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   2016| September-December  | Volume 13 | Issue 3  
    Online since October 27, 2016

 
 
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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.
  3 134,839 1,500
Better thyroid cytopathology reporting and interpretation using different classification systems
Vivek Gupta, Arvind Bhake, Seema Dayal
September-December 2016, 13(3):110-114
DOI:10.4103/0973-0354.193129  
Context: Palpable thyroid nodules may be found in 4-7% of the general population and can be approached by fine needle aspiration cytology (FNAC). Standardized terminology for thyroid cytopathology reporting is due need of the time. Aims: To (1) classify various thyroid lesions in Bethesda reporting pattern. (2) Classify the various thyroid lesions in the UK the British Thyroid Association/The Royal College Pathologist (BTA/RCP) Thy 1−Thy 5 categories. (3) Compare the results of both systems with old conventional system of reporting. Settings and Design: UP Rural Institute of Medical Sciences and Research, Saifai, Etawah and Jawaharlal Nehru Medical College, Sawangi, Wardha. Subjects and Methods: Totally, 300 thyroid lesions who attended the pathology department of both colleges were taken and classified in different classification systems, and their comparative analysis was done. Statistical Analysis Used: SPSS. Results: Total number of patients was 300. The age range was 10-70 years for both genders. Maximum Number of cases was in 20-29 years of age. The conventional reporting pattern classified 33 cases as inadequate, 233 cases as benign, Follicular adenoma 10 cases, indeterminate 13 cases, and malignancy 11 cases. In the Bethesda System of thyroid cytopathology, there were 234 cases, 6 cases, 9 cases, 3 cases, and 15 cases in category II, III, IV, V, VI, respectively. The RCP Thy 1−Thy 5 categories included 18 cases in Thy 1, 15 cases in Thy 1c, 171 cases in Thy 2, 63 cases in Thy 2c, 6 in Thy 3a, 9 in Thy 3f, 3 in Thy 4, and 15 in Thy 5 categories, respectively. Conclusions: The Bethesda System of thyroid classification and UK the BTA/RCP has superior edge over the conventional reporting pattern and should be followed more commonly and should be incorporated in routine reporting pattern for thyroid FNAC.
  1 2,901 342
Comparative Study of thyroidectomy wound closure using tissue glue versus subcuticular suture
Vinay V Rao, Caren D'Souza, Saurabh Kumar, Ashwin Kumar
September-December 2016, 13(3):115-118
DOI:10.4103/0973-0354.193130  
Background: The purpose of this study is to compare closure of thyroidectomy incisions using octyl-cyanoacrylate (OCA) and traditional subcuticular suturing in terms of wound morbidity and patient satisfaction outcomes. Study Design: A prospective randomized study was performed on adult patients scheduled for thyroidectomy surgery in a tertiary referral center. Patients were randomized to have closure of thyroidectomy incisions using either OCA or subcuticular sutures. Patients were evaluated for scar appearance and pain at the operated site on 1 st and 3 rd postoperative week. Results: Seventy-four patients were enrolled in the study. They were randomly divided into two groups, group 1 (N-36): OCA was used and group 2 (N-38): Subcuticular sutures were used. Scar appearance was better and pain was relatively less in group 2 in early postoperative phase. Subjective sensation of pain at the operated site in the first postoperative week was more in patients in group 1, which was the only statistically significant finding (P value 0.010). Conclusion: OCA is as effective as conventional method of wound closure. Early postoperative changes of pain and appearance do not vary much. Cost is the major limiting factor in widespread usage.
  1 2,086 210
CASE REPORT
Pulmonary hypertension: The thyroid connection
Pooja Prakash Prabhu, GD Ravindran, Jyothi Idiculla
September-December 2016, 13(3):144-145
DOI:10.4103/0973-0354.193137  
A 52-year-old female presented with exertional dyspnea and swelling of feet for 3 weeks. On examination, she was found to have tachycardia and hypertension, with a small goiter visible on her neck. All routine investigations were normal. Echocardiogram (ECHO) revealed moderate tricuspid regurgitation and severe pulmonary hypertension (PHTN). Pulmonary function tests were normal. There was no evidence of pulmonary embolism on computed tomography pulmonary angiogram. Immunology workup was negative. She was diagnosed to have hyperthyroidism, and a technetium-99 scan of the thyroid was suggestive of Graves' disease. She was treated with radio-iodine. And is euthyroid and asymptomatic. A repeat ECHO confirmed resolution of PHTN. This case is being reported to highlight the need to detect and treat hyperthyroidism, which can cause resolution of PHTN.
  - 1,659 204
EDITORIAL
Improving decision-making in thyroid nodules
Krishna G Seshadri
September-December 2016, 13(3):99-100
DOI:10.4103/0973-0354.193126  
  - 1,615 3,387
LETTERS TO THE EDITOR
Autoimmune thyroid disorder and recurrent depression: Clinicians must be aware of the links
Karishma Rupani, Avinash De Sousa, Nilesh Shah
September-December 2016, 13(3):146-147
DOI:10.4103/0973-0354.193138  
  - 1,608 167
Thyroid abnormalities and suicidality in patients with first-episode schizophrenia
Samir Kumar Praharaj
September-December 2016, 13(3):147-148
DOI:10.4103/0973-0354.193139  
  - 1,324 150
Author reply
Avinash De Sousa
September-December 2016, 13(3):149-149
DOI:10.4103/0973-0354.193140  
  - 1,040 129
ORIGINAL ARTICLES
Clinical profile of thyroid dysfunction in elderly: An overview
Harish Kumar, Veer Bahadur Singh, Babu Lal Meena, Subhash Gaur, Rahul Singla, Mahendra Singh Sisodiya
September-December 2016, 13(3):101-105
DOI:10.4103/0973-0354.193127  
Aim and Objective: To study the presentation and clinical profile of thyroid disorder in elders in the North-West Rajasthan. Subjects and Methods: This study was carried out on 553 elderly patients in the Department of Medicine, S P Medical College, Bikaner, North-Western Rajasthan. All patients above 60 years were included. Clinical examination was done for detection of thyroid disorders and, keep in mind, the sign and symptoms of hypothyroidism and hyperthyroidism. Recently, a new immunoassay methodology has been applied to the measurement of thyroid stimulating hormone (TSH)/T3/T4 level. The analysis was undertaken using SPSS (version 10). Chi-square test was used to examine the association and trends for categorical. Results: There were 456 cases in the age group 60-71 years. 71-80 and >80 years patients were in numbers of 57 and 20, respectively. Prevalence of hyperthyroidism, euthyroidism, and hypothyroidism according to age was 5.9%, 80.9%, and 13.2%, respectively. When we compared TSH with age, no statistically difference was found (χ2 = 9.366, df = 4; P = 0.05). Of 456 cases, 27 (5.9%) were in decrease level, 359 (80.9%) were within normal range, and 60 (13.2%) cases were having increasing pattern of TSH. Around 8 (4.8%) females having decrease level, 135 (81.8%) were having within normal range of TSH, 22 (13.3%) females having increase level. Around 24 (6.5%) male having decrease level while 40 (10.9%) were having increase level of TSH. Weakness is the most common symptoms of thyroid dysfunction. A highly significant difference was found in weakness, feeling cold, constipation, palpitation, and diarrhea (P < 0.001) while significant difference was found in menstrual irregularity, hoarseness of voice, and irritability (P < 0.01). Conclusion: The current study aimed at spectrum of various clinical aspects in the elderly population that differs from typical presentation. As the age advances, the incidence of thyroid disorders increases. Hypothyroidism was more common than hyperthyroidism. Hence, we recommended that more study required knowing clinical presentation of thyroid disorder in elderly populations.
  - 3,714 1,942
Thyroid dysfunction associated with excess fluoride intakes: Scope for primary prevention
Sandeep Sachdeva, Juned Ahmed, Balbir Singh
September-December 2016, 13(3):119-125
DOI:10.4103/0973-0354.193132  
Background: Preventable thyroid dysfunction has remained a neglected entity worldwide. Excess fluoride consumption over years leads to irreversible thyroid dysfunction. Materials and Methods: Subjects (N = 275) with thyroid dysfunction were recruited from medicine and endocrinology OPDs/wards and were thoroughly examined. The source and type of water consumed by these subjects was asked and sampled for fluoride analysis. Results: A majority (75%) of the subjects were females. Hypothyroidism including subclinical hypothyroidism was the major underlying dysfunction. Majority of the afflicted (53%) consumed ground water as their predominant drinking water source. Fluoride content was well above acceptable limits of potability (1mg/L) in ground water and this correlated positively with elevated serum thyroid stimulating hormone (TSH) and negatively with free T3 levels in blood. The correlation was statistically significant (P < 0.05). Conclusion: Excess of fluoride in drinking water was the plausible cause of hypothyroidism in study individuals. Fluoridation of water for prevention of dental caries is a policy that can be amended for the sake of this larger picture. Thyroid diseases deserve recognition as non-communicable diseases (NCDs) of public health importance.
  - 2,177 187
Study for optimal dose determination of levothyroxine in subclinical hypothyroidism in pregnancy
Semanti Chakraborty, Jayanta Chakraborty, Ankan Bandopadhay
September-December 2016, 13(3):126-130
DOI:10.4103/0973-0354.193133  
Context: Subclinical thyroid dysfunction has been associated with pregnancy complications and affects both maternal and fetal outcomes such as impaired neuropsychological development in offspring and adverse obstetric outcomes-including miscarriage, premature birth, gestational hypertension, placental abruption, and fetal death. Endocrine Society guidelines recommend that all pregnant women with subclinical hypothyroidism be treated with Levothyroxine. The American Thyroid Association guidelines recommend that pregnant women with subclinical hypothyroidism and detectable thyroid-peroxidase antibodies receive Levothyroxine. But till date no authority has given any guideline about the initial dose of Levothyroxine. Aims: To formulate a dosage regime of levothyroxine which is optimal for urgent correction of hypothyroid state in pregnancy. Settings and Design: Prospective (longitudinal) study. Subjects and Methods: A total of 42 apparently normal pregnant women, with known last-menstrual period, with no known metabolic or hypertensive disorder who presented to the clinic had thyroid screening using a standardized method. Women with thyroid stimulating hormone (TSH) value in the range to be diagnosed as subclinical hypothyroidism were included in the study. All patients were followed-up till the time of delivery for the obstetric outcome. Levothyroxine was the mainstay of treatment. Levothyroxine dose were adjusted every trimester on the basis of thyroid function tests (TFTs) including free thyroxine (FT4) and TSH values. Anthropometric measurements included height and body weight at baseline. Statistical Analysis Used: Significance is assessed at 5% level of significance. Pearson and Spearmen correlation test used to find out correlation among normally and non-normally distributed data respectively. Analysis of variance (ANOVA) and Kruskal-wallis with distribution free multiple comparison test used to find the significance of study parameters between three or more groups of patients for normally distributed data and non-normally distributed data. Results: 81.25% of subjects achieved euthyroidism in third trimester. The mean levothyroxine dose used in the first trimester was 40.18 ± 13.78 μg. The mean levothyroxine dose used in the third trimester was 58.25 ± 18.57 μg. Significant increase in the mean dose of levothyroxine required in the third trimester (58.25 ± 18.57 μg) as compared to the first trimester (40.18 ± 13.78 μg, P = 0.0012). Conclusions: Significant improvement in the thyroid function as indicated by higher proportion of patients achieving normal TSH values with significant increase in the mean levothyroxine dose used during the course of treatment gives us guideline about the initial starting doses of levothyroxine.
  - 1,832 178
Nerve conduction studies in patients with primary hypothyroidism
Sampada Swapneel Karne, Nilima Sudhakar Bhalerao
September-December 2016, 13(3):131-135
DOI:10.4103/0973-0354.193134  
Background: Hypothyroidism is an important cause of peripheral as well as focal neuropathy. Reported prevalence of neuropathy in hypothyroidism is varied widely. Objective: To study nerve conduction abnormalities and to correlate electrodiagnostic findings with clinical features in patients with primary hypothyroidism. Materials and Methods: This study was done in Smt. Kashibai Navale Medical College, Pune, Maharashtra. Adult patients with primary hypothyroidism were included. Patients with other possible causes of neuropathy were excluded. Detailed medical history was obtained, and clinical examination and nerve conduction study by electrophysiological method were done in all patients. Results: Total 40 patients were included, of which, 25% patients showed evidence of neuropathy. Six patients had carpal tunnel syndrome while four had other peripheral neuropathy. Presence of neuropathy correlated independently with advanced age and female gender. There was significant correlation between presence of signs and symptoms of neuropathy to electrophysiologically confirmed neuropathy. Occurrence of neuropathy was more common in patients with duration of disease more than 5 years (44.44%) and obesity (50%), but these findings were not statistically significant (P = 0.08 and 0.09, respectively). No correlation found between etiology of disease, serum thyroid-stimulating hormone level and occurrence of neuropathy (P = 0.43, 0.9, respectively). Conclusion: Advanced age and female gender are important risk factors for development of neuropathy in patients with hypothyroidism. The thorough clinical examination is very important as clinical signs and symptoms are sensitive predictors for the presence of neuropathy.
  - 2,734 307
Effect of prednisolone on thyroid and gonadotrophic hormones secretion in male domestic rabbits
Barakat Elmahdi, M Hassan, Sabry Mohamed El-Bahr
September-December 2016, 13(3):136-139
DOI:10.4103/0973-0354.193135  
Context: An excess of endogenous and exogenous glucocorticoids causes many biochemical endocrine effects. Such alterations resulted in erroneous misleading interpretation of laboratory results. Aims: The effect of six intramuscular (I/M) injections of prednisolone on the serum concentrations of thyroxin (T 4 ), triiodothyronine (T 3 ), thyroid stimulating hormone (TSH), and luteinizing hormone (LH) of male domestic rabbits was assessed. Materials and Methods: Ten rabbits were assigned into two equal groups, treated and control groups. The treated group was injected prednisolone 1% at a rate of 2.2 mg/kg body weight every other day for a total of six doses. The control group was injected I/M with an equivalent volume of vehicle solution of prednisolone 1%. Statistical Analysis: All data were presented as mean ± standard error of mean by Student's t-test. All tests were performed using the Statistical Package for Social Science Program. Results: At day 6 of the experiment (after three injections of prednisolone), there were nonsignificant differences (P > 0.5) in serum T 4 , T 3 and TSH concentrations in prednisolone-treated animals compare to control. However, the concentration of serum LH was decreased significantly (P < 0.5) in prednisolone-treated animals compare to control. At day 12 of the experiment (after six injections of prednisolone), there were nonsignificant changes (P > 0.5) in the concentration of TSH in prednisolone-treated animals compare to control whereas the concentrations of serum T 4 , T 3 and LH were decreased significantly (P < 0.5) in prednisolone-treated animals compare to control. Conclusion: Multiple administration of prednisolone was clearly associated with substantial reduction in the concentrations of T 4 and T 3 and reduction of LH concentration without any effect on TSH concentration in serum of domestic rabbits.
  - 3,864 186
Accuracy of fine needle aspiration cytology of thyroid lesion with corresponding histopathology: A single institutional experience
Nasar Alwahaibi, Jawhara Alsalami, Usha Rani Bai, Ritu Lakhtakia
September-December 2016, 13(3):140-143
DOI:10.4103/0973-0354.193136  
Aim: The aim of this study was to evaluate and compare the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of thyroid lesions with the final histopathologic diagnosis in the surgical specimens. Materials and Methods: A retrospective study was performed over an 11-year-period at Sultan Qaboos University Hospital, Sultanate of Oman. The records of all patients who had undergone FNAC and subsequent surgery for thyroid cancer were included. Cytological diagnosis was classified into five categories: Unsatisfactory, benign, papillary carcinoma, undifferentiated thyroid carcinoma, and suspicious for malignancy. Histopathological diagnosis was classified into two categories: Papillary carcinoma and other thyroid carcinomas. Results: A total of 1460 cases of FNAC thyroid were retrieved. Female to male ratio was 6.3:1, and the mean age was 43.4 years. There were 20 papillary carcinomas, two undifferentiated thyroid carcinomas, and 118 suspicious for malignancy representing 9.6% of all cases. Of these 140 FNAC cases, subsequent histopathologic diagnosis found in only 95 cases. Papillary carcinoma was seen in 83.16% followed by follicular and medullary types with a rate of 12.6% and 2.1%, respectively. Conclusion: The findings of this study showed that FNAC is a sensitive method for the diagnosis of thyroid lesion if cytological yield is adequate and papillary carcinoma is the most common type of thyroid cancer in our institution.
  - 2,245 264
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