The process of normal aging affects the hypothalamic-pituitary-thyroid axis in a number of ways, resetting of the set point being the most important of them. Contrary to the earlier belief, longevity has been reported to be associated with high serum TSH. Most recent studies have demonstrated an age dependent decline in serum free T3 levels, whereas FT4 levels remains relatively unchanged and TSH & rT3 levels increase with age. Two recent meta-analyses have shown increased risk of adverse cardiovascular outcomes in patients younger than 65 years of age, but not in those more than 65 year old. There is a good number of evidence documenting increased mortality in elderly individual with sub- clinical hyperthyroidism, which should be kept in mind while treating mildly elevated TSH in these patients. It is also important to remember that thyroid functions in the elderly closely mimics that found in sick euthyroid syndrome.

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.

Neonatal thyroid dysfunction is quite common in India. The clinical presentation is very subtle and can be captured by neonatal thyroid screening. Neonatal screening paves a better way in detecting and preventing neuro-cognitive insult. In India lack of a national policy, field staff and certified lab; screening programme is not carried out effectively. Managing thyroid disorder in neonates and in children poses unique difficulties. Hypothyroidism can be transient, hence to be reassessed. Neonatal thyrotoxicosis is not commonly seen.

Subclinical hypothyroidism (SH), defined as an elevated serum TSH level, but normal serum Free T4 and T3 levels, is a common laboratory finding, but its clinical significance remains uncertain and controversial. This brief review will summarize the definition, epidemiology, current data related to the effects of SH on cardiovascular risk and in pregnancy, and clinical guidelines on therapy.

Central compartment lymph node (CCLND) management in patients without clinical or radiologic evidence of CCLND metastasis is debatable. CCLND in Papillary Thyroid Cancer has the advantages of complete clearance of the disease, thereby reducing the chances of recurrence and the subsequent morbidity of reoperation. However, it is associated with increased risk of hypo-parathyroidism and recurrent laryngeal nerve palsy. Therefore experience is required from the part of the operating surgeon, to minimize surgical morbidity.