasma on some serum CE marked thyroid methods. This forced us to do on-board analytical correction for the plasma total T4 (TT4) method on ADVIA Centaur® XP. We, next, validated the capability of the ADVIA Centaur® XP thyroid methods on plasma by (1) first carrying out a prospective method comparison with the ED-ID-LC/MS reference method using collected plasma samples, (2) we verified the clinical reference intervals by analyzing collected plasma samples from healthy individuals, and (3) retrospectively compared laboratory results from two different time periods using serum TT4 and serum total triiodothyronine (TT3) versus plasma free thyroxine (FT4) and plasma TT3, respectively, to diagnose thyroid disease. The plasma FT4 method displayed a negative concentration-dependent bias against the reference method. This bias was apparently counteracted by a fitted reference interval for the plasma FT4 method. Indeed, overt hyperthyroid disease was found in 1.0% and 1.1% of the cases using serum and plasma and overt hypothyroid condition were in 1.3% and 0.6% of the cases using serum and plasma, respectively. In conclusion, the ADVIA Centaur® XP FT4 method displayed a negative bias at high plasma FT4 concentrations against the reference method, but the diagnostic performance was not compromised due to a fitted reference interval. [ABSTRACT FROM AUTHOR]

Background: Laboratory thyroid function tests play a central role in the diagnosis of thyroid disorders. The aim of our cross-sectional study was to determine reference values for thyroid tests in a rigorously selected group of Montenegrin females, investigate the impact of possible age-related changes and the influence of the interassay bias between three frequently used immunoassays. Methods: Female subjects were randomly selected, aged between 20 and 69 and 946 of them met the selection criteria. TSH, fT3, fT4, thyroid peroxidase and thyroglobulin antibodies were measured. Eighty samples were further analyzed on two other immunochemistry platforms. Results: Median TSH progressively increased with age, there was no difference in fT3, while fT4 was significantly higher in the two oldest groups compared to the others. When using the age-related 97.5 percentile of TSH the percentage of reclassification was highest in the 20-29 years of age group (5.2%, p<0.05). In the oldest band, 7.7% had TSH values above cohort-specific and below the age-related upper reference limit. Bland-Altman bias plots revealed the highest interassay absolute mean difference between compared TSH assays of 24.5% and for fT4 assays of 13.8%. Conclusions: The correlation coefficients between fT3 assays from different manufacturers were low. Serum TSH and fT4 concentrations increased with age and the implementation of age-specific TSH reference intervals would be of interest. The bias between the three commercial immunoassays indicated that the standardization of thyroid function tests is a task of great importance. [ABSTRACT FROM AUTHOR]

Background: Sick euthyroid syndrome (SES) is the most common endocrine disorder in critically ill patients. It has been shown that the decrease in T4 levels correlates with disease severity and prognosis. Whether SES is a compensatory response to the disease course or needs to be treated is not known yet. Objectives: To our knowledge, there are only a few studiesoncritically ill infants and children investigating the correlation between thyroid function and disease severity as well as its outcome. Therefore, this study aimed to investigate thyroid hormone levels in critically ill patients. Methods: In this study, thyroid function tests including thyroid stimulating hormone (TSH), total T3 (TT3), free T3 (FT3), total T4 (TT4), free T4 (FT4), and reverse T3 (rT3) were measured in 35 critically ill children admitted to intensive care unit (ICU) on days 1 and 3 of admission. Disease severity was evaluated using pediatric logistic organ dysfunction score (PELOD). Then the patients were divided into groups of survivors and non-survivors and the results were compared between these two groups accordingly. Results: Thirty-five patients, including 19 (54.3%) female and 16 (45.7%) male, with the mean age of 2 years (SD:_3.8 years, range: 4 months- 15 years) had entered the study basedonthe inclusion criteria. 25 (71.6%) patients were transferred from PICUto other wards and 10 (28.4%) patients died. Age and sex were not statistically different in survivors and non-survivors (P > 0.05). It was revealed that there was a significant reduction in mean TT3 levels in non-survivors compared to survivors on the first day of admission (P = 0.007). On the third day of admission, however, a significant reduction in TT4 levels were seen in non-survivors (P = 0.03). Conclusions: Thyroid function assessment, especially TT3 on the first day and TT4 on the third day of admission, along with PELOD score, might be helpful in predicting disease outcome and patient's survival. [ABSTRACT FROM AUTHOR]

Abstract Background Measuring thyroid-stimulating hormone (TSH) is essential for diagnosing and monitoring thyroid diseases. The aim of this study was to evaluate the effect of sex, age, sampling time and season on TSH in a large Chinese population and to determine which factor had the greatest impact on TSH measurement results. Methods Data were obtained from the laboratory information system from September 1, 2013 to August 31, 2016. A total of 80150 TSH measurements of outpatients were enrolled in this study. TSH was measured using a Siemens ADVIA Centaur XP automatic chemiluminescence immunoassay analyzer. Linear regression models were used to assess the association between log-transformed TSH concentrations and sex, age, sampling time and season. Results The serum TSH concentrations in women were significantly higher than in men. In all subjects, serum TSH concentrations increased by 0.005 μIU/mL for each year of age. TSH concentrations showed circannual variation during the 3 consecutive years of data collection and decreased during the summer while increased during the winter. The serum TSH concentrations decreased from 7 a.m. to 1 p.m. while increased from 1 p.m. to 4 p.m. The same trend was observed in TSH concentrations for sampling time stratified by sex. Linear regression revealed that sampling time might be the major factor affecting serum TSH concentrations. Conclusion Sex, age, season, and sampling time significantly affected serum TSH concentrations. Age-related alteration in serum TSH concentrations was observed in this study. Sampling time was the major factor affecting serum TSH concentrations. Highlights • Serum TSH concentrations in women were significantly higher than in men. • TSH concentrations decreased during the summer while increased during the winter. • TSH concentrations decreased from 7 a.m. to 1 p.m. while increased from 1 p.m. to 4 p.m. • Sex, age, season, and sampling time affected serum TSH concentrations. • Sampling time was the major factor affecting serum TSH concentrations. [ABSTRACT FROM AUTHOR]

Objective: This meta-analysis was done to estimate the prevalence of autoimmune thyroid diseases (ATDs) in Turner Syndrome patients, and to determine the clinical status of thyroid autoimmune diseases that occur frequently in association with Turner Syndrome. Results: A total of 18 studies were included in the meta-analysis. The pooled overall prevalence of autoimmune thyroid diseases in Turner Syndrome patients was 38.6% (95% CI 29.7–47.6%), with 12.7% (95% CI 9.30–16.1%) of them had clinical hypothyroidism and 2.6% (95% CI 1.5–3.8%) had hyperthyroidism. I-squared test had a high result of heterogeneity. In subgroup analyses, the prevalence of ATDs was higher in the European region than Asian region. Autoimmune thyroid diseases are commonly associated with Turner Syndrome. Early detection of thyroid diseases by optimal screening among children with Turner Syndrome is required to ensure effective management. [ABSTRACT FROM AUTHOR]

Abstract Background Non-thyroidal illness syndrome is characterized by decreased serum free T3 (FT3) level and associates with long term mortality. Serum free T4 (FT4) may affect on mortality with FT3 in course of chronic illness. This study performed to evaluate the association between both decreased FT3 with elevated FT4 levels and mortality risk. Methods This study is a retrospective cohort analysis and consisted up 1164 (571 male, 593 female) patients with a 36 months follow up period. Patients divided into four groups according to thyroid functions. Patients with euthyroidism were in Group A, elevated FT3 in group B, decreased FT3 in group C and both decreased FT3 and elevated FT4 levels in group D. The levels of thyroid hormones and all cause mortality were compared between four groups. Results Mortality rate was elevated between Groups A and B, A and C, A and D, B and C, B and D, C and D, (p <.001, p <.001, p <.001, p <.001, p <.001, p:0.019, respectively). A multivariate Cox proportional hazards model was performed to evaluate the mortality risk between groups. A close relationship was observed in Group C and D patients for the mortality risk (OR:1.561, 95% CI:1.165–2.090, p:0.003 and OR:2.224, 95% CI:1.645–3.006, p:0.0001, respectively). Conclusion Both decreased FT3 and elevated FT4 levels are independent predictor for long term mortality risk in hospitalized chronic patients with non-thyroidal illness syndrome. Highlights • Low FT3 in hospitalized patients is associated with mortality. • Elevated FT4 levels in chronic patients have an additional risk for mortality. • Decreased FT3 with an elevated FT4 is an independent predictor for the mortality. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the diagnostic performance of ultrasound (US)-based risk-stratification systems for thyroid nodules in the 2015 American Thyroid Association (ATA) guidelines with those of the 2016 Korean Thyroid Association (KTA)/Korean Society of Thyroid Radiology (KSThR) and 2017 American Congress of Radiology (ACR) guidelines. Methods: From June 2013 to May 2015, a total of 902 consecutive thyroid nodules were enrolled in four institutions, and their US features were retrospectively reviewed and classified using the categories defined by the three guidelines. The malignancy risk of each category, as defined by all three risk-stratification systems, was calculated, and the diagnostic performance of the fine-needle aspiration (FNA) indications of the ATA guidelines were compared to those of the KTA/KSThR and ACR guidelines. Results: Of all nodules, 636 (70.5%) were benign and 266 (29.5%) malignant. The calculated malignancy risks for ATA categories 5, 4, 3, 2, and 1 nodule(s) were 71.7, 21.5, 2.6, 3.8, and 0%. Of all nodules, 7.6% (69/902) did not meet the ATA pattern criteria, but the malignancy risk was calculated to be 10.1% (7/69). The ATA guidelines afforded significantly higher diagnostic sensitivity (95.0%) than the ACR guidelines (80.2%; p = 0.001) but a lower specificity (38.1 vs. 68.9%; p < 0.001). On the other hand, the ATA guidelines exhibited a lower diagnostic sensitivity than the KTA/KSThR guidelines (100.0%; p = 0.07) but a higher specificity (28.2%; p < 0.001). The unnecessary FNA rate was the lowest when the ACR guidelines were used (25.8%), followed by the ATA (51.2%) and KTA/KSThR (59.4%) guidelines. Conclusion: The 2015 ATA guidelines afford relatively moderate sensitivity and an unnecessary FNA rate for thyroid cancer detection compared to the 2016 KTA/KSThR and 2017 ACR guidelines. US practitioners require a deep understanding of the benefits and risks of the US-based FNA criteria of different guidelines and potential impact on the diagnosis of low-risk thyroid cancers. [ABSTRACT FROM AUTHOR]