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ORIGINAL ARTICLES
Trimester specific ranges for thyroid hormones in normal pregnancy
Jidnyasa Mankar, Anagha Sahasrabuddhe, Shailesh Pitale
September-December 2016, 13(3):106-109
DOI:10.4103/0973-0354.180192  
Maternal and fetal thyroid profiles differ throughout gestation. Due to many physiological changes during pregnancy, interpretation of thyroid function tests needs trimester specific reference intervals. American Thyroid Association strongly recommends to refer to population defined trimester-specific reference ranges with optimal iodine intake Though some studies have reported this reference range in South and a few in North, there has been no data from Central India yet. Aims and Objectives: To establish normative range of TSH in each trimester of pregnancy, To establish normative range of f T3 and f T4 in each trimester of pregnancy and to know the prevalence of subclinical hypothyroidism in normal pregnancies. Materials and Methods: in all 177 normal singleton pregnant women were screened and out of them 150 enrolled in the study(50 in each trimester). Their TSH, fT3, fT4 and urinary iodine was estimated. Observations and Results: The reference range of thyroid hormones for 1st trimester found in the present study are as follows: TSH: 0.24-4.17 (uIU/ml), fT3: 0.29-3 .1 (ng/100 ml), fT4: 01-2.2 (ng/100 ml). For 2 nd trimester: the reference range for TSH , fT3 and fT4 are 0.78-5.67 (uIU/ml) , 0.27-3.34(ng/100 ml) ,and 0.45-2.24 (ng/100 ml) respectively. For 3 rd trimester, the reference range for TSH , fT3 and fT4 are 0.47-5.78 (uIU/ml), 0.24-3.61(ng/100 ml) and 0.47-5.1 (ng/100 ml). Prevalence of subclinical hypothyroidism was found to be 4% in first and second trimesters and 8% in third trimester. No case was seen with clinical hypothyroidism. Conclusion: This study states the range of thyroid hormones in all 3 trimesters of pregnancy. The prevalence of subclinical hypothyroidism was found out to be 4% in first and second trimesters each and 8% in third trimester.
  78,368 912 -
CASE REPORTS
Radiological manifestations of juvenile hypothyroidism
Prem P Patidar, Rajeev Philip, Ajit Toms, Keshavkumar Gupta
September-December 2012, 9(3):102-104
DOI:10.4103/0973-0354.99660  
Thyroid hormone is required for the normal growth and maturation of the skeleton. The action of thyroid hormone on skeleton is varied, including direct chondrocyte and osteoblast stimulation, as well as potentiating the action of growth hormone on the bone. Juvenile hypothyroidism is evolving as the most common form of thyroid dysfunction in the growing age, and it has different radiological manifestations from that of congenital hypothyroidism. We present the skeletal X-rays of a 24-year-old man with juvenile onset autoimmune hypothyroidism (duration of illness of approximately 16 years), who came for evaluation of short stature.
  21,333 1,042 2
ORIGINAL ARTICLES
Fine needle aspiration cytology of thyroglossal duct cyst: Diagnostic pitfalls and a study of 14 cases
Shirish S Chandanwale, Archana C Buch, Kaur R Chawla, Pratik U Mittal
September-December 2013, 10(3):104-107
DOI:10.4103/0973-0354.116136  
Objectives: To review the cytohistological features of 14 cases of thyroglossal duct cyst (TDC), to ascertain the role of fine needle aspiration cytology (FNAC) in the diagnosis and treatment, and to discuss the diagnostic pitfalls. Materials and Methods: FNAC of 14 patients of TDC diagnosed clinically and by ultrasound examination of neck was studied. Cytology features were correlated with histopathologic features. Results: Cytology smears showed most commonly few macrophages (n = 7), followed by polymorphonuclear leukocytes (n = 4). One case showed few small sheets and many dispersed follicular cells showing features suspicious of papillary thyroid carcinoma (PTC). Histopathology showed pseudostratified columnar and cuboidal epithelium (n = 6) in maximum cases and confirmed PTC in one case. Conclusion: Imaging techniques or FNAC alone is not adequate for pre-treatment assessment of all TDC cases. All TDC patients must be subjected to image-guided FNAC for early and accurate diagnosis of TDC carcinoma for timely clinical intervention.
  21,168 598 -
LETTERS TO THE EDITOR
Dental treatment modifications in thyroid disorders: An overview
Prince Kumar, Harkanwal P Singh, Ashish Kumar, Roshni Goel
September-December 2012, 9(3):105-105
DOI:10.4103/0973-0354.99661  
  17,394 1,349 -
ORIGINAL ARTICLES
Vitamin D and primary hypothyroidism: Is there an association?
Jyothi Idiculla, Pooja Prabhu, Rekha Pradeep, Kranti Khadilkar, Subramanian Kannan
January-April 2018, 15(1):34-37
DOI:10.4103/trp.trp_49_17  
Background: Association studies between the vitamin D deficiency (VDD) and hypothyroidism have given mixed results. Because of this controvery and relatively common prevalence of these two conditions, we conducted a case-control study investigating the prevalence of VDD in patients with hypothyroidism (both TPO-Ab positive and negative) and compared it with euthyroid controls. Methodology: This is a single centre cross sectional study. Adults (aged 18 years or more) of both the sexes diagnosed with primary hypothyroidism (TSH >5.1 mIU/L) were included (n = 115) along with age and sex matched euthyroid (TSH <5 mIU/ml) controls (n = 120) chosen from the outpatients' department. Biochemical parameters like Thyroid stimulating hormone (TSH), free T4 (fT4), 25 hydroxy vitamin D (Vit D) and thyroid peroxidase antibody (TPO-Ab) were tested in both the groups. Results: Patients in the hypothyroid group [38 (males) and 77 (females)] had a mean (SD) age 46 (15) years, while the euthyroid control group [24 (males) and 96 (females) had a mean (SD) age of 45 (17) years. In the hypothyroid group, 96% (110/115) had VDD as compared to 90% (108/120) in the control group with a significantly lower mean Vit D level was observed in the hypothyroid group as compared to the euthyroid group (12+8.6 vs 17.49+11.89 ng/ml; P < 0.001). While 27 cases with hypothyroidism had severe VDD (Vit D levels <4.2 ng/ml) only 10 among the control group had severe VDD (OR 2.04, CI: 1.03-4.05, P < 0.05)). The mean level of Vit D in the TPO-Ab positive hypothyroid group was 10.4+7.2 ng/ml in comparison to the TPO-Ab negative group 15.3+10.3 (P = 0.004) (OR 3.39, CI:1.18-9.80; P < 0.05) 3.62). Conclusion: The vitamin D levels in patients with hypothyroidism were significantly lower compared to euthyroid controls.TPO-Ab positive patients had lower levels of vitamin D in comparison with negative
  17,868 349 -
MINI REVIEWS
Hashitoxicosis: A clinical perspective
AG Unnikrishnan
February 2013, 10(4):5-6
DOI:10.4103/0973-0354.106803  
Chronic autoimmune thyroiditis is the most common cause of hypothyroidism worldwide. Sometimes, it is associated with a transient hyperthyroid phase. This hyperthyroid phase, called Hashitoxicosis (the term generally refers to a combination of thyrotoxicosis/hyperthyroidism in the setting of ongoing autoimmune thyroiditis), is self limiting, and lasts for a period of a few weeks to some months. During this time, classical symptoms of mild to moderate hyperthyroidism may co-exist with a diffuse, firm, painless goiter. Thyroid scintigraphy may show normal or a slightly increased uptake. Anti-thyroid antibodies are often positive, and ultrasound with Doppler is a useful test. A combination of clinical features, thyroid function tests, and appropriate radiology will help make the diagnosis. This mini review will touch upon the clinical aspects of Hashitoxicosis.
  15,670 1,236 4
CASE REPORTS
Study of growth promoting effect of vitamin D supplementation in vitamin D deficient hypothyroid children
Santosh Kumar Singh
May-August 2014, 11(2):81-82
DOI:10.4103/0973-0354.129737  
Insulin-like growth factor 1 (IGF-1) regulates growth. 1,250HD 3((1,25 dihydroxy vitamin D3) promotes IGF-1 action, hence vitamin D deficiency may impair growth. This retrospective study showed that vitamin D supplementation in vitamin D deficient children promoted growth.
  13,168 340 -
Association of autoimmune thyroiditis and Sjogrens syndrome: Case based review
Babul H Reddy, Mounika Guntaka, Sri V Nagesh, Jayanthy Ramesh
January-April 2013, 10(1):26-28
DOI:10.4103/0973-0354.105844  
Sjogrens syndrome is a slowly progressing autoimmune disease, primarily affects exocrine glands, in addition non-exocrine glands affected as well. The coexistence of Sjogrens syndrome and autoimmune thyroiditis is frequent and suggests a common genetic or environmental factor predisposition with similar pathogenic mechanisms. We herein report three cases of this association, who presented to us with different manifestations of Sjogrens syndrome.
  11,898 460 -
An unusual case of precocious puberty and macroorchidism
Rajeev Philip, Sanjay Saran, Manish Gutch, Kumar K Gupta
January-April 2013, 10(1):29-31
DOI:10.4103/0973-0354.105845  
The role of thyroid hormone in pubertal development is complex, with majority of the hypothyroid patients failing to attain puberty. However, isosexual precocious puberty with delayed bone age has been described in female hypothyroid patients, and is called Van Wyk Grumbach Syndrome (VWGS). The presentation of VWGS in boys is different, with the major presentation being isolated enlargement of the testes, with no signs of virilisation. The cross over action of Thyroid Stimulating Hormone (TSH) on Follicle Stimulating Hormone (FSH) receptor producing Sertoli cell hyperplasia produces testicular enlargement, and lack of action of TSH on Luteinizing hormone (LH) with no Leydig cell hyperplasia explaining lack of virilisation. Delayed bone age and typical features of hypothyroidism help to differentiate this condition from other causes of precocious puberty.
  10,965 432 1
REVIEW ARTICLE
Impact of tobacco on thyroid function
Yatan Pal Singh Balhara, Koushik Sinha Deb
January-April 2014, 11(1):6-16
DOI:10.4103/0973-0354.124187  
A psychoactive substance is any chemical that, upon consumption, leads to a state of intoxication and alteration of physiological functions. Tobacco is the most common licit psychoactive substances being used globally and is the biggest contributors to mortality and morbidity. Tobacco has multiple effects on the hypothalamic-pituitary-thyroid axis and the functioning of the thyroid gland. This article presents a review of the clinically relevant effects of tobacco on the hypothalamic-pituitary-thyroid axis. This review mainly focuses on clinical issues. Tobacco smoking modifies almost all functions of the thyroid gland.
  9,802 533 2
CASE REPORTS
Levothyroxine replacement before glucocorticoid replacement leading to adrenal crisis in a case of autoimmune polyendocrine syndrome type II (Schmidt syndrome)
Om J Lakhani, Sudhir Tripathi, KC Indu, Mitali Desai
September-December 2015, 12(3):116-118
DOI:10.4103/0973-0354.157932  
Autoimmune polyendocrine syndrome II (APS II) is defined as Primary adrenal insufficiency with Autoimmune hypothyroidism and/or Type 1 Diabetes. Hypothyroidism is commonly diagnosed but adrenal insufficiency often gets missed out. Levothyroxine replacement before glucocorticoid replacement in a patient APS II can lead to precipitation of adrenal crisis. We report a case of Autoimmune polyendocrine syndrome type II (Schmidt syndrome) who presented to us in adrenal crisis after having started on Levothyroxine without glucocorticoid replacement.
  9,271 287 1
COMMENTARY
Hypothyroidism and glaucoma: Is there an association?
Savita Bhat
January-April 2014, 11(1):4-5
  8,926 392 -
ORIGINAL ARTICLES
Fine-needle aspiration of the thyroid: A cytohistologic correlation with critical evaluation of discordant cases
Pinki Pandey, Alok Dixit, Nanak C Mahajan
May-August 2012, 9(2):32-39
DOI:10.4103/0973-0354.96026  
Background: There is some "gray zone" of thyroid cytology, where the diagnostic efficacy declines sharply rendering it difficult to exactly categorize the lesion resulting in discrepancy. The aim of the study is to assess the accuracy of fine needle aspiration of the thyroid and critically evaluate the cytohistological discordant cases. Materials and Methods: A total of 447 patients with thyroid swelling were aspirated during a seven-year study period. Cases showing cytohistologic disparity were reevaluated for the detection of possible causes of failure. Results: In our study, cytohistologic concordance was achieved in 80.28% of the cases. Of the discordant cases, false positives accounted for 11.60% and false negatives for 9.8%. Suboptimal material and underdiagnosis of papillary carcinoma due to cystic degeneration were recognized as common pitfalls. Too much emphasis on cellularity and architectural pattern led to the erroneous false positive diagnoses. Conclusion: Strict adherence to adequacy criterion and meticulous examination of all the smears are of paramount importance in reducing discrepant cases.
  8,242 816 1
Oral calcium and vitamin D supplementation after total thyroidectomy
Mohamed El-Shinawi, Aly El-Anwar, Mohamed Nada, Tarek Youssef, Essam Fakhry, Salah Raslan, Hatem El-Gohry
September-December 2014, 11(3):98-102
DOI:10.4103/0973-0354.138553  
Introduction: Hypocalcemia is an important and common complication following thyroid surgery with reports varying from 0.5% to 75%. Despite being self-limiting in most patients, symptomatic hypocalcemia is of particular concern because of a delay in its manifestation and the consequent need for prolonged patient hospitalization or re-admission. Aim of the Work: The aim of this study is to evaluate the clinical usefulness of oral calcium and vitamin D administration after total thyroidectomy in the prevention of post-operative hypocalcemia. Materials and Methods: Fifty patients who underwent total thyroidectomy for non-toxic goiters were randomly assigned to routinely receive or not receive oral calcium (1.5 g/d) and vitamin D (0.5 μg/d) for 4 weeks. Hypocalcemic symptoms and signs and total serum calcium levels were monitored and compared between the 2 groups. Results: The incidence of symptomatic and laboratory hypocalcemia was lower in the treatment group receiving the supplement than in the control group not receiving the supplement: 6 of 25 patients (24%) versus 11of 25 (44%). The hypocalcemic symptoms were minimal in the treatment group but more severe in the control group not receiving the supplement. Serum calcium levels decreased in both groups after surgery but were less in the treatment group. Conclusion: Routine administration of a supplement containing oral calcium and vitamin D may be effective in reducing the incidence and severity of hypocalcemia after total thyroidectomy.
  8,015 535 3
EDITORIAL
Metformin and the thyroid: An unexplored therapeutic option
Sanjay Kalra, Puneet Dhamija, Ambika Gopalakrishnan Unnikrishnan
September-December 2012, 9(3):75-77
DOI:10.4103/0973-0354.99642  
  5,014 3,279 -
ORIGINAL ARTICLES
Radioactive iodine therapy for hyperthyroidism: Our experience
Subodh Banzal, Abhishek Singhai, Jamal Asaraf, DC Tiwary, Padmnabh Sharma, Pragya Jain
September-December 2013, 10(3):96-99
DOI:10.4103/0973-0354.116134  
Context: Radioactive iodine (RAI) therapy for hyperthyroidism is safe and definitive, although, post-treatment hypothyroidism and the need for life-long thyroxine are to be expected. The optimal dose of I-131 for hyperthyroidism is still debated. Aims: The aim of this study is to evaluate the response rate of hyperthyroidism to RAI treatment, optimum effective dose, effect of pre-treatment with anti-thyroid medications, ophthalmopathy, and hypothyroidism incidence post RAI therapy. Subjects and Methods: A prospective study was conducted in a tertiary care center to look at the therapeutic practice of use of RAI in the treatment of hyperthyroidism, to determine whether the expected or desired therapeutic outcome is achieved. Seventy consecutive subjects of hyperthyroidism, treated with RAI were followed-up. Results: Grave's disease was the most common cause of hyperthyroidism. The dose of RAI ranged from 4 mCi to 17.5 mCi. Over 95% cure rate achieved with RAI dose 4-7 mCi. Hypothyroidism occurred in 52.17% cases with this dose. Goiter size significantly decreased with RAI therapy. No deterioration of eye signs observed with RAI therapy. Pre-treatment with anti-thyroid drugs had no influence on outcome. Conclusions: RAI treatment is an effective modality for definitive treatment of hyperthyroidism with long-term cure approaching 95%. Its efficacy, safety and low cost made it the preferred definitive treatment for most patients with hyperthyroidism.
  7,251 438 1
Goiter prevalence and current iodine deficiency status among school age children years after the universal salt iodization in Jamnagar district, India
Naresh R Makwana, Viral R Shah, Sumit Unadkat, Harsh D Shah, Sudha Yadav
May-August 2012, 9(2):40-44
DOI:10.4103/0973-0354.96030  
Introduction: Iodine is an essential micronutrient with an RDA of 100-150 μg for normal human growth and mental development. Iodine deficiency disorder (IDD) refers to complex clinical and subclinical disorder caused mainly due to inadequate intake of food with sufficient iodine . Aims and Objectives: The objective was to find out the prevalence of goiter in primary school children; to determine median urinary iodine concentration; to assess the level of iodine in salt samples at household. Materials and Methods: A 30-cluster survey was done in Jamnagar district in primary school children (6-12 years). A total of 70 children from first to seventh standards (35 boys and 35 girls) and 20 children from the community in each cluster were included. Total 2792 children were taken for the total goiter examination by population proportion to size in each cluster with informed consent. A total of 360 children were tested for the median urinary concentration and 750 salt samples were tested on the spot with a test kit from the households of the study population. Results: The total goiter rate was 4.83% among primary school children aged 6-12 years with no significant difference between age and sex. As the age increased the goiter prevalence also increased but the difference was not statistically significant (P > 0.05). The median urinary iodine excretion level of the district was found 80 mcg/l. It was observed that 81.9% salt samples had more than 15 ppm (as recommended) iodine content. Conclusion: The goiter prevalence is less in the study district but low median urinary iodine excretion and use of insufficient iodized salt at households describe the inadequacy in efforts to eliminate IDDs in the district.
  6,950 657 3
CASE REPORTS
Thyrotoxic neuropathy; an under recognized condition: A clinical vignette
Partha Pal, Sayantan Ray, Kaushik Biswas, Animesh Maiti, Deep Mukhopadhyay, Rintu George, Debabrata Mukherjee
September-December 2014, 11(3):118-120
DOI:10.4103/0973-0354.138559  
Neurological sequelae such as neuromuscular or primary muscle disorders are well recognized complications of hyperthyroidism. However, the association of neuropathy with thyrotoxicosis is uncommon. Thyrotoxic neuropathy or Basedow's paraplegia is a rarely reported entity, which was first described by Charcot in 1889. We are reporting the case of a middle-aged man with subacute distal neuropathy as the presenting manifestation of thyrotoxicosis which improved on antithyroid treatment. Peripheral neuropathy in hyperthyroidism is underdiagnosed and may be found even in patients with mild thyrotoxicosis. Thyroid function tests can be helpful in the diagnosis of this treatable neuropathy in such cases and hence should be included in the routine workup in patients with peripheral neuropathy.
  6,560 331 -
ORIGINAL ARTICLES
Cultural beliefs and attitudes: The psychosocial and economic problems associated with goiter and thyroidectomy in an African population
Abdus-Samiu Adewale Musa, Monsurat Titilayo Musa, Issa Baba
January-April 2014, 11(1):22-25
DOI:10.4103/0973-0354.124191  
Objective: To evaluate the effects of cultural beliefs and attitudes on goiter and thyroidectomy and assess their psychosocial and economic implications on patients. Patients and Methods : In a 3-year period, between January 2008 and December 2011, a total of 65 patients were randomly selected and interviewed by using an interviewer administered questionnaire in our surgical outpatient department. Standard expressions and explanations in English and local dialects were used. Results: The patients consisted of 60 females and 5 males with a male to female ratio 1:12. Age range was 20-69 years. Major ethnic groups were Yoruba 60%, Ibo 20%, and Hausa 8%. Most of the patients, 72% believed goiter was caused by poison from witchcraft/devil and only 10% have the true knowledge of causes of goiter. In 60%, the most common psychosocial problem was exploitation by the traditional healers (THs), 15% were withdrawn and 12% were apprehensive. About 88% could not afford surgical bill until 2-7 months after initial hospital attendance. Failure of trado-medical treatment and cosmetics were the reasons for advancement in 44 patients for seeking orthodox medical services. In 16 patients, thyroidectomy was successful because neighbors encouraged them to come to hospital, while in 9 patients, it was a result of health education (HE) from electronic media, and in 3 patients, it was because of toxicity and malignant transformation. Formal education had some influence on the attitudes of patients toward goiter and modified their behavior and cultural beliefs. Conclusion: Goiter is believed by some patients to be one of psychic and psychosomatic disorders as a result of cultural beliefs and attitudes. Hence, trado-medical treatments are sought to cure it to no avail. This eventually inflicts a lot of psychosocial and economic problems on patients. HE and medical services need to be improved upon.
  6,583 304 -
The effects of Nigella sativa L. ethanolic extract on thyroid function in normal and alloxan-induced diabetic rats
Saleh Hassan Sharif, Barakat Mohammed Elmahdi, Ammar Mohammed Ali Mohammed, Alrasheed Hamid Mohammed
May-August 2012, 9(2):48-52
DOI:10.4103/0973-0354.96044  
Context: Nigella sativa, (black cumin seeds) compounds display a remarkable array of biochemical, immunological, and pharmacological actions, including bronchodilatory, antibacterial, hypotensive, immunopotentiating, hypoglycemic, and antitumor activity. Aims : The aim of the present study was to evaluate effects of Nigella sativa L. ethanolic extract (NSE) on the thyroid function test in normal and alloxan-induced diabetic Wistar albino rats. Settings and Design: Experimental study. Materials and Methods: Alloxan monohydrate was injected intraperitoneally at single dose of 150 mg/kg body weight to induce diabetes. Twenty Wistar albino rats were divided into four groups: NSE-treated normal, diabetic, NSE-treated diabetic, and control. NSE was administered daily orally by gavage at a dose of 1 g/kg body weight for 14 days. Serum concentration of TSH, T 4 , T 3 were measured by radioimmunoassay on day 7 th and 14 th . Statistical Analysis Used: Data are expressed as the mean ± S.E.M. For statistical analysis, ANOVA was used. Results: NSE induced a significant increase in the T 3 serum concentration on both day 7 th and 14 th in the diabetic rats and increase T 4 serum concentration on day 14 th in the normal rats. Conclusions: The results revealed that daily oral administration of Nigella sativa L. ethanolic extract (1 g/kg Bwt.) for 14 days significantly increased the serum concentration of T 4 in the normal Wistar albino rats. On the other hand the results revealed that treatment returned the serum concentration of T 3 to the normal level in the Alloxan-induced diabetic rats. Further work is suggested for evaluating the effect of Nigella sativa L. on the serum concentration of thyroid hormones to elucidate the possible mode of action.
  6,121 512 4
REVIEW ARTICLE
Effects of drugs on thyroid function
Manash P Baruah, Rajkumar Johny Singh
January-April 2012, 9(1):3-6
DOI:10.4103/0973-0354.92387  
A good number of drugs used in different indications in wide variety of clinical fields may influence the thyroid function tests (TFT), the use of which has seen a substantial increase in various clinical fields. Therefore, it is important to consider the possible effect of these drugs both on the results of TFT. Although two classical examples, i.e., amidarone and lithium are discussed in details, some special drugs classes like cytokines, tyrosine kinase inhibitors, and highly active antiretroviral therapy are also highlighted.
  5,374 819 -
ORIGINAL ARTICLES
Thyroid function in pregnant women with gestational diabetes: Is screening necessary?
Mahmoud Parham, Firouzeh Asgarani, Mohammad Bagherzadeh, Gholamreaza Ebrahimi, Jamshid Vafaeimanesh
January-April 2015, 12(1):3-7
DOI:10.4103/0973-0354.147271  
Background: The goal of prenatal care is mother's and baby's health. Pregnancy is the time of hormonal changes, which cause endocrine disorders in pregnant woman encountering risk to the mother and fetus. Two important and more common problems in pregnancy are gestational diabetes mellitus (GDM) and thyroid disorders. Approximately 1.1-14.3% of pregnant women suffer from GDM and hypothyroidism affects 2.5-6.47% of them. There are some recommendations for diagnosis and screening of GDM but there is no clear advice about the need for performing thyroid function tests during pregnancy. In this study, we aimed to evaluate the need for measurement of thyroid function tests in pregnant women with GDM. Materials and Methods: In this case-control study, 210 pregnant women (105 with and 105 without GDM) were enrolled during 2011-2012 and serum levels of free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were compared between two groups. Results: Mean TSH levels in case and control groups were 3.43 ± 2.06 and 1.74 ± 1.47 μIU/mL, respectively and was statistically higher in case group (P = 0.023). Mean FT4 levels in case and control groups were respectively 1.41 ± 0.69 and 1.5 ± 0.61 ng/dL, which were not statistically different in both groups (P = 0.67). Among patients with GDM, 18 (17.1%) had subclinical hypothyroidism and 11 (10.48%) had clinical hypothyroidism, while among non-GDM patients, 7 (6.66%) had subclinical hypothyroidism and 4 (3.81%) had clinical hypothyroidism. Conclusion: In patients with GDM, hypothyroidism (clinical and subclinical) was obviously higher, the mean serum TSH level was higher in these women, and it was within a range that required treatment. So, it is suggested considering screening and treatment of hypothyroidism in patients with gestational diabetes.
  5,447 637 1
Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions: A hospital-based study
Komal Singh Likhar, Rakesh A Hazari, Santosh G Gupta, Umashankar Shukla
May-August 2013, 10(2):68-71
DOI:10.4103/0973-0354.110588  
Background: Fine needle aspiration cytology (FNAC) is the commonly used test for diagnosis of thyroid nodules. FNAC is a cost-effective procedure that provides specific diagnosis rapidly with minimal complications. Based on the cytology findings, patients can be subjected to surgery only in cases of malignancy, thereby decreasing the rate of surgery and its consequent complications. The purpose of our study was to find the diagnostic accuracy of FNAC in thyroid lesions and to compare it with histopathology. Materials and Methods: A retrospective hospital-based study was conducted at Department of Pathology in a tertiary care institute and associated hospital of Bhopal. Data were collected from the records of FNAC and histopathology of thyroid lesions, done in last 4 years duration. Analysis was done by entering data in SPSS software, and Chi-square test was applied to find statistical significance. Results: FNAC was done on 234 patients in 4 years duration. The most common thyroid lesions were benign [221 (94.4%)], followed by malignant only [6 (2.6%)], indeterminate [3 (1.3%)], and inadequate [4 (1.7%)]. Out of 221 (94.4%) benign thyroid lesions, 33% were simple colloid goiter, 27.6% goiter with cystic changes, 16.28% nodular colloid goiter, 10.41% lymphocytic thyroiditis, 4.53% thyroglossal cyst, 4.07% colloid goiter with hemorrhage, 0.9% were follicular adenoma, and others formed 3.17%. Out of six (2.6%) malignant thyroid lesions, three were papillary carcinoma and the other three were follicular neoplasm. Conclusions: The cytological criterion for the diagnosis of thyroid lesions as benign and malignant by FNAC is a highly reliable method for the diagnosis. FNAC showed sensitivity, specificity, and diagnostic accuracy of 100% in the diagnosis of malignant lesions like papillary carcinoma as well as thyroglossal cyst and abscess.
  5,447 554 1
CASE REPORTS
Hyperthyroidism due to bilateral benign cystic struma ovarii: A rare case report
Bharathi Kannusamy, Anuradha Subramanyam
January-April 2013, 10(1):23-25
DOI:10.4103/0973-0354.105843  
Struma ovarii is a rare specialized monodermal teratoma of ovary composed predominantly of thyroid tissue (> 50%). Most of the cases are asymptomatic. Hyperthyroidism due to functional struma ovarii is seen only in 5 to 10% of cases. We report here a case of bilateral benign cystic struma ovarii in a 50-year-old lady presenting with signs and symptoms of hyperthyroidism. Her thyroid profile showed elevated levels of total and free thyroxine levels. Pelvic ultrasonogram showed bilateral cystic ovarian tumor along with minimal ascites. 131-I whole body scan revealed bilateral focus of high radioactive iodine uptake in the pelvis. A provisional diagnosis of cystic struma ovarii was made. Abdominal exploration showed cystic mass lesion in both ovaries. She underwent total abdominal hysterectomy with bilateral salphingo-oophorectomy. Histopathological examination confirmed the mass as benign cystic struma ovarii. Signs and symptoms rapidly disappeared after surgical removal of tumor. This rare case is reported here for its unusual clinical presentation.
  5,597 351 2
ORIGINAL ARTICLES
Prevalence of hypothyroidism in patients with metabolic syndrome
Lalit K Meher, Suryanath Kalapurakal Raveendranathan, Sunil K Kota, Jagannath Sarangi, Siba N Jali
May-August 2013, 10(2):60-64
DOI:10.4103/0973-0354.110583  
Aim: Hypothyroidism and metabolic syndrome are well-associated risk factors for atherogenic cardiovascular disease. Insulin resistance, being a common pathogenic mechanism in both, can cause a considerable overlap between hypothyroid and metabolic syndrome population. This cross-sectional study was intended to assess the thyroid function in patients with metabolic syndrome and to investigate the association between hypothyroidism and metabolic syndrome. Materials and Methods: One hundred patients with metabolic syndrome as per National Cholesterol Education Program-Adult Treatment Panel (NCEP ATP) III criteria and 50 controls (0 out of 5 criteria) attending the internal medicine outpatient clinic were included in the study. Patients were subjected to anthropometry, evaluation of vital parameters, and lipid and thyroid profile, along with other routine laboratory parameters. Students' "t" test, Chi-square test, linear regression, and multiple logistic regression models were used for statistical analysis. P value <0.05 was considered significant. Results: Body mass index, waist circumference, mean systolic pressure, diastolic pressure, fasting blood sugar, total cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, and thyroid stimulating hormone (TSH) were significantly higher, and free triiodothyronine (FT3), free thyroxine (FT4), and high density lipoprotein (HDL) cholesterol were significantly lower in the study group compared to the control group. In the metabolic syndrome group, 22 had subclinical hypothyroidism (22%), 4 were overtly hypothyroid (4%), and 74 were euthyroid (74%). Subclinical hypothyroidism was significantly associated with metabolic syndrome group (P = 0.032). There was significant linear association between TSH levels and total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol across the metabolic syndrome group in the linear regression model. Multiple logistic regression analysis recognized the association between body mass index with subclinical hypothyroidism (P = 0.006) in the metabolic syndrome group. Conclusion: It is concluded from this study that there is significant association between subclinical hypothyroidism and metabolic syndrome, and it highlights the importance of thyroid function tests in patients with metabolic syndrome.
  4,990 845 7
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