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   2016| January-April  | Volume 13 | Issue 1  
    Online since January 5, 2016

 
 
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ORIGINAL ARTICLES
Thyroid dysfunction in patients of hemorrhagic stroke
Apurva Pande, Vijay Kumar Goel, Amit Rastogi, Abhinav Gupta
January-April 2016, 13(1):19-24
DOI:10.4103/0973-0354.159531  
Introduction: Alteration in the thyroid profile has been associated with occurrence of stroke. A lot of work is being done all over the world in order to establish a link between the two events. Materials and Methods: In the present study the variation in the thyroid profile of the patients presenting within 48 hrs of an acute hemorrhagic stroke were studied. Results: Of the 185 patients included in the study, 124 had nonthyroidal illness syndrome (NTIS), 35 were euthyroid, 15 were hyperthyroid, eight had subclinical hypothyroidism (SCH), and three had hypothyroidism. A low free triiodothyronine (FT3) level was associated with unfavorable outcome as accessed by the Glasgow Coma Scale (GCS) and the Scandinavian Stroke Scale (SSS) scoring. Conclusion: In the present study involving patients of acute hemorrhagic stroke, high mortality rates were observed in patients with a low FT3 and free thyroxine (FT4).
  3,580 328 2
Impact of the Bethesda System in Reporting Thyroid Cytopathology
S Prathima, TN Suresh, ML Harendra Kumar, A Bhaskaran
January-April 2016, 13(1):9-14
DOI:10.4103/0973-0354.168900  
Context: Fine needle aspiration cytology (FNAC) has emerged as one of the well-established first-line diagnostic techniques in the evaluation of thyroid lesions as well as solitary thyroid nodule. But in the cytological diagnosis of borderline lesions, various diagnostic criteria have led to confusion and differences in reporting between cytopathologists and clinicians. To overcome this situation, the Bethescda System of Reporting Thyroid Cytopathology (TBSRTC) 2007 recommended by the National Cancer Institute put down six general diagnostic categories. Aims: The current study evaluates diagnostic utility, reproducibility, and prognostic significance of TBSRTC and report the malignancy risk for FNA of thyroid lesions. Settings and Design: Retrospective study. Materials and Methods: It is a retrospective study of FNAC in 178 patients presenting with thyroid swelling from January 2013 to December 2013 to cytopathology section at our rural based tertiary care center. Distribution of cases in different age groups, sex, size, and type was analyzed. FNAC slides were reviewed and reported by both conventional and TBSRTC method. Diagnostic efficacy was assessed by comparing subsequent histopathological examination wherever possible. Statistical Analysis Used: SPSS version 14. Results: Among the 178 thyroid FNA's, 60 were followed by surgical resection. The overall surgical yield of malignancy was 23.3%. The malignancy rate for the six diagnostic categories was as follows: Nondiagnostic: 33.3%, benign: 2.1%, atypia of undetermined significance: 50%, suspicious for follicular neoplasm: 1%, suspicious for malignancy: 67% and malignant: 100%. Conclusion: TBSTRC has been proven to be an efficient and robust thyroid classification scheme to guide the clinical treatment of patients with thyroid nodules.
  2,943 426 2
CASE REPORTS
A rare association of Henoch–Schönlein purpura and autoimmune thyroidits
Zeba Siddiqi, Ritu Karoli, Jalees Fatima, Abdul Allam Waris
January-April 2016, 13(1):33-35
DOI:10.4103/0973-0354.157916  
Poor compliance is the most common cause of elevated thyroid-stimulating hormone in patients with hypothyroidism who are on levothyroxine replacement. We present an interesting report of a patient who was a known case of primary hypothyroidism and had been euthyroid for more than 5 years on 75 μg daily levothyroxine, suddenly became grossly hypothyroid and diagnosed to have Henoch–Schönlein purpura (HSP) with nephritis.
  2,842 164 -
LETTERS TO THE EDITOR
Dirty nails in hyperthyroidism
Rajeev Philip, Sarojiniyamma Cheradiyil Sivaraman, Shalu Mariam John, Keshavan Charamel Sankaran
January-April 2016, 13(1):47-48
DOI:10.4103/0973-0354.168877  
  2,545 171 -
ORIGINAL ARTICLES
Pregnancy outcomes in subclinical hypothyroidism and thyroid autoimmunity
Suhitha Chittamuri, Vivekanand Bongi, Mythili Ayyagari, Dileep Kumar Kandregula, Subrahmanyam A.V Kandregula
January-April 2016, 13(1):1-4
DOI:10.4103/0973-0354.168893  
Context: This is a study on “pregnancy outcomes in subclinical hypothyroidism (SCH) and thyroid autoimmunity,” as the data from previous Indian studies is inconclusive. Aims: The aims were to evaluate pregnancy outcomes in SCH and to compare outcomes with and without thyroid peroxidase antibodies (TPOAbs). We also looked at pregnancy outcomes in euthyroid in relation to TPOAb. Design: This is an observational, prospective, cohort study. Subjects and Methods: One Hundred (50 SCH and 50 euthyroid) pregnant women are recruited in the study. Samples are analyzed for thyroid stimulating hormone, free T4, and TPOAb. SCH women are treated with levothyroxine. Pregnancy outcomes that are, miscarriage, pregnancy induced hypertension (PIH), gestational diabetes, preterm (PT) delivery, cesarean section (CS), Apgar score, and birth weight are recorded in follow-up. Statistical Analysis: Unpaired t-test and standard error of the difference between proportions are used for statistical analysis. P < 0.05 is considered as significantResults: Pregnancy outcomes between cases and controls, TPOAb positive and negative cases are similar. However, there is a significant increase of PT deliveries (10% vs. 0) and CS (36.73% vs. 15%) in cases when compared to TPOAb negativecontrols. PIH (6.67% vs. 0) is significantly higher in TPOAb positive controls when compared to TPOAb negative controls. Conclusions: Adverse pregnancy outcomes are not significantly higher in treated SCH when compared to euthyroid women, and TPOAb status have not affected the outcomes in SCH. However, there are significantly higher PT deliveries and need for CS in SCH compared to TPOAb negative euthyroid women. Euthyroid women with TPOAb are associated with significantly higher risk of PIH.
  1,759 366 -
CASE REPORTS
Congenital hypothyroidism due to thyroid dysgenesis associated with distal renal tubular acidosis and hypoplastic kidney, an unknown association
Raiz Ahmad Misgar, Idrees Mubarik, Naseer Ahmad Choh, Arshad Iqbal Wani
January-April 2016, 13(1):40-42
DOI:10.4103/0973-0354.159526  
Congenital hypothyroidism, the most common congenital endocrine disorder, is associated with increased risk of additional congenital malformations involving other organs. Distal renal tubular acidosis (dRTA) in children is usually a primary disorder of renal tubular acidification. Hypothyroidism, usually of autoimmune etiology and only occasionally of nonautoimmune etiology, has been reported to be associated with dRTA. The association has seldom been reported in children and to the best of our knowledge congenital hypothyroidism associated with dRTA has not been reported. Here, we report a child with congenital hypothyroidism associated with dRTA and hypoplastic kidney.
  1,934 176 -
ORIGINAL ARTICLES
Papillary microcarcinoma in clinically benign thyroidology
Anshu Jain, Kiran Alam, Veena Maheshwari, Divya Rabindranath, Varsha Narula, Azka Anees Khan, Roobina Khan
January-April 2016, 13(1):15-18
DOI:10.4103/0973-0354.159530  
Context: Multi-nodular goitre (MNG) is one of the most common presentations of thyroid diseases. Although a benign entity, MNG has recently been associated with a significant risk of malignancy, as Papillary Thyroid Microcarcinoma (PTMC) is often an incidental finding in such patients. Aim: The objective of this study was to highlight the value of mandatory and diligent gross as well as histopathological examination in clinically benign thyroid specimens. Materials and Methods: This was a prospective study which included all the resected thyroid specimens of provisionally diagnosed MNG cases received in the histopathology laboratory of our department over a period of 6 months. Result: The microscopic examination showed a predominant picture of MNG along with foci of PTMC in 3 cases. Conclusion: All the patients with MNG who are treated conservatively need a close and careful follow-up for malignancy. In case of surgical treatment, careful grossing and histopathological examination of thyroid specimens is of utmost importance to identify minute foci of Papillary Thyroid Microcarcinoma (PTMC).
  1,826 166 -
Academic heterogeneity: A tale of management of thyrotoxicosis across textbooks - A bibliometric review
Garima Bhutani, Sanjay Kalra, Puneet Dhamija
January-April 2016, 13(1):5-8
DOI:10.4103/0973-0354.168898  
Objectives: The aim of this communication is to assess whether the information about the management of thyrotoxicosis and thyrotoxic crisis as given in standard endocrinology, thyroidology and pharmacology textbooks is similar and concordant with each other. Methods: Three standard textbooks of endocrinology, one of diabetology and four of pharmacology were assessed for the published information regarding treatment of thyrotoxicosis and thyrotoxic crisis. Attention was given to the drugs used, their dose and prescribing frequency. Results: Various omissions and contradictions were found in the coverage of drugs used for thyrotoxicosis treatment in standard textbooks. Information about carbimazole, radio contrast media, cholestyramine, and lithium is missing in many of these texts. There were certain discrepancies in the doses of the drugs as is given in different textbooks. This is especially true in case of methimazole, propylthiouracil, and dexamethasone. Conclusions: This article stresses upon the need of homogeneity in different textbooks for providing adequate and accurate knowledge to physicians and students regarding frequency and dose of the drugs used in treatment of thyrotoxicosis and thyrotoxic crisis.
  1,719 243 -
CASE REPORTS
Sternal metastasis from dedifferentiated thyroid cancer: Value of 18F-fluorodeoxyglucose positron emission tomography–computed tomography imaging in thyroglobulin elevated negative iodine scan syndrome
Meghana Prabhu, Nalini Raju, Subramanian Kannan, RL Vijayaraghavan
January-April 2016, 13(1):30-32
DOI:10.4103/0973-0354.168902  
Differentiated thyroid cancers are generally iodine avid and have an indolent growth rate. Dedifferentiation of thyroid cancer is rare and is commonly accompanied with more aggressive growth, metastatic spread, and loss of iodine avidity. 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F FDG PET–CT) plays an important role in identifying the extent of dedifferentiated disease and aids further management. The present case highlights the importance of 18F FDG PET-CT imaging in thyroglobulin elevated negative iodine scan syndrome clinically presenting with sternal metastasis.
  1,783 144 -
Diffuse lipomatosis of thyroid gland: A rare condition
Pooja D Vyas, Shaileshkumar S Garge, Bushra B Rasool, Sunila T Jaggi, Inder A Talwar
January-April 2016, 13(1):43-44
DOI:10.4103/0973-0354.157937  
Diffuse lipomatosis of the thyroid gland is a rare condition characterized by diffuse proliferation of adipose tissue in the gland. We report the case of a 51-year-old male with chronic renal failure caused by amyloidosis and past history of neck lymph node tuberculosis, 10 years before. He presented with an enlarged thyroid gland. His thyroid hormone levels were normal. Ultrasound of the neck showed an enlarged thyroid gland with diffusely increased echogenicity suggestive of fatty infiltration which was confirmed by MRI and later computed tomography (CT) scan. Patient remained euthyroid on follow-up at one year. As the natural history of this condition is unknown, further follow-up is warranted.
  1,754 147 -
Synchronous medullary carcinoma of thyroid and ductal carcinoma of breast: A report of a rare case with immunohistochemical study
Sanjay D Deshmukh, Rupali R Bavikar, Hemant Lekawale, Lalit Datar, Bageshri Gogate, Snehal Purandare
January-April 2016, 13(1):27-29
DOI:10.4103/0973-0354.168872  
Synchronous malignancies of breast and thyroid have been rarely documented in literature. The reports of secondary malignancies after thyroid cancer and treated breast cancer are relatively not uncommon. We encountered a case of thyroid tumor coexisting with carcinoma of breast. On histopathological and immunohistochemical (IHC) studies, the thyroid was involved by medullary carcinoma and the breast revealed invasive ductal adenocarcinoma. The rarity of this association has prompted us to report this case.
  1,667 136 -
Double pyramidal lobe of thyroid gland: A rare presentation
Arsheed Hussain Hakeem, Imtiyaz Hussain Hakeem, Fozia Jeelani Wani
January-April 2016, 13(1):25-26
DOI:10.4103/0973-0354.168887  
Knowledge of the variations of the pyramidal lobe of the thyroid assumes importance as it has direct implications on the outcome of the primary surgery and on the postoperative radioiodine ablation. If not recognized and completely removed at the time of initial thyroid surgery, it may be site of residual/recurrent disease and also may interfere with the efficient radioiodine ablation postoperatively. We report a unique case of the double pyramidal lobe of thyroid gland in an operated woman with papillary carcinoma thyroid. Our literature search revealed only one documented case of the double pyramidal lobe. Knowledge and recognition of such a variation is highly useful for clinicians to perform safer and effective thyroid surgery.
  1,589 170 3
LETTERS TO THE EDITOR
Cervical lymph node metastases from papillary thyroid cancer: Can they skip the central compartment?
Subramanian Kannan, Nalini Raju, Naveen Hedne Chandrasekhar
January-April 2016, 13(1):46-47
DOI:10.4103/0973-0354.168901  
  1,628 130 -
CASE REPORTS
Unusual presentation of occult follicular carcinoma of thyroid: As thoracic wall lump
Nadeesha J Nawarathna, Navam R Kumarasinghe, Deepthika N Chandrasekera, Ranjith J. K Senevirathna
January-April 2016, 13(1):36-39
DOI:10.4103/0973-0354.157928  
Occult thyroid carcinoma presenting with clinically apparent metastasis is rare and is a diagnostic challenge. Here we report a 68-year-old male who presented with a left side chest wall mass of one year duration. The mass showed rapid enlargement at the latter end of its course, following an initial asymptomatic period. Imaging studies showed a soft tissue mass eroding into several ribs. Wide local excision with primary reconstruction was performed. Histological studies and immune staining revealed metastasis from a follicular thyroid carcinoma. Total thyroidectomy followed, confirming the diagnosis. Post-operatively radio isotope ablation (I131) was done. A suppression dose of thyroxin was continued with regular thyroglobulin assays. Painful bone metastasis responded well to analgesics, bisphosphonates and external beam radiotherapy. Follicular carcinoma comprise 10–15% of thyroid malignancies. Localized thyroid carcinoma has a very good prognosis, 10 year survival rates reducing by 50% with metastatic disease. Commonly thyroid cancer presents as detectable thyroid nodules, 25% having metastasis. In contrast metastatic manifestations are reported in less than 5% of occult thyroid cancers.
  1,529 169 -
LETTERS TO THE EDITOR
Malignancy in thyroid nodule - Preoperative role of ultrasound and fine-needle aspiration cytology
Amitabh Jena, Rashmi Patnayak, Suresh Vaikkakara, Alok Sachan, Amarchala Yadagiri Lakhmi
January-April 2016, 13(1):45-45
DOI:10.4103/0973-0354.173255  
  1,157 187 1
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