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   Table of Contents - Current issue
Coverpage
January-April 2020
Volume 17 | Issue 1
Page Nos. 1-50

Online since Friday, April 24, 2020

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EDITORIALS  

Indian Thyroid Society: Glimpse into thyroid research from India and way forward p. 1
Rajesh Rajput
DOI:10.4103/trp.trp_27_20  
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Redefining euthyroidism: A biopsychosocial construct Highly accessed article p. 2
Sanjay Kalra, AG Unnikrishnan, Atul Kalhan
DOI:10.4103/trp.trp_12_20  
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CONSENSUS STATEMENT Top

Coronavirus disease 2019 and thyroid disease: Position statement of Indian Thyroid Society Highly accessed article p. 4
Rajesh Rajput, Amit Agarwal, Mohd Ashraf Ganie, CS Bal, DC Sharma, Krishna Seshadri, Jabbar Puttiyaveettil, Narendra Kotwal, KM Prasanna Kumar, RV Jayakumar, Sarita Bajaj, Shashank Joshi, Subhankar Chowdhury, Sujoy Ghosh
DOI:10.4103/trp.trp_28_20  
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ORIGINAL ARTICLES Top

Pattern of autoimmune thyroiditis in Egyptian children and adolescence p. 7
Kotb Abbass Metwalley, Mohamed Kotb Abbass Metwalley
DOI:10.4103/trp.trp_5_20  
Background: Autoimmune thyroiditis (AIT) is the most common thyroid disorder in the pediatric age range. Aim: The aim of the retrospective study is to analyze the demographic, clinical, ultrasonographical, hormonal, immunological, and histopathological characteristics of 362 children and adolescents with a diagnosis of AIT. Patients and Methods: Data relating to the patient demographic and clinical characteristics both on presentation and during follow-up were collected. We also analyzed the investigations performed; these included thyroid function tests, immunological, radiological, and fine-needle aspiration biopsy (FNAB) results. Results: Patients' age ranged from 8.2 to 16.5 years and a female: male ratio of 5.1:1. The common presenting features were goiter and short stature (138 [38.1%] and 68 [18.7%], respectively). At diagnosis, 83 (22.9%), 23 (6.3%), and 256 (67.0%) patients were euthyroid, subclinical hypothyroid, and overt hypothyroid, respectively. High-resolution thyroid ultrasound revealed higher rate of nodular pattern compared to clinical examination (17 vs. 13 for single nodule and 6 vs. 4 for multiple nodules). Fine-needle aspiration of the thyroid gland was performed in 12 patients; none of them was malignant. Patients were followed for a mean period of 38 months (range: 6–45 month). Only 3 (13%) patients with subclinical hypothyroidism progressed to overt hypothyroidism, and started on L thyroxine therapy, while the rest of the case had stationary course. Conclusions: Our study reported the highest rate (68.7%) of overt hypothyroidism compared with other studies. The study reported that AIT in children and adolescents has benign course. Thyroid ultrasound can identify clinically unapparent thyroid nodules and play an important role in the selection of cases for FNAB. Careful follow-up of thyroid function is important to determine the necessity and timing of L-thyroxine replacement therapy.
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A comparison of liquid-based cytology and conventional smears in fine needle aspiration cytology of thyroid lesions: Diagnostic efficacy and pitfalls p. 14
Manju Kumari, Mukul Singh
DOI:10.4103/trp.trp_42_19  
Introduction: Fine needle aspiration cytology is an unrivalled method of preoperative triage of thyroid lesions. The use of liquid-based cytology (LBC) is now extended to nongynecological samples due to the advantages of lesser screening time, clearer background, and potential use of leftover material for ancillary investigations. Aims and Objectives: The aim of the study is cytomorphological comparison of LBC and conventional method and cytohistopathological correlation in surgically resected cases. Materials and Methods: Fine needle aspiration was done in 100 patients. Conventional smears were prepared followed by LBC from the remaining material. The smears from both the methods were scored semiquantatively and were compared cytomorphologically. Pearson's Chi-square test and fisher's exact test were used for P value calculation using SPSS software. A P < 0.05 was considered as significant. A cytohistopathological correlation was done in operated cases. The remaining material from LBC was used for immunocytochemistry wherever required. Results: LBC had more unsatisfactory as well as suspicious for malignancy cases. The cells in LBC were in three-dimensional clusters and singly scattered with loss of cellular architecture. The nuclei were shrunkun and hyperchromatic with spilling of cytoplasm. The background colloid, blood as well as lymphocytes were mostly washed off. Immunocytochemisrty results were not affected by the LBC procedural steps. Conclusion: It was very difficult to come to a conclusive diagnosis with the help of LBC alone. It can be useful for ancillary investigations like immunocytochemistry as in this study. Thus, it can be used as a supplement to conventional method rather than replacing it.
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CASE REPORTS Top

Vanishing pituitary macroprolactinoma and secondary hypothyroidism due to pituitary apoplexy p. 19
Deep Dutta, Meha Sharma, KS Shivaprasad, Manoj Kumar
DOI:10.4103/trp.trp_11_20  
Macroprolactinomas usually need long-term cabergoline therapy, often lifelong, as complete resolution of these tumors is rare. We present a vanishing pituitary macroprolactinoma which evolved into a complete empty sella following 2 years of cabergoline therapy. A 17-year-old girl with primary amenorrhea, chronic headache, and galactorrhea for 2 months was diagnosed to have pituitary macroprolactinoma (20 mm × 17 mm × 16 mm; prolactin 451 ng/ml). T2-weighted imaging revealed fluid level in adenoma suggestive of bleed in the tumor suggestive of pituitary apoplexy. Cabergoline was initiated at 0.5 mg/week and was uptitrated to 3 mg/week over 6 months to ensure prolactin was suppressed. Magnetic resonance imaging pituitary after 2 years of cabergoline therapy revealed empty sella with pituitary stalk traced till the floor of sella turcica, without any evidence of adenoma. Hormone evaluation revealed low total T4 levels (5.1 mcg/dl); low thyroid-stimulating hormone (0.9 mIU/L); normal morning cortisol (18.1 mcg/dl); and normal prolactin (4 ng/ml), leading to the diagnosis of secondary hypothyroidism. Cabergoline dose was tapered gradually. Levothyroxine replacement was started at 50 mcg/day. Pituitary apoplexy and associated infarction 2 years back lead to ischemic necrosis in adenoma, leading to its spontaneous resolution in our patient. The adenoma had damaged adjacent normal pituitary cells due to limited space in sella, resulting in empty sella. Pituitary apoplexy is nature's way of curing pituitary adenoma. Complete disappearance of adenoma and the resulting empty sella syndrome are the novelty of this report.
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Hypokalemia and metabolic alkalosis in an Egyptian boy with Pendred syndrome p. 22
Kotb Abbass Metwalley, Hekma Saad Farghaly, Mohamed Kotb Abbass Metwalley
DOI:10.4103/trp.trp_13_20  
Pendred syndrome (PDS) is manifested by congenital sensorineural deafness in association with goiter due to defective organic binding of iodine in the thyroid gland. Herein, we report on an unusual case of a 14-year-old Egyptian boy with PDS presenting with hypokalemia and metabolic alkalosis.
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LETTER TO THE EDITOR Top

An unusual cause of periodic weakness p. 25
Abhishek Juneja, Kuljeet Singh Anand
DOI:10.4103/trp.trp_41_19  
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ABSTRACTS Top

ITSCON 2019 Abstracts p. 27

DOI:10.4103/0973-0354.283222  
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ITSCON 2020 Abstracts p. 43

DOI:10.4103/0973-0354.283223  
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