Common Thyroid Research Articles

English

BACKGROUND Type 2 diabetes mellitus (DM) and thyroid dysfunction have long term sequalae on cardiovascular health. The present study was conducted to assess the spectrum of abnormalities in patients of type 2 DM with thyroid disorders. METHODS This case-control study included 52 patients of type 2 DM with thyroid dysfunction (cases) and 52 patients of type 2 DM without thyroid dysfunction (controls). Laboratory investigations like thyroid profile, lipid profile and glycosylated haemoglobin were measured for all the patients. RESULTS Subclinical hypothyroidism was the most common thyroid abnormality. Mean body mass index (BMI) was found to be similar in the two patient groups. We observed a higher mean HbA1c levels in patients with thyroid dysfunction as compared to those without thyroid dysfunction (8.75% vs 7.16%, P value < 0.01). Among the lipid profile parameters, mean triglyceride levels and total cholesterol levels were also found to be significantly higher in patients with thyroid dysfunction as compared to those without thyroid dysfunction. Urine Protein Creatinine Ratio (UPCR) was also found to be significantly higher among patients with thyroid dysfunction. Furthermore, we observed mean BMI, HbA1c, mean total cholesterol and UPCR to be significantly higher among cases with hypothyroidism as compared to those with hyperthyroidism. Mean triglyceride levels were similar in the two patient groups. CONCLUSIONS We recommend that all type 2 DM patients should have a baseline evaluation of thyroid function. KEYWORDS Diabetes Mellitus, Dyslipidaemia, Hypothyroidism

Relationship between Biliary Lithiasis and Subclinical Hypothyroidism: Myth or Truth?

With an average prevalence in the general population at 4-15% and more than 20% in the elderly, subclinical hypothyroidism (SCH) is the most common thyroid dysfunction. The clinical and biological impact of SCH is sometimes atypical, unusual, and very challenging in current medical practice. Among these atypical manifestations of SCH, some publications have suspected a particularly promoting role in the genesis of biliary lithiasis.

DNA repair proteins may differentiate papillary thyroid cancer from chronic lymphocytic thyroiditis and nodular colloidal goiter

Malignant thyroid lesions are the most common malignancy of the endocrine glands with increasing rates in the last two decades. Papillary thyroid cancer is the most common thyroid malignancy. In our study, we aimed to quantitatively evaluate the levels of DNA repair proteins MSH2, MLH1, MGMT, which are representative blocks of patients diagnosed with papillary carcinoma, chronic thyroiditis, or colloidal goiter. Total or subtotal thyroidectomy material of 90 patients diagnosed with papillary carcinoma, nodular colloidal goiter, or chronic thyroiditis between 2009 and 2012 were retrospectively evaluated. Tissue samples obtained from paraffin blocks were stained with MGMT, MSH2, MLH1 proteins and their immunohistochemistry was evaluated. Prepared sections were examined qualitatively by an impartial pathologist and a clinician, taking into account the staining method under the trinocular light microscope. Although there was no statistically significant difference in MGMT, MSH2, MLH1, follicular cell positivity, staining intensity, and immunoreactivity values, papillary carcinoma cases showed a higher rate of follicular cell positivity, and this difference was more pronounced between papillary carcinoma and colloidal goiter. In the MSH2 follicular cell positivity evaluation, the difference between chronic thyroiditis and colloidal goiter was significant (p = 0.023). The difference between chronic thyroiditis and colloidal goiter was significant in the MSH2 staining intensity evaluation (p = 0.001). The difference between chronic thyroiditis and colloidal goiter was significant in MLH1 immunoreactivity evaluation (p = 0.012). Papillary carcinoma cases were demonstrated by nuclear staining only for MSH2 and MLH1 proteins as opposed to hyperplastic nodules. The higher levels of expression of DNA repair genes in malignant tumors compared to benign tumors are attributed to the functional activation of DNA repair genes. Further studies are needed for DNA repair proteins to be a potential test in the development and progression of thyroid cancer.

Xeroderma Pigmentosum: An Uncommon Risk Factor for Aggressive Follicular Thyroid Carcinoma

Abstract Introduction: Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer, which typically presents in an older populations, and carries a near 100% 5-year relative survival rate if diagnosed prior to cancer spreading outside of the thyroid. Clinical Case: A 26-year old female presented to emergency room with persistent jaw pain, despite course of antibiotics prescribed by dentist. She has a past medical history of xeroderma pigmentosum (XP) with over 130 surgeries for malignant skin lesions, as well as benign multinodular goiter for which she underwent total thyroidectomy at the age of 18, with pathology reporting benign tissue and follicular adenoma. Emergency room imaging of maxillofacial/sinus incompletely captured a mass in the left paratracheal region, extending into the lumen of the trachea. Patient was then transferred to University Hospital for further evaluation. Dedicated neck imaging confirmed 4.6cm mass in expected area of thyroid gland, invading into left tracheal wall, cervical esophagus, and hypopharynx. Additional imaging revealed numerous pulmonary nodules, and a 4mm enhancing focus of left superior temporal gyrus. Nuclear positron emission tomography imaging revealed regions of hypermetabolic activity in the left maxillary sinus, the facial nodules, cervical lymph nodes, and mass like region of hypermetabolic activity in the thyroid bed. Biopsy confirmed follicular thyroid parenchyma, concerning for follicular carcinoma. Patient then underwent mass resection and tracheostomy. Some thyroid tissue was left on contralateral side to malignancy due to adjacency to only functional recurrent laryngeal nerve. Pathology following surgery confirmed follicular thyroid carcinoma, with evidence of angioinvasion. Thyroglobulin mass spectrometry prior to surgery was 302 ng/mL. Conclusion: While it is well known that patients with XP suffer from early development of mucocutaneous and ocular cancers in sun-exposed areas, these patients also have increased risk for multinodular goiter as well as internal malignancies. Furthermore, treatment of any internal malignancy is limited due to inability for patients with XP to be treated with radiation. Providers for patients with XP should have very low thresholds to investigate all new symptoms aggressively, maximizing chances of diagnosing malignancies in early stages.

Glioblastoma Multiforme and Papillary Thyroid Carcinoma: Rare Combination of Primary Malignancies

Introduction: Studies have reported thyroid cancer patients are potentially at 30% increased risk of getting second primary cancer when compared to the general population. We are describing a young Caucasian male patient who was diagnosed with two synchronous cancers, papillary thyroid cancer (PTC) and glioblastoma multiforme (GBM). Case Report: A 52 year old Caucasian male with past medical history of hypertension, partial right thyroidectomy in 1999 for thyroid nodular disease, and postsurgical hypothyroidism on levothyroxine. He underwent FNA of left thyroid nodule found on routine monitoring of thyroid nodules showed to be suspicious for malignancy. He underwent left hemi-thyroidectomy in July 2019, revealing PTC, follicular variant, encapsulated, noninvasive type measuring 0.9 x 0.9 x 0.5 cm, completely excised with negative margins; reminder of the right hemi-thyroidectomy performed in February 2020, revealing cystic adenomatoid nodule and no evidence of malignancy. Postoperative thyroglobulin and thyroglobulin antibodies levels were undetectable. A diagnostic whole body iodine scan didn’t show metastasis hence Iodine-131 treatment was not warranted. A week following the right hemi-thyroidectomy he presents to the ER with apraxia, difficulty with concentration, visual difficulty, headaches. CT scan of the brain revealed left occipital region revealed a 3.7 x 2.3 cm lesion concerning for malignancy. A follow up contrast-enhanced MRI brain showing multiple ring-enhancing lesions identified within the left posterior occipital lobe measuring 1.7 x 1.8 cm, additional occipital lobe lesion measuring 2.7 cm, mid and posterior parietal lobe measuring 3.0 cm extending to collateral sulcus measuring 2 x 3 x 1.9 cm compressing the posterior horn of left lateral ventricle. Patient underwent suboccipital craniotomy, pathology revealing glioblastoma NOS, WHO grade IV; further biomarker analysis was not available. CT of the chest, abdomen, pelvis showed no evidence of metastatic disease. Postoperative MRI of the brain revealed postoperative changes with resection of the left occipital portion of the lesion with additional enhancing regions in the left parietal and temporal lobes and splenium unchanged. Patient underwent concurrent, definitive chemo-radiation with temozolomide, now on maintenance temozolomide and levothyroxine. Conclusion: PTC is the most common thyroid malignancy, affecting young patients less than 45 years old. GBM can occur in people of any age, but they are more frequent in older adults. Physicians should maintain high surveillance for second primary cancers at a variety of sites in patients who have been found or treated for primary cancers, especially at a young age. Further evaluation of genetic and environmental factors between papillary thyroid cancer and glioblastoma multiforme will improve our understanding of the etiology of these malignancies.

Thyroid Disorders in Pediatric Patients with Turner Syndrome; A 16 Years' Experience

Background Turner syndrome patients are more likely to develop autoimmune diseases in contrast to the general population. Many research have had controversial results suggest a possible relation between the cytogenetic findings and development of autoimmune thyroid disease in Turner syndrome. Therefore, we aimed to evaluate the prevalence of thyroid disorders and the possible relationship between thyroid disorders with the cytogenetic findings in these patients. Materials and Methods: The present retrospective study took place in pediatric endocrinology clinic of Imam Reza Hospital (Mashhad, Iran), and every pediatric patient who were younger than 18 years old with the clinical phenotype of Turner syndrome and had complete thyroid function tests enrolled. The medical records of these patients were evaluated and patients were recalled if any further information was needed. The study data including thyroid function tests as well as patients' age, height, weight, and karyotype findings were entered in a check list and the relationship between thyroid functions tests and karyotype findings were evaluated. Results: Among the 79 patients enrolled in the present study, the mean ± standard deviation of age was 10.82 ± 2.6 years. The most of the study population had negative anti-TPO results (62 patients, 78%). Among all patients, eight patients (10.1%) had autoimmune hypothyroidism There was not any significant relationship between thyroid function tests with different cytogenetic findings (P>0.05). Conclusion Hypothyroidism (26.6%) was the most common thyroid disorder among Turner syndrome patients. Although there was not any significant relationship between thyroid function tets, Z-scores for hight and weight with cytogenetic findings; however, our findings highlights the need for more specific screening programs for evaluating the thyroid functions in turner patient.

Demographic, radiological and pathological profile of head and neck cancers

<p><strong>Background</strong>: Objective of the current study was to assess incidence of various head and neck cancers, their demographic, radiological, pathological characteristics and patterns of regional lymph node metastasis.</p><p><strong>Methods: </strong>This is a retrospective analysis of data available from medical records department in our institution from the period of January 2017 to November 2020. Patients as per inclusion and exclusion criteria, were selected, the disease was staged and analyzed.</p><p><strong>Results: </strong>Males were more commonly affected (78%). Among the upper aerodigestive tract cancers, lip and oral cavity cancers were most common (26%). Most common stage at presentation was stage IV A. Cervical lymph node metastasis was present in 69% of cases. Most common upper aerodigestive tract cancer was squamous cell carcinoma. Most common thyroid malignancy was papillary carcinoma.</p><p><strong>Conclusions: </strong>Head and neck cancers have high morbidity and mortality owing to advanced stage of presentation and cervical lymph node metastasis affects the outcome of the disease adversely. Every case of head and neck malignancy, hence, need to be evaluated thoroughly and staged appropriately before taking treatment decisions.</p>

Thyroid Immune-related Adverse Events Following Immune Checkpoint Inhibitor Treatment.

Thyroid dysfunction occurs commonly following immune checkpoint inhibition. The etiology of thyroid immune-related adverse events (irAEs) remains unclear and clinical presentation can be variable. This study sought to define thyroid irAEs following immune checkpoint inhibitor (ICI) treatment and describe their clinical and biochemical associations. We performed a retrospective cohort study of thyroid dysfunction in patients with melanoma undergoing cytotoxic T-lymphocyte antigen-4 (CTLA-4) and/or programmed cell death protein-1 (PD-1) based ICI treatment from November 1, 2009, to December 31, 2019. Thyroid function was measured at baseline and at regular intervals following the start of ICI treatment. Clinical and biochemical features were evaluated for associations with ICI-associated thyroid irAEs. The prevalence of thyroid autoantibodies and the effect of thyroid irAEs on survival were analyzed. A total of 1246 patients were included with a median follow-up of 11.3 months. Five hundred and eighteen (42%) patients developed an ICI-associated thyroid irAE. Subclinical thyrotoxicosis (n = 234) was the most common thyroid irAE, followed by overt thyrotoxicosis (n = 154), subclinical hypothyroidism (n = 61), and overt hypothyroidism (n = 39). Onset of overt thyrotoxicosis occurred a median of 5 weeks (interquartile range [IQR] 2-8) after receipt of a first dose of ICI. Combination immunotherapy was strongly associated with development of overt thyrotoxicosis (odds ratio [OR] 10.8, 95% CI 4.51-25.6 vs CTLA-4 monotherapy; P < .001), as was female sex (OR 2.02, 95% CI 1.37-2.95; P < .001) and younger age (OR 0.83 per 10 years, 95% CI 0.72-0.95; P = .007). By comparison, median onset of overt hypothyroidism was 14 weeks (IQR 8-25). The frequency of overt hypothyroidism did not differ between different ICI types. The strongest associations for hypothyroidism were higher baseline thyroid-stimulating hormone (OR 2.33 per mIU/L, 95% CI 1.61-3.33; P < .001) and female sex (OR 3.31, 95% CI 1.67-6.56; P = .01). Overt thyrotoxicosis was associated with longer progression free survival (hazard ratio [HR] 0.68, 95% CI 0.49-0.94; P = .02) and overall survival (HR 0.57, 95% CI 0.39-0.84; P = .005). There was no association between hypothyroidism and cancer outcomes. Thyroid irAEs are common and there are multiple distinct phenotypes. Different thyroid irAE subtypes have unique clinical and biochemical associations, suggesting potentially distinct etiologies for thyrotoxicosis and hypothyroidism arising in this context.

Study of thyroid profile in relation to glycemic control in type 2 diabetes mellitus patients

Diabetes mellitus is an endocrine metabolic disorder that causes significant morbidity and mortality around the world. Thyroid gland dysfunction is a significant problem in diabetic patients. In diabetics, hypothyroidism is the most common thyroid abnormality. When compared to healthy people, diabetic patients have a higher incidence of thyroid abnormalities. Diabetes mellitus treatment can be complicated due to irregular thyroid activity. A total of 120 people were studied, with 60 patients with type 2 diabetes mellitus (Cases group) and 60 healthy people (Control group). Patients with and without strong diabetic control are represented in 60 cases. Both subjects had their fasting venous blood samples taken. In both the cases and control groups, fasting blood sugar, HbA1c, serum T3 (Triiodothyronine), serum T4 (Thyroxine), and serum TSH (Thyroid-stimulating hormone) were measured.The thyroid abnormality was significantly seen in diabetic patients when compared to healthy individuals. The abnormality was more significant in patients with poor glycemic control. When comparing cases to controls, mean serum TSH levels were significantly higher, whereas mean serum T3 and T4 levels were significantly lower. Thyroid hormone levels in type 2 diabetics are abnormal due to a change in the hypothalamic–pituitary–thyroid axis. This in turn produces significant metabolic disturbances. This is more significant in diabetics with poor glycemic control. Routine screening for thyroid function should be done in diabetics, which helps in preventing complications. This contributes to improved treatment by lowering morbidity and improving quality of life.

Thyroid Disease in Children and Adolescents.

The thyroid plays a major role in growth and development, and the hormones it produces can affect many different systems of the body. For this reason, the thyroid should always be at the front of our minds when evaluating children and adolescents. The symptoms of thyroid abnormalities can often be subtle and evolve over time, so we must have a high index of suspicion when providing care for our patients. It is important to understand what can go wrong with the thyroid, how to diagnose thyroid disease, and how to manage thyroid abnormalities. Whether it is structural changes in the thyroid such as goiter or nodules, functional changes that lead to hyperthyroidism or hypothyroidism, or thyroid cancer, a thorough examination and appropriate treatment is essential to maintain optimal cognitive and physical growth throughout childhood and adolescence. This article will discuss the most common thyroid abnormalities, how to diagnose them, and how to treat and manage them in both the short and long term. [Pediatr Ann. 2021;50(4):e143-e147.].

The correlation of thyroid diseases with anemia among Iraqi patients

Objective: To assess the relation between types of thyroid diseases with types of anemia. Methods: This prospective study of 123 cases of patients with different thyroid goiters. The blood samples were collected and complete blood count was done for them, each patient with low PCV (&lt;35%) the blood film was done for them to classify the type of anemia. Surgical operation thyroidectomy, paraffin block and hematoxylin and eosin stain was performed, the slides assess and read by pathologist to classify the thyroid goiter to (thyroiditis, thyroid tumor, multinodular goiter) other the causes of anemia are excluded by history like (vaginal bleeding, gastric bleeding, hemorrhoid). Results: Among 123patients, 84 patients with thyroid diseases without anemia, 39 patients with thyroid diseases had anemia, 21 patients with thyroid diseases had iron deficiency anemia, 18 patients with thyroid diseases had anemia of chronic diseases. Conclusion: Most common type of anaemia in different thyroid diseases is iron deficiency anaemia (IDA), the common age group of anaemia and thyroid diseases is middle age (40-49) years. The female incidence of anemia and thyroid diseases is more in female than male and the multinodular goiter (MNG) is the common thyroid diseases.

Highly Sensitive Detection of Low-Abundance BRAF V600E Mutation in Fine-Needle Aspiration Samples by Zip Recombinase Polymerase Amplification.

Papillary thyroid carcinoma (PTC) is the most common thyroid cancer with high incidence in endocrine tumors, which emphasizes the significance of accurate diagnostics. Still, the commonly used cytological method (fine-needle aspiration (FNA) cytology) and molecular diagnostic methods (such as PCR and sequencing) are limited in terms of diagnostic time, sensitivity, and user-friendliness. In this study, we introduce a novel Zip recombinase polymerase amplification (Z-RPA) strategy to efficiently detect rare mutant alleles in PTC fine-needle aspiration samples, which is sensitive, fast, and simple to manipulate. Using Zip nucleic acid (ZNA) probes to clamp the mutation region, the phi 29 polymerase could selectively displace mismatched ZNA probes and start amplification, while leaving complementary ZNA probes untouched and blocking amplification according to genotype. We demonstrated the good sensitivity and specificity of this strategy with optimized conditions and design, which enabled detection of BRAF V600E mutation in a total 4 ng of genomic DNA within 40 min (≈1 copy). Robust behavior in clinical specimen analysis was also demonstrated. The Z-RPA strategy provides a pragmatic approach to rapidly, sensitively, and easily detect BRAF V600E mutation in clinical fine-needle aspiration samples, which is a promising method for early cancer diagnosis and treatment guideline.

Ultrasonographic Findings in Common Thyroid and Parathyroid Disorders—Advantages of Real Time Observation by the Endocrinologist with their Own Ultrasound Machine

In this review we discuss the significance of the main ultrasonographic features of common thyroid and parathyroid conditions, with a focus on the advantages of real time observation. The thyroid specialist, defined as an endocrinologist with a major interest in thyroid disorders and access to a portable ultrasound machine, can correlate what they see with the thyroid blood test results and clinical findings in a way that is not available to the general endocrinologist who relies on the interpretation by the consultant radiologist of ultrasound images prepared by a technician. We also discuss the significance of the small, very bright, intra nodular microcalcifications found in benign colloid nodules, which we call “colloid spots” and the difference between these and the 3–4 mm soft microcalcifications that are 90% specific for papillary thyroid cancer and provide a new system for staging the inflammatory changes in Hashimoto thyroiditis, as observed on ultrasonography.

Hoffman Syndrome as a Rare Presentation of a Common Thyroid Condition

Hoffman Syndrome as a Rare Presentation of a Common Thyroid Condition

SHCBP1 Promotes Papillary Thyroid Carcinoma Carcinogenesis and Progression Through Promoting Formation of Integrin and Collagen and Maintaining Cell Stemness.

Papillary thyroid carcinoma (PTC) is the most common thyroid cancer with a rapidly increasing incidence globally. Bioinformatics analyses suggested that SHCBP1 (SHC SH2 Domain-Binding Protein 1) was significantly up-regulated in PTC tumor tissues, which was further confirmed by immunohistochemical staining and qPCR analyses in Xuzhou cohort. Moreover, the results indicated that the mRNA level of SHCBP1 was negatively associated with patients’ disease-free survival rate, and further analysis reveals that patients with high SHCBP1 expression tend to have more lymph node metastasis. Afterward, MTT, colony formation, cell-cycle assay, FACS apoptosis assay, invasion, migration, as well as scratch assay were performed to study the phenotypes change of PTC cells after knocking down SHCBP1. The in vivo subcutaneous tumor model was developed to study the proliferation ability of PTC cells after SHCBP1 knockdown. We show that knock down of SHCBP1 significantly inhibits PTC cell proliferation, cell cycle, invasion and migration in vivo and in vitro. Western blot and qRT-PCR showed that knockdown of SHCBP1 could significantly reduce MYC, KLF4, CD44, ITGA6, ITGB1, ITGB5, and COL4A2 expression at both RNA and protein levels, which indicated that SHCBP1 might be involved in PTC carcinogenesis and progression through targeting formation of integrin and collagen and cell stemness pathways, and can be a potential diagnosis biomarker and therapeutic target for PTC.

A Genome-First Approach to Characterize DICER1 Pathogenic Variant Prevalence, Penetrance, and Phenotype

Genetic disorders are historically defined through phenotype-first approaches. However, risk estimates derived from phenotype-linked ascertainment may overestimate severity and penetrance. Pathogenic variants in DICER1 are associated with increased risks of rare and common neoplasms and thyroid disease in adults and children. This study explored how effectively a genome-first approach could characterize the clinical traits associated with germline DICER1 putative loss-of-function (pLOF) variants in an unselected clinical cohort. To examine the prevalence, penetrance, and phenotypic characteristics of carriers of germline DICER1 pLOF variants via genome-first ascertainment. This cohort study classifies DICER1 variants in germline exome sequence data from 92 296 participants of the Geisinger MyCode Community Health Initiative. Data for each MyCode participant were used from the start of the Geisinger electronic health record to February 1, 2018. Prevalence of germline DICER1 variation; penetrance of malignant tumors and thyroid disease in carriers of germline DICER1 variation; structured, manual review of electronic health records; and DICER1 sequencing of available tumors from an associated cancer registry. A total of 92 296 adults (mean [SD] age, 59 [18] years; 98% white; 60% female) participated in the study. Germline DICER1 pLOF variants were observed in 1 in 3700 to 1 in 4600 participants, more than double the expected prevalence. Malignant tumors (primarily thyroid carcinoma) were observed in 4 of 25 participants (16%) with DICER1 pLOF variants, which is comparable (by 50 years of age) to the frequency of neoplasms in the largest registry- and clinic-based (phenotype-first) DICER1 studies published to date. DICER1 pLOF variants were significantly associated with risks of thyroidectomy (odds ratio [OR], 6.0; 95% CI, 2.2-16.3; P = .007) and thyroid cancer (OR, 9.2; 95% CI, 2.1-34.7; P = .02) compared with controls, but there was not a significant increase in the risk of goiter (OR, 1.8; 95% CI, 0.7-4.9). A female patient in her 80s who was a carrier of a germline DICER1 hotspot variant was apparently healthy on electronic health record review. The term DICER1 did not appear in any of the medical records of the 25 participants with a pLOF DICER1 variant, even in those affected with a known DICER1-associated tumor or thyroid phenotype. This cohort study was able to ascertain individuals with germline DICER1 variants based on a genome-first approach rather than through a previously established DICER1-related phenotype. Use of the genome-first approach may complement more traditional approaches to syndrome delineation and may be an efficient approach for risk estimation.

Shear-Wave Elastography-Diagnostic Value in Children with Chronic Autoimmune Thyroiditis.

Chronic autoimmune thyroiditis (CAT) is the most common thyroid disorder in the pediatric population. Ultrasound evaluation may suggest the diagnosis. Additionally, shear-wave elastography (SWE) proved to be a valuable additional diagnosis tool in adults with CAT by assessing thyroid stiffness (TS). This study aims to assess its use also in detecting children with CAT. The study group consisted of 50 children with confirmed diagnosis of CAT, who were compared to the control group, consisting of 50 children with no thyroid pathology and with an adult group of 50 subjects with CAT. The evaluation included, besides bioimmunochemical evaluation, also thyroid ultrasound evaluation and elastography measurements in the same session (Aixplorer Mach 30, Supersonic imagine, France). The mean TS values were significantly lower for children in the CAT group compared to adults with CAT (15.51 ± 4.76 kPa vs. 20.96 ± 6.31 kPa; p < 0.0001) and higher compared to the healthy aged matched controls (15.51 ± 4.76 kPa vs. 10.41 ± 2.01 kPa; p < 0.0001). SWE elastography definitely seems a promising technique in the evaluation of children with autoimmune thyroid pathology.

Status of Thyroid Disorder among the Thyroid Function Test Samples Received in a Laboratory among Postmenopausal Women: A Descriptive Cross-sectional Study.

Thyroid dysfunction prevalence is high in females worldwide which increases with age. Postmenopausal and elderly women are particularly at risk of developing comorbidities and mortality related to thyroid dysfunction. We aimed to study the prevalence of thyroid dysfunction in postmenopausal women in the National Reference Laboratory of Nepal. A descriptive cross-sectional study was conducted in National Reference Laboratory from January 2019 to June 2019 including postmenopausal females, ≥49 years. The database of thyroid function test result was used for statistical analysis and proportion of thyroid dysfunction was calculated. The data was collected after approval from the institutional review committee. Statistical Package for Social Sciences version 21 was used to study descriptive data. Out of a total of 160 postmenopausal females with thyroid function tests, 71 (44.4%) had thyroid dysfunction. Subclinical hypothyroidism was the frequently occurring thyroid dysfunction 51 (32%) followed by subclinical hyperthyroidism 13 (8%), hypothyroidism 3 (2%) and hyperthyroidism 3 (2%). In our study population, thyroid dysfunction peaked at 49 to 58 years of age interval 53 (33.1%) and subclinical hypothyroidism was the most frequent form 38 (23.7%). Subclinical hypothyroidism was the common thyroid dysfunction in postmenopausal age which peaked at 49 to 58 years of age group. Early postmenopausal females are predisposed to increased risk of comorbidities (cardiovascular disease, osteoporosis with high fracture, depression) which could be exacerbated with thyroid dysfunction; therefore awareness of thyroid dysfunction prevalence and thyroid screening for early management seems appropriate in Nepalese postmenopausal women.

Thyroid disease: Using diagnostic tools effectively.

Symptoms of thyroid disease are common, and patients often seek initialassessment from their general practitioners. The aim of this article is to assist with identifying the appropriate sequence of investigations for thyroid disorders, and identify investigations with low diagnostic yield in certain clinical contexts. Common thyroid disorders - such as hypothyroidism, hyperthyroidism and thyroid nodules - require different sequences of investigations to assist with formulating a diagnosis and plan. Thyroid disorders are frequent in women of childbearing age and require a specialised approach. Awareness of less common thyroid conditions allows for individualised workup in these cases.

Cytologic and histological features of rare nonepithelial and nonlymphoid tumors of the thyroid.

Thyroid tumors can be classified into epithelial, nonepithelial, and nonprimary lesions. Nonepithelial thyroid tumors are rare. They can be of primary origin within the thyroid gland, arise secondary to contiguous growth from adjacent tissues, or represent metastatic disease. The incidence of nonepithelial tumors of the thyroid is only 1% to 2%, most of which are lymphomas; the remainder includes mesenchymal and histiocytic tumors. This review examines the cytohistological features of various nonepithelial and nonlymphoid tumors of the thyroid, including vascular lesions, neural tumors (including granular cell tumor and paraganglioma), smooth muscle tumors, solitary fibrous tumor, histiocytic neoplasms (eg, Langerhans cell histiocytosis and Rosai-Dorfman disease), and follicular dendritic cell sarcoma. Their differential diagnosis is discussed, including recommendations to prevent the pitfall of mistaking these rare tumors for more common epithelial thyroid neoplasms.