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   Table of Contents - Current issue
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May-August 2019
Volume 16 | Issue 2
Page Nos. 53-92

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EDITORIAL  

Thyroid autoimmunity, hypothyroidism, and polycystic ovarian syndrome: In search of the missing link p. 53
Partha Pratim Chakraborty, Asish Kumar Basu
DOI:10.4103/trp.trp_24_19  
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ORIGINAL ARTICLES Top

Prevalence of hypothyroidism and thyroid autoimmunity in polycystic ovarian syndrome patients: A North Indian study p. 55
Diksha Goyal, Pooja Relia, Angela Sehra, Deepak Khandelwal, Deep Dutta, Dimpy Jain, Sanjay Kalra
DOI:10.4103/trp.trp_7_19  
Background: There is limited data regarding the prevalence of hypothyroidism and thyroid autoimmunity in patients with polycystic ovarian syndrome (PCOS). Objective: To evaluate thyroid status and frequency of hypothyroidism and thyroid autoimmunity in patients with PCOS in comparison to age-matched controls. Materials and Methods: In a case–control study conducted at Gynecology outpatients department of our institute, 70 consecutive PCOS women diagnosed by Rotterdam criteria as well as 70 age-matched controls were evaluated. All patients underwent history, physical examination, thyroid function tests, and anti-thyroid peroxidase antibody (TPO Ab) tests. All patients who had positive TPO Ab also underwent ultrasonography of thyroid. Results: Mean serum thyroid-stimulating hormone (TSH) in PCOS was significantly higher (5.11 ± 4.41 uU/ml vs. 3.62 ± 3.38 uU/ml; P = 0.026) than age-matched controls. Subclinical hypothyroidism (14.3% vs. 7.1%) and TPO Ab positivity (25.7% vs. 17.1%) were numerically higher in PCOS patients as compared to age-matched controls, although not statistically significant. Conclusions: Mean serum TSH was significantly higher in PCOS patients as compared to age-matched controls. Numerically higher percentage of patients with PCOS had subclinical hypothyroidism and TPO Ab positivity; however, these were not statistically significant.
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Fine-needle aspiration cytology of nodular thyroid lesions: A 1-year experience of the thyroid cytopathology in a large regional and a University Hospital, with histological correlation p. 60
Kaumudi Konkay, Radhika Kottu, Mutheeswaraiah Yootla, Narendra Hulikal
DOI:10.4103/trp.trp_34_18  
Background: Fine-needle aspiration cytology (FNAC) plays an important role in evaluation of nodular thyroid lesions and in planning appropriate management. Aim: the aim of the study is to reinterpret the FNAC diagnosis using the new 2017 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and explore its utility and to review the accuracy by correlating with histopathology and analyze the distribution of thyroid lesions. Settings and Design: A retrospective study for a period of 1 year will be undertaken, and all the cases of thyroid FNAC during the study period will be included in the study. Materials and Methods: All FNACs of the thyroid, which were done during the year 2011, were retrieved. The results of adequate FNAC samples were correlated with the histological diagnoses in 50 cases. Statistical Analysis: the statistical analysis was performed using MedCalc Statistical Software Results: About 592 cases were included in the study, after recategorization according to the TBSRTC, Bethesda I – 2 cases (0.33%), Bethesda II – 473 cases (79.8%), Bethesda III – 54 cases (9.1%), Bethesda IV – 23 cases (3.8%), Bethesda V – 3 cases (0.5%), and Bethesda VI – 37 cases (6.25%). The false-negative rate is 9%, accuracy rate is 91%, and rate of malignancy in atypical lesions is 53.3%, with overall rate of accuracy of 61.5%. The incidence of microcarcinoma was 4/50 (8%). Conclusions: The distribution of thyroid lesions in our institute is similar to that seen elsewhere. The rate of malignancy in indeterminate lesions was 33.33%. FNA has a low false-negative rate for diagnosis of thyroid malignancy; however, controversy exists regarding the accuracy of FNA for nodules smaller than 1 cm. The nomenclature change of follicular variant of papillary thyroid carcinoma to noninvasive follicular thyroid neoplasm with papillary-like nuclear features has led to necessary changes in definitions of various categories in 2017 TBSRTC as well and is discussed in this paper.
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Clinical, biochemical, and cytomorphological profile of lymphocytic thyroiditis: A study from a medical college in the Kangra Valley, India p. 66
Manish Sharma, Rashmi Kaul Raina, Suman Singh, Sujeet Raina
DOI:10.4103/trp.trp_4_19  
Background: Lymphocytic thyroiditis has not been studied in the population of this sub-Himalayan region in North India. Aims: The aim is to study the clinical, biochemical, and cytomorphological profile of lymphocytic thyroiditis. Methodology: Patients diagnosed with lymphocytic thyroiditis on cytology between August 2017 and July 2018 were included for further evaluation. The demographic characters, clinical features, biochemical and radiology findings of the patients were analysed in this hospital based cross-sectional study. Results: The clinical, biochemical, and cytomorphological profile of 52 patients were analyzed. The mean age was 37.2 ± 14.2 years. Female patients were 46 (88.4%). Grade II thyroiditis was seen in 42 (80.8%) cases followed by Grade I in 8 (15.4%) and Grade III in 2 (3.8%) cases. Thyroid-stimulating hormone level was normal in 18 (34.6%), increased in 16 (30.8%), and decreased in 18 (34.6%) cases. Antithyroid peroxidase was done in 37 patients and was raised in 35 (94.5%) cases. Conclusion: In this study, cytological grades of thyroiditis correlate poorly with clinical, biochemical, and ultrasonography findings.
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Iodine nutrition status in schoolchildren of Dhaka city in Bangladesh p. 71
Mohammad Atiqur-Rahman, Md Fariduddin, Mashfiqul–Hasan , Nusrat–Sultana , Sharmin–Jahan , Bajarang Kumar Rauniyar, Md Rafiq-Uddin, Jobaida–Naznin , Yasmin–Aktar , Muhammad Abul Hasanat
DOI:10.4103/trp.trp_6_19  
Objectives: The objective of this study was to observe iodine nutrition status (urinary iodine [UI] and total goiter rate [TGR]) of schoolgoing children with the age of 6–12 years in Dhaka city. Materials and Methods: This study comprised 530 schoolchildren of 6–12 years of Dhaka city of Bangladesh selected by multistage random sampling. Goiter classified according to the WHO/ICCIDD/UNICEF, and UI was assessed. UI was estimated using wet digestion method. Results: Iodine nutrition status revealed 83.2% children as deficient, which was relatively more in 6–8 years group (89.5%), followed by 9–10 years (80.6%) and 11–12 years (77.2%), (P = 0.008). Out of 530 children, 55.7% had no goiter (295/530), whereas 20.2% (107/530) had Grade I and 24.2% (128/530) had Grade II goiter. There was no statistical difference for iodine sufficiency/deficiency between the children with or without goiter (χ2 = 0.129, P = 0.719). Highest mean (± standard error of mean [SEM]) and median UI was found in low socioeconomic class (81.48 ± 7.84 and 78.85 μg/L, respectively), followed by average (75.12 ± 6.31 and 65.11 μg/L, respectively) and high socioeconomic status (47.81 ± 2.68 and 34.82 μg/L, respectively) (P < 0.001). UI values were comparably higher in children whose parents were aware of iodized salt intake than those who were not (aware vs. unaware: mean [±SEM], 71.52 ± 8.90 vs. 57.20 ± 2.79, P= 0.116; median 51.43 vs. 38.72). Conclusions: Iodine nutrition status of children in Dhaka city of Bangladesh was found to be insufficient as yet. TGR is still much higher though not solely related to iodine nutrition status. Continuous surveillance over the matter is very much needed for a satisfactory iodine nutrition status.
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Cord blood thyroid-stimulating hormone as a screening tool for congenital hypothyroidism: A single-center 5-year experience p. 76
Ravi Bhatia, Dinesh Rajwaniya
DOI:10.4103/trp.trp_15_19  
Introduction: Congenital hypothyroidism remains one of the most common preventable causes of mental retardation in the pediatric age group. Screening for congenital hypothyroidism is one of the most cost-effective tools to prevent mental retardation among the general population. Umbilical cord blood thyroid-stimulating hormone (CB TSH) estimation remains an easily available option for screening for congenital hypothyroidism. Aim: The aim of this study was to find normative values of CB TSH for the study group and to use CB TSH levels as a screening tool for congenital hypothyroidism. Design: This study was a cross-sectional study. Setting: This study was conducted in a private medical college. Materials and Methods: CB TSH levels were measured in 2916 neonates using chemiluminescence immunoassay. All neonates who had an umbilical CB TSH level >20 mIU/ml were called back on day 7 for a repeat thyroid profile testing. Results: CB samples of 3102 neonates were tested for TSH; of them, 186 samples were hemolyzed, and hence, 2916 neonates formed the study group. Male-to-female ratio was 1544:1378, i.e., 1.2.1. The birth weights of the study group ranged between 0.8 kg and 4.76 kg, with the average birth weight being 2.9 kg. The cohort was divided into two groups: Group 1 (n = 1983) comprised of neonates who were born term and Group 2 (n = 933) comprised of neonates who were born before term gestation. TSH values ranged between 1.2 and 100 mIU/ml. The mean TSH value of the cohort was 7.17 mIU/ml. The mean TSH value in Group 1 was 6.89 mIU/ml, whereas in the Group 2, it was 7.57 mIU/ml. TSH values corresponding to the 3rd, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentile were 2.3, 2.9, 3.48, 5.4, 7.1, 10.67, 13.4, and 21.4, respectively, in Group 1, whereas TSH values corresponding to the 3rd, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentile in Group 2 were 2.32, 3.12, 4.12, 5.63, 7.65, 10.67, 13.4, and 22, respectively. Seventy neonates (2.4%) had a CB TSH value >20 mIU/ml and had to be recalled for a repeat workup. Of the 70 babies recalled for repeat testing, 59 turned up and eventually two turned out to be hypothyroid on repeat testing. The incidence of congenital hypothyroidism in our study was 1 in 1458. To conclude, we can safely use a cutoff of CB TSH >20 mIU/ml for screening for congenital hypothyroidism. Conclusion: A cut off Cord Blood TSH value > 20 IU/ml can be used for screening purpose.
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CASE REPORTS Top

Travesty of a thyroglossal cyst – A clinical scenario p. 80
Basavaraj P Belaldavar, Vikrant B Ghatnatti, Manali Ramana Bhat
DOI:10.4103/trp.trp_8_19  
A 14-year-old girl presented to the outpatient department with a midline neck swelling, clinically suspected to be a thyroglossal cyst. Routine ultrasonography of the neck showed the absence of thyroid gland in its anatomical position and the presence of lingual thyroid with multiple cystic changes. Computed tomography revealed an infrahyoid and lingual dual ectopic thyroid with the absence of thyroid in its normal anatomical location. Tc-99m pertechnetate confirmed the diagnosis of dual ectopic thyroid. Thus, ectopic thyroid, though rare, must be considered as a differential diagnosis for a thyroglossal cyst.
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A rare case of follicular adenoma in an ectopic mediastinal thyroid p. 84
Salwa Bano, Veena Ramaswamy, BN Tejaswini, Chaitra Chandrashekar
DOI:10.4103/trp.trp_43_18  
Ectopic thyroid refers to the presence of thyroid tissue located far from its usual anatomic place with no vascular connection to the main gland. Ectopic thyroid tumor is a thyroid neoplasm that occurs in sites other than the cervical thyroid gland. Ectopic thyroid tumors arising in the mediastinum without connection to the cervical thyroid gland are very rare. They are either discovered incidentally or present with symptoms referable to a mediastinal mass. We present a case of a mediastinal ectopic thyroid in a 70-year-old man investigated for chest pain and cough. Radiology showed a well-defined lesion in the mediastinum. Biopsy and resection specimens showed follicular adenoma of the thyroid. On immunohistochemistry, tumor was reactive for thyroglobulin. The possibility of ectopic thyroid in the mediastinum which can be a site for adenoma or carcinoma of the thyroid should be considered in the differentials of a mass lesion in the mediastinum. Symptomatic diseases should be treated surgically.
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Incidental detection of papillary microcarcinoma along with follicular adenoma: A report of two cases p. 88
Amul K Butti, Shakti Kumar Yadav, Swapna Kaloor Gopinathan, Namrata Sarin, Sompal Singh
DOI:10.4103/trp.trp_1_19  
Papillary thyroid carcinoma (PTC) is the most common thyroid neoplasms accounting for about 80%–90% of thyroid malignancies. Thyroid papillary microcarcinomas are the subtype of papillary carcinoma, defined as thyroid tumor <1–1.5 cm. They are incidentally encountered in autopsies or surgical specimens or nodular thyroid diseases where malignancy is not suspected. Hence, a meticulous search is mandatory for finding foci of PTC before labeling as benign.
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LETTER TO THE EDITOR Top

Variable selection, unnecessary adjustments, and multicollinearity in thyroid eye disease studies p. 91
Red Thaddeus Dela PeÑa Miguel, Ronald Steven Seno Medalle
DOI:10.4103/trp.trp_18_19  
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