Palpable Thyroid Research Articles

Ultrasonography screening in children and adolescents who have one parent with familial non-medullary thyroid carcinoma.

To evaluate ultrasonography (US) screening for thyroid cancer in children and adolescents who have one parent with familial non-medullary thyroid carcinoma (FNMTC) unrelated to known genetic syndromes. In this prospective study, we selected 72 children and adolescents (age ≤18 years) without a palpable thyroid nodule or history of radiation exposure, but who have one parent diagnosed with FNMTC (i.e. at least one other affected first-degree relative). The children and adolescents were evaluated by US during initial assessment and after 5 years. Initial US revealed pure cysts in five participants and nodules in seven, which were ≥5 mm in five. These patients were submitted to fine needle aspiration, which revealed benign cytology in four and a follicular lesion of undetermined significance in one. Fine needle aspiration was repeated in the last case and in one case with benign cytology but suspicious US. The second cytology was benign in both cases. After 5 years, another two participants with initially normal US had nodules <5 mm in the absence of suspicious findings. The frequency of lesions detected by US was not associated with participant sex or age, number of relatives with thyroid cancer (2 or 3), maternal or paternal origin of tumour, or age of the relatives at diagnosis. The present results suggest that US screening is not necessary in children or adolescents when one parent has a diagnosis of FNMTC (≥2 affected relatives).

Outcome and complications after surgery for thyroid carcinoma in pediatric age—an evaluation of practice

ObjectivesTo discuss management protocol, surgical complications, and outcomes of thyroid carcinoma in children.MethodsWe performed a retrospective analysis including all pediatric patients with thyroid carcinoma who were managed at our institution between January 2011 and January 2021. Data were analyzed regarding demographics, clinical features, operative details, postoperative complications, and survival data.ResultsThirty-two patients were identified; 26 females (81.25%) and 6 males (18.75%). The median age at operation was 14 years (range: 5–18). Twenty-six (81.25%) patients presented with palpable thyroid swelling. Median tumor size was 3 cm (range: 1–7). Metastatic workup did not detect any pulmonary metastases. Total thyroidectomy was performed in 25 patients (78%), and 16 of them underwent additional bilateral neck dissection (16 had central nodal dissection, and 7 had both central and lateral nodal dissection). Seven patients (22%) underwent hemithyroidectomy, and only one of them had a completion thyroidectomy after 2 weeks. Conservative resection was adopted in six children with similar criteria (tumor size < 1.5 cm in one lobe, no extrathyroid extension, differentiated thyroid carcinoma, no detected lymph nodes). Postoperative complications occurred in eight patients (all had total thyroidectomy) with an overall incidence of 25%. Seven patients had transient morbidities that were managed conservatively (chylous leak n = 1, hypoparathyroidism n = 3, and nerve palsy n = 3). At a median follow-up time of 54 months, four patients had relapsed (all underwent total thyroidectomy). The 5-year OS and EFS were 100% and 87.5%, respectively.ConclusionOperative resection for pediatric thyroid carcinoma can be performed with average short-term complications and achieving excellent outcomes. Total thyroidectomy remains the standard procedure of choice in the majority of those patients. However, conservative surgery can be successfully adopted in a well-selected group of children with favorable long-term results as per our findings.

Menorrhagia as main presentation sign of severe hypothyroidism in a pediatric patient: a case report

BackgroundThe relative high frequency of menstrual irregularities in the first two–three years after menarche may lead to the risk of underestimation of associated pathological conditions, which are always to be accurately researched with careful examination and anamnesis. The association between menstrual irregularities and hypothyroidism is described in literature but the available data are scarce and mainly based on adult case series. It is described that low plasma levels of thyroid hormone can shift the hemostatic system towards a hypocoagulable and hyperfibrinolytic state and seem to lead to an increased bleeding risk.Case presentationThis case report describes the case of a thirteen years old girl who presented to our Emergency Department complaining of menorrhagia for the last fifteen days, leading to severe anemia. The objective examination revealed clinical signs of hypothyroidism and a severe short stature, lower than mid-parental height, with stunting of growth and a significant bone age delay. Blood exams and thyroid ultrasound were consistent with the diagnosis of severe hypothyroidism in autoimmune thyroiditis with acquired von Willebrand syndrome, growth hormone deficiency. Magnetic resonance showed pituitary functional hyperplasia.The substitutive therapy with levothyroxine led to the resolution of heavy bleeding after five days and following normalization of coagulative parameters and pituitary hyperplasia.ConclusionsHypothyroidism usually presents with unspecific symptoms, with consequent risk of diagnostic delay. It can influence the coagulation system and it seems to be associated to increased risk of menstrual irregularities.We underline the importance of a regular follow up of the pubertal development, including height measurements, thyroid palpation and menstrual anamnesis to intercept red flags findings for hypothyroidism.

A comparative study of sonographic evaluation of thyroid nodules, using TIRADS, with fine needle aspiration cytology

Various imaging modalities have been used in the diagnosis of thyroid diseases. Ultrasonography followed by USG guided FNAC is usually done in evaluating any thyroid nodule that is palpable on physical examination. FNAC often used as the initial screening test for diagnosis of thyroid nodule. This study was a cross-sectional study where patients with palpable thyroid nodules or clinically evident thyroid disease (hypothyroidism/hyperthyroidism) were evaluated by ultrasound examination, which were correlated with FNAC of the patient. Statistical software SPSS (version 20.0) and Microsoft Excel were used to carry out the statistical analysis of data. It was concluded that conclusion high resolution ultrasound is an accurate technique to assess the morphology of thyroid nodules.

Validity of Elastography in Differentiating Benign and Malignant Thyroid Nodules, Keeping Histopathology as Gold Standard

Background: Elastography is a method recently being used in the evaluation of thyroid nodules by comparing tissue elasticity. The aim of this study was to determine the diagnostic accuracy of elastography in differentiation between benign and malignant thyroid nodules, taking histopathology as gold standard. Methods: Total of 50 patients with palpable thyroid nodule of any size of age 20-60 years of either gender were included. elastography was performed in every patient by using a high resolution unit with a linear array probe centered at 7.5 MHz, elastography was performed in every patient by a consultant radiologist benign or malignant thyroid nodules was noted. Elastography findings were compared with histopathology report Results: All the patients were subjected to strain ultrasound elastography. USG supported the diagnosis of malignant thyroid nodules in all 50 patients. Histopathology confirmed malignant thyroid nodules in 46 (true positive) cases where as 4 (false positive) had no malignant lesion on histopathology. In USG negative patients, 47 were true negative while 2 were false negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of strain ultrasound elastography in differentiation between benign and malignant thyroid nodules, taking histopathology as gold standard is 90.0%, 90.30%, 92.31%, 94.77% and 93.18% respectively Conclusion: According to this study, strain ultrasound elastography is the non-invasive modality of choice with high diagnostic accuracy in diagnosing malignant thyroid nodules. Keywords: Thyroid cancer, Ultrasound elastography, Sensitivity, Specificity

A man with difficulty dysphagia

A 50-year-old man with history of type II diabetic mellitus attended the emergency department with persistent foreign body sensation after swallowing a drug pill. He also had mild odynophagia. Tracing his history, it was found that he had progressive dysphagia in previous 2 months. There was no coughing or choking immediately after swallowing the pill and speech quality was normal. He denied weight loss in last 6 months. On physical examination, no palpable mass or thyroid goiter was noted. Laboratory data were in acceptable range. A point-of-care ultrasound with a linear probe over the patient’s neck was done. Later, computed tomography was done for confirming the diagnosis.

Comparison of Modified Rose Method of Thyroid Palpation Versus Other Methods for the Detection of Retrosternal and Nodular Goitre.

ObjectivesThis is a diagnostic test research study to evaluate the various existing methods of thyroid examination and their comparison with the novel modified Rose method. It also aims to measure inter-examiner variation in clinical findings based on the level of education and training, as compared to ultrasonography.MethodologyThis cross-sectional study was conducted at a tertiary care hospital with 83 patients presenting to surgery OPD with neck swelling. Each patient was examined by one trained Junior Resident and a Surgery Consultant with all the four methods and with ultrasonography. Data was analysed by Stata-14, agreement between the two categorical variables was assessed by Kappa. In case of continuous variable agreement was assessed by Intra class correlation and Bland-Altman plot.ResultsModified Rose method by the consultant has the highest sensitivity (98%) and diagnostic odds (210) as compared to others but its specificity ranges from 46.7-91.1% to diagnose retro-sternal extension of a goiter. It has 93.98% agreement for identification of nodules. It has a high specificity (Consultant - 100%, Resident - 95.5%) with relatively lower sensitivity (Consultant - 94%, Resident - 86.8%) to diagnose solitary thyroid nodule (STN) but the sensitivity and specificity for diagnosing a multinodular goitre (MNG) was high. However, the highest sensitivity to diagnose STN was highest with Crile’s method, but specificity was low. Lahey’s method was a better clinical method to palpate lymph nodes compared to the other three.ConclusionExamination in modified Rose’s position is a better method of clinical examination of thyroid especially in patients with occult substernal extension. Lahey’s method is a better method to examine cervical lymph nodes.

Virchow node of an unusual aetiology – the experience of a clinical case

BackgroundThe cause of adult adenomegalies may be defiant. On the other hand, ectopic thyroid is a rare condition that happens in every 1:100000 to 300,000 of healthy individuals. Here, we present a case report that joins these two clinical rare and defiant challenges.Clinical caseForty-seven-year-old woman, with known thyroid nodules for several years. She had no other relevant personal or familiar history. At our appointment she had no complaints. At the physical examination she had a palpable right thyroid nodule (previously known). The routine blood analysis showed normal thyroid function. The routine cervical ultrasonography showed no dimensional progression of the known thyroid nodules and identified a 31x18mm nodule at the left supraclavicular fossa. The patient underwent a cervical, thoracic, and abdominal computed tomography that exhibited no relevant findings, such as abdominal malignancies. The cytology of the nodule showed characteristics that were “compatible with a benign follicular nodule in ectopic thyroid tissue”.ConclusionThis is a rare case in which we incidentally found a follicular nodule in ectopic thyroid tissue in the left supraclavicular fossa. Given the rarity of the situation, clinical sense is the mainstay of treatment and follow-up.

Precision of ultrasonography and fine needle aspiration cytology in the evaluation of thyroid nodules in correlation with histopathology

Background and Objectives: The incidence of palpable thyroid nodules is approximately 4%–7% in the population. Most thyroid nodules are benign in nature but malignancy should be ruled out, which is quite less frequent. In such cases, a reliable diagnostic modality to evaluate and differentiate the malignant thyroid nodules is required. This retrospective study was conducted with the objective to evaluate the accuracy of Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) for diagnosis of euthyroid nodules &amp; to differentiate malignant thyroid nodules from the benign nodules in comparison to histopathological diagnosis. Materials and Methodology: It’s a retrospective study that included 132 patients who underwent USG and FNAC of thyroid nodules. Only patients with available histopathology were included in the study. The results of USG, FNAC were evaluated and correlated with histopathology report considered as the final diagnosis. Results: Out of 132 patients, USG showed benign lesions in 107(81.06%) patients, out of which histopathology showed benign lesions in 103 (96.26%) patients and malignant lesions in 4 (3.74%) patients. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false-positive rate, false-negative rate and accuracy of USG of thyroid lesions were 78.95%, 91.15%, 60%, 96.26%, 8.85%, 21.05%, 89.39% respectively.

Role of Magnetic Resonance Spectroscopy in Differentiating Benign From Malignant Nodules of Thyroid Gland, Using Tissue Diagnosis as Gold Standard

Objective: To analyze the diagnostic accuracy role of Magnetic Resonance Spectroscopy in differentiating benign from malignant nodules of thyroid gland by using tissue diagnosis as a gold standard. Study Design: Co-relational Analytical study. Place and Duration: At Department of Radiology, Children Hospital and Institute of Child Health, Multan from 1st October 2017 to 1st October 2018. Methodology: A total of seventy patients (of both genders) were recruited for this study who clinically presented with palpable thyroid nodule. The patients who had any previous surgery of thyroid, thyroid malignancy (proven by biopsy), claustrophobic and with contraindications to Magnetic Resonance Spectroscopy that is cardiovascular implanted electronic devices were excluded. Magnetic Resonance Spectroscopy was done for Choline Peak and Choline/Creatine ratio to assess thyroid nodule and results were then compared with tissue diagnosis. Results: among total of 70 patients, malignant thyroid nodules diagnosed in 51 (72.85%) and Magnetic Resonance Spectroscopy shows true positive in 96.07% (n=49) patients and with and among them 93.87% (n=46) were found to be true positive while 6.13% were false positive. Among 24 Magnetic Resonance Spectroscopy negative patients, 16 were true negative while 05 were false negative patients (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Magnetic Resonance Spectroscopy in diagnosing malignant thyroid nodule taking tissue diagnosis as gold standard was 93.51%, 84.35%, 95.24%, 79.51% 91.40% respectively. Conclusion: Magnetic Resonance Spectroscopy is an extremely sensitive and noninvasive tool which gives accurate method for diagnosing malignant thyroid nodules. Keywords: Magnetic Resonance Spectroscopy, Thyroid Nodules, Benign, Malignant, Tissue, Diagnosis, Sensitivity

Abstract 75: Prediction score for malignancy in thyroid nodule

Background: In India, prevalence of differentiated thyroid cancer (DTC) is 0.1% and incidence has increased over past decade by 55%.Aims and Objectives: To formulate a scoring system for prediction of malignancy in thyroid nodule using clinical risk factors, ultrasound and FNAC characteristics. Consecutive subjects >10 years, with palpable or ultrasound-revealed thyroid nodule who presented to outpatient department underwent ultrasonography for determination of 2017-ACR-TIRADS. All nodules >1 cm maximum diameter and those with TIRADS score of 4 or 5 with maximum diameter >5 mm underwent ultrasound-guided FNAC. All Bethesda 4, 5 and 6 nodules underwent thyroidectomy. Patients with Bethesda 3 nodules were given option of close follow up or surgery.Results: Present study found age and TSH to be significantly different between benign and malignant nodules. Hence a prediction score (Trivandrum prediction score (TiPS)) was formulated with four variables namely age, TSH, 2017 ACR TIRADS and Bethesda score, for predicting risk of malignancy in nodule. Each of the four variables were stratified and weightage points assigned. Age (in years) >40;0, <40;1. TSH (mIU/L)< 2;0, >2;1. TiPS=age score+TSH score+[TIRADS-1]+[Bethesda -2]x2. Final outcome variable was considered as the gold standard and was defined as FNAC report of Bethesda2 or all other nodules which had undergone surgery and histopathology (HPR) is available. Nodules with either Bethesda 2 report on FNAC or a benign HPR report were considered benign. HPR report of malignancy was considered malignant. 226/240 nodules included in study had final outcome variable. ROC curve was analysed for cut off value of total prediction score. Total score >6 had a sensitivity of 96.2% and specificity of 97.5% in predicting malignancy.Conclusions: Cumulative scoring system had high diagnostic accuracy for prediction of malignancy risk and can be a useful tool in clinical practice for selecting thyroid nodules for surgery, especially indeterminate nodules.

Validity of Thyroid Ultrasound in Diagnosing Malignancy in Thyroid Nodule

Aim: To determine the validity of ultrasound in the diagnosis of malignant thyroid nodule keeping histopathology as gold standard. Methodology: This was a cross sectional study conducted in Radiology department of a Tertiary care Hospital, Islamabad for a period of one year. In this study, 55 patients who presented to indoor and outdoor department of hospital with palpable thyroid nodules underwent USG. The results of ultrasound were then compared with histopathological findings. Result: Out of 55 patients, on the basis of ultrasound, 5 male cases with thyroid nodule were malignant and 9 were benign while 8 females were malignant and 33 benign. But on histopathology report, out of 5, only 3(21%) males had malignancy while in females, 7(17%) out of 8 found malignant. 9 patients were true positive for malignancy and 4 patients were false positive, 41 patients were true negative for malignancy and one was false negative. Sensitivity was 90% while specificity was 91.1%. Positive predictive value was 69.2% and negative predictive value was 97.6%. Conclusion: Thyroid ultrasound is a valuable diagnostic tool in predicting malignancy in thyroid nodules with sensitivity of 90% and specificity of 91.1%. Keywords: Thyroid ultrasound, Echogenicity, Calcifications, Thyroid nodule

American college of radiology thyroid imaging reporting and data system score has high diagnostic value in the diagnosis of malignant thyroid nodules: A prospective single-center cross-sectional study.

A palpable thyroid swelling is a very common finding and is seen in almost 12% of Asian Indian population. Thyroid imaging reporting and data system (TI-RADS) can be used as a risk stratification system to determine malignant or benign thyroid nodules and necessity of further intervention. The objective of this study was to determine the positive predictive value (PPV) of TI-RADS category/ultrasound using TI-RADS categories in the diagnosis of malignancy in clinically suspected thyroid nodule and necessity for further intervention in the case of malignant thyroid nodules. We conducted a prospective study evaluating 110 patients (140 thyroid nodules) from March 2018 to April 2020 including patients with thyroid swelling. Ultrasound was performed by a radiologist on the patients, and targeted fine-needle aspiration cytology from thyroid nodules was interpreted by an experienced pathologist. Ultrasound features and TI-RADS category were compared with cytology and surgical histopathology. Sensitivity, specificity, PPV, and positive likelihood ratio in different categories of TI-RADS nodules were calculated. A total of 113 thyroid nodules were assessed. Out of 113 nodules (right lobe - 64, isthmus - 6, and left lobe - 43), 84 nodules were benign and 29 nodules were malignant. Eleven (10%) patients were found to have metastatic cervical lymphadenopathy. There was no significant difference in the occurrence of malignant nodules according to gender, location of the nodule, or size of the nodule. The mean anteroposterior and transverse diameter of benign nodule was 14.1 ± 6.9 mm and 20.9 ± 9.9 mm, respectively, whereas in the case of malignant nodules, it was 15.6 ± 7.1 mm and 19.5 ± 9.0 mm, respectively. A TI-RADS score of ≥4 had 84% PPV for malignancy. The PPV for malignancy was 32.2%, 49.1%, and 100% for TI-RADS 2, 3, and 5 categories. TI-RADS is a simple, practical, and cost-effective tool for assessing the malignancy rates of thyroid nodules. TI-RADS categories 4 and 5 have high PPV for malignancy in thyroid nodules.

Serum TSH Levels as a Predictor of Thyroid Malignancy in Euthyroid Patients with a Thyroid Nodule- A Cohort Study

Introduction: Palpable thyroid nodules are a common disorder in the general population. In many cases, the initial presentation of thyroid cancers can be a thyroid nodule. Hence, this is important to distinguish between a benign and a malignant nodule. Fine Needle Aspiration Cytology (FNAC) is the gold standard for evaluating a thyroid nodule. Currently, FNAC is a much more reliable diagnostic technique. However, there are certain limitations of FNAC, which makes the serum Thyroid Stimulating Hormone (TSH) an essential marker in evaluating the thyroid nodule. It has been observed that the frequency of malignancy varies by the serum TSH levels within its normal range itself. Hence, in the present study, authors aim to assess the role of preoperative serum TSH in predicting the malignancy associated with thyroid nodules. Aim: To evaluate the usefulness of preoperative serum TSH levels in patients with ‘nodular thyroid disease’, in prediction of malignancy. Materials and Methods: This is a cohort study conducted over 7 years from January 2014 to December 2020 by the surgery Department of Gandhi Medical College and associated Hospital, Bhopal, India. A total of 50 patients with thyroid nodule(s) having preoperative serum TSH levels within the normal range were included in this study. Serum TSH levels were measured by Electrochemiluminscent Immunoassay (ECLIA). In additaion, patients’ postoperative tissue biopsies were analysed and associated with preoperative serum TSH levels statistically using student’s t-test, Wilcoxon Mann Whitney U-test, Fisher’s exact test, or Chi-square test. Results: A total of 50 patients were included in the study. The age (years) ranged from 19 to 70. Out of 50 patients who participated in the study, 46 (92%) were female. All 50 (100%) patients had thyroid swelling as their initial presentation. Authors subdivided the sample into three groups by the TSH level distribution of the study (category A 0.4-1.4, category B 1.41- 2.5, and category C 2.51-4.0 mIU/L). The serum TSH category C participants had the largest proportion of biopsy impressions as malignant (p-value &lt;0.001). A cut off level of TSH 2.86 mIU/L showed a sensitivity of 58.8% and specificity of 100%. Conclusion: In patients with thyroid nodule/s having serum TSH levels within their normal range, the higher limits of serum TSH levels are associated with an increased risk of thyroid cancer. Preoperative serum TSH levels can be used as an adjunctive diagnostic test for identifying the risk of malignancy associated with a thyroid nodule. It may aid in decision making on diagnostic approaches and may help in making the best therapeutic plans.

Rare Presentation of Subclinical Hypothyroidism from a Lingual Thyroid.

A 25-year-old female, presented with a posterior lingual mass, without pain nor bleeding (Figure 1). She became more prone to shortness of breath upon exercise and felt uncomfortable swallowing solid food but denied snoring, cold intolerance, or unintentional weight gain. Examination revealed a mass posterior to her tongue and no palpable thyroid gland at the thyroid fossa. Investigations revealed thyroid function tests (TFTs): FT4 1.29 μg/dl (0.89-1.76); TSH 17,049 IU/ml (0.55-4.78); T3 total 1.27 μg/dl (0.6-1.81). Fiber optic laryngoscopy showed a smooth, slippery, unilocular mass attached to the base of tongue. CT cervical-head showed a high-density 2.6 x 2.2 x 2 cm3 soft tissue mass posterior to the tongue, which narrowed the airway to a diameter of 0.4 cm (Figure 2). The mass was likely to be thyroid tissue. To reduce the obstructive symptoms from the mass we did excisional surgery followed by the administration of levothyroxine 25 μg once daily. She had no complaints after surgery. A follow-up thyroid function profile showed FT4 1.46; TSH 6.467; T3 1.59. Histopathology of the tissue revealed multiple thyroid follicles consistent with ectopic thyroid (Figure 3). The ectopic thyroid is a rare congenital disorder with incidence between 1:3000- 1:300000 although it could present with thyroid dysfunction. Most ectopic thyroid cases are euthyroid, only a few patients are subclinically hypothyroid.1 It is usually aysmptomatic but as the mass increases it can cause obstructive symptoms.2 At the age of puberty, thyroid hormone deficiency causes hypertrophic glands &nbsp;and results in obstructive symptoms. Asymptomatic cases can be monitored with serial exams or receive hormonal therapy with levothyroxine. However, such treatment does not have a good success rate. The reduction in size occurs very slowly, without significant decreases in volume. 1 Therefore, the decision to excise the mass was made for this patient. After surgery, monitoring of symptoms and thyroid hormone levels should be done regularly. Levothyroxine supplementation is recommended to prevent overt hypothyroidism and to suppress production of TSH.3,4

A Subacute Thyroiditis Case After SARS-CoV-2 Infection: A Case Report and Current Literature Review

Subacute thyroiditis (SAT), is a self-limiting inflammatory disorder which is linked to a viral infection. A few cases of SAT were reported after Severe Acute Respiratory syndrome Coronavirus-2 (SARS-CoV-2) infection. We here reported a case of SAT that occurred two weeks after SARS-CoV-2 infection. A thirty-nine-year-old male with no comorbid diseases applied to our outpatient clinic with the complaints of sore throat, fatigue and subfebrile fever. He had a contact history of his wife who has a positive SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test. The nasopharyngeal swab was performed and his SARS-CoV-2 RT-PCR test was confirmed positive. He recovered from all symptoms in one week. On the second week of the first diagnosis, he developed neck pain, fatigue, muscle pains, palpitation and tremors. Because his thyroid palpation was painful and he was more symptomatic thyroid function tests were performed. Thyrotropin was suppressed (0.01 mIU/L), free triiodothyronine and free thyroxine levels were high as 11 ng/L and 3.72 ng/dL, respectively. His cervical ultrasound also revealed SAT. He was treated with prednisolone, ibuprofen and propranolol. Within one week, there was a progressive resolution of signs and symptoms. After the third week, his laboratory results returned to normal ranges.

Cytopathological study of thyroid lesions and its correlation with histopathology in a tertiary care centre of Gujarat – A retrospective study

Thyroid gland is one the important organs, which play a wide and vital physiological role in the body. Thyroid diseases are quite common. The incidence of thyroid diseases depends mainly depending upon iron deficiency status. Fine-needle aspiration cytology (FNAC) plays a vital role in evaluating patients with thyroid nodules. Surgical excision and histopathological evaluation are crucial to establish the diagnosis.This study mainly aims to classify the cytomorphology of palpable thyroid lesions by FNAC and correlate the results with histopathology. This study also aims to determine the spectrum of histopathological diagnosis in thyroid surgeries. The present study was carried out at cytopathology and histopathology section of pathology department of GMERS Medical College, Valsad. In present study, we analysed 276 cases of palpable thyroid nodule underwent FNAC. Out of them 152 cases underwent surgical procedure like lobectomy or partial or total thyroidectomy Out of these 276 patient, females were 218 and males were 58 with F:M ratio of 3.76:1. Out of total 276 patients, 81 (29.3%) were between 31-40 years followed by 75 (27.2%) were between 21-30 years and 237 (85.9%) were fall into category-II. Out of these 152 patients, 88 (57.9%) having colloid goitre and 79 (89.7%) were confirmed histologically. FNAC is an invaluable tool in management of thyroid lesions. It is a safe, simple and cost effective procedure and can be performed on outdoor patients. If the cytology report is malignant, surgery is the recommended procedure; for suspicious lesions, repeat aspiration is required and for benign lesions no further immediate diagnostic studies are required.

Different Approaches for Thyroid Surgery.

Surgery remains main treatment of choice for thyroid nodule for diagnosis and treatment. Conventional thyroid surgery gives scar in the neck so many young patients particularly unmarried females demand thyroid surgery without visible scar in the neck for cosmetic reason. Extra cervical approaches have continued to evolve with an increasing body of research (Sarda AK, Bal S, Kapoor MM (1989) Near-total thyroidectomy for carcinoma of thyroid. Br J surg 76(90):2).majority of them presenting in 21-30 age So, here there is evaluation of minimally invasive or endoscopic thyroid techniques. Here, we have studied endoscopic approach and utilize it to minimize scar and scarless thyroid surgery. To evaluate optimal patient selection criteria. To study various surgical approaches and outcomes. To decide surgical approach according to size. To study patients satisfaction. It was a prospective study of 50 patients with a duration of 3years. All the Euthyroid cases with clinically palpable thyroid swelling in age group 15-60, after a detailed clinical history and examination, who required surgery and concern for visible neck scar are councelled and included in our study. In our study 45 patients were females and 5 were males with majority of them presenting in 21-30 age group. All the patients in our study are presented with neck swelling. In most patients FNAC is suggestive of colloid goiter. Endoscopic thyroid surgery is mainly indicated for young patients having benign thyroid tumor less than 3cm in size. Transaxillary and retroauricular are common approaches and is selected as per patient choice and surgeon expertise. Transaxillary thyroidectomy can be performed safely as conventional thyroidectomy.

Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas

PurposeThyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide.MethodsThe telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard.ResultsNovice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen’s kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care.ConclusionThyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.

Amiodarone-Induced Hypothyroidism Initially Presenting as Decompensated Heart Failure and Hyponatremia

Introduction: Amiodarone is an effective antiarrhythmic, but it is associated with altering thyroid function, ranging from thyrotoxicosis to hypothyroidism. In this study, we discuss amiodarone-induced hypothyroidism (AIH) presenting with hyponatremia and myxedema. Case Presentation: A 75-year-old Caucasian man with a history of ischemic heart disease with an ejection fraction of 55-60% was seen in the ED with complaints of worsening lower limb edema and shortness of breath. Associated symptoms of constipation, generalized weakness, daytime sleepiness, and increased urinary frequency were noted. He was recently diagnosed with atrial fibrillation with a CHA₂DS₂-Vasc score of 5 and started on amiodarone nine months ago. He weighed 235 lbs with a BMI of 33.85 and vital signs are as follows: blood pressure 90/64, heart rate 64, respiration rate 13, and a temperature of 36.6 °C. Physical examination revealed a well-developed man in mild distress and slightly lethargic, with a palpable thyroid gland, heart sounds revealed an irregularly irregular heart rate, elevated JVD, bilateral rales, and bilateral pitting edema. Labs showed mildly low HB of 11.7, low Na of 125 mmol/L, elevated creatinine at 1.67 mg/dl, low urine osmolality at 270 mOsm/kg, and BNP of 24 with negative troponin. Chest x-ray showed cardiomegaly. TSH was elevated at 93 uIU/mL and low free T4 at less than 0.25 ng/dL with a negative anti-TPO. A diagnosis of amiodarone-induced hypothyroidism was made, and the patient was started on increased furosemide and levothyroxine 25 mcg daily. Significant improvement was noted in mental status, sodium level, and volume status within three days; and the patient was discharged home on 50mcg of levothyroxine. Discussion: This case illustrates the need to constantly investigate the etiology of decompensated heart failure, especially when new medications with potential culprit side effects are noted or suspected. Amiodarone which is helpful in the management of atrial fibrillation has been known to cause thyroid dysfunction as hypo or hyperthyroidism. What is not widely known is that these endocrine dysfunctions can occur just a few weeks after therapy initiation. Conclusion: We recommend that patients who started on amiodarone be monitored for thyroid dysfunction; especially when they present with deterioration in the cardiac function or show symptoms of endocrinopathy.