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[en] In rare cases, autoimmune thyroiditis preserves a localized portion of the thyroid gland which simulates on the scintiscan a hot nodule or a toxic adenoma. Eight such cases are analyzed. The thyroid status of the patients was variably altered, either depressed normal or elevated with correlative increasing diagnostic difficulties
[fr]Dans de rares cas, la thyroidite auto-immune preserve une portion localisee de la thyroide qui simule sur le scintigramme un nodule chaud ou un adenome toxique. On a analyse 8 cas de ce genre. Le fonctionnement de la thyroide de ces malades etait altere de facon variable, soit deprime, normal ou eleve avec correlativement des difficultes diagnostiques accrues
[en] To determine the frequency and profile of carcinoma in multi-nodular goiter and solitary thyroid nodule. Study Design: Case series. Place and Duration of Study: Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Centre, Karachi, from January 1999 to January 2009. Methodology: Cases with solitary thyroid nodules and multi-nodular goiter were included. Patients under 12 years of age, cystic benign lesion in solitary thyroid nodules or those multi-nodular goiters which were not causing pressure symptoms, cosmetic problems or sign of malignancy were excluded. In solitary thyroid nodule, hemithyroidectomy was done and if histopathology examination revealed carcinoma thyroid then completion thyroidectomy was done. In multi-nodular goiter sub-total thyroidectomy done. Results were described as frequency percentages and mean. Results: Out of 397 patients of multi-nodular goiter only one patient was found to be papillary carcinoma (0.25%). In 220 patients of solitary thyroid nodules, 93 patients were diagnosed as carcinoma of thyroid (42.27%). Others diagnosed in solitary thyroid nodule were thyroid adenoma, colloid goiter, thyroiditis and multi-nodular goiter. The frequency of papillary carcinoma in 65.95% occurring females of 12-30 years of age and being multifocal in 6.45%, follicular carcinoma in 23.40%, medullary carcinoma in 7.44%, anaplastic carcinoma in 2.12% and lymphoma in 1.01%. Female were predominantly involved and papillary carcinoma was common in 12-30 years of age (71.63%) and follicular was common in 30-40 years of age (68.18%). 6.45% of papillary carcinoma was found to be multifocal in nature. Conclusion: Frequency of carcinoma of thyroid is very high in solitary thyroid nodule (42.27%), but markedly low in multi nodular goiter. Papillary carcinoma is the most common variety, most of in younger female. (author)
[en] A major reduction in T3 turnover has been demonstrated previously in clinically hypothyroid patients, using 125I labelled T3. Non-compartmental (NC) and monocompartmental (MC) analysis was used to study ten patients with Graves' disease who, following treatment with iodine-131 (RAI), are now clinically euthyroid but who showed hyper-responsiveness to TRH although serum T3 and T4 concentrations are within the normal range. T3 production rate (PR), metabolic clearance rate (MRC) and fractional-turnover (K) were all significantly reduced in patients compared with seven controls (P < 0.01). T3, MCR and PR were consistently higher, and T3 K lower, when calculated by MC, than values calculated by NC analysis. The difference in T3 production rates between patients (mean 16.6 nmol/day) and controls (mean 38.9 nmol/day) raises the question of replacement therapy in patients who are apparently euthyroid but TRH hyper-responsive. (author)
[en] The improvements in the sensitivity and specificity of biochemical thyroid tests have dramatically impacted clinical strategies for diagnosis and treating thyroid disorders. This article is designed to give an overview of the current strengths and limitations of the in vitro thyroid tests most commonly used in clinical practice. Despite recent methodological achievements, current thyroid tests still exhibit wide variability and are prone to a variety of technical limitations of which physicians are often unaware. Such problems include binding protein abnormalities that affect the FT4 tests, thyroglobulin autoantibodies that interfere with serum Tg measurement, medications or sever non thyroid illness that have myriad effects on thyroid tests. It is recommended that an active laboratory-physician interface be maintained to ensure that quality, cost-effective assays are used in a logical sequence and to assess abnormal thyroid test results and investigate discordance. These discordance need to be interpreted with care using a collaborative approach between laboratory and physicians. (author)
[en] We analyzed Radioisotope scan findings of 46 patients of thyroiditis which were proven pathologically at K.C.H. The results were as follows 1) 45 patients were female, one was male and average age of patients was 37 years old. 2) The lesion site was predominant in both lobe (67%) Hashimoto's thyroiditis showed enlarged thyroid (85%) with cold nodule (20%), diffuse decreased activity (10%), while subacute thyroiditis was presented absent activity (53%), poor visualization (20%) or cold nodule (7%). 4) Radioisotope scan was valuable in evaluating function of thyroid gland and detection of lesion but there was a limit of pathological nature.
[en] To demonstrate sonographic features of Hashimoto's thyroiditis according to the thyroid function. We reviewed 54 thyroid ultrasonographic examinations of untreated Hashimoto's thyroiditis. We reviewed thyroid ultrasonographic examinations and focused on the presence of ill-defined low echoic lesions and glandular enlargement. We performed another thyroid ultrasonographic examination of 14 healthy volunteers, in order to obtain normal size of thyroid gland. Comparison was made between these morphologic characteristics and functional stage of the disease. The mean diameter of thyroid gland was 2.16 ± 0.43 cm in patients with Hashimoto's thyroiditis, and 1.41 ± 0.42 cm in normal control group of the thyroid gland. There was no statistically significant relationship between thyroid function and size. There was morphologic abnormalities in 46 patients (85%). Among them, 7 patients revealed diffuse low echogenicity in the entire thyroid gland, 32 patients showed peripherally located, ill-defined focal hypoechoic lesion, and 7 patients showed solitary or multiple. well-defined nodular lesions. Decreased echogenicity of the thyroid gland was related to hypothyroid status. Hashimoto's thyroiditis has specific morphologue characteristics in ultrasonographic features, which are well correlated with thyroid function.
[en] The thyroid gland is vulnerable not only to external radiation but also to internal radiation, because the thyroid cells can incorporate radioactive iodine when synthesizing thyroid hormones. Since radiation-induction of thyroid neoplasia, including thyroid cancer, is well recognized, the data on radiation-related thyroid autoimmunity and dysfunction are summarized and reviewed. High-dose irradiation, irrespective of being external or internal, is strongly associated with a risk of hypothyroidism (with the prevalence ranging from 2.4% to 31%) and of Graves’ hyperthyroidism (with the prevalence being up to 5%). It is easy to understand that high-dose irradiation induces hypothyroidism with some frequency, because high-dose irradiation destroys the thyroid gland. On the other hand, the basis for development of hyperthyroidism is mechanistically unclear, and it is merely speculative that autoantigens may be released from damaged thyroid glands and recognized by the immune system, leading to the development of anti-thyrotropin receptor antibodies and Graves’ hyperthyroidism in subjects who are immunologically predisposed to this ailment. In contrast, the data on moderate to low-dose irradiation on thyroid autoimmunity and dysfunction are inconsistent. Although it is difficult to draw a definitive conclusion, some data may suggest a transient effect of moderate- to low-dose irradiation on hypothyroidism and autoimmune thyroiditis, implying that the effect, if it exists, is reversible. Finally, no report has shown a statistically significant increase in the prevalence of moderate- to low-dose irradiation–induced Graves’ hyperthyroidism.
[en] In a study on 44 patients with subacute thyroiditis (SAT), high thyroid hormone levels were found in 66% of cases during the early stage of the disease related to the extension of the lesion. ft4 was most frequently elevated. TSH response to TRH was suppressed in all but one patients independent of thyroid hormone levels. Clinical thyrotoxicosis was always mild. Reserve T3 was significantly above normal only in patients with elevated thyroid hormones (group A), probably because of the large availability in T4, and it was positively correlated with T3 and T4. The rT3 to T3 ratio was also significantly increased. TBG was within the physiologic range in all instances. Following recovery all the a forementioned parameters returned within normal limits. Thirteen patients, belonging to group A, were monotored by sequential measurements of T3, T4, FT3, FT4, rT3, TBG and basal TSH during the course of the disease while either on corticosteroid therapy or after recovery. They showed a similar trend: after the acute phase all hormones fell to normal, T3 and FT3 to hypothyroid values for approximately 30 days to eventually revert to the normal range. TSH was still whitin the normal limits, with a peak value about the 40th day. These changes seem to reflect the peripheral disposal of T4 since thyroid hormone release ceases during the initial phase of SAT. However, cannot to be excluded a contributory effect similar to that observed in acute febrile illness together with an inhibitory action of glucocorticoid on monodeiodination
[en] Ectopic thyroid gland is a rare embryological fault of thyroid development .Dual ectopic thyroid is more rare and only 8 cases have been reported in the literature. The author presents a case of dual ectopic thyroid in a 16 year old boy with an anterior red neck mass, which is gradually growing in size particularly in last 2 years. The initial diagnosis was thyroglossal duct cyst. Thyroid function test revealed elevated thyroid-stimulating hormone. Ultrasound of the neck did not show thyroid gland in its normal pre tracheal position. Thyroid scan (Technetium 99)revealed the diagnosis of dual thyroid ectopia(lingual and subhyoid). (author)