Clinical Thyroid Research Articles

A Case of Thyroid Storm Complicated with Cardiorespiratory Failure without Obvious Trigger: Early Suspicion is the Key

Thyroid storm, also known as thyrotoxic crisis is an acute, rare life-threatening condition of thyroid gland; possessing 100% mortality when it’s not treated in time. Thyroid storm coexisting with respiratory failure further can contribute to this mortality. Respiratory collapse can be irreversible. This is an endocrine emergency first described in 1926. This is important to recognize it early and treat to reduce mortality. Herein, we review a case of 75 years of male who developed Cardio-respiratory failure while he was manifesting clinical features thyroid storm.

Estimating the risk of completion total thyroidectomy using real-world data to guide initial surgical decision-making for patients with clinical low-risk papillary thyroid carcinoma

BackgroundContinuing controversy exists in different guidelines’ recommendations regarding whether total thyroidectomy (TT) or lobectomy is the optimal surgery for patients with low-risk papillary thyroid carcinoma (PTC). Diverse perceptions of the risk of completion TT after lobectomy are the main debate between guidelines and institutions.MethodsPatients who underwent thyroidectomy and prophylactic central lymph node dissection for ≤ 4 cm PTC (January 2007 to December 2020) by high-volume surgeons were included. Patients with preoperatively known high-risk characteristics or suspicious bilateral multifocality were excluded. The pathological findings were defined as the risk stratifications of completion TT from low to high to evaluate which initial surgical procedure could allow more patients to meet the criteria of optimal surgical extent.ResultsOf 4965 consecutive patients met lobectomy criteria as the initial operation. Aggressive histological subtypes were found in 2.5% of patients, T3b disease in 1.1%, T4 disease in 3.1%, LNs involved ≤ 5 in 29.5%, LNs involved > 5 in 3.1%, and incidental bilateral multifocality in 7.9%. According to our defined risk stratification system, TT and lobectomy would be considered the optimal initial procedure in 12.0% and 67.2% PTC patients with a tumor ≤ 1 cm and 28.7% and 36.6% in the 1–4 cm groups in our real-world cohort, respectively.ConclusionLobectomy alone, as an initial procedure, could allow more low-risk PTC patients with a tumor either ≤ 1 cm or 1–4 cm to achieve the optimal surgical extent. Moreover, surgeons should balance the high-risk characteristics and complication risks during surgery to re-evaluate surgical decision-making.

Thyroid Function and Metabolic Syndrome in Children and Adolescents with Neuromotor Disability.

Thyroid function plays a crucial role in nervous system integrity and metabolic homeostasis. We evaluated the pattern of TSH, FT4 and FT3 release in children with neuromotor impairment (NI) in relationship with metabolic syndrome (MS). We enrolled 55 patients with NI and 30 controls. Clinical parameters, thyroid function and MS presence were recorded. Principal component analysis (PCA), cluster analysis, and logistic regression models were performed. MS was detected in 54.5% of patients. Four clusters were identified: the first one included only controls and, contrasting with cluster 4, was exclusively characterized by children with disability and MS. This latter showed increased FT4 and FT3 and decreased TSH levels. Cluster 2, characterized by disability without MS showed high FT4 and FT3, whereas cluster 3 with low FT4 and FT3 mainly included disability (90%) and showed prevalent MS (57%). The association between TSH and NI is represented by a U-shape structure. The TSH, FT3 and FT4 release patterns may reflect thyrotropic adaptation, allostatic response and compensatory mechanisms. These mechanisms, found in both MS and disability, show that the odds of having a condition of NI with or without MS increase as the TSH values deviate, in both directions, from a value of 2.5 mLU/mL.

Preoperative prediction of central neck metastasis in patients with clinical T1-2N0 papillary thyroid carcinoma.

Central neck metastasis (CNM) is common in patients with papillary thyroid carcinoma (PTC). However, the prediction of CNM risk remains poorly defined, especially for patients with clinically negative lymph nodes. We developed a preoperative clinical nomogram to predict CNM risk in patients with clinical T1-2N0 (cT1-2N0) PTC. Data from 436 patients with unifocal cT1-2N0 PTC were available. We analyzed the association between preoperative variables and CNM using univariate and multivariate logistic regression and developed a clinical nomogram based on the multivariate regression model. The nomogram was validated externally using an independent dataset. The CNM rate was 25.5%. Three clinical variables were associated with CNM, including age, gender, and tumor size. We built a CNM nomogram integrating these three variables. It had a poor index of internal discrimination (C-index, 0.655; 95% CI 0.596-0.715) and a poor index of external discrimination (C-index, 0.690; 95% CI 0.611-0.769). We developed a preoperative nomogram to quantify the risk of CNM in unifocal cT1-2N0 PTC patients. However, our data showed that preoperative clinical parameters were not able to accurately predict the likelihood of CNM. Other variables need to be investigated to improve the prediction capability of this nomogram.

Hypothyroid Symptoms Throughout Pregnancy Are Predominantly Associated with Thyroxine and Not with Thyrotropin Concentrations.

Background: It is unclear whether levels of hypothyroid symptoms in pregnant women with (sub)clinical thyroid dysfunction differ from euthyroid controls and whether free thyroxine (fT4)/thyrotropin (TSH) changes throughout pregnancy affect hypothyroid symptom levels. The objective was twofold: (1) To compare hypothyroid symptom levels between thyroid dysfunction subgroups and a carefully defined reference group; (2) to assess the association between fT4/TSH changes throughout pregnancy and hypothyroid symptom levels adjusted for depressive symptoms. Methods: The current study was a longitudinal prospective cohort study in 1800 healthy pregnant women. At each trimester of pregnancy, hypothyroid symptoms were assessed with a 12-item symptom hypothyroidism checklist and depressive symptoms with the Edinburgh Depression Scale. Thyroid dysfunction was defined using the 2.5-97.5th fT4/TSH percentile of thyroid peroxidase antibodies-negative women. Euthyroid controls consisted of women with appropriate fT4 levels within the 10-90th percentile and with a normal TSH level. Hypothyroid symptom mean scores were compared between controls and several thyroid dysfunction subgroups. Growth mixture modeling was performed to evaluate possible longitudinal trajectories of hypothyroid and depressive symptoms. The association between hypothyroid symptom trajectories (adjusted for depression) and fT4/TSH changes was assessed with multivariate logistic regression analysis. Results: Women with overt hypothyroidism (fT4 < 2.5th, TSH >97.5th) and hypothyroxinemia (fT4 < 2.5th, TSH: 2.5-97.5th) showed higher hypothyroid symptom levels compared with the euthyroid controls and women with subclinical hypothyroidism (SCH, fT4: 2.5-97.5th, TSH >97.5th), because 82% of these SCH women had fT4 levels in the euthyroid range. Two groups of hypothyroid and depressive symptoms were defined: a persistently low and persistently high symptom group. fT4 decreased in 98% of the women from the first to third trimester and per unit pmol/L fT4 decrease (not TSH increase), the likelihood to present persistently high hypothyroid symptoms increased with 46%, adjusted for depression. Conclusions: A properly defined euthyroid control group distinguishes women with hypothyroid symptoms. An fT4 decrease toward end term is associated with persistently high hypothyroid symptom levels. Clinicians should be aware of the importance of fT4 stratification in SCH women.

H-Net: A dual-decoder enhanced FCNN for automated biomedical image diagnosis

Skin lesions and thyroid cancer have become diseases with a high incidence. The computer-aided diagnosis (CAD) system for dermatological diseases offers one of the most remarkable performance where deep learning technologies demonstrate their superiority in surpassing human experts. For developing a CAD system, a critical step is skin lesions and thyroid nodules diagnosis from dermoscopic images and ultrasound images, respectively. Although notable successes have been obtained using deep convolutional neural network (DCNN) models, several challenges hamper the practical applications in clinical due to the complexity of clinical data, e.g., skin lesions or thyroid nodules are irregular shapes or low contrast. To alleviate these issues, we propose a novel dual encoder-decoder network, called H-Net, for automated thyroid nodule and skin lesion segmentation. Specifically, a shallow CNN is applied at its left to learn the low-level details information called L-Net and a deep CNN is employed at its right to capture the high-level information called R-Net. Furthermore, to transfer information between the L-Net and the R-Net mutually, we propose a novel crossed skip connection strategy, which is a specific reliability skip connection way. In addition, to enhance the representation learning ability of the proposed pipeline, we propose a novel contextual information encoding module, which replaces conventional convolutional layers in H-Net. Meanwhile, we propose a novel hybrid loss to alleviate the imbalance training problem. To validate the effectiveness of H-Net, 600 pairs of dermoscopic images and 139 pairs of ultrasound images have been used for evaluation in experiments. Seven latest biomedical image segmentation approaches are compared, and ten metrics are utilized to evaluate the segmentation performance. Extensive experimental results demonstrate that our H-Net yields the new record, achieving a mIoU value of 84.8% on the ISIC-2017 dataset and a mIoU value of 87.5% on the TNUI-2021 dataset, which outperforms state-of-the-art approaches in both visual comparisons and quantitative evaluation. The codes are available at https://github.com/zxg3017/H-Net.

Prediction of recurrent spontaneous abortion using evolutionary machine learning with joint self-adaptive sime mould algorithm

Recurrent spontaneous abortion (RSA) is a frequent abnormal pregnancy with long-term psychological repercussions that disrupt the peace of the whole family. In the diagnosis and treatment of RSA worsened by thyroid disorders, recurrent spontaneous abortion is also a significant obstacle. The pathogenesis and possible treatment methods for RSA are yet unclear. Using clinical information, vitamin D and thyroid function measurements from normal pregnant women with RSA, we attempt to build a framework for conducting an effective analysis for RSA in this research. The framework is presented by combining the joint self-adaptive sime mould algorithm (JASMA) with the common kernel learning support vector machine with maximum-margin hyperplane theory, abbreviated as JASMA-SVM. The JASMA has a complete set of adaptive parameter change methods, which improves the algorithm’s global search and optimization capabilities and guarantees that it speeds convergence and departs from the local optimum. On CEC 2014 benchmarks, the property of JASMA is validated, and then it is utilized to concurrently optimize parameters and select optimal features for SVM on RSA data from VitD, thyroid hormone levels, and thyroid autoantibodies. The statistical results demonstrate that the proposed JASMA-SVM can be treated as a potential tool for RSA with accuracy of 92.998%, MCC of 0.92425, sensitivity of 93.286%, specificity of 93.064%.

Towards De-Implementation of low-value thyroid care in older adults.

This review discusses the current literature regarding low-value thyroid care in older adults, summarizing recent findings pertaining to screening for thyroid dysfunction and management of hypothyroidism, thyroid nodules and low-risk differentiated thyroid cancer. Despite a shift to a "less is more" paradigm for clinical thyroid care in older adults in recent years, current studies demonstrate that low-value care practices are still prevalent. Ineffective and potentially harmful services, such as routine treatment of subclinical hypothyroidism which can lead to overtreatment with thyroid hormone, inappropriate use of thyroid ultrasound, blanket fine needle aspiration biopsies of thyroid nodules, and more aggressive approaches to low-risk differentiated thyroid cancers, have been shown to contribute to adverse effects, particularly in comorbid older adults. Low-value thyroid care is common in older adults and can trigger a cascade of overdiagnosis and overtreatment leading to patient harm and increased healthcare costs, highlighting the urgent need for de-implementation efforts.

The Thyroid Condition and Residual Clinical Signs in 31 Existing Endemic Neurological Cretins After 42 Years of Iodine Supplementation in China.

BackgroudEndemic cretinism is the most severe manifestation among the iodine deficiency-related disorders. The clinical status of the cretins may be modified subsequently by the duration and severity of the disease. We aimed to reassess the clinical status and thyroid function of 31 surviving “neurological cretins” after 42 years of iodine supplementation in a historically severely iodine deficiency area of China.MethodsIt was a cross-sectional study in design and we investigated all 31 surviving neurological cretins and 85 controls. A detailed neurological examination was conducted on each patients. All the participants were given a questionnaire and underwent B-mode ultrasonography of the thyroid. The serum levels of thyroid hormones, thyroid antibodies, serum iodine concentration (SIC) and urine iodine concentration (UIC) were measured.ResultsThe neurological cretins had shorter stature than that of the control. Neurological damage is still present in patients with cretinism. The prevalence of subclinical hypothyroidism and thyroid nodule in the cretins was significantly higher (χ2 =4.766, P=0.029 and χ2 =17.077, P<0.0001, respectively) compared with the control. After adjusting for confounding factors, endemic neurocretinism was found to be an independent risk factor for subclinical hypothyroidism (OR=4.412; 95% CI: 1.358–14.334; P=0.014) and thyroid nodule (OR=6.433; 95% CI: 2.323–17.816; P<0.0001).ConclusionsIodine supplementation after birth does not reverse the neurological damage that results from maternal/foetal hypothyroidism in utero and is subsequently manifested as neurological cretinism. There is a cross-sectional association between endemic neurocretinism and subclinical hypothyroidism and thyroid nodule.

Assessment of serum dipeptidyl peptidase-IV levels in autoimmune thyroid disease

ObjectiveDecreased serum dipeptidyl peptidase-IV (sDPPIV) levels have been reported in patients with autoimmune diseases. However, few studies have analyzed the association between sDPPIV levels and autoimmune thyroid disease (AITD). This study aimed to evaluate the association between sDPPIV levels and three types of AITD: Graves’ disease (GD), Graves’ ophthalmopathy (GO), and Hashimoto’s thyroiditis (HT).MethodsPatients newly diagnosed with GD (n = 65), GO (n = 22), and HT (n = 27) and healthy individuals (n = 30) were recruited. Clinical characteristics and thyroid function data were collected. sDPPIV was measured using enzyme-linked immunosorbent assays.ResultsCompared with controls (786.3 ± 46.95), patients with GD and GO had significantly lower sDPPIV levels (662.2 ± 38.81 and 438.4 ± 31.78). Additionally, sDPPIV levels were negatively associated with antithyroid peroxidase antibody (r = −0.20) and antithyroglobulin antibody (r = −0.19), but there was no significant relationship between thyroid hormone and sDPPIV levels. GO cases were divided by proptosis with and without muscle thickening; sDPPIV levels were lower in the muscle thickening group than those in the without muscle thickening group. Logistic regression analysis showed that sDPPIV was negatively correlated with GO and GD.ConclusionssDPPIV concentrations were abnormal in patients with GD and GO, and reduced sDPPIV expression may be involved in the progression of GO and GD.

Thyroid nodule segmentation and classification in ultrasound images through intra- and inter-task consistent learning.

Thyroid nodule segmentation and classification in ultrasound images are two essential but challenging tasks for computer-aided diagnosis of thyroid nodules. Since these two tasks are inherently related to each other and sharing some common features, solving them jointly with multi-task leaning is a promising direction. However, both previous studies and our experimental results confirm the problem of inconsistent predictions among these related tasks. In this paper, we summarize two types of task inconsistency according to the relationship among different tasks: intra-task inconsistency between homogeneous tasks (e.g., both tasks are pixel-wise segmentation tasks); and inter-task inconsistency between heterogeneous tasks (e.g., pixel-wise segmentation task and categorical classification task). To address the task inconsistency problems, we propose intra- and inter-task consistent learning on top of the designed multi-stage and multi-task learning network to enforce the network learn consistent predictions for all the tasks during network training. Our experimental results based on a large clinical thyroid ultrasound image dataset indicate that the proposed intra- and inter-task consistent learning can effectively eliminate both types of task inconsistency and thus improve the performance of all tasks for thyroid nodule segmentation and classification.

A Mathematical Model to Assess the Effect of Residual Positive Lymph Nodes on the Survival of Patients With Papillary Thyroid Microcarcinoma.

BackgroundActive surveillance (AS) has been considered the first-line management for patients with clinical low-risk papillary thyroid microcarcinoma (PTMC) who often have lymph node micrometastasis (m-LNM) when diagnosed. The “low-risk” and “high prevalence of m-LNM” paradox is a potential barrier to the acceptance of AS for thyroid cancer by both surgeons and patients.MethodsPatients diagnosed with PTMC who underwent thyroidectomy with at least one lymph node (LN) examined were identified from a tertiary center database (n = 5,399). A β-binomial distribution was used to estimate the probability of missing nodal disease as a function of the number of LNs examined. Overall survival (OS) probabilities of groups with adequate and inadequate numbers of LNs examined were estimated using the Kaplan–Meier method in the Surveillance, Epidemiology, and End Results (SEER) database (n = 15,340). A multivariable model with restricted cubic splines was also used to verify the association of OS with the number of LNs examined.ResultsThe risk of residual m-LNM (missed nodal disease) ranged from 31.3% to 10.0% if the number of LNs examined ranged from 1 and 7 in patients with PTMC. With 7 LNs examined serving as the cutoff value, the intergroup comparison showed that residual positive LNs did not affect OS across all patients and patients aged ≥55 years (P = 0.72 and P = 0.112, respectively). After adjusting for patient and clinical characteristics, the multivariate model also showed a slight effect of the number of LNs examined on OS (P = 0.69).ConclusionsEven with the high prevalence, OS is not significantly compromised by persistent m-LNM in the body of patients with low-risk PTMC. These findings suggest that the concerns of LNM should not be viewed as an obstacle to developing AS for thyroid cancer. For patients with PTMC who undergo surgery, prophylactic central LN dissection does not provide a survival benefit.

Risk Factors for Contralateral Occult Papillary Thyroid Carcinoma in Patients with Clinical Unilateral Papillary Thyroid Carcinoma: A Case-Control Study.

Introduction Papillary thyroid cancer (PTC) is one of the most prevalent endocrine malignancies that has increased in recent decades around the world. Although the indicator for navigating the surgical extent in PTC patients is still in debate, a key issue is how to predict that there are undetected preoperative tumors in the contralateral thyroid lobe. This study aims to find risk factors for contralateral occult papillary thyroid cancer (COPTC) to facilitate more accurate surgical decisions made for patients with PTC. Materials and Methods In our study, we included 229 patients who underwent total thyroidectomy plus central and ipsilateral lateral lymph nodes dissection from January 1, 2019, to September 1, 2021. Univariate and multivariate logistic regression analyses were conducted to assess the association between COPTC and clinical-pathological characteristics, as well as the relation between the diameter of the occult lesions and predictors. The forest plot was plotted to visualize the prediction factors from the output of the multivariate regression analysis. A ROC curve was used to evaluate the combining potency of all the risk factors. Results Of the 229 patients included in our study, 46 with COPTC were assigned to the case group, representing 20.1% in this study. Multifocality in one lobe (OR = 2.21, P=0.03), intact capsule (OR = 2.54, P=0.01), central lymph node metastasis (OR = 3.00, P=0.02), and Hashimoto's thyroiditis (OR = 2.08, P = 0.04) are more prone to present contralateral occult papillary thyroid carcinoma. The ROC curve of the aggregate potency of the risk factors presents AUC = 0.701 (P < 0.001), and the best cutoff value was 2.02, with a sensitivity of 78.3% and specificity of 55.2%. Furthermore, there was no statistical correlation between the diameter of the occult tumor and the four obtained variables. Conclusion Patients with multifocality in one lobe, intact capsule, central lymph node metastasis, and HT may harbor contralateral papillary thyroid carcinoma. It is essential to be prudent to make a surgical or follow-up decision on these patients. In addition, more clinical rather than postoperative pathological indicators need to be revealed in the future.

Greetings From the Editor of Clinical Thyroidology

Clinical ThyroidologyVol. 34, No. 6 Greetings from the EditorFree AccessGreetings From the Editor of Clinical ThyroidologyAngela M. LeungAngela M. LeungSearch for more papers by this authorPublished Online:13 Jun 2022https://doi.org/10.1089/ct.2022;34.235-236AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail DEAR COLLEAGUESWelcome to the June issue of Clinical Thyroidology. This issue begins with a review by Dr. Kenneth Burman, who summarizes a study on suboptimal thyroid hormone replacement. Drs. Ricardo Correa and Ricardo Villela discuss a study done in patients with subclinical hyperthyroidism and cardiovascular outcomes, while Drs. Eijun Nishihara and Takashi Akamizu review the findings of a recent trial of rituximab use in young patients with Graves’ disease.On the topic of thyroid nodules and thyroid cancer, Dr. Benjamin Gigliotti comments on a survey study summarizing respondents’ viewpoints of the various risk-stratification systems available for estimating malignancy risk. Drs. N. Rhea Udyavar and Lilah Morris-Wiseman review a study reporting the associations between thyroid autoimmunity and incident thyroid cancer, while Dr. Ulla Feldt-Rasmussen describes a Danish study assessing the relationships between education, socioecononomic status, and thyroid cancer incidence.The potential need for levothyroxine replacement in patients who undergo hemithyroidectomy for low-risk papillary thyroid cancer is always an interesting clinical question. Drs. Erivelto Volpi and Leonardo Volpi summarize a retrospective trial that studied this question. This issue also features a review by Drs. Anupam Kotwal and Whitney Goldner, who examine a recent study reporting the characteristics of patients with BRAF V600E–mutant papillary thyroid cancer. Drs. Sara Duffus and Lindsay Bischoff discuss a study assessing the differences between Hürthle-cell and follicular thyroid carcinomas. Finally, Dr. Mayumi Endo summarizes the findings of a phase 3 trial studying treatment with selumetinib and radioactive iodine in patients with high-risk differentiated thyroid cancer.Clinical Thyroidology will continue to feature select highlighted abstracts presented at the American Thyroid Association's 2021 annual meeting. In this issue, Drs. Tiba Abdulwahid and Karen Selk share their case report entitled “A Rare Hideaway.” I invite all our readers to learn about the interesting clinical course they describe.As always, we invite our readers to join us through our social media channels. Through these other ways of communication, we discuss content featured in each month's issue and other issues related to hot topics in the clinical thyroid literature:Twitter:https://twitter.com/clinicalthyroid(@clinicalthyroid)Facebook:https://www.facebook.com/ThyroidAssociationLinkedIn:https://www.linkedin.com/company/american-thyroid-associationYoutube:https://www.youtube.com/user/thyroidorgAlso note that most of the material covered in Clinical Thyroidology is also translated into shorter lay summaries in our sister journal, Clinical Thyroidology for the Public [CTFP] (https://www.thyroid.org/patient-thyroid-information/ct-for-patients), that is edited by Dr. Alan Farwell and his team each month. The summaries in CTFP may be of use to patients and the public who are interested in reading more about recently published studies in the clinical thyroid literature.I hope that each issue provides helpful reviews, commentaries, editorials, and perspectives regarding how best to treat patients with thyroid disease. Guidelines for submitting Letters to the Editor and select Guest Editorials that cover timely and innovative aspects of clinical thyroid disease management may be found at https://home.liebertpub.com/publications/clinical-thyroidologyand174/623/for-authors.Thank you again for your interest in Clinical Thyroidology. Please feel free to send me any questions or comments at clinicalthyroidology@thyroid.org.Warmest regards,Angela M. Leung, MD, MScEditor-in-Chief, Clinical ThyroidologyFiguresReferencesRelatedDetails Volume 34Issue 6Jun 2022 Information© Copyright 2022, Mary Ann Liebert, Inc.To cite this article:Angela M. Leung.Greetings From the Editor of Clinical Thyroidology.Clinical Thyroidology.Jun 2022.235-236.http://doi.org/10.1089/ct.2022;34.235-236Published in Volume: 34 Issue 6: June 13, 2022PDF download

Acquired Hypothyroidism Masquerading As Post Hepatitis Sequelae in a Moderate Acute Malnutrition Child

ObjectivesThe thyroid hormone influences the physiological process of almost all organ systems in children .It is essential for modulation of cardiovascular, neurological, gastrointestinal and metabolic function. In children at the early ages, it influences growth, physical and neurological development. As it is a preventable cause of intellectual disability, prompt recognition and treatment of hypothyroidism is integral to optimize physical and neurodevelopmental outcome.MethodsA 5 year 6 months old female child presented with history of 5 days of abdominal distension, fever and 1 episode of bloody stools. Examination showed icterus and bilateral pedal edema. Liver function test was deranged. Triglycerides and total cholesterol were elevated. Hepatitis serologies were negative. As there was no clinical improvement paediatric thyroid profile was requested which showed low T4 and significantly elevated TSH of 100 uIU/ml. Thyroid ultrasound was suggestive of thyroiditis .Anti-TPO antibodies were elevated. Treatment for Hashimoto's thyroiditis was initiated. Oral thyroxine was started at the dose of 5mcg/kg/day. The child improved symptomatically and icterus resolved. On follow up, her weight for height plotted was between −2 and −3 standard deviations and classified as moderate acute malnutrition. Diet counselling and nutritional supplements was initiated.ResultsAutoimmune thyroiditis is the most common cause of acquired hypothyroidism. Studies have shown thyroiditis to be linked with genetic loci such as CTLA-4, PTPN22. A goitre may not be present due to rapid immune-mediated destruction of the gland. Thyroid ultrasound is usually diagnostic. This child presented with jaundice, edema and abdominal distension. A post hepatitis sequelae was suspected but all serum markers were negative. Subsequently, hypothyroidism was diagnosed. On follow up, child was labelled as moderate acute malnutrition. This child is at risk for severe malnutrition; supplementary feeding and monitoring of growth curves should be done to ensure proper growth and development of the child.ConclusionsChildhood malnutrition is a public health crisis and a major cause of mortality under five years of age. Prevention of severe malnutrition is a global health goal. In a country like India, health programmes should focus on maternal and child malnutrition.Funding SourcesNone.

A stability-enhanced CycleGAN for effective domain transformation of unpaired ultrasound images

As a cost-effective, non-invasive and radiation-free medical imaging modality, ultrasonic imaging is widely used in clinical diagnosis. However, database bias is commonplace among different medical centers. Deep learning based ultrasound image analysis algorithms are usually data driven, rendering high requirements on the uniformity of image datasets. In this paper, we propose a stability-enhanced cycle-consistent generative adversarial network (CycleGAN) method with well detail preservation for the domain transformation to normalize ultrasound images from various medical centers. To stabilize the training process of CycleGAN model, we adopt spectral normalization for 1-Lipschitz continuity to reduce model oscillation. Besides, two time-scale update rule and label smoothing strategy are also utilized to maintain the balance between generators and discriminators for further stability enhancement. Moreover, our method applies skip connections to preserve ultrasound image details and prevent resolution loss during the domain transformation process. Experiments were conducted on clinical thyroid and carotid image datasets acquired from several medical centers. Massive results demonstrate that our proposed model is easier to reach a steady state when training, outstanding 50% from the basic CycleGAN model. Compared with representative algorithms, our proposed method reaches the state-of-the-art performance, with a 11.3% decrease in the mean absolute error and a 9.8% increase in the structural similarity. Hence, our proposed algorithm has a strong capacity of the domain transformation in ultrasound images to reduce the database bias for uniformly distributed datasets. We believe that our method can contribute to the development of the ultrasound image analysis and computer aided clinical diagnosis..

M234 Evaluation of the quick clotting serum separate tube, VQ-tube, a product for clinical chemistry and thyroid hormone assays

M234 Evaluation of the quick clotting serum separate tube, VQ-tube, a product for clinical chemistry and thyroid hormone assays

Abstract #1185078: Resistance to Thyroid Hormone Misdiagnosed and Mistreated as Congenital Hyperthyroidism

Resistance to thyroid hormone (RTH) is a rare genetic disorder that is often difficult to diagnose early in life, due to confusing clinical presentation and thyroid function tests (TFTs). The best management is just monitoring without specific therapy. Patients with RTH are often misdiagnosed as hyperthyroidism and subsequent treatment especially with thyroidectomy or radioactive iodine ablation results in hypothyroidism that is difficult to treat.

STUDY OF THYROID PROFILE IN GERIATRIC AND NON GERIARTIC DIABETES MELLITUS

Introduction: In clinical practice, diabetes mellitus (DM) and thyroid diseases are very common endocrine disorders. These are commonly affected by each other and association between both conditions have long been reported. Objective: To Study correlation and association between Thyroid disorder and Diabetes mellitus in geriatric and non geriatric age group patients. To study correlation between TSH and HBA1C in previously diagnosed Diabetes Mellitus patients. Method: The study includes 80 patients in geriatric age groups with type 2 diabetes mellitus visiting the Medicine out patients department. Thyroid profile were assayed A in type 2 diabetic patients. Results: It was noted that thyroid dysfunction was prevalent in 41(51.25%) A out of the 80 geriatric age group patients with 31(38.75%) being hypothyroidism, 7 (8.7%) having subclinical hypothyroidism and 3 (3.7%) having a hyperthyroid state. Conclusion: The study shows that screening should be strongly recommended for all type 2 diabetics to rule out thyroid dysfunction in patients with increasing age.

Serum Thyroid Hormones Pictures in Non Thyroidal Illness Syndrome and Circulating Leptin Concentration in Patients with Uncontrolled Type 2 Diabetes Mellitus in a Group of Bangladeshi Population

Background: Thyroid diseases and diabetes mellitus are common endocrine disorders and Euthyroid Sick Syndrome is very common in uncontrolled type2 Diabetes Mellitus. As of thyroid hormones; the catabolic hormone Leptin is thought be closely linked with Diabetes Mellitus and Euthyroid Sick Syndrome. Objective: To evaluate the thyroid hormone pictures in absence of clinical thyroid diseases among type2 diabetic subjects in a Bangladeshi population. To see the baseline serum leptin concentration in a group of Bangladeshi adult population and to document how the leptin is related to glycemic status and Sick Euthyroid syndrome in the setting of uncontrolled type 2 Diabetes Mellitus. Method: This case and control study was carried out in the Endocrinology Department in collaboration with the Bio-Medical Research Group (BMRG), Research Division, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrinology and Metabolism (BIRDEM)), Dhaka, Bangladesh during the period of January 2000 to December 2002. A total of 100 type 2 diabetic subjects, 30-50 years of age, irrespective of glycemic status, duration of diabetes, Body Mass Index (BMI) and sex were recruited from the outpatient department (OPD) of BIRDEM hospital. Control subjects (n=30) were selected from friends and family of the patients within 5 years of age band without diabetes or impaired glucose regulation {Impaired Fasting Glycemia (IFG), Impaired Glucose Tolerance (IGT)} determined according to American Diabetic Association (ADA) criteria [37] and having no clinical thyroid diseases or other evident systemic diseases documented on clinical evaluation. Results: It was observed that mean± SD of the thyroid hormone pictures in diabetic and control subjects were; TT3 (ngm/dl) {in controls (88.91±15.88) and in diabetic subjects (84.27±22.29)} was not statistically significant to each other (p=0.209). Mean±SD of TT4 (µgm/ dl) in control subjects was 8.32±1.64 and in the diabetic subjects was 9.26±1.44, which is almost similar in both the groups (p= 0.589). FT4: (pgm/ml) in control subjects was 2.60±0.54 and in diabetics was 2.53±1.72 (p= 0.830). FT4. (µgm/ dl) in control subjects was 1.43±0.22 and in diabetics subjects 1.36±0.25. (p 0.179). TSH (µlu/ml) in control subjects was 1.34±1.00 and in diabetic subjects 1.54±1.21 (p: 0.411). FT3; FT4 and TSH showed no significant difference between control and diabetic subjects. Thyroid hormones (TT3, TT4, FT3, FT4) and TSH were reanalyzed according to HbA1c and BMI category and showed no significant differences. But when the FPG and HbA1c goes beyond 12 mmol/l and 10% respectively there was more worsening thyroid hormone pictures in comparison to groups whose FPG and HbA1c were below 12mmol/l and 10%. It was also noticed that there was a tendency to develop lower thyroid hormone pictures and more deteriorating glycemic status in patient with low and normal BMI groups in comparison to higher BMI groups of patients. Insulin and leptin were found to have strong positive correlation with BMI and other indices of obesity. Serum leptin was also found to be positively correlated with FPG and HbA1c upto a certain limit, but HbA1c went beyond 10%; serum leptin concentration tended to be declined. Serum leptin and Insulin showed strong positive correlation to each other’s. Thyroid hormones and TSH were re-analyzed and its relationship to FPG, HbA1c, fasting serum Insulin and Leptin were explored. Fasting serum Insulin and Leptin showed no significant differences among the different thyroid hormones groups. Conclusion: Uncontrolled type2 diabetes mellitus is associated with alteration of thyroid hormone pictures particularly affecting TT3, FT3 and TSH. This biochemical feature is more evident if the BMI of the Diabetic subjects is low or within the normal range and also the more worsening the glycemic status, there were more deteriorating serum thyroid hormone pictures. Serum leptin was not found to have any relation with these changes.