Examination Of Thyroid Gland Research Articles

P-56 THE CASE OF SUBACUTE THYROIDITIS IN AN ELDERLY PATIENT MIMICKING MALIGNANCY

Abstract Introduction Subacute thyroiditis is a self-limiting inflammatory thyroid disease characterized by fever, neck pain, and thyroid dysfunction. It typically appears following an upper respiratory tract viral infection. Most cases of subacute thyroiditis are diagnosed through clinical and laboratory testing. The thyroid gland is large, painful, and tender during thyroid examination. Blood tests typically reveal elevated levels of free T4 and free T3, as well as a significantly increased sedimentation rate and C-reactive protein (CRP). Ultrasonographic findings of subacute thyroiditis are well defined. Clinical Case A 68-year-old male was consulted by the anesthesia department before the endoscopy and colonoscopy procedure planned to screen for malignancy. He was very worried and afraid because of the possibility of cancer and was psychologically negatively affected. He presented with night sweats and 10 kg of weight loss in the last 6 weeks. He had no history of previous disease. When a detailed history was taken, he stated that he had severe pain in his neck before his complaints started and that it went away on its own after a few weeks. On examination, he had no fever, a heart rate of 90 beats per minute, and a blood pressure of 120/80 mmHg. Neck examination showed no thyromegaly or lymphadenopathy. The general and systemic examination was unremarkable. Laboratory investigations showed hemoglobin 12.2 g/dL, WBC 8380 (x109/L), erythrocyte sedimentation rate (ESR) 78 mm/hour, CRP 50.1 mg/L, thyroid stimulating hormone 0.08 mIU/L (N = 0.55 – 4.78 mIU/L), free t4 1.4 ng/dL (N = 0.89 – 1.76 ng/dL), free t3 4.34 ng/L (N = 2.3 - 4.2 ng/L), and negative anti-thyroid peroxidase and thyroid stimulating immunglobulin. Thyroid ultrasonography was suggestive for subacute thyroiditis. He was given NSAIDS. Since his free T4 and T3 levels were normal at follow-up, endocrinological approval was given for the planned procedures. It was recommended to have a beta blocker ready during the procedure if needed. No findings in favor of cancer were detected in the detailed examinations, and the weight loss was attributed to subacute thyroiditis. Conclusion When elderly patients have complaints of weight loss or fatigue, it is important to exclude thyrotoxicosis and make a diagnosis by performing the necessary examinations. Subacute thyroiditis may not be severe; it is easy to diagnose with careful history-taking and simple laboratory examinations, and clinicians should keep it in mind in the differential diagnosis of weight loss.

Optimizing Care for Primary Glomerulonephritis: The Role of Thyroid Evaluation.

The coexistence of primary glomerulonephritis and autoimmune thyroid disease has not been investigated. This study aimed to assess thyroid morphology using sonography, determine the prevalence of autoimmune thyroid disorders, and evaluate thyroid function status in patients diagnosed with primary glomerulonephritis. This single-center cross-sectional and observational study included 58 consecutive patients with primary glomerulonephritis and 58 healthy controls (HC). All participants underwent thyroid examination through laboratory tests and thyroid ultrasonography. The findings were subsequently compared between the two groups. Among the patients, 17.2% (n = 10) exhibited subclinical hypothyroidism, while 8.6% (n = 5) had overt hypothyroidism. None of the HCs showed overt hypothyroidism, whereas 3.4% (n = 2) of them exhibited subclinical hypothyroidism. Patients displayed significantly lower free triiodothyronine (FT3) levels than HCs (p < 0.001). A linear correlation was observed between patients' thyroid-stimulating hormone (TSH) levels and the degree of proteinuria (p = 0.044). Furthermore, thyroid volume (p < 0.001), hypoechogenicity (p < 0.001), heterogeneous structure (p < 0.001), pseudonodular hypoechoic infiltration (p = 0.05), and the presence of nodules (p < 0.001) were notably higher in patients compared to HCs. The prevalence of both overt and subclinical hypothyroidism, along with the frequency of nodular goiter, was found to be elevated in patients with primary glomerulonephritis. Considering that primary glomerulonephritis predominantly afflicts young individuals, and these patients bear the lifelong burden of chronic kidney disease, we underscore the significance of routine thyroid function tests and sonographic examinations for the early detection of thyroid disorders.

Comparison Between Ultrasonography and Radiography in the Detection of Epiphyseal Ossification Centers of the Knee in Infants With Permanent Congenital Hypothyroidism.

To demonstrate the usefulness of ultrasonography in detecting knee ossification centers in infants with permanent congenital hypothyroidism (PCH). From 2011 to 2021, all infants with PCH referred for thyroid ultrasound also underwent left knee ultrasound and radiography on the same day. Knee radiographs were compared with knee sonograms. Two pediatric radiologists reviewed the consensus knee radiographs and sonograms to identify femoral and tibial epiphyseal ossification centers (presence/absence). The concordance between ultrasonography and radiography was assessed. Another radiologist conducted a second late review to evaluate interobserver agreement. We identified 125 patients (65 girls, 60 boys) with a mean age of 24 days (5 days-5 months). On scintigraphy, the thyroid was in place in 66.4%, ectopic in 24%, and absent in 9.6% of patients. The femoral center was observed in 108 patients (86.4%) via sonography and 106 patients (84.8%) via radiography. The tibial center was observed in 84 patients (67.2%) via sonography and radiography. Both femoral and tibial centers were present on sonography and radiography in 84 patients (67.2%). A single nucleus was present in 24 patients (19.2%) on sonography and 22 patients (17.6%) on radiography; it corresponded to the femoral center in all patients. The concordance between ultrasonography and radiography was 99% and 100%, respectively, for the detection of the femoral and tibial centers. Interobserver agreement was substantial to almost perfect for both ultrasonography and radiography. Ultrasonography is as effective as radiography in detecting knee ossification centers in PCH. It can be performed at the same time as thyroid examination, in place of radiography.

7659 Iodinated Contrast Induced Thyrotoxicosis Leading to Takotsubu Cardiomyopathy

Abstract Disclosure: A. Jain: None. E. Naous: None. S. Sedrakyan: None. A.T. Sweeney: None. Background: Thyrotoxicosis may cause many cardiovascular manifestations including tachycardia, hypertension, atrial fibrillation and heart failure. Iatrogenic exposure to iodinated contrast media (ICM) precipitating iodine induced thyrotoxicosis (or the Jod-Basedow phenomenon) is often overlooked. Here, we describe a case of iodine induced thyrotoxicosis leading to takotsubu cardiomyopathy, following multiple exposures to ICM. Case Presentation: An 88-year-old male with a history of hypertension, dyslipidemia, chronic obstructive pulmonary disease, and an ED visit one month ago for hemoptysis for which a CT Angiography (CTA) of the chest was obtained (which excluded Pulmonary Embolism(PE)), presented with fever and shortness of breath. On physical examination his temperature was 100.3F, heart rate was 104bpm, blood pressure 130/62mmHg, respiratory rate was 20/min and saturation was 88% (room air). He was frail but his examination was otherwise unremarkable. Electrocardiogram (EKG) revealed sinus tachycardia. Chest CTA excluded PE. Transthoracic echocardiogram (TTE) showed an ejection fraction (EF) of 73% and no wall motion abnormalities. He was admitted to the hospital for a viral upper respiratory infection and was treated conservatively with bronchodilators. Odynophagia prompted a CT with contrast of the neck soft tissue, which was unrevealing. He was planned to be discharged the next day, but overnight developed severe abdominal pain, and atrial fibrillation with a rapid ventricular response (Troponin t was 191 ng/L (normal {nl}: &amp;lt;9 ng/L)). EKG showed new T-wave inversions in the anterolateral leads, raising a suspicion of myocardial ischemia. A repeated TTE revealed a new drop in EF from 73 to 41%, with new apical akinesis, suspicious for takotsubo cardiomyopathy. CT of the abdomen with contrast was unrevealing. Lab results showed a suppressed TSH of &amp;lt;0.01uIU/mL (nl: 0.34-5.60 uIU/mL), elevated FT4 of 13ng/dL (nl: 0.93-1.70 ng/dL), and TSI 4.97 IU/ L (nl: 0-0.55 IU/ L). Endocrinology was consulted. His thyroid examination was normal, and he had no eye findings. Neck ultrasound revealed a homogeneous thyroid gland without any nodules. His clinical course was consistent with the diagnosis of acute thyrotoxicosis precipitating takotsubu cardiomyopathy. He likely developed iodine induced thyrotoxicosis from multiple exposures to ICM, in a background of previously undiagnosed Graves’ disease. Discussion: Screening for thyroid disease is critical in patients with new onset tachyarrhythmias and stress cardiomyopathy. Iodine induced thyrotoxicosis typically presents after patients with underlying thyroid disease are exposed to iodinated contrast. Prior to ordering studies requiring ICM, it is important to thoroughly evaluate patients for possible pre-existing thyroid disease. Presentation: 6/2/2024

Prevalence of Thyroid Disorders in Patients with Type 2 Diabetes Complicated with Diabetic Neuropathy

Abstract Background Diabetic peripheral neuropathy(DPN) is the most common complication of Type 2 diabetes mellitus (T2DM), affecting as many as 50% of diabetic patients. Thyroid dysfunction and diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorders particulary hypothyroidism in patients with diabetes mellitus and vice versa. Recent studies have shown that free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels have been linked to insulin resistance and chronic complications of diabetes particulary DPN. Aim of work: This study aims to investigate the prevalence of thyroid dysfunction in patients with type 2 diabetes mellitus complicated with diabetic peripheral neuropathy. Patients and Methods This study was a cross sectional study that was conducted at Diabetes outpatient clinic at Ain Shams university Hospital. This study was performed on 250 patients with type 2 diabetes with diabetic peripheral neuropathy aging from 18 to 60 years old not known to have thyroid dysfunction, with a clinical diagnosis of diabetes (type 2) and diabetic peripheral neuropathy. All candidates were subjects to full history, full clincal, neurological and thyroid examination and laboratory investigations (Fasting blood glucose, 2hrs post prandial, HbA1c, lipid profile. Tsh, ft3,ft4, alb/cr ratio, Alt, Ast, urea, creatinine, urine analysis and thyroid U/S if needed). Results Among the studied 250 patients, 192 (76.8%) patients have Normal thyroid status, 58 (23.2%) patients have thyroid dysfunction distributed as the following : 23 (9.2%)patients with Subclinical Hypothyrodism, 19 (7.6%) patients with Hypothyrodism, 7 (2.8%)patients withSubclinical hyperthyroidism and 9 (3.6%) patients with Hyperthyrodism. Regarding the DPN grade, 43 (17.2%) patients have Mild DPN, 167(66.8%) patients have Moderate DPN and 40(16.0%) patients have DPN according to DPN grade using the known questionnaire of neuropathy (total ssympto NTSS-6 questionnaire). Among the studied population 79 (31.6%)patients are males while 171(68.4%) are females and their ages ranged from 35 to 64 years (mean 52.11 years), The Mean BMI was 27.59 ± 3.77kg/m2. Among patients with Thyroid Dysfunction There were statistically significant difference between Severity of DPN and Thyroid function tests. Among patients with thyroid dysfunction, moderate DPN was the most prevelant47/58patients (81.0%)followed by mild DPN 8/58 patients (13.8%) and the least was severe DPN 3/58 patients (5.2%). Also Among the euthyroid patients, moderate DPN was the most frequent 120/192 patients (62.5%),but followed by severe DPN 37/192 patients (19.3%) and the least was mild DPN 35/192 patients (18.2%). (P value = 0.015) There were highly statistically significant difference between patients with normal Thyroid status and patients with Thyroid dysfunction regarding Cholesterol (P value=0.000), Triglyceride (P value = 0.000) and LDL (P value = 0.001) being higher in those with thyroid dysfunction, and there were statistically significant difference between patients with normal thyroid status and patients with thyroid dysfunction regarding Alb/cr R (p value=0.034), and there were no statistically significant difference between patients with normal Thyroid status and Thyroid dysfunction regarding FBG(mg/dl), 2hrs PP(mg/dl), Hba1c(%), FT3(pg/ml), FT4(ng/dl) and HDL (mg/dl) Conclussions Thyroid dysfunction mainly subcinical hypothyroidism is more prevalent among T2DM subjects with DPN.

Histopathological and Immunohistochemical Studies on Endocrine Glands of Dogs with Special Emphasis on the Immunoexpression of β-cells of the Pancreas

The aim of this study to evaluate the histopathological, histochemical and immunohistochemical changes of the endocrine glands namely, thyroid, pancreas and adrenal gland in dogs submitted to routine necropsy. A total number of 45 endocrine samples were collected from 15 carcasses of dogs received at Department of Veterinary Pathology, Madras Veterinary College, Chennai- 600 007 were chosen for the present study, namely thyroid, pancreas and adrenal gland. The tissue samples were collected in 10% neutral buffered formalin. Tissues were processed after 48 hours as per recommended procedure and 3 µm thickness sections were made and stained with haematoxylin and eosin for histopathological evaluation. The special stains like Masson’s trichrome and Picrosirius red were used to assess the extent of replacement with collagen fibers. Immunohistochmical protocol was followed as per the manufactured recommendation (Pathnsitu, USA).The histopathological changes recorded in the pancreas included vacuolar changes (2/15), necrosis (2/15), periductular fibrosis (1/15), perivascular fibrosis (1/15), congestion (5/15), hemorrhages (3/15) and inflammatory changes (1/15) while in the adrenal glands included diffuse cortical hyperplasia (4/15) succeeded by nodular hyperplasia (3/15), adrenalitis (2/15), hyperaemia (2/15), hemorrhages (1/15) and atrophy (1/15). Histopathological examination of thyroid revealed atrophy of follicles suggesting thyroiditis (3/15), presence of follicular epithelial cells which were found separated from the basement membrane with cellular debris in the lumen indicating necrosis (2/15) and presence of large cystic gaps with eosinophilic proteinaceous material consistent with cystadenoma(2/15). The remaining samples showed hemorrhages (2/15), perivascular fibrosis (1/15) and congestion (2/15). However no histological alterations were noticed in 3 cases (3/15). Immunohistochemistry revealed that pancytokeratin was expressed by all epithelial cells including ducts. The expression of insulin was noticed in all the cases indicating that no reduction of â cells in all the above said pathological conditions.

A Case Series of Papillary Thyroid Carcinoma in Patients with Acromegaly

Introduction: Acromegaly is a rare disorder with an approximate incidence of 3-11 new cases per million of population per year. It’s associated to an increased risk of benign and malignant neoplasms, especially thyroid, colorectal and breast cancer. Case Series: We report 2 cases of two patients followed in our department for acromegaly who were diagnosed also with papillary thyroid carcinoma. Discussion and Conclusion: IGF1 inhibit cell apoptosis and promote cell proliferation in multiple tissues. An association between IGF1 levels and cancer risk such as thyroid cancer was detected. Careful screening for thyroid cancer, with periodic thyroid examination, should be an important part of the management of acromegalic patients. Keywords: Acromegaly - malignancy - papillary thyroid carcinoma

Effects of Overweight on Risk of Thyroid Nodules in Children and Adolescents: The Fukushima Health Management Survey.

Examining how overweight/obesity impacts thyroid nodule development in children and adolescents by sex and age can speculate on the mechanism. We examined whether overweight in children and adolescents are associated with thyroid nodule development by sex and age. Approximately 300,000 participants who underwent thyroid ultrasonography in the Fukushima Health Management Survey after a nuclear accident were enrolled. Those without nodules in the initial two examinations (1-3 and 4-5 years postaccident) were prospectively assessed for nodule development in the third examination (6-7 years postaccident) relative to baseline overweight status, with an average follow-up of 4.2 years. A population-based prospective cohort study. The first and second thyroid examinations involved 299,939 and 237,691 participants, respectively, excluding those with thyroid nodules. After the third examination, 184,519 participants were finalized for analysis. Multivariable-adjusted odds ratios of new detected thyroid nodules for overweight participants compared with normal-weight participants. New thyroid nodules were detected in 660 participants. Being overweight was positively associated with thyroid nodules. The adjusted odds ratio (95% confidence interval) of thyroid nodules for overweight participants compared with other participants was 1.27 (1.04-1.57). Additionally, the multivariable-adjusted odds ratios for males and females with overweight were 1.21 and 1.32, respectively, and those for different age groups (0-9, 10-14, and 15-19 years) ranged from 1.17 to 1.75. Being overweight was associated with thyroid nodules in children and adolescents, mostly adolescent females, regardless of their proximity to the nuclear power plant.

Synchronous Triplanar Reconstruction Integrated with Color Doppler Mapping for Precise and Rapid Localization of Thyroid Lesions.

This paper proposes a novel thyroid examination technique based on five-dimensional (5D) synchronous reconstruction of ultrasound data. The raw temporal sequences are reconstructed into 3D volumetric data reflecting anatomical structure. Triplanar visualization from three orthogonal planes is realized to provide a systematic inspection of the entire gland. Color Doppler imaging is integrated into each triplanar slice to map vascularity changes. This multi-modal fusion enables synchronous display of structural, functional, and blood flow information in the reconstructed 5D space. Compared to conventional scanning, this technique offers the benefits of flexible offline diagnosis, reduced dependency on scanning, enhanced intuitive interpretation, and comprehensive multi-aspect evaluation. By minimizing oversight errors, it could improve diagnostic accuracy, especially for novice practitioners. The proposed 5D fusion method allows rapid and precise localization of lesions for early detection. Future work will explore integration with biochemical markers to further improve diagnostic precision. The technique has considerable clinical value for advancing thyroid examination.

Trends of Pathological Findings in Patients with Thyroid Diseases: A Single-center, Retrospective Study.

Globally, a rising trend has been observed in the prevalence of thyroid disorders, with many demographic and geographic factors influencing its epidemiology. Nonetheless, some cases often go undetected due to the inconsistent and non-specific nature of the clinical symptoms. Therefore, we aimed to determine the trend and relationship between various pathological findings in thyroid disease patients and their demographic factors to aid clinicians in making a prompt diagnosis and treatment plan. A descriptive correlational study was conducted from January 2020 to May 2022 at Jinnah Postgraduate Medical Center, Karachi. We collected data via random sampling from 258 patients suffering from thyroid disorders. We evaluated baseline patient characteristics, along with, thyroid scan and fine needle aspiration cytology (FNAC) reports, and local thyroid gland examination findings. Out of 258 participants, 192 (74.4%) were females, whereas 66 (25.6%) were males, giving a female: male ratio of 2.9: 1. On local examination, 167 (64.7%) were found to have a solitary nodule, 79 (30.6%) had multinodular goiter. Findings revealed that benign follicular lesions had the highest prevalence (35.3%). Moreover, among the cancerous growth, papillary carcinoma presented the highest cases (12.4%). Of 258 cases, 24 patients had non-surgical interventions, while most (234) had surgical interventions. Total thyroidectomy was the most common procedure opted for by 45.3% (n = 117) of the participants, followed by lobectomy 70 (27.1%), near total thyroidectomy 43 (13.2%), modified radical neck dissection 5 (1.9%). Our study showed that nearly all thyroid-related pathologies were more prevalent amongst females than males, with the majority having an acute to sub-acute clinical presentation. Multinodular goiter was a prominent finding indicating a greater need for screening tools and access to healthcare facilities, especially in rural areas, to allow future studies to compare provinces accurately.

2022 Fukushima Medical University International Symposium on the Fukushima Health Management Survey Build Back Better, Together. “Science for Society: Advancing Fukushimaʼs Well-Being”

The Fukushima Medical University (FMU) International Symposium on the Fukushima Health Management Survey (FHMS) convened for the fourth time in March 2022 to share FHMS findings within Fukushima and beyond. Dr. TAKENOSHITA Seiichi, FMU President, underscored Fukushima's restoration journey, while Governor UCHIBORI Masao committed to partnering with FMU for residents' welfare.The Introduction by Dr. KAMIYA Kenji highlighted FHMS results for more than 460,000 participants, of whom 99.8% were exposed to radiation doses below 5 mSv post-accident. Thyroid examinations detected tumors, but no dose-response relationship was found. The Comprehensive Health Check showed increased lifestyle-related diseases among evacuees, with improvements in some health markers. Mental health issues initially prevalent after the accident decreased over time, and perinatal outcomes were consistent with national data.Session 1 focused on radiation effects in Fukushima. The UNSCEAR 2020 Report indicated significantly reduced radiation exposure estimates and negligible cancer risks. Studies from Hiroshima, Nagasaki, and Chernobyl found no radiation-induced genetic effects.Session 2 explored post-disaster well-being, emphasizing the evolution of psychological responses. Practices like Psychological First Aid (PFA) and emotional resilience promotion were highlighted. Katsurao Village's post-evacuation health measures addressed lifestyle diseases, but faced challenges. The WHO framework for mental health and psychosocial support in nuclear emergencies emphasized the importance of mental health care throughout all disaster phases.The symposium facilitated valuable insights, underlining comprehensive health strategies and the significance of long-term studies for Fukushima's recovery and health management.

SAT531 Thyroid Metastasis From Non-small Cell Lung Cancer: An Unusual Case Presentation

Abstract Disclosure: E.Y. Ibrahim: None. I. Guillen Alvarez: None. I. Hulinsky: None. D. Regelmann: None. C. Janowiecki: None. Background: Cases of thyroid tumors metastasizing from the lungs are rare, and their diagnosis is often challenging and can be mistaken for primary thyroid tumors or subacute thyroiditis. Thyroid function tests are typically normal and not helpful in establishing the diagnosis. Ultrasonography commonly shows focal or diffuse hypoechoic lesions. Correspondingly, heterogeneous hypodense areas with mild contrast enhancement are seen on CT scans. Clinical Case: Our patient is a 61-year-old male with a history of diabetes mellitus and 40 years tobacco use, who presented with a 1-week history of right-sided weakness and 3-weeks of dry cough. The weakness of his leg progressed to the point he could not ambulate. Initially, he was evaluated for a stroke and underwent CT imaging showing extensive lesions of the bilateral frontal, temporal, and parietal lobes. These findings were suspicious, and confirmed by MRI, to reflect multifocal metastatic lesions with vasogenic edema. Initial physical examination revealed a palpable thyroid nodule in the right lobe with bilateral cervical lymphadenopathy. CT of the neck demonstrated lymphadenopathy as well as multiple bilateral hypoechoic thyroid nodules, the largest of which measured 0.8 cm in the right thyroid lobe. TSH was 0.34 (0.48-4.17mU/L) with Free T4 at 1.39 (0.8-1.90ng/dL). The patient had denied symptoms of heat intolerance, tremor, or palpitations. A CT chest with contrast found a 3.5 cm cavitary lesion in the right upper lobe concerning for a primary lung neoplasm, as well as multiple bilateral lung nodules, mediastinal and hilar lymphadenopathy, and bilateral adrenal masses. Subsequent ultrasound-guided biopsy of the thyroid tumor revealed histologic features of a poorly differentiated non-small cell carcinoma, with features of a primary lung origin. These features were also present on a concurrent fine needle biopsy of an enlarged cervical lymph node. Immunohistochemistry staining showed the tumor was highly expressive for PDL1, focally positive for p40, pancytokeratin AE1/AE3, and negative for TTF-1 and thyroglobulinDue to the vasogenic cerebral edema, he was given dexamethasone with good response, and his weakness improved to the point that patient was able to ambulate. Treatment also included radiation therapy with subsequent pembrolizumab upon completion of radiotherapy. Conclusion: Several thyroid lesions representing metastases may go unnoticed because the physician’s attention toward lesions at other, more common sites, and detailed thyroid examination can be commonly overlooked. Patients with newly diagnosed malignancies should also be screened for thyroid involvement, including detailed physical, radiographic, and histologic examination of pathologic findings. Presentation Date: Saturday, June 17, 2023

Is It Appropriate to Completely Eliminate Contact Shielding during CT Examination? A Discourse Based on Experimental Findings.

Through the integration of experimental data and literature, this study examines whether complete elimination of contact shielding during CT examination is warranted, with a particular focus on potential impacts to children's thyroid and pregnant women, as well as limitations associated with contact shielding. Methods: The thermoluminescent dosimeter (TLD) tablets were inserted into the phantom's five organs and tissues. Select fixed exposure, automatic exposure control (AEC), and use contact shielding combined into four experimental modes, with scanning of the phantom's four parts. Obtain the absorbed dose measurements within or outside the FOV. Statistical analysis was conducted using SPSS software. Results: (1) The AEC significantly reduces dose within and outside the FOV, with a dose reduction of 40%-60%. (2) The application of contact shielding outside the FOV significantly reduced the dose adjoin the FOV. (3) Both the use of AEC mode and contact shielding can effectively minimize the dose, with a reduction of 50-80%. (4) The shielding within the FOV may introduce image artifacts or interfere with AEC, the implementation of contact shielding outside FOV provides little reduction in radiation exposure risk through previous literature. (5) Contact shielding exhibits certain drawbacks in all aspects. Conclusion: The utilization of AEC mode in clinical CT should be widely adopted to minimize patient radiation exposure. In general, contact shielding both inside and outside the FOV should be avoided during exposure. However for children under 12 years old with thyroid gland examination, contact shielding could maximally reduce external radiation and may be appropriate. Pregnant women require careful evaluation when considering the use of contact shielding. Contact shielding should not be entirely abandoned.

Povidone-iodine-induced transient triiodothyronine thyrotoxicosis in a Japanese patient with prolonged habitual gargling: A case report and literature review.

Iodine-induced hyperthyroidism and triiodothyronine (T3) thyrotoxicosis in patients who routinely gargle with povidone-iodine (PVP-I) gargling solution are rare in Japan. A 50-year-old man presented to our hospital for a close examination of an enlarged thyroid, which was noted during a complete health checkup. The thyroid was slightly enlarged with no palpable nodules. He had an increased appetite but no weight gain. He had been routinely gargling with PVP-I gargling solution 4 times daily for >10 years. He had no history of thyroid disease. Test results revealed suppressed thyroid-stimulating hormone, normal free thyroxine, and increased free triiodothyronine levels, leading to the diagnosis of T3 thyrotoxicosis. The patient agreed to stop gargling with PVP-I gargle solution. The free triiodothyronine and thyroid-stimulating hormone levels returned to normal at 18 and 21 weeks, respectively, after discontinuation of PVP-I gargling. After an improvement in thyroid function, he gained 5 kg in 1 year. To our knowledge, this is the first case report that describes PVP-I gargle-induced T3 thyrotoxicosis in a healthy individual without thyroid disease. In Japan, which is an iodine-sufficient country, considering the possibility of high-dose iodine intake-induced thyrotoxicosis due to long-term PVP-I gargling or other causes is necessary, even in individuals with no history of thyroid disease.

Critically ill patients: Histopathological evidence of thyroid dysfunction

PurposeCritical illness is characterized by severe biphasic physical and metabolic stress as result of systemic inflammatory response syndrome and/or multiple organ dysfunction syndrome, and is frequently associated with non-thyroidal illness. Purpose of this study is to better understand the cytomorphological basis of NTI by performing histopathological examinations of thyroid gland on autopsies of patients who died from critical illness. MethodsHistopathological examination of thyroid gland of 58 critically ill patients was performed in our hospital. The cases included 24 cases of burn injury, 24 cases of traumatic brain injury, and 10 cases of cerebral stroke. Thyroid samples obtained during autopsy were preserved in formol saline and stained with hematoxylin and eosin. The sections were visualized under light microscopy. ResultsOut of 58 cases examined, 21 patients showed normal thyroid findings, and rest of the cases had unusual thyroid findings in the histopathological study. The principal finding was distortion of thyroid follicular architecture. Other findings include mononuclear cell infiltration, clumping of thyroglobulin, and exhaustion of thyroid follicles. ConclusionCritical illness produces metabolically damaging effects on thyroid gland, which functionally corresponds to a state of low T3 syndrome. These changes are more pronounced in BI and cerebral stroke than in TBI.

Evaluation of multigenerational effects of 2-ethylhexyl 4-hydroxybenzoate in Japanese medaka.

The Japanese medaka (Oryzias latipes) extended one-generation reproduction test (MEOGRT) (Test Guideline 890.2200) is a Tier 2 test within the Endocrine Disruptor Screening Program of the US Environmental Protection Agency (US EPA). A modified MEOGRT was used to evaluate multigenerational effects of 2-ethylhexyl 4-hydroxybenzoate (2-EHHB) under flow-through conditions starting with adults (parent generation, F0) through a 3-week reproductive phase of the second generation (F2). Fish were exposed to one of five 2-EHHB test concentrations or a dechlorinated tap water control. Fecundity was affected at the lowest exposure (5.32 μg/L) and greater sensitivity occurred in the F1 and F2 generations. Percent fertility was also diminished from no effect level observed in the F0 generation to 101 and 48.8μg/L in the F1 and F2 generations, respectively. Growth indices were decreased for F0 adult females and F1 subadults and adults at 48.8μg/L 2-EHHB. Histopathologic examination of gonads, liver, kidney, and thyroid yielded possible delayed reproductive tract development in F1 subadult males, masculinization of the renal phenotype in F1 adult females (renal tubular eosinophilia) and reduced hepatic energy storage (liver glycogen vacuoles) in F1 (11.3 and 48.8μg/L) and F2 (48.8 and 101 μg/L) males and females, respectively. Endocrine-related findings included a decrease in anal fin papillae in F2 adult males at 101 μg/L. Results of this study demonstrate effects on growth, development, and reproduction that may be mediated by endocrine (weak estrogenic) and nonendocrine mechanisms. Duration of the MEOGRT should not be routinely extended beyond the OCSPP 890 guideline study design.

Hypothyroidism, Hyperthyroidism and its Relationship with Lipid Profile in Thyroid Dysfunction Patients

Background: -&#x0D; Thyroid hormone synthesis is necessary for the growth, development, and healthy function of all body organs. Because thyroid malfunction causes a considerable shift in lipid levels, It is well known that thyroid hormones influence how lipid and lipoprotein metabolism is regulated. An essential regulator of intermediate metabolism are thyroid hormones. The purpose This study's objective was to look at the relationship between thyroid dysfunction patients' lipid profiles, hypothyroidism, and hyperthyroidism ..&#x0D; Materials and Methods:-&#x0D; In this study, the EIA method was used to evaluate the levels of T4, thyronine, and TSH in a sample of 50 patients and 50 healthy individuals. When assessing TG, LDL , TC ,and HDL , A fully automated biochemistry analyzer was employed.&#x0D; Results:-&#x0D; According to our research, HDL values are much lower in hypothyroidism cases compared to hyperthyroidism and control subjects, whereas TC, LDL, VLDL, and TG levels are significantly greater. When compared to control persons. Serum levels of, TG, TC, LDL, and VLDL are much lower in hyperthyroidism patients On the basis of a clinical examination of thyroid hormone., we found T4,T3 in serum sample wear higher than in control in hyperthyroid group while TSH wear low. In hypothyroid sample we found on the contrary .&#x0D; Conclusion:-&#x0D; In this research we found a significant correlation between thyroid dysfunction and lipid profile

S-DETECT SOFTWARE AS A TOOL FOR ULTRASOUND DIAGNOSIS OF THYROID LESIONS

Relevance: Thyroid cancer (TC) is the most common oncological pathology of the endocrine organs.&#x0D; According to the International Agency for Research on Cancer (IARC), 567,233 new cases of thyroid cancer were registered worldwide in 2018. According to IARC, in 2018, 486 new cases were detected in Kazakhstan, which accounted for 1.4% of all cases in Asian countries.&#x0D; TC ranks 10th in the overall structure of cancer incidence globally; TC accounts for 3.1% of all cases of primary malignant tumors. Despite the relatively low incidence, the problems of pathogenesis have been extremely relevant in recent decades due to the increasing prevalence of thyroid cancer.&#x0D; Samsung Medison introduced AI-based S-Detect to improve sensitivity, specificity, and accuracy in the differential diagnosis of thyroid masses.&#x0D; The study aimed to explore the S-Detect program capacities in differential diagnostics of thyroid masses.&#x0D; Methods: 75 patients with focal lesions in the thyroid gland were examined using the Samsung Medison RS85 ultrasound machine equipped with the S-Detect program; additionally, Doppler and non-Doppler methods were used.&#x0D; Results: The S-Detect program made it possible to make a correct diagnosis in 97% of patients (73 of 75), which was confirmed by the results of morphological verification (histology, cytology). The sonoelastography method showed correct results in 91% of patients (68 of 75).&#x0D; Conclusion: The use of the S-Detect program for thyroid examination positively affects the diagnostic value of ultrasound in the differential diagnosis of thyroid masses, increasing the sensitivity, specificity, and accuracy of diagnosis, as well as avoiding redundant biopsies.

Anatomy-based approach to the thyroid examination

In this article, the authors will discuss a modified anatomy-based neck and thyroid examination that allows for a more comprehensive evaluation. It is the opinion of the authors that an organ and its function are best evaluated utilizing the following steps: anatomy-based inspection and palpation, imaging, and blood tests. Approximately half of the lateral part of the thyroid is deep to the sternocleidomastoid (SCM) and sternothyroid muscles, which makes it rather difficult to palpate the entire gland utilizing prior physical examination techniques. The goal of this modified anatomy-based thyroid examination is to minimize the number of structures between the physician's fingers and the patient's thyroid by utilizing neck flexion, side bending, and rotation. If one approaches the thyroid from behind thepatient, nodules can be missed due to the muscles andtransverse processes overlaying them. The incidence of thyroid cancer in the United States is drastically increasing, which demonstrates the importance of a more thorough thyroid palpation. Our anatomy-based approach may allow for earlier detection and therefore earlier treatment.

Clinical and ultrasonography evaluation of thyroid tumor screening in symptomatic patient of Bajulmati primary care center, Banyuwangi, East Java, Indonesia

This study aims to assess the prevalence, clinical, and ultrasonography (US) in thyroid screening in healthy subjects with general symptoms of thyroid abnormality in low iodine intake in Bajulmati primary care center, East Java Indonesia. We retrospectively reviewed US thyroid examination of 74 subjects with symptoms of mass in the neck, shaky, sleep difficulties, over sweating, and chronic fatigue on September 15th, 2021. Following the WHO guidelines, subjects also underwent physical examination in which the result were classified into 3 categories, that is, no palpable nor visible goiter, palpable but no visible goiter, as well as palpable and visible goiter. We evaluate US thyroid characteristics following Korean Society of Thyroid Radiology guidelines. Image analysis was reviewed by 4 general radiologists with 2 to 13 years' experience. Categorical variables were compared using chi-squared or Fisher exact tests. Correlation between variables was measured with gamma statistics. Statistical analyses were conducted using IBM SPSS Statistics 23.0. A P-value < .05 was considered to indicate statistical significance. Of the 74 subjects, 32 (43.2%) show abnormalities. Statistical analysis showed no significant differences in the result of thyroid US in subjects with complaint fatigue (P = .464), insomnia (P = .777), over sweating (P = .158), and tremor (P = .778), but there were significant differences with the complaint of mass in the neck (P = .008). Furthermore, there was also a strong correlation between goiter palpation and US thyroid result (R = 0.773, P = .00). We conclude there were significant differences in US result of patients with and without complaint of mass in the neck. We also found a strong correlation between goiter palpation and US examination. Clinical findings, laboratory examination, cytology and molecular markers, patients' age, nodules size, and ultrasound features should be considered for the treatment planning.