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  Citation statistics : Table of Contents
   2014| May-August  | Volume 11 | Issue 2  
    Online since March 31, 2014

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Quaternary prevention in thyroidology
Sanjay Kalra, Manash P Baruah, Rakesh Sahay
May-August 2014, 11(2):43-44
  4 3,173 394
Spectrum of thyroid disorders: A retrospective study at a medical college hospital
Jimmy Antony, TM Celine, Michale Chacko
May-August 2014, 11(2):55-59
Background: The spectrum of thyroid disease varies from underactive thyroidism (hypo) to overactive (hyper) thyroidism. It is a common endocrine disease reported worldwide and leads to major consequences of the human body, if left untreated. Aim: The aim is to exhibit the spectrum of thyroid disorders based on age and sex during the period of study in the hospital. Settings and Design: This study was conducted in a teaching and medical college hospital in Kerala State during a time period of five years from April 2005 to March 2010. Materials and Methods: The medical records department follow the guidelines of World Health Organization-International Classification of Diseases (WHO-ICD)-10 for classification of diseases and collected data were analysed by Statistical Package for the Social Sciences software (SPSS) package. Statistical Analysis: 'Z' test applied for finding out the comparison of proportions. Results: Out of 1088 thyroid cases, 152 (14%) were males and 936 (86%) were females. In males and females, the highest proportion of cases was reported in 40-60 years, which accounted for 58 cases (38.2%) and 386 cases (41.2%), respectively. The age group <20 years only shows significant difference between male and female (P = 0.02). The most commonly observed type of thyroid disorder is non-toxic multinodular goiter (E04.2), which is 528 (48.5%). In females, the most common type of thyroid disorder is non-toxic multi nodular goitre (E04.2) and in males it is hypothyroidism, unspecified (E03.9) is 45 29.6%. Conclusion: Public awareness regarding the thyroid disorder is important especially among the females and untreated thyroid disease can produce serious consequences to the health.
  3 4,774 585
Association of obesity and thyrotropinemia in children and adolescents
Rajendra Prasad Namburi, Amaresh Reddy Ponnala, Karthik T Srikanth, Rushikesh Maheshwari Raviraj, Radha Rani Palanki
May-August 2014, 11(2):45-48
Introduction: Alteration in the hypothalamo-pituitary-axis results in elevated thyroid stimulating hormone (TSH) in obesity. Aim: The aim of our study is to compare serum TSH level among obese and overweight children with normal weight and also to assess the relation between body mass index (BMI) and TSH in these children. Materials and Methods: A total of 124 patients aged between 6 and 17 years attending our obesity clinic were recruited. The patients were subdivided into three groups; Group 1: Normal weight (n = 24), Group 2: Overweight (n = 30), and Group 3: Obese (n = 70). All subjects underwent thyroid profile along with other routine tests. Fisher's exact test and Mann-Whitney U test were done to compare between study groups. Pearson's correlation analysis was done to assess the relationship between BMI and TSH. P < 0.05 was considered significant. Results: Out of 124 obese children and adolescents, 72 were females and 52 were and males. The overall mean age of the children was 11.99 ± 2.7 years (range 6.2-17 years). Subclinical hypothyroidism (5.5-10 mIU/L) was present 0/24 in Group 1, 13.33% (4/30) in Group 2, and 15.71% (11/70) in Group 3. The mean TSH values in Groups 1, 2, and 3 are 2.33, 3.03, and 3.35 mIU/L, respectively. Overall, serum TSH did not show correlation with BMI (r = 0.078; P = 0.681). Discussion: In this study, higher BMI resulted in elevated TSH levels, but there was no significant relation between severity of obesity and TSH. Large scale data from population based studies are required to confirm our findings.
  2 3,071 306
Thyrotoxic bulbar myopathy: An unusual presentation of Grave's disease
P Baburaj, BV Shankara
May-August 2014, 11(2):68-69
The most common manifestations of thyrotoxic neurological disease are in the form of myopathy. The muscles usually involved are proximal skeletal muscles. Bulbar myopathy is an uncommon presentation of Grave's disease. We are reporting a case of thyrotoxic bulbar myopathy.
  1 4,340 250
Multinodular goitre turning into follicular carcinoma thyroid after a latency of seven years
Mani Charan Satapathy, Dharitri Dash, Charan Panda, Ambuja Satapathy
May-August 2014, 11(2):70-72
Follicular carcinoma thyroid (FTC) is the second most common category after papillary variety with relative incidence estimated from 10-20%. Follicular thyroid carcinoma (FTC) rarely develops in a preexisting multinodular goiter (MNG) and tends to metastasize to lungs and bone through the blood-stream. The latency period for conversion varies significantly. We herein report a 48-year-old female presented with thyroid swelling since seven years with recent onset of multiple painful swellings over sternum and skull confirmed as a case of FTC on core needle biopsy. Considering her low socioeconomic status and advanced stage of the disease, she was treated with external beam radiotherapy (EBRT) and showing good response to EBRT at 6 months follow-up without any new bone secondaries thereafter.
  1 4,108 403
Ocular myasthenia with thyroid associated ophthalmopathy in subclinical Graves' disease: Diagnostic challenge and treatment outcomes
Krishna Biswas, Meha Sharma, Deep Dutta, Navjyoti Barman
May-August 2014, 11(2):73-75
Ocular myasthenia in Graves' disease is very rare with less than 10 cases reported. We present a clinically euthyroid lady with features of thyroid-associated ophthalmopathy (TAO) who had mild ptosis, external ophthalmoplegia, firm goiter and subclinical hyperthyroidism. Hertel exophthalmometry confirmed exophthalmos. CT orbit revealed thickening of bilateral inferior, medial and superior recti. Anti-thyroid peroxidase antibody was positive (154 IU/ml; normal <40 IU/ml). Repetitive nerve stimulation test of bilateral nasalis muscle showed decremental response, more prominent on the left side. Electrodiagnostic screening for concomitant myopathy or neuropathy was unremarkable. A subsequent positive neostigmine test and a positive anti-acetylcholine receptor antibody (1.46 nmol/L; normal <0.5 nmol/L) lead to the diagnosis of ocular myasthenia with TAO and subclinical Graves' disease. Ptosis and ophthalmoplegia improved with pyridostigmine and carbimazole. She was doing well even after 2 years of follow-up. Any patient of TAO with ptosis and ophthalmoplegia should be evaluated for ocular myasthenia. This case intends to highlight that TAO and ocular myasthenia can coexist, is a diagnostic challenge, with important consequences, as lack of treatment of Graves' disease can aggravate myasthenia.
  1 5,180 296
Postoperative hypothyroidism after thyroidectomy for nontoxic multinodular goiter: Can we prevent it by leaving more?
Badamutlang Dympep, Arun Kumar Kakar, Raman Tanwar, Ravi L Shankar, Ishita B Sen, Ethel Shangne Belho
May-August 2014, 11(2):49-54
Introduction: A study was done to evaluate the function of the thyroid remnant after subtotal and near total thyroidectomy (STT and NTT) in nontoxic multinodular goiter (MNG) by using radioactive iodine uptake (RAIU) and serum thyroid stimulating hormone (TSH), after leaving variable amounts of remnant thyroid tissue. Materials and Methods: A prospective study included 25 patients with nontoxic MNG over a period of 18 months where in STT and NTT was performed. Depending on the availability of the normal thyroid tissue found intraoperatively, a definite volume of thyroid tissue was left in the tracheoesophageal groove along the recurrent laryngeal nerve. Serum TSH and RAIU were performed 4 weeks after surgery. Patients were divided into three groups A, B, and C depending on the size of thyroid remnant left during surgery that is a volume of <2, 2-5, and >5 mL, respectively. Results: There is no statistical significant correlation seen between the size of the remnant thyroid tissue, hypothyroidism, and the postoperative serum TSH value. RAIU study conducted at 4 weeks postsurgery showed no correlation between the volume of the thyroid tissue remnant and its RAIU uptake. Conclusion: The thyroid function of the patients after thyroidectomy does not depend on the volume of the thyroid remnant left. There may be many other factors which determine the thyroid function like the total preoperative gland mass, histopathological nature of the gland, sex, and preoperative thyroid function.
  1 6,743 387
'Graves' disease: A rare cause of cholestasıs
Ahmet Tarik Eminler, Serdar Olt, Mustafa Ihsan Uslan, Orhan Veli Ozkan, Selcuk Yaylaci, Tayfun Garip, Fehmi Celebi
May-August 2014, 11(2):76-77
Rarely, intrahepatic cholestasis may occur during the course of Graves' disease. It is important to rule out other causes of intrahepatic cholestasis for diagnosis. In this article, we present a case of intrahepatic cholestasis due to Graves' disease in a 52-year-old male patient with jaundice, pruritus, and weight loss.
  - 2,667 266
Bifascicular block in a patient with Graves disease-rare manifestation of a common disease
Prashant Panda, Vikas Bhatia, Somesh Thakur, Kiran Mokta, Jitender K Mokta, Surender Thakur
May-August 2014, 11(2):78-80
There are many cardiovascular manifestations of hyperthyroidism. Rhythm disturbances commonly occur in the form of tachyarrhythmia's. Conduction block are not commonly found in the hyperthyroid patients. We report a rare manifestation of hyperthyroidism in the form of bifasciular block.
  - 3,181 245
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
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.
  - 20,055 465
International thyroid days
Aakshit Goyal
May-August 2014, 11(2):83-84
  - 2,324 179
Thyroidology at the first South Asian Federation of Endocrine Societies conference: A report
Sanjay Kalra, Rakesh Kumar Sahay, Sarita Bajaj
May-August 2014, 11(2):84-85
  - 1,709 150
Screening for thyroid dysfunction during pregnancy
Mohammed El Amine Amani, Farida Chentli
May-August 2014, 11(2):85-85
  - 1,721 186
Empirical 131 Iodine therapy in thyrotoxicosis based on 99mTechnetium thyroid scan and gamma camera based uptake values
Ajit S Shinto, Koramadai K Kamaleshwaran, P Velayudham, Suresh Damodharan, A Prem Kumar
May-August 2014, 11(2):60-65
Objective: Radioactive iodine-131 (RAI) has been established in the treatment of patients with various etiologies of hyperthyroidism. However, the short term and long term clinical outcome of patients receiving RAI is different in various studies. The aim of this study was to assess clinical outcome one year after RAI therapy and identify factors associated with a good response. Materials and Methods: In this experimental study among patients with Graves' disease, referred to the Nuclear Medicine Department and had indication for RAI therapy, 164 consecutive subjects were enrolled for the study. Radioiodine dose was calculated based on the uptake of the thyroid gland by routine pertechnetate thyroid scan done on a gamma camera. Patients with less than 10% uptake of injected dose were given 10 mCi of oral Na-I 131 and if uptake was higher than 10%, a dose of 15 mCi was administered. Patients were monitored closely clinically and with blood investigations after treatment for one year. Results: Among the 158 patients, who completed follow-up, 96.2% recovered and 3.8% remained thyrotoxic. Among patients who recovered, 77.6% became hypothyroid and 22.4% euthyroid. The incidence of hypothyroidism was 32.2% in first trimester, 58.5% in second trimester, 5.1% in third trimester and 4.2% in fourth trimester. Conclusion: In our study, a good result was seen in more patients than other studies and it might relate to higher absorption of radioactive iodine in our region . According to our result, incidence of hypothyroidism was the most in second trimester, and so patients should be carefully followed in this period.
  - 3,800 294
Management of primary hypothyroidism: Role of addition of levothyroxine at night
Santosh Kumar Singh
May-August 2014, 11(2):66-67
Background: Levothyroxine (LT4) is conventionally taken in the morning. Methods and Result: This retrospective study was done to assess the effect of addition of LT4 on thyroid hormone profile in primary hypothyroid patients. Conclusion: The study demonstrated significant improvement, which could be explained by greater bioavailability of LT4 and improved compliance.
  - 2,528 270