Colloid Goiter Research Articles

Cyto-morphologic spectrum of thyroid lesions in children.

Fine needle aspiration (FNA) is routinely used in triaging thyroid lesions in adults. However, role of FNA in pediatric thyroid lesions is less studied. To study the cyto-morphologic spectrum of thyroid lesions in pediatric population. A retrospective analysis (duration-6 years) of thyroid FNA for patients who were 18 years or younger was conducted. The aspirates were classified according to the Bethesda System for Reporting Cytopathology. A total of 2716 thyroid aspirates were reviewed, out of which 327 (12%) were pediatric thyroid FNAs performed on 301 patients. Of these 256 (85%) were females and 45 (15%) were male patients. Aspirates were classified as follows: Nondiagnostic-30 (10%), Benign-260 (86%), Atypia of undetermined significance-6 (2%), Suspicious of follicular neoplasm-0 (0%), Suspicious of malignancy-0 (0%), Malignant-5 (2%). Out of the 253 benign lesions, 153 (58%) were spectrum of colloid goitre, 106 (42%) were Lymphocytic thyroiditis and 1(0.5%) was granulomatous thyroiditis (0.5%). Thyroid disorders are fairly common in children. Majority of these are benign in nature of which most common are spectrum of colloid goitre. With the benefits of being a noninvasive procedure and cost effective, FNA is a reliable method for screening and diagnosis of thyroid lesions in pediatric population.

Correlation of ultrasonography guided fine needle aspiration cytology of thyroid nodules with histopathology

Background: This study aims to establish correlation of ultrasonography guided fine needle aspiration cytology (USG-FNAC) of thyroid nodules with histology. USG-FNAC was carried out in fifty cases of thyroid nodules and the result of USG-FNAC was compared with histopathology.Materials and Methods: The study was performed in the Department of Pathology, National Academy of Medical Sciences, Bir Hospital over a period of one year. Fine needle aspiration of solid area of thyroid nodule was done in each case with USG guidance. FNAC results were classified according to Bethesda system of reporting. Finally, comparison was done between cytological and histological findings. Results: The age of patients that underwent thyroidectomy ranged from 16 - 70 years. Maximum number of cases fell in age group 31-40 years. Female patients outnumbered male patients by a ratio of 9: 1.On cytological study, 70% cases were diagnosed as benign, 28% as malignant and 2% as inadequate for evaluation. On histopathology, 70% cases of diagnosed cases were benign lesions. Nodular hyperplasia and colloid goiter were kept under the term ‘follicular nodule’. Follicular nodule was the most commonly diagnosed thyroid lesion. Fifteen cases of nodular hyperplasia and fourteen cases of colloid goiter were detected. Total number of malignant cases diagnosed was 15, out of which papillary carcinoma was the commonest (66.67%). We found two cases of medullary thyroid carcinoma.Conclusion: Sensitivity and specificity of USG-FNAC was 93.33 % and 100 %, respectively. The study showed significant correlation between FNAC (USG-guided in this study) and histopathology.

Characterization of Thyroid Nodule by Sonographic Features

Introduction: The thyroid is an endocrine gland situated in the infrahyoid compartment of neck in a space outlined by muscle, trachea, esophagus, carotid arteries and jugular veins. Though nodular thyroid disease is relatively common, thyroid cancer is rare and accounts for less than 1% of all malignancies indicating that overwhelming majority of thyroid nodules are benign. The purpose of this study was to assess the sonographic characteristics in a solitary thyroid nodule and predict risk of malignancy.Methods: This prospective study was conducted in a tertiary care hospital in Kathmandu.62 patients with palpable thyroid nodule were evaluated for sonographic characteristics .USG guided FNA for cytopathological examination was then performed.Results: Out of 66 patients, four were subsequently excluded because they didn’t fulfill the inclusion criteria. Of the 62 patients, 47 (75.8%) were females and 15 (24.2%) were males. Among 56 benign nodules, 45 (80.4%) were in females and 11(19.6) were in male. Among 6 malignant nodules, 4(66.7%) were in males and 2 (33.3%) were in females. Result shows 5 malignant nodules (83.3%) were solid where as 1 malignant nodule (16.7%) was complex with solid predominance. All 4 cystic nodules (7.1%) were benign. All complex nodules with predomint cystic components were also benign. One malignant nodule (16.7%) had snow storm type of microcalcification. None of the benign nodules had microcalcification. Nodule having microcalcification was malignant. Findings showed that all malignant nodules (100%) had increased internal vascularity whereas benign nodules were variable in internal vascularity.Conclusion: This study has shown that colloid goiter is the commonest benign diagnosis whereas papillary carcinoma is the commonest malignancy. Malignant nodules are solid or predominantly solid whereas cystic and predominantly cystic nodules are likely to be benign. Macrocalcification and internal vascularity are not reliable to differentiate benign from malignant nodule. However, snowstorm calcification makes a nodule likely to be malignant whereas egg shell calcification is characteristic for benign nodule.

CD58; leucocyte function adhesion-3 (LFA-3) could be used as a differentiating marker between immune and non-immune thyroid disorders

The link between Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) has been debated for decades due to the shared pathological and immunological components. Immune intolerance and inappropriate immune reaction against self-thyroid cells are distinctive features of both diseases, but definitive data for the clinical presentation of autoimmune thyroid disease remains unclear. To analyse the expression of T-regulatory cells, CD58, the CD4/CD8 ratio and the neutrophil/lymphocyte ratio and to determine if these parameters could be used as differentiating markers between auto- and non-immune thyroid diseases, 75 patients were enrolled in this study—40 with autoimmune thyroid disease (HT and GD ), 15 with non-immune thyroid disease, and 20 healthy controls. Multicolour flow cytometry was used to analyse CD58, T-regulatory cells (Treg) expressing CD4, CD25, HLA-DR and CD8 using different stained fluorescent labelled monoclonal antibodies. The neutrophils and lymphocyte ratio was also measured. Lower expression of Treg with higher expression of CD58 (LFA-3) was found in the autoimmune diseases when compared with the non-immune and control groups. ROC analysis showed that CD58 with sensitivity 88% and specificity 100% with cut-off value more than or equal to 29.9 indicates Hashimoto’s disease, while lower value indicates colloid goitre, and higher or equal to 29.84 indicates Graves’ disease and lower indicates colloid goitre with 100% sensitivity and specificity. CD58 could be used as differentiating marker between immune and non-immune thyroid disorders.

The Role of Insulin Resistance/Hyperinsulinism on the Rising Trend of Thyroid and Adrenal Nodular Disease in the Current Environment.

Thyroid follicular cells, as well as adrenocortical cells, are endowed by an intrinsic heterogeneity regarding their growth potential, in response to various stimuli. This heterogeneity appears to constitute the underlying cause for the focal cell hyperplasia and eventually the formation of thyroid and adrenal nodules, under the influence of growth stimulatory factors. Among the main stimulatory factors are the pituitary tropic hormones, thyroid-stimulating hormone (TSH) or thyrotropin and adrenocorticotropic hormone (ACTH), which regulate the growth and function of their respective target cells, and the insulin/insulin-like growth factor system, that, through its mitogenic effects, can stimulate the proliferation of these cells. The predominance of one or the other of these growth stimulatory factors appears to determine the natural history of thyroid and adrenal nodular disease. Thus, iodine deficiency was, in the past, the main pathogenic factor responsible, through a transient rise in TSH secretion, for the endemic nodular goiter with the characteristic colloid thyroid nodules among the inhabitants in iodine deficient areas. The correction of iodine deficiency was followed by the elimination of endemic colloid goiter and the emergence of thyroid autoimmunity. The recent epidemic of obesity and metabolic syndrome (MS), or insulin resistance syndrome, has been associated with the re-emergence of nodular thyroid disease. A parallel rise in the incidence of benign, nonfunctional adrenocortical tumors, known as adrenal incidentalomas, has also been reported in association with the manifestations of the MS. It is likely that the compensatory to insulin resistance hyperinsulinemia may be responsible for the rising trend of thyroid and adrenal nodular disease in the current environment.

It is no longer the time to disregard thyroid metastases from breast cancer: a case report and review of the literature

BackgroundMetastases to the thyroid gland are more frequent than previously thought, although most of them are occult or not clinically relevant. Overall, only 42 cases of metastases to thyroid from breast cancer have been reported thus far. Here we report the case of a patient with breast cancer metastatic to the thyroid. We also review the 42 previously reported cases (published between 1962 and 2012). This is the first review about metastases to thyroid gland from breast cancer.Case presentationA 64-year-old woman of Caucasian origin was diagnosed with a lobular invasive carcinoma of the breast (luminal A, stage II). She received adjuvant chemotherapy, followed by endocrine therapy. During follow-up, fine-needle cytology of a thyroid nodule revealed malignant cells that were estrogen-positive, which suggested a diagnosis of metastases to the thyroid. Imaging did not reveal any other metastatic site and showed only enlargement of the left thyroid lobe and an inhomogeneous pattern of colloid and cystic degeneration and calcifications. The patient underwent left hemithyroidectomy. Histology of thyroid tissue showed a colloid goitre containing dispersed small atypical neoplastic cells with eccentric nuclei. Immunohistochemistry showed cytokeratin-19 and oestrogen receptor, but not tireoglobulin, e-cadherin or cytokeratin-7, thereby confirming metastases from a lobular breast carcinoma. Hormonal treatment is ongoing.ConclusionThis case report and first review of the literature on metastases to thyroid from breast cancer highlight the importance of a correct early diagnostic work-up in such cases. Indeed, a primary lesion should be distinguished from metastases given the different treatment protocol related to primary cancer and the clinical impact on prognosis.

A comparative study of fine needle aspiration cytology versus non aspiration technique in thyroid lesions

Background: Fine needle aspiration cytology (FNAC) is regarded as the gold standard investigation in the diagnosis of thyroid swellings. But often unsatisfactory specimen, especially mixed with blood, poses an obstacle in proper cytological interpretation. To overcome this problem, an alternative method of fine needle non aspiration cytology (FNNAC) technique was developed which, relies on the capillary pressure only to suck the cells inside the needle bore.Methods: Patients presenting with thyroid swellings from July 2008 to January 2009 were included in the study. 91 patients treated for thyroid lesions entered a prospective comparative evaluation of fine needle cytology with aspiration and non-aspiration techniques in thyroid. The thyroid swelling in every patient was sampled by both the aspiration as well as the non-aspiration technique by a single operator. Both procedures were done using 23G needles. Aspiration was done using a 10ml syringe. Both dry and wet smears were made and stained. All smears were interpreted by a cytologist without knowledge of the technique employed. Apart from the diagnosis, comments were made on the quality of the slides and three qualitative categories are created as unsuitable specimens, diagnostically adequate and diagnostically superior.Results: Non-neoplastic lesions accounted for 92.3%. They comprised mainly of nodular colloid goiter 53.84%, colloid nodules 29.6%, thyroiditis 8.79%, and one case of suppurative lesion. Out of the 7 neoplasms, 2 were follicular neoplasms, 1 was papillary carcinoma, 2 cases of Hurthle cell neoplasm and 1 cellular nodule in an MNG. Diagnostically superior material was obtained in 42 cases (46.15%) of the non-aspiration samples, as compared with 18 cases (19.78%) of aspiration samples which was statistically significant.Conclusions: The FNNAC produces better results in the form of a better quality of the cellularity and less field obscurity by blood. This technique should be used alone or in tandem with FNAC for better diagnostic yield.

Clinicopathological study of thyroid swellings in HSK hospital in Karnataka, India

Background: A thyroid enlargement whether diffuses or in the form of nodules have to be investigated to rule out neoplasm. FNAC is the first line of investigation. USG and TFT are also used. The cases which are at high risk are considered for surgery. Aims and objectives of the study was the clinical presentation of thyroid swellings, incidence of various thyroid swelling, benign versus malignant lesion and to correlate the clinical diagnosis with that of pathological diagnosis.Methods: A case series study of 60 patients attending surgical OPD IPD with symptoms of thyroid in SNMRC and HSK hospital Bagalkot between 1-1-2015 to 30-6-2016. After detailed history thorough, clinical examination was carried out all the patients underwent routine investigations TFT FNAC USG neck. Few patients underwent surgery and all the thyroid specimens were sent for HPE and the clinical diagnosis is correlated with that of pathological diagnosis.Results: Of 60 cases female to male ratio was 9:1. The age group involved is between 31-40 years (31.67%). Duration of goiter is less than one year in 60% of cases. The chief complaint was swelling in front of the neck 100%. Duration of swelling ranged from 15 days to 15 years. Toxic features were present in 18.33% of cases, but after TFT the toxic cases were only 6.67%. Most of the patient showed colloid goiter (43.33%) on FNAC. Out of 60 cases only 22 cases did undergo surgery histopathological specimen were colloid versus nodular goiter in 81.88% out of 22 cases only.Conclusions: Thyroid swellings are common in females they occur in 3rd and 4th decade most commonly. FNAC is very useful in the diagnosis. The main indications of surgery are cosmetic problems, pressure effect symptoms are suspicion of malignancy.

Histopathological findings of solitary thyroid nodule: An institutional retrospective analysis

Background: Thyroid swellings are commonly encountered in the surgical practice and accurate preoperative evaluation of thyroid disorder becomes mandatory for the proper management of the patients. Aims and Objectives: The aim of this study was to study the histopathological finding in patients of solitary thyroid nodule at tertiary center of Kanpur region. Materials and Methods: A total of 100 patients with solitary thyroid nodules were thoroughly examined clinically after taking detail history and fine-needle aspiration cytology. All the patients were subjected to surgery after preoperative preparation and anesthesia checkup. Thyroidectomy specimen was evaluated by histopathological examination. Results: Majority of the patients were between the age group of 21 and 40 years. Female:male ratio was about 5.6:1. Swelling in front of the neck was the most common presentation. Most common solitary thyroid swelling was the colloid goiter. The most common surgery performed was hemithyroidectomy. On histopathological examination, a total of 98 out of total 100 patients presented with benign lesions which included 66 patients of colloid goiter, 16 with follicular adenoma, 4 with lymphocytic thyroiditis, and 12 with adenomatous goiter. Two out of total 100 patients had malignant lesions. Among malignant lesions, papillary carcinoma was found in one patient and anaplastic carcinoma in one patient. Conclusion: The most common histopathological findings of solitary thyroid nodule were colloid goiter followed by follicular adenoma, adenomatous goiter and thyroiditis. Thyroid malignancy was very rare histopathological finding.

Cytomorphological Spectrum of Thyroiditis: A Review of 110 Cases.

Introduction Different types of thyroiditis may share some parallel clinical and biochemical features. Timely intervention can significantly reduce morbidity and mortality. Aim Aim of this study is to find the frequency of various thyroiditis, study the cytomorphological features and correlate with clinical findings including radiological findings, thyroid function test, and anti-thyroid peroxidase antibodies (Anti-TPO antibodies). Materials and Methods The study included consecutive 110 cases of thyroiditis. Detailed cytomorphological features were studied and correlated with ultrasonography findings, thyroid function test, anti-thyroid peroxidase antibodies (anti-TPO) and histopathological features where thyroidectomy specimens were received for histopathological examination. Results The majority were Hashimoto's thyroiditis (n = 100) and females (n = 103). Other forms of thyroiditis were Hashimoto's thyroiditis with colloid goiter (n = 5), De Quervain's thyroiditis (n = 3), and one case each of postpartum thyroiditis and Hashimoto's thyroiditis with associated malignancy. The majority of patients were in the age group of 21–40 (n = 70) and the majority (n = 73) had diffuse enlargement of thyroid. The majority of patients were hypothyroid (n = 52). The serum anti-TPO antibodies were elevated in 47 patients out of 71 patients. In the 48 patients who underwent ultrasonography, 38 were diagnosed as having thyroiditis. The most consistent cytomorphological features seen in fine-needle aspiration smears of Hashimoto's thyroiditis were increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. Conclusion The diagnostic cytological features in Hashimoto's thyroiditis are increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. FNAC remains the “Gold Standard” for diagnosing Hashimoto's thyroiditis. Clinical history, thyroid function, and biochemical parameters are the key for diagnosis of other forms of thyroiditis.

Incidence of differentiated thyroid carcinoma in multinodular goiter patients

BackgroundThe prevalence of multinodular goiter in all over the world is high, commonly in developing countries. Incidence of differentiated thyroid carcinoma among patients with multinodular goiter is increased in recent literature. Aim of studyTo determine the incidence rate of differentiated thyroid carcinoma among patients with multinodular goiter. Patients and methodsThis study is a cross sectional study carried out in Surgical Ward of Baghdad Teaching Hospital during the period from 1st of October, 2016 to 31st of September, 2017 on convenient sample of 120 patients with multinodular goiter. Clinical history and examination, fine needle aspiration and postoperative histopathology examination was done to confirm the diagnosis. ResultsMean age of patients was 43.9 years, with 10 males and 110 females. Fine needle aspiration test showed that 26 (21.7%) multinodular goiter patients had differentiated thyroid carcinoma, while 94 (78.3%) patients had benign goiter. The histopathology of multinodular goiter patients revealed that 40.8% of them had colloid goiter, 17.5% of them had micro-papillary carcinoma and 37,5% of them had follicular adenoma. Differentiated thyroid carcinoma among multinodular goiter patients was significantly associated with smoking and exposure to ionizing radiation. ConclusionsThe incidence of differentiated thyroid carcinoma among multinodular goiter patients is high.

Histopathological pattern of thyroid diseases in Zaria: A 10-year review.

Majority of the previous studies on thyroid diseases in Northern Nigeria focussed mainly on neoplastic lesions. The non-neoplastic lesions are more common and constitute more public health burdens. To determine the histopathological pattern of thyroid diseases in our region and compare our findings with similar studies in Nigeria and elsewhere. This is a retrospective study carried out at the Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, from January 2005 to December 2014 using specified criteria. All cases of thyroid diseases diagnosed histologically within the study period had their histology reports as well as their haematoxylin and eosin-stained slides reviewed and analysed. Statistical package for the social sciences (SPSS) software for windows version 20.0 (IBM SPSS Inc. Chicago, IL) was used. There were 302 thyroid diseases diagnosed during the study period. Only 297 cases fulfilled the study inclusion criteria. There were 255 females and 42 males with a male-to-female ratio 1:6. Ages ranged from 4 months to 80 years, with peak age incidence between 31 and 50 years. Thyroglossal cysts accounted for 17 (5.7%) cases. Non-neoplastic diseases composed of colloid goitre, Graves' disease, Hashimoto thyroiditis and lymphocytic thyroiditis. They accounted for 214 (72.1%), 12 (4.0%), 3 (1.0%) and 1 (0.3%) cases, respectively. The neoplastic diseases comprised 36 (12.1%) adenoma cases and 14 (4.7%) carcinomas, with papillary carcinoma being the most common (71.4%) thyroid cancer. This study showed that thyroid diseases in Zaria had a female predominance with a peak age frequency between 30 and 50 years of age. The most common diseases were colloid goitre, follicular adenoma and papillary carcinoma. These findings are comparable with several studies on thyroid diseases in Nigeria and globally.

BRAF 1799T>A Mutation Frequency in Mexican Mestizo Patients with Papillary Thyroid Cancer.

Thyroid cancer is the most frequent endocrine malignancy, and its incidence and prevalence are increasing worldwide. Despite its generally good prognosis, the observed mortality rates are higher in the less-developed regions. This indicates that timely diagnosis and appropriate initial management of this disease are important to achieve a positive outcome. We performed an observational study in order to describe the frequency of the BRAF 1799T>A mutation in Mexican mestizo patients with thyroid nodules, a scarcely studied ethnic group with large populations. Competitive allele-specific Taqman PCR was performed in 147 samples of thyroid tissue DNA obtained from patients histologically diagnosed with papillary thyroid cancer (PTC), colloid goiters, and follicular adenomas. The BRAF 1799T>A mutation frequency was 61.1% in PTC samples (p = 4.99 × 10−11). Potential diagnostic values were as follows: sensitivity, 61.1%; specificity, 96%; PPV, 94.2%; NPV, 69.5%; accuracy, 77.9%. Taking into account the fact that this mutation is not frequently found in cytologically indeterminate nodules, we suggest that the BRAF mutational analysis should be implemented in the clinical setting along with other diagnostic criteria such as USG, in order to contribute to diagnosis and to surgical decision-making during the initial management of thyroid nodules in Mexican public hospitals.

Histopathological Characterization and Whole Exome Sequencing of Ectopic Thyroid: Fetal Architecture in a Functional Ectopic Gland from Adult Patient.

Ectopic thyroid results from a migration defect of the developing gland during embryogenesis causing congenital hypothyroidism. But it has also been detected in asymptomatic individuals. This study aimed to investigate the histopathological, functional, and genetic features of human ectopic thyroids. Six samples were histologically examined, and the expression of the specific thyroid proteins was assessed by immunohistochemistry. Two samples were submitted to whole exome sequencing. An oropharynx sample showed immature fetal architecture tissue with clusters or cords of oval thyrocytes and small follicles; one sample exhibited a normal thyroid pattern while four showed colloid goiter. All ectopic thyroids expressed the specific thyroid genes and T4 at similar locations to those observed in normal thyroid. No somatic mutations associated with ectopic thyroid were found. This is the first immature thyroid fetal tissue observed in an ectopic thyroid due to the arrest of structural differentiation early in the colloid stage of development that proved able to synthesize thyroid hormone but not to respond to TSH. Despite the ability of all ectopic thyroids to synthetize specific thyroid proteins and T4, at some point in life, it may be insufficient to support body growth leading to hypothyroidism, as observed in some of the patients.

A Retrospective Analysis of Thyroid Disease in Pregnancy at Chris Hani Baragwanath Academic Hospital, Soweto, South Africa

Background Thyroid diseases in pregnancy are associated with adverse outcomes for mother and fetus. No studies have been reported examining the spectrum and nature of such disorders in the Black population of South Africa. Aims To examine thyroid disorders in pregnancy at Chris Hani Baragwanath Academic Hospital in Soweto, by assessing the causes, management and outcomes. Methods A retrospective review of thyroid disorders was undertaken in 88 patients, attending the Antenatal Endocrine Clinic over a four-year period. All underwent initial and follow-up clinical and biochemical assessments. Maternal delivery records and thyroid function tests of the neonates 48 hours or later following delivery were reviewed. Results Fifty-eight (66%) were hyperthyroid, 23(26%) hypothyroid, and 7(8%) had euthyroid colloid goiters. Forty-eight (83%) hyperthyroid patients had Graves’ disease, whilst had gestational hyperthyroidism. Regarding the hypothyroid patients, more than half followed I 131 ablation for Graves’ disease. Eighty-seven percent of the hyperthyroid and 83% of the hypothyroid patients were euthyroid prior to delivery. One fatal maternal outcome, due to uterine rupture and six intra-partum fetal losses occurred. Amongst neonates, there was one case of a tracheo-esophageal fistula and one of neonatal thyrotoxicosis. Conclusion This is the first report in sub-Saharan Africa detailing thyroid diseases in pregnancy.

Case report: An interesting case of large colloid goiter with dyspnea

Benign nodular goitre is one of the most common endocrine disorder, especially in countries like Nepal where iodine deficiency is endemic. Case History: A 59 years old female presented with large thyroid swelling. Investigations showed it to be colloid goiter compressing the airway. Left hemithyroidectomy was done. Post operative period was uneventful.Discussion: Management of thyroid nodules depends upon assessment of thyroid function, fine needle aspiration cytology and imaging. Surgery is the common method of treatment.

Aberrant Iodine Autoregulation Induces Hypothyroidism in a Mouse Strain in the Absence of Thyroid Autoimmunity.

We investigated factors underlying the varying effects of a high dietary iodide intake on serum T4 levels in a wide spectrum of mouse strains, including thyroiditis-susceptible NOD.H2h4, NOD.H2k, and NOD mice, as well as other strains (BALB/c, C57BL/6, NOD.Lc7, and B10.A4R) not previously investigated. Mice were maintained for up to 8 months on control or iodide-supplemented water (NaI 0.05%). On iodized water, serum T4 was reduced in BALB/c (males and females) in association with colloid goiters but was not significantly changed in mice that developed thyroiditis, namely NOD.H2h4 (males and females) or male NOD.H2k mice. Neither goiters nor decreased T4 developed in C57BL/6, NOD, NOD.Lc7, or B10.A4R female mice. In further studies, we focused on males in the BALB/c and NOD.H2h4 strains that demonstrated a large divergence in the T4 response to excess iodide. Excess iodide ingestion increased serum TSH levels to the same extent in both strains, yet thyroidal sodium iodide symporter (NIS) messenger RNA (mRNA) levels (quantitative polymerase chain reaction) revealed greatly divergent responses. NOD.H2h4 mice that remained euthyroid displayed a physiological NIS iodine autoregulatory response, whereas NIS mRNA was inappropriately elevated in BALB/c mice that became hypothyroid. Thus, autoimmune thyroiditis-prone NOD.H2h4 mice adapted normally to a high iodide intake, presumably by escape from the Wolff-Chaikoff block. In contrast, BALB/c mice that did not spontaneously develop thyroiditis failed to escape from this block and became hypothyroid. These data in mice may provide insight into the mechanism by which iodide-induced hypothyroidism occurs in some humans without an underlying thyroid disorder.

258P - Comparison of results of cytological and hystological research of thyroid gland nodes

Background: Purpose: to assess the sensitivity and specificity of the cytomorphological method in the diagnosis of the nosological variant of nodal goiter Methods: Materials and methods: a comparison of the results of cytological and histological studies of thyroid nodules in 36 patients (15 women and 11 men, average age 54.2 ± 9 years), operated for nodular goiter. Cytological findings were divided into 4 categories: “non-informative material”, “benign lesion”, “follicular neoplasia”, “malignant formation”. Results: the analysis of the results of cytological research showed that 17 (47.2%) cases were given the conclusions “non-informative material”, 14 (38.9%) “benign lesion”, in 5 (13.9%) - “follicular neoplasia”, and not a single conclusion “malignant formation”. According to the results of histological examination, in 10 (58.8%) cases, colloidal proliferating nodes were diagnosed in different categories, in 6 (35.3%) - follicular adenoma, in 1 (5.9%) - papillary cancer. Among the conclusions of the category “benign lesion” in 9 (64.3%) cases, according to the results of histological examination, colloidal proliferative nodes in different degrees were diagnosed, in 5 (35.7%) - follicular adenoma. Among the conclusions of the category “follicular neoplasia” in 3 (60%) cases - follicular adenoma, in 1 (20%) - colloidal proliferative nodes in different degrees, in 1 (20%) - papillary cancer. The sensitivity of the cytomorphological method of diagnosis of “nodular colloid goiter” was 44%, specificity-69%, “follicular neoplasia” 20% and 91%. Conclusions: the results of the study showed a high percentage of the conclusions of the category “non-informative material” and identified malignant formations in this category, which significantly reduces the sensitivity of the cytomorphological diagnostic method at the preoperative stage with nodular goiter and requires unification and optimization of both FNA and cytological classification. Legal entity responsible for the study: Ismailov S.I. Funding: None Disclosure: All authors have declared no conflicts of interest.

Detection of Pan Braf in Thyroid Tumors in Iraqi Patients

The B-type Raf kinase (BRAF) is a member of RAS\RAF\MEK\ERK pathway and this pathway can lead to increased cellular growth, invasion and metastasis. The mutated BRAF protein activates MAPK signaling pathway, results in abnormal cellular growth, apoptosis resistance, tumor progression and metastasis. Pan-BRAF is one of available BRAF monoclonal antibodies and shared by both the wild and mutant BRAF.BRAF status is mostly determined by DNA sequencing methods. In this investigation we assessed the monoclonal Pan BRAF specific antibody that can identify wild and mutant type proteins together in formalin-fixed paraffin-embedded thyroid tumor tissues by Immunohistochemistry (IHC). Archival thyroid samples from 43 iraqi patients were immunohistochemically tested with antibodies for BRAF. Out of 43 thyroid tissue cases, (23) were thyroid malignant,(12) benign, and (8) control cases(diagnosed as colloid goiter).The malignant tumors included Papillary Thyroid Carcinoma (PTC), Follicular Thyroid Carcinoma (FTC), Medullary Thyroid Carcinoma (MTC), Anaplastic Thyroid Carcinoma (ATC) and Hürthle cell cancer (HCC).Immunohistochemical staining for BRAF was performed for all specimens. Results of the study showed that Immunohistochemical expression of pan BRAF was significantly higher in malignant thyroid tumors as compared with adenomas and control cases (P<0.05). BRAF over-expression was detected in 5\12 of PTC, 3\5 MTC, 2\4 of FTCas well as all cases of HCC, ATC.Whereas it was detected in 4\12 of adenomas, and totally negative in control cases. No association was observed between BRAF and other clinicopathological traits. We conclude from this study that IHC using BRAF monoclonal antibody is asuccessful way for checking of BRAF status in different thyroid tumors. IHC may be the alternative to molecular biology for the routine detection of this marker in patients with thyroid tumors.

Identification and preservation of External Branch of the Superior Laryngeal Nerve during thyroid surgeries at NMCTH

Background & Objectives:The most common reason for thyroid surgery is the presence of benign or malignant nodules. Subjective voice disturbance after thyroidectomy is very common, even without injury to the recurrent laryngeal nerves. One possible cause for postoperative dysphonia is injury to the External branch of superior laryngeal nerve (EBSLN). Cernea classification, which we followed in this study, is one of the most popular worldwide classifications of the EBSLN. The study was conducted with objectives to identify and classify EBSLN according to Cernia classification in Nepalese population and help surgeons understand the anatomy of the EBSLN and to preserve the nerve during thyroidectomy. Materials & Methods:A prospective observational case series of seventy-nine patients, who were diagnosed with thyroid neoplasms and underwent thyroid surgeries at the tertiary centre of Kathmandu between 1st January 2015 to 31st December 2016. All procedures were performed by transverse collar incision. We classified the anatomy of the EBSLN using Cernea classification. Results:There were total of 79 patients. Most common diagnosis and surgery were colloid goitre and hemithyroidectomies respectively. A total of 94 EBSLNs were evaluated. Cernia Type I was observed in 27.66%, type IIa in 46.80%, and type IIb in 14.89%. Incidences of types IIa and IIb, which put patients at greater risk for intra-operative injury, were observed in 61.69% in our study. The nerve could not be identified in 10.64%. Conclusion:It is possible to increase the rate of nerve identification and avoid the nerve injury even in the absence of sophisticated equipment.