Low Thyroid Research Articles

Development of a novel clinical support tool for active surveillance of low risk papillary thyroid cancer.

Active surveillance (AS) is an alternative to surgery in select patients with very low risk papillary thyroid cancer (PTC). Many clinicians feel ill-equipped in selecting appropriate patients. We aimed to 1) Develop an evidence-based web delivered decision support tool to assist clinicians in identifying patients appropriate for AS; and 2) Evaluate the prevalence of patients suitable for AS in a tertiary high volume thyroid cancer centre. A REDCap web based clinical support tool was developed utilising evidence-based characteristics for AS suitability available to clinicals during initial assessment. A retrospective database was interrogated for patients who underwent hemithyroidectomy between 2012 - 2021 with final histopathology demonstrating PTC. Patients with PTCs>2cm, missing data, benign disease on surgical histopathology or incidental PTC were excluded. Between 2012 - 2021, 763 patients underwent hemithyroidectomy with final histopathology confirming PTC. Of these, 316 patients were excluded (missing data, incidental PTC, concomitant hyperparathyroidism were most common reasons for exclusion) and 114/447 remaining patients had a pre-operative fine needle aspirate (FNA) of Bethesda V or VI (high likelihood of malignancy). Using the tool, 59/114 (52%) met criteria for AS. The majority of patients were female (85% vs 15% male); median age 36 years (range 19 - 78). Following initial surgery, 10/59 patients had a completion thyroidectomy, with 4/10 demonstrating malignancy in contralateral lobe and eight of those patients undergoing I131 ablation. During a median follow up of over 3 years, 49/59 (83%) did not require further surgery or intervention with no patients developing recurrence. A subgroup analysis with second radiology assessment excluded 4/59 patients as meeting criteria for AS based on presence of ETE on preoperative ultrasound. None of these 4 patients had completion thyroidectomy. Our clinical support tool identifies patients with PTC potentially suitable for AS which could be utilised during initial patient assessment. In a retrospective cohort of patients who had hemithyroidectomy for PTC with a pre-operative FNA diagnosis of Bethesda V or VI, 55/114 (48%) patients may have been suitable for AS. Prospective validation studies are required for implementation of the tool in clinical practice.

Development of a predictive score for post-hemithyroidectomy hypothyroidism using skeletal muscle index, remnant thyroid index, and thyroid-stimulating hormone levels: a retrospective cohort study.

Hypothyroidism is a major complication of hemithyroidectomy. Low remnant thyroid volume and high serum thyroid-stimulating hormone (TSH) levels are suggested as risk factors for post-hemithyroidectomy hypothyroidism. Reduced skeletal muscle mass is associated with a variety of postoperative complications. However, its impact on post-hemithyroidectomy hypothyroidism has not yet been studied. This study aimed to evaluate the association between skeletal muscle mass and the onset of post-hemithyroidectomy hypothyroidism and develop a predictive score using skeletal muscle mass in combination with previously reported risk factors. This study retrospectively analyzed 226 consecutive patients who underwent hemithyroidectomy at Shinshu University Hospital between January 2011 and December 2020. The skeletal muscle area at the fourth thoracic vertebral level and maximal remnant thyroid area were quantified using preoperative computed tomography and standardized by dividing them by the square of the patient's height, designated as the skeletal muscle index (SMI) and remnant thyroid volume index (RTI). Subclinical hypothyroidism was defined as a postoperative elevated serum TSH level (>5 µU/mL) with a normal free thyroxine (FT4) level (≥0.9 ng/dL), overt hypothyroidism as a postoperative increase in serum TSH level (>5 µU/mL) and a decrease in serum FT4 level (<0.9 ng/dL), and symptomatic hypothyroidism as an elevated serum TSH level (>5 µU/mL) with hypothyroidism-related symptoms. Logistic regression analysis was used to determine the factors associated with the onset of hypothyroidism. Patients with euthyroid status had significantly higher SMI and RTI than those who developed post-hemithyroidectomy hypothyroidism (SMI, euthyroid: 12.0±2.4 vs. subclinical hypothyroid: 10.2±1.7, P<0.001, euthyroid vs. overt or symptomatic hypothyroid: 10.1±1.7, P<0.001, RTI, euthyroid: 1.19±0.41 vs. subclinical hypothyroid: 0.92±0.35, P<0.001, euthyroid vs. overt or symptomatic hypothyroid: 0.84±0.30, P<0.001). Multivariable analysis demonstrated that low SMI, low RTI [hazard ratio (HR): 3.35, P<0.001], and preoperative high serum TSH levels (HR: 2.54, P=0.003) were independent predictive factors for hypothyroidism. Patients who had low SMI, low RTI, and preoperative high serum TSH levels were more likely to develop hypothyroidism (68.8%) than those with either one (25.3%), two (47.8%), or none (15.2%) of these three factors. Preoperative evaluation of the SMI, RTI, and serum TSH levels may be useful in predicting the development of post-hemithyroidectomy hypothyroidism.

Practice of low risk papillary thyroid cancer treatment: Active surveillance vs immediate surgery

Practice of low risk papillary thyroid cancer treatment: Active surveillance vs immediate surgery

Diagnosis and management of thyroid disorders and thyroid hormone supplementation in adult horses and foals.

Equine thyroid disorders pose a diagnostic challenge in clinical practice because of the effects of nonthyroidal factors on the hypothalamic-pituitary-thyroid axis, and the horse's ability to tolerate wide fluctuations in thyroid hormone concentrations and survive without a thyroid gland. While benign thyroid tumours are common in older horses, other disorders like primary hypothyroidism or hyperthyroidism in adult horses and congenital hypothyroidism in foals are rare. There is a common misunderstanding regarding hypothyroidism in adult horses, especially when associated with the clinical profile of obesity, lethargy, and poor performance observed in dogs and humans. Low blood thyroid hormone concentrations are often detected in horses as a secondary response to metabolic and disease states, including with the nonthyroidal illness syndrome; however, it is important to note that low thyroid hormone concentrations in these cases do not necessarily indicate hypothyroidism. Assessing equine thyroid function involves measuring thyroid hormone concentrations, including total and free fractions of thyroxine (T4) and triiodothyronine (T3); however, interpreting these results can be challenging due to the pulsatile secretion of thyroid hormones and the many factors that can affect their concentrations. Dynamic testing, such as the thyrotropin-releasing hormone stimulation test, can help assess the thyroid gland response to stimulation. Although true hypothyroidism is extremely rare, thyroid hormone supplementation is commonly used in equine practice to help manage obesity and poor performance. This review focuses on thyroid gland pathophysiology in adult horses and foals, interpretation of blood thyroid hormone concentrations, and evaluation of horses with thyroid disorders. It also discusses the use of T4 supplementation in equine practice.

Nodal Metastases Associated With Fusion Oncogenes Are Age Dependent in Young Adult Patients With Thyroid Cancer.

Fusion oncogenes, especially those involving RET or NTRK, are known drivers of papillary thyroid cancer (PTC). They are prevalent in pediatric patients and correlate with aggressive tumor behavior. We explored the age dependence of fusion oncogenes and aggressive tumor behavior in young adult PTC patients. We examined 150 tumors from 142 PTC patients aged between 17∼35 years old with established tumor-node-metastasis stages. Oncogenic drivers and the thyroid differentiation score (TDS) were determined by DNA and RNA sequencing of a target panel. Transcriptome analysis was performed in PTCs with RET fusions. Among 150 PTCs, we detected BRAF V600E (n = 105), RET fusions (n = 15), NTRK3 fusions (n = 8), and BRAF fusions (n = 4). We found that fusion oncogenes were associated with nodal metastasis when age was tiered into 3 groups: <25 years, 25∼29 years, and 30∼35 years. Patients under 25 years old showed a marginal increase in tumor stage compared to those over 25 years (75.00% vs 21.74%, P = .0646). Risk of lateral lymph node metastasis increased with younger age (75.00% vs 27.27% vs 8.33%, P = .0369). As with advanced tumor and node stage, patients harboring fusion oncogenes and aged under 25 years showed the lowest TDS; genes associated with immunoglobulin production and production of molecular mediators of the immune response were significantly upregulated. Adult PTC patients under 25 years with fusion oncogenes showed a tendency toward advanced tumor stage and lower thyroid differentiation. Integrating onset age together with oncogenic alterations is worthwhile when managing adult PTC patients.

Per- and polyfluoroalkyl substances and the associated thyroid cancer risk: A case-control study in China

The role of perfluoroalkyl and polyfluoroalkyl substances (PFAS) as thyroid carcinogens is unclear. Therefore, we intended to identify associations between each PFAS congener and their mixture with thyroid cancer risk. This case-control study of thyroid cancer was conducted in Shijiazhuang, Hebei Province, China. Three hundred participants were recruited from January to May 2022 and were matched according to sex and age. Twelve PFAS were assessed using ultra-high-performance liquid chromatography-tandem mass spectrometry. Associations between PFAS congeners and thyroid cancer risk were considered under conditional logistic regression analysis and a restricted cubic spline model. Mixture effects were also assessed with quantile g-computation and a Bayesian kernel machine regression model. Compared to the first tertile, third tertile PFOA, PFNA, PFHxS, PFDA, and PFUnDA concentrations were associated with lower thyroid cancer risk (ORPFOA: 0.32, 95% confidence interval (CI): 0.15–0.69; ORPFNA: 0.18, 95% CI: 0.07–0.46; ORPFHxS: 0.37, 95% CI: 0.15–0.92; ORPFDA: 0.07, 95% CI: 0.02–0.23; ORPFUnDA: 0.12, 95% CI: 0.05–0.30) after adjusting for confounding factors. PFNA, PFDA, and PFUnDA had a negative dose-response relationship with thyroid cancer risk. Mixture analysis also showed that thyroid cancer risk is negatively associated with the overall mixture and carboxylates. In the overall mixture, PFOS and PFDA contributed most to positive and negative changes in thyroid cancer risk, respectively. However, PFOS, PFNA, PFDA, and PFUnDA were of equally high importance. This study is the first to confirm the effects of the PFAS mixture on thyroid cancer, and further large-scale prospective studies are still warranted to test these inverse associations.

A REVIEW AND CURRENT SITUATION OF PCOS WITH INFERTILITY

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens. PCOS causes an imbalance of androgen hormones and causes many of the symptoms of the disorder. It affects about 8-10% of all women of reproductive age and 22% in India. If lifestyle changes are not successful in controlling the symptoms of PCOS, then women may be advised to consider weight loss surgery.In some cases, the weight loss surgery may be combined with hormonal therapy.This treatment aims to achieve even greater weight loss, which may lead to the reduction of excessive facial and body hair. Too much testosterone can also interfere with the development of the follicles (the sacs in the ovaries where eggs develop) and prevents normal ovulation (the release of a mature egg). Hypothyroidism (low thyroid function) is common in women with PCOS. Excess androgens can be induced by insulin resistance and hyperinsulinemia, as they cause a reduction in sex hormone binding globulin levels, which lead to a subsequent increase in free androgens and unfavourable metabolic profiles. The ovarian PCOS morphological traits of enlarged, multi-cystic ovaries and theca interstitial hyperplasia are reported in women who are subjected to high levels of androgens as a result of endogenous adrenal androgen hyper secretion in congenital adrenal hyperplasia treatment in female-to-male transsexuals. Even if an egg is released, the uterus lining or the endometrial may not be ready for pregnancy Symptoms of PCOS The following symptoms will help you understand PCOS occurrence: Irregularity in menstrual cycles or lack of cycles Excessive body or facial hair is seen in teens and females in their 20s The condition worsens over the years with an increase in hair growth It is due to the surplus testosterone and androstenedione that results in high male hormone production in females in their blood. Reproductive age, approx 10% of women are affected by this syndrome, with common symptoms including weight gain, irregular periods, acne, an increase in body hair, and infertility due to ovulation failure.

1573-P: Association of Thyroid Hormone Levels with NAFLD in Recent-Onset Diabetes

Nonalcoholic fatty liver disease (NAFLD) is a growing health concern associated with obesity and type 2 diabetes (T2D). Thyroid hormones are important regulators of lipid homeostasis. Indeed, people with hypothyroidism are at greater risk for NAFLD and it has been suggested that humans with T2D are more likely to develop hypothyroidism. However, little is known about the relationship of thyroid function with NAFLD in type 1 diabetes (T1D) and T2D. We hypothesized that (i) low free thyroxin (fT4) and high thyroid-stimulating hormone (TSH) levels are associated with increased hepatocellular lipid content (HCL) and (ii) that fT4 and TSH can identify persons at high-risk for hepatic steatosis in people with recent-onset diabetes. We examined people with T1D (n=358) or T2D (n=596) and 175 healthy participants of the German Diabetes Study (GDS). First, validation of the fatty liver index (FLI) against quantification of HCL by 1H-magnetic resonance spectroscopy revealed a close correlation (ß=0.715, p&amp;lt;0.001; n=446). Second, FLI negatively correlated with fT4 in males (ß=−0.139, p&amp;lt;0.01), but not in females with T2D (ß=−0.086, p=0.26). Likewise, TSH associated positively with FLI in males (ß=0.116, p&amp;lt;0.05), but not in females with T2D (ß=−0.057, p=0.45). TSH and FLI were differently associated between males and females before (p&amp;lt;0.05), but not after (p=0.82) adjustment for BMI. Finally, fT4 had a low diagnostic precision for steatosis (by FLI) as derived from the respective area under the receiver operating curve (0.57, 95% CI [0.53;0.62]; p&amp;lt;0.001) in T2D and was not significant in other groups. TSH had no diagnostic precision for steatosis in any groups. In conclusion, FLI can be used as a surrogate measure of HCL in recent-onset diabetes. The correlation of FLI with lower thyroid function in male T2D suggests a sex-specific interaction between thyroid and liver lipid metabolism, which is mainly driven by body mass. Both, fT4 and TSH offer no relevant efficacy to detect steatosis at least in recent-onset diabetes. Disclosure N. Saatmann: None. M. Schön: None. O.P. Zaharia: None. M. Huttasch: None. K. Strassburger: None. S. Trenkamp: None. Y. Kupriyanova: None. V. Schrauwen-Hinderling: None. S. Kahl: None. V. Burkart: None. R. Wagner: Speaker's Bureau; Novo Nordisk, Sanofi. Advisory Panel; Daiichi Sankyo. M. Roden: Advisory Panel; Eli Lilly and Company. Research Support; Boehringer-Ingelheim, Novo Nordisk, Novartis. Consultant; TARGET PharmaSolutions, Inc. Research Support; Sanofi.

Factors Affecting Ablation Success After I-131 Radioactive Iodine Therapy in Low and Intermediate Risk Papillary Thyroid Cancer.

The study was to evaluate the effect of radioactive iodine (RAI) treatment application time and clinical, histopathological factors on ablation success in patients with operated papillary thyroid cancer (PTC) in low and intermediate-risk. One hundred sixty-one patients with PTC in the low and intermediate-risk were evaluated. Most patients (89.4%) were in the low-risk, and 10.6% were in the intermediate-risk. When the patients were divided into two groups according to the date of receiving RAI treatment after surgery, those who received early treatment (≤3 months) constituted the majority of the patients (72.7%). Seventeen patients received 1.85 Gigabecquerel (GBq), 119 3.7 GBq, 25 5.55 GBq RAI. Most patients (82%) achieved ablation success after the first RAI treatment. The time interval between surgery and RAI treatment did not affect ablation success. Stimulated Tg level measured on the RAI treatment day was an independent predictive factor for successful ablation (p<0.001). The cut-off value of Tg found to predict ablation failure was 5.86 ng/ml. It was concluded that 5.55 GBq RAI treatment could predict ablation success compared to 1.85 GBq dose (p=0.017). It was concluded that having a T1 tumor may predict treatment success compared to a T2 or T3 tumor (p=0.001, p<0.001, retrospectively). The time interval does not affect ablation success in low and intermediate-risk PTC. The ablation success rate may decrease in patients who receive low-dose RAI and have high Tg levels before treatment. The most crucial factor in achieving ablation success is giving enough doses of RAI to ablate the residual tissue.

Selenium level correlates negatively with antibodies but positively with thyroid function in children with down syndrome: an Indonesian study.

Children with Down syndrome (DS) are prone to developing autoimmune thyroid disease (AITD). Previous studies found lower selenium (Se) levels in children with AITD. Glutathione peroxidase-3 (GPx3) and selenoprotein-P (SePP) are widely used to measure Se levels. DS children tend to have lower Se levels, the main contributor to hypothyroidism in this population. This study aimed to analyze the Se's role in AITD in Indonesian children with DS. This cross-sectional study was conducted between February 2021-June 2022 at the Pediatric Outpatient Clinic of Dr Soetomo Hospital. DS children aged 1 month to 18 years were enrolled using consecutive sampling. Thyroid-stimulating hormone, free thyroxine, thyroid peroxidase (TPO-Ab) and thyroglobulin (Tg-Ab) autoantibody, GPx3, and SePP levels were measured in plasma samples using enzyme-linked immunosorbent assays. Statistical analyses used Chi-square, Mann-Whitney, and Spearman's rank correlation (r s). All results with p<0.05 were considered statistically significant. Among 62 children with DS, SePP and GPx3 levels were significantly lower in those with AITD than those without AITD (p=0.013 and p=0.018, respectively). SePP and GPx3 levels correlated significantly with lower TPO-Ab (r s=-0.439 with p=1×10-5 and r s=-0.396 with p=0.001, respectively) and Tg-Ab (r s=-0.474 with p=1×10-5 and r s=-0.410 with p=0.001, respectively) levels. SePP levels correlated significantly with lower thyroid dysfunction incidence (r s=-0.252, p=0.048) in the AITD group. Selenium deficiency contributes to autoimmune process in the thyroid and to thyroid dysfunction in children with Down syndrome. Our findings recommend increasing Se levels through Se-containing foods to reduce the risks of AITD and thyroid dysfunction in DS children with AITD.

A Pilot Study to Assess the Efficacy of Kanchnaradi Kashaya in the Management of Hypothyroidism w.s.r. to Kaphavrutta Vata

Hypothyroidism is a condition characterized by abnormally low thyroid hormone production. Subclinical hypothyroidism is one of the most common endocrine disorders in india affecting one in ten adults. Major portion of hypothyroidism remain undetected. Various treatment protocols are applied in this disease with portion success. In present clinical study, 20 patients of clinically proven hypothyroidism were treated with kanchnaradi kashayam to evaluate its efficacy. The ingredients of Kanchnaradi Kashaya are Kanchnar (Bauhinia variegata), Varun (Crateva religiosa) Shigru (Moringa oleifera),Shunthi (Zingiber officinale) Shaindhav and Madhu. Ayurveda parameters ( Nidan and Lakshan) and modern symptoms of hypothyroidism were used as subjective parameters, and investigations were used as objective parameters to assess the efficacy of the drug. Analysis was done and results were calculated statistically using P test. Results obtained are encouraging and indicates the efficacy of Kanchnaradi Kashaya ( Anubhoot yoga) in the management of hypothyroidism exploring many aspects of this clinical entity.

Low Differential Thyroid Cancer Metastasizing to the Sphenoid Sinus and Orbital Apex: A Case Report

Low Differential Thyroid Cancer Metastasizing to the Sphenoid Sinus and Orbital Apex: A Case Report

Abstract #1413302: A Case of a 25-Year-Old Woman with Congenital Pseudohypoparathyroidism and Hypothyroidism with Prediabetes

Pseudohypoparathyroidism (PHP) is a group of rare disorders, with fewer than 60 clinically-confirmed cases worldwide by 2016. PHP and related disorders mostly result from the genetic and/or epigenetic changes that cause end-organ parathyroid hormone resistance with a cyclic adenosine monophosphate (cAMP) generator down-regulation. These changes are often associated with the GNAS gene. PHP type IA tends to present with hypocalcemia, hyperphosphatemia, elevated PTH levels and Albright hereditary osteodystrophy (AHO). Clinical features of AHO are obesity, round face, short stature, brachydactyly (BD), subcutaneous ossifications and mental retardation. PHP is associated with increased risk for metabolic syndrome and diabetes with related complications. We present a case of a 25-year-old woman, who was referred to the adult Endocrinology clinic for management of PHP type IA and hypothyroidism by her primary care provider who was managing her condition for the last 7 years. She was last evaluated by her pediatric endocrinologist at age 18. She was initially diagnosed with PHP and hypothyroidism at age 7 after a syncopal episode requiring hospitalization. She had severely low serum calcium and elevated thyroid stimulating hormone levels upon diagnosis. She has a past medical history of seizures as a child. There is no family history of PHP. On physical examination, she had a round face with short stature, shortened chubby extremities and absent knuckles in all except index fingers of both hands. She weighed 173 pounds with a height of 62 inches and a BMI of 31.64. She is currently taking 150 mcg oral once daily levothyroxine, 0.25 mcg oral once daily calcitriol and calcium carbonate 625 mg oral four times per day. Laboratory investigations: Her TSH is 3.4, serum calcium is 8.7mg/dl, intact parathyroid hormone level is 169.4 picograms/milliliter. Her 25-OH-vitamin D level is low at 14.8nanogram/milliliter. Her serum Phosphorus is high at 5.3 mg/dl and her HbA1c is high at 5.8 mg/dl. Her lipid profile is normal except for a low level of HDL at 35 mg/dl. Patients with PHP are at higher risk for weight gain, type 2 diabetes, dyslipidemia and hypertension. Our patient with PHP and prediabetes was referred to the dietitian for nutrition education. Increasing physical activity was recommended. Vitamin D deficiency was treated with a high dose vitamin D course. Calcium and calcitriol treatments were continued. We conclude that patients with PHP should transition from pediatric endocrinology to adult endocrinology in a timely fashion for regular follow-ups to avoid morbidity and mortality. Educational programmes, as well as psychological support, should be provided to patients and families even in the presence of a normal BMI as a preventive strategy.

Clinical features and prognosis of patients hospitalized with heart failure and low T3 syndrome

Objective: To investigate the association between triiodothyronine (T3) and inflammatory factors, and its potential effect on long-term outcomes in hospitalized patients with heart failure (HF). Methods: A total of 2 475 patients with HF admitted in Heart Failure Care Unit were consecutively enrolled in this retrospective cohort study from December 2006 to June 2018. Patients were divided into low T3 syndrome group (n=610, 24.6%) and normal thyroid function group (n=1 865, 75.4%). The median follow-up time was 2.9 (1.0, 5.0) years. A total of 1 048 all-cause deaths were recorded at the final follow-up. The effects of free T3 (FT3) and high-sensitivity C-reactive protein (hsCRP) on the risk of all-cause death were evaluated by Cox regression analysis and Kaplan-Meier analysis. Results: The age of the total population was 19-95 (57±16) years, 1 823 cases (73.7%) were male. Compared to those with normal thyroid function, albumin [(36.5±5.4) vs. (40.7±4.7) g/L], hemoglobin [(129.4±25.1) vs. (140.6±20.6) g/L], total cholesterol [3.6 (3.0, 4.4) vs. 4.2 (3.5, 4.9) mmol/L] (all P<0.001) were lower, Whereas age [(60.5±16.0) vs. (55.2±15.4) years], creatinine [105.0 (83.6, 137.0) vs. 87.8 (75.6, 106.3) mmol/L], log N-terminal B-type natriuretic peptide [(8.2±1.3) vs. (7.2±1.4) ng/L] were higher in LT3S patients (all P<0.001). In Kaplan-Meier survival analysis, patients with lower FT3 and higher hsCRP had significantly lower cumulative survival (P<0.001), lower FT3 combined with higher hsCRP subgroup had the highest risk of all-cause death (Ptrend<0.001). In multivariate Cox regression analysis, LT3S was an independent predictor of all-cause mortality (HR=1.40, 95%CI 1.16-1.69, P<0.001). Conclusion: LT3S is an independent predictor of poor prognosis in patients with heart failure. FT3 combined with hsCRP improve the predictive value of all-cause death in hospitalized patients with heart failure.

Abstract #1412915: Malignant Struma Ovarii - A Rare Disease with Unpredictable Nature and Treatment Option Controversies

Struma ovarii is a rare kind of ovarian teratoma which consists of >50% of thyroid tissue. It contributes to 2-5% of all ovarian teratomas. 5-10% of ovarian teratomas undergo malignant transformation. To date, due to its rarity, unpredictable nature and high recurrence rate no consensus have been reached regarding the optimal treatment strategy. Therefore, it is prudent to highlight this rare disease and its management as sharing experiences will further expand the accruing data and helps in reaching consensus regarding its optimal treatment strategy. 42-year-old lady presented in clinic with missed periods. She had no weight loss and hyper or hypo thyroidism related symptoms. Her ultrasound pelvis revealed left ovarian cyst and MRI showed left ovarian dermoid cyst. She underwent left oophorectomy whose biopsy showed malignant struma ovarii having papillary thyroid carcinoma, FIGO stage 1a and BRAF V600 mutation was present. Her thyroid function test, thyroid scan, CT chest and abdomen were normal. She underwent staging laprotomy, right salphingo-oophorectomy, left salphingectomy and total hystrectomy whose biospy was normal. Subsequently total thyroidectomy was done which showed <1cm low grade papillary thyroid carcinoma involving left lobe of thyroid gland, stage pT1a, Nx, Mx. Her stimulated thyroglobulin and antithyroglobulin antibody were normal. Her 6 weeks postop ultrasound neck was normal. She was kept on replacement thyroxine doses. Malignant struma ovarii presents with abdominal pain, menstrual irregularity, bloating, abdominal mass and ascites. At times it may be asymptomatic. Thyroid symptoms are not frequent. Studies demonstrated good survival with malignant struma ovarii. However, its clinical course remains unpredictable with relatively high frequency of recurrences and metastasis irrespective of its morphology which poses difficulty in optimal treatment selection. Mostly aggressive approach including total hystrectomy, bilateral salphingo-oophorectomy, total thyroidectomy followed by radioactive iodine therapy and thyroxine in TSH suppressive doses have been adapted. Though some prefer less aggressive approach. Due to its uncertain nature and scanty data on its management, its optimal treatment is still a matter of debate. Tumor size, molecular profiling and histopathology have been proposed to consider while stratifying risk and selecting treatment approach. Moreover, vigilant followups should be done to detect early recurrence or metastasis so that timely intervention could be done.

Novel Interactomes of Cardiac Noncoding RNA Transcriptome under Altered Thyroid Hormonal States

Background: Noncoding RNAs are emerging as key players in cardiovascular diseases. Both Hypothyroidism (HypoTH; low thyroid hormones [THs]) and hyperthyroidism (HyperTH; high THs) can be deleterious to the heart. We recently showed the involvement of long noncoding RNAs (lncRNAs) in HypoTH under caloric restriction. However, a comprehensive view of the cardiac transcriptome and its interactions under altered TH states is lacking. We hypothesized that cardiac noncoding interaction networks are significantly altered in the cardiac-TH regulatory axis. Methods: In this randomized, blinded study (2.5 mon), adult C57 mixed-sex mice (n=8-10/group; 5 females, 3-5 males) were divided into Control, HypoTH (low iodine diet with oral methimazole), HyperTH (1 microgram [ug]/gram Thyroxine, T4; intraperitoneal) and HypoTH+T3 (similar to HypoTH with oral 12 ug/kilogram/day Triiodothyronine, T3). Morphometrics, ultrasound, immunosorbent assay, Quantitative real-time PCR (qPCR) and whole transcriptome sequencing were performed. Statistical analyses were done by Tukey’s analysis of variance (with post hoc), Benjamini &amp; Hochberg and others using Prism, R, etc. RNA quality was validated by Nanodrop, gel electrophoresis and Bioanalyzer. Results: In mixed-sex mice, HypoTH showed significant cardiac atrophy (whole heart, LV and right ventricle), low serum total T3 and T4 levels (p&lt;0.001), low heart rate, (p&lt;0.01) diminished systolic LV posterior (p&lt;0.05) and septal wall thicknesses (p&lt;0.01) and fractional shortening (-34%; p&lt;0.01) compared to controls. T3 therapy showed feedback inhibition of T4 (p&lt;0.001) and restored all other parameters including LV systolic diameter (p&lt;0.05). Among others, HyperTH had cardiac hypertrophy and increased T3 and T4 (p&lt;0.05) compared to controls (p&lt;0.001). Similar significant results were obtained in males and females. qPCR of shorter-term treatment showed significantly altered lncRNAs in inflammatory and immune pathways. Whole transcriptome sequencing showed numerous differentially expressed, significantly altered and enriched ( GO and KEGG) targets across the groups among all RNA species studied (p-adjusted; padj&lt;0.05). These include novel and known lncRNAs, microRNAs (miRNAs) and messenger (m) RNAs that change in opposite directions in low vs high TH groups. These also include 11 novel circular RNAs (circRNAs; CIRI2) decreased with HyperTH (padj&lt;0.05). We also uncovered novel co-expression and interactions of miRNA-mRNA, miRNA-lncRNA, mRNA-lncRNA, circRNA-miRNA and miRNA-lncRNA-mRNA (including TH receptor alpha; miRanda, Cytoscape) and also splicing and base editing events (padj&lt;0.05). Conclusions: This is the first cross-disciplinary study reporting a comprehensive cardiac transcriptome-wide interactome network of circRNA, lncRNA, miRNA and mRNA in a TH-responsive manner. This offers significant translational potential to develop diadiagnostic and therapeutic targets for cardiac-endocrine co-morbid conditions. NYITCOM at A-State, ABI This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Immunomorphological Patterns of Chaperone System Components in Rare Thyroid Tumors with Promise as Biomarkers for Differential Diagnosis and Providing Clues on Molecular Mechanisms of Carcinogenesis.

Hurthle cell (HC), anaplastic (AC), and medullary (MC) carcinomas are low frequency thyroid tumors that pose several challenges for physicians and pathologists due to the scarcity of cases, information, and histopathological images, especially in the many areas around the world in which sophisticated molecular and genetic diagnostic facilities are unavailable. It is, therefore, cogent to provide tools for microscopists to achieve accurate diagnosis, such as histopathological images with reliable biomarkers, which can help them to reach a differential diagnosis. We are investigating whether components of the chaperone system (CS), such as the molecular chaperones, can be considered dependable biomarkers, whose levels and distribution inside and outside cells in the tumor tissue could present a distinctive histopathological pattern for each tumor type. Here, we report data on the chaperones Hsp27, Hsp60, and Hsp90. They presented quantitative levels and distribution patterns that were different for each tumor and differed from those of a benign thyroid pathology, goiter (BG). Therefore, the reported methodology can be beneficial when the microscopist must differentiate between HC, AC, MC, and BG.

Ayurvedic Review of Hypothyroidism W.S.R Dhatvagnimandya

Hypothyroidism (also known as underactive, low thyroid). It is a disorder of absolute or relative deficiency of thyroid hormone due to dysfunction of thyroid gland or Pituitary gland. It is one of the most prevalent disorders affecting 2-5% of global population which is more prevalent among females. Due to modernization of the society, irregular food habits and stressful lifestyles leading to many metabolic conditions. In Ayurveda metabolism can be co-related with functions of Agni which are transformation and assimilation of substrate. The balanced state of Agni (enzymatic activity) Tridoshas (bodily humours) Dhatu and Mala together helps in orderly functioning and Samavastha of human body. If any one of them got disturbed it leads to diseased condition. In Hypothyroidism there is dysfunctioning of Jatharagni and Dhatwagni along with dysfunctioning of Kapha and Vata Dosha as well as Rasavaha, Raktavaha, Sukravaha and Manovaha Srotases. Dosha Dushyasamoorchhana in various Dhatus resulting is the systemic manifestation of the disease. If we look through modern eye there is only hormonal replacement treatment continuous medication make the patient drug dependent till the end of mortal life and has many side effects. So, there is a need of replacement of modern drug by a safe and effective alternative in Ayurveda. Thus, the line of management should be Deepana, Pachana Srotoshodhana and Kapha Vata Shamana

Application of oral inorganic iodine in the treatment of Graves' disease.

Iodine is a crucial trace element for the human body and the basic raw material for the synthesis of thyroid hormones. Oral inorganic iodine includes dietary iodine and therapeutic iodine, both of which are closely associated with thyroid immunity and metabolism. Graves' disease (GD), also known as diffuse toxic goiter, is characterized by hyperthyroidism and high iodine metabolism. Clinically, patients diagnosed with GD are often asked to limit iodine intake or even avoid iodine in their diet. The latest research has demonstrated that the interference of dietary iodine with antithyroid drugs (ATDs) treatment may be overestimated. In addition, as a medication for GD treatment, the administration of inorganic iodine has shown positive results in patients with mild hyperthyroidism, a low thyroid autoantibody concentration, a small thyroid volume, a high iodine diet and so on. Inorganic iodine may also be used as an alternative when patients experience side effects with traditional ATDs and for those who still prefer conservative treatment. Due to its low teratogenicity, blood toxicity and bone marrow toxicity, inorganic iodine plays a unique role in special populations, such as pregnant or lactating patients and patients receiving tumor radiotherapy or chemotherapy. In this review, the research progress, biological function, doses and effects, applicable populations and specific applications of dietary iodine and therapeutic iodine are summarized to provide references for the diagnosis and treatment of GD, thus improving the quality of life of GD patients.

Hypothyroidism treated with homoeopathic medicine natrium muriaticum: A Case report

Reduced production of thyroid hormone is the central feature of the clinical state termed hypothyroidism (also called as underactive thyroid, low thyroid or hypothyreosis). Primary hypothyroidism which is due to disease of thyroid itself, accounts for approximately 99% of cases while < 1% is due to TSH deficiency known as central or secondary hypothyroidism. Since the main purpose of thyroid hormone is to run our body’s metabolism, it is not surprising that people with hypothyroidism often have symptoms associated with a slow metabolism. Worldwide, too little iodine in the diet is the most common cause of hypothyroidism. Hypothyroidism affects approximately 11% of the population of India. This article deals with a case of hypothyroidism homoeopathically managed with a constitutional remedy Natrium Muriaticum. Kent’s method of evaluation of symptoms was adopted in this case as the patient showed mostly mental and physical general symptoms.