Thyroid Patients Research Articles

Calsequestrin is Decreased in the Thyroid Gland of Patients with Graves’ Disease – Further Evidence for a Role of Autoimmunity against this Protein in Graves’ Ophthalmopathy

Background: The pathogenesis of Graves’ ophthalmopathy (GO) and the mechanism for its link to thyroid autoimmunity is poorly understood. Our present research focuses on the role of the skeletal muscle calcium binding protein calsequestrin (CASQ1). Earlier studies showed that the CASQ1 gene was up-regulated in thyroid tissue from patients with GO compared to those with Graves’ hyperthyroidism (GH) without eye signs, however, the protein levels remained the same in both groups, raising the possibility that the orbital autoimmune reaction begins in the thyroid gland. Here, we measured the concentration of the CASQ1 protein in normal and Graves’ thyroid tissue, correlating levels with parameters of the eye signs, CASQ1 antibody levels and the CASQ1 gene polymorphism rs3838216, shown previously to be a risk factor for ophthalmopathy.

Clinical genetics of congenital hypothyroidism.

Congenital hypothyroidism (CH) is a state of insufficient thyroid hormone supply to the organism, starting in utero. Two forms of permanent primary or thyroidal CH are known. Thyroid dysgenesis (TD) describes a spectrum of defects of thyroid organogenesis. Five monogenetic forms due to mutations in TSHR, PAX8, NKX2-1, FOXE1 and NKX2-5 have been identified so far. Thyroid dyshormonogenesis comprises defects at every step of thyroid hormone synthesis. Mutations in 7 genes are well described causing iodine transport defect (SLC5A5), iodine organification defect (TPO, DUOX2, DUOXA2, SLC26A4), thyroglobulin (TG) synthesis or transport defect or iodotyrosine deiodinase (IYD/DEHAL1) deficiency. The new consensus guidelines for CH recommend genetic counseling for each family with an affected child. Mode of inheritance, recurrence rate and possible associated malformations in the context of syndromic forms should be outlined. Molecular genetic studies should be preceded by a detailed phenotypic description of the patient's thyroid disease and a detailed family history. This review summarizes clinical, biochemical and radiological phenotypes and molecular aspects of the known genetic forms of TD and thyroid dyshormonogenesis relevant for genetic counseling and molecular studies.

Polymorphisms of endothelin 1 (G5665T and T-1370G) and endothelin receptor type A (C+70G and G-231A) in Graves' disease

Endothelin 1 (EDN1) is a strong angiogenic and mitogenic factor, playing a key role in hypervascularization, thyroid follicle cell hyperplasia, and lymphocyte infiltration in the thyroid gland of patients with Graves' disease (GD). EDN1 induces angiogenesis and mitogenesis via endothelin receptor type A (EDNRA). This study examined the possible association of EDN1(G5665Tand T-1370G) and EDNRA (C+70G and G-231A) single nucleotide polymorphisms (SNPs) with the occurrence of GD, and evaluates the relationship between genotypes and clinical/laboratory manifestations of GD. We analyzed genotype and allele distributions of EDN1 and EDNRA polymorphisms in 165 patients with GD and 181 healthy controls by real-time PCR combined with melting curve analysis. No significant associations between GD and variant alleles of the studied polymorphisms were observed. However, the anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) levels in EDN1 G5665T GG genotype were higher than those in T allele carriers (GT+TT) (p=0.001 and p=0.026, respectively). In addition, anti-TPO levels in EDN1 T-1370G wild-type homozygous patients were found to be higher than in mutant gene carrying patients (GT+GG) (p=0.006). The presence of EDNRA+70G allele was associated with 3.37-fold increased risk for development of ophthalmopathy in GD patients (p=0.009). Although there were no associations between EDN1 (G5665T and T-1370G) and EDNRA (C+70G and G-231A) SNPs and susceptibility to GD, EDN1 G5665T and T-1370G polymorphisms were related to alterations of autoantibody production and EDNRA C+70G polymorphism is related with increased risk for ophthalmopathy in GD patients.

Use of Spiral Computed Tomography Volumetry for Determining the Operative Approach in Patients with Graves’ Disease

The purposes of the present study were to assess (1) the correlation between the weight of the postoperative thyroid specimen and the spiral computed tomography (CT) volumetry results of the thyroid gland in patients with Graves' disease, and (2) the utility of CT volumetry for determining the operative approach. From 2009 to 2010, a total of 56 patients with Graves' disease underwent total or subtotal thyroidectomy. An enhanced spiral CT was taken in all patients prior to the operation. From 2.5mm-thick slices of the thyroid gland, the surface area was calculated to measure the volume of the thyroid gland. The glandular volume was compared to the weight of the postoperative thyroid specimen. A total of 42 and 14 patients underwent total and subtotal thyroidectomy, respectively. The mean weight of the postoperative thyroid specimen was 43.9±33.4g, and the mean volume obtained by CT volumetry was 44.2±32.8mL. A good correlation was observed between the weight of the postoperative thyroid specimen and the volume calculated by CT (r=0.98, p<0.001). When 100mL was set as the higher cut-off value of the thyroid volume for minimally invasive thyroid surgery, the estimated blood loss showed a significant difference between the >100mL and the ≤100mL groups (608.3±540.8 vs. 119.7±110.4mL; p=0.036). Spiral CT volumetry may be used to measure the thyroid volume reliably in patients with Graves' disease. For cases in which surgery is indicated in patients with Graves' disease, CT volumetry provides useful information from which to determine the operative approach. One hundred milliliter or less of thyroid volume in CT volumetry is recommended to perform minimally invasive thyroid surgery.

FEATURES OF THE FUNCTIONING OF THE THYROID GLAND IN HIV-INFECTED

In the article analyzed the current literature, devoted to the peculiarities of functioning of the thyroid gland in patients with HIV infection. Based on the analysis of literature data bases demonstrated the structure of thyroid function disorders in HIV-infected, as well as the mechanisms of the pathogenesis of these disorders. In the structure of thyroid function is dominated by hypothyroidism, euthyroid pathological syndrome, Graves' disease, for which the opportunistic infections are triggers immune activation. It should be noted that the step of acquired immunodeficiency syndrome is accompanied by the development of inflammatory and neoplastic processes in the thyroid gland. Convincingly demonstrated the negative impact of highly active antiretroviral therapy in HIV-positive for the development of thyroid dysfunction, in connection which the expediency of forming risk groups and the timely correction of the projected thyroid diseases.

Prevalence Of Hypothyroidism In Chronic Kidney Disease Among Sample Of Iraqi Patients.

Background: Patients with chronic kidney disease have multiple alterations of thyroid hormone metabolism in the absence of concurrent thyroid disease. These may include elevated basal TSH values, which may transiently increase to greater than 10 mU/liter, blunted TSH response to TRH, diminished or absent TSH diurnal rhythm, altered TSH glycosylation, and impaired TSH and TRH clearance rates. In addition, serum total and free T3 and T4 values may be reduced, free rT3 levels are elevated while total values are normal, serum binding protein concentrations may be altered, and disease-specific inhibitors reduce serum T4 binding .Objective:. To assess the prevalence of hypothyroidism and u/s abnormalities of thyroid gland in patients with chronic kidney disease at different levels of estimated glomerular filtration rate (eGFR) and their association with age , sex and duration of chronic renal failure . cross sectional study.Patients and Method: a cross sectional study total of 50 patients who seek medical advice in Baghdad teaching hospital (29 male , 21 female) , the mean of their age was 60, with established chronic kidney disease were categorized into five groups according to the stages of chronic kidney disease . Full clinical, biochemical ( includes blood urea , serum creatinine , total T3, total T4 , TSH ) , thyroid ultrasonography studies were performed to all patients in this study. Risk factors such as hypertension, diabetes mellitus, smoking and family history of CKD were also recorded. Type of treatment of CKD whether conservative or renal replacement therapy (in form of peritoneal or hemodialysis) were also.Results:- From a total of 50 patients with chronic kidney disease (CKD ), eight patients had hypothyroidism (16 %) , three patients from stage 4 CKD and five patients from stage 5 CKD . Twelve patients from study sample had abnormalities in thyroid ultrasonography (24%) , one patient from stage 2 CKD , three patients from stage 3 CKD ,three patients from stage 4 CKD and five patients from stage 5 CKD . Thyroid ultrasound abnormalities includes six patients with simple goiter and six patients with multinodular goiter .From those eight patients with hypothyroidism , six patients were males (75%) and two patients were females (25%) .Regarding 12 patients with thyroid u/s abnormalities , five patients were male (41.6%) and seven patients were female (58.4%).Statistical analysis showed a significant association between drop in GFR and drop in thyroid function, from 13 patients in stage 4 CKD , three patients (23.07%) had hypothyroidism , and from 23 patients in stage 5 CKD , five patients (21.739%) had hypothyroidism .Conclusion:- reduced glomerular filtration rate was associated with an increased prevalence of hypothyroidism, with many subclinical cases. Future studies are needed to determine the potential adverse effects of subclinical and clinical hypothyroidism in persons with chronic kidney disease.

Longterm results and their prognosis in surgical treatment of Grave's disease

This study focuses on improving the results of surgical treatment of patients with diffuse toxic goiter way jus tify the selection of thyroid residue and thyroid status in predicting longterm periods. The basis of the study is the immediate and longterm results of surgical treatment of 138 patients suffering from diffuse toxic goi ter. As a result of the research, with a modern point of clinical and statistical analysis proved the effective ness of fascial subtotal resection of the thyroid gland in patients with diffuse toxic goiter (Graves' disease). The dependence of disorders of the thyroid is remainded of its volume, autoimmune changes and limitations of the operation. The quality of life of patients in the late postoperative period is studied. The tactics of sur gical treatment of patients with diffuse toxic goiter, aimed at the prevention of postoperative recurrence of hyperthyroidism and hypothyroidism on the basis of prediction of the functional state of the thyroid residue in the longterm period, is proposed. Detected optimal sizes of thyroid balance after subtotal resection of the thyroid gland in patients with diffuse toxic goiter permit to objectify the technique of intervention.

Функціональний стан щитоподібної залози у хворих на кропив’янку тактика і стратеґія діаґностики та лікування

Функціональний стан щитоподібної залози у хворих на кропив’янку тактика і стратеґія діаґностики та лікування

Papillary thyroid carcinoma in a lateral neck cyst: primary of ectopic thyroid tissue versus cystic metastasis

To review the diagnosis of primary papillary carcinoma of ectopic thyroid tissue within branchial cleft cysts, and to discuss the diagnostic challenge of differentiating this condition from metastatic disease when an occult microcarcinoma is found in the thyroid gland. These comprise a case report and a literature review. We present the case of a 75-year-old woman with papillary thyroid carcinoma within the wall of a recurrent, 15 cm, lateral neck cyst. Histological examination of the patient's thyroid gland found a 0.5 mm papillary thyroid microcarcinoma. Our differential diagnosis was primary papillary carcinoma arising from ectopic thyroid tissue, or metastatic cystic degeneration of a lateral lymph node. We make an argument for the former.

Prescience of a Surgeon in 1980

ThyroidVol. 23, No. 6 Letters to the EditorPrescience of a Surgeon in 1980Sandra M. McLachlanSandra M. McLachlanSearch for more papers by this authorPublished Online:6 Jun 2013https://doi.org/10.1089/thy.2012.0636AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Prescience of a Surgeon in 1980." , 23(6), pp. 773–774FiguresReferencesRelatedDetails Volume 23Issue 6Jun 2013 InformationCopyright 2013, Mary Ann Liebert, Inc.To cite this article:Sandra M. McLachlan.Prescience of a Surgeon in 1980.Thyroid.Jun 2013.773-774.http://doi.org/10.1089/thy.2012.0636Published in Volume: 23 Issue 6: June 6, 2013Online Ahead of Editing: January 25, 2013PDF download

Computation of thyroid doses and carcinogenic radiation risks to patients undergoing neck CT examinations

The aim of the study was to investigate how differences in patient anatomy and CT technical factors in neck CT impact on thyroid doses and the corresponding carcinogenic risks. The CTDIvol and dose-length product used in 11 consecutive neck CT studies, as well as data on automatic exposure control (AEC) tube current variation(s) from the image DICOM header, were recorded. For each CT image that included the thyroid, the mass equivalent water cylinder was estimated based on the patient cross-sectional area and average relative attenuation coefficient (Hounsfield unit, HU). Patient thyroid doses were estimated by accounting for radiation intensity at the location of the patient's thyroid, patient size and the scan length. Thyroid doses were used to estimate thyroid cancer risks as a function of patient demographics using risk factors in BEIR VII. The length of the thyroid glands ranged from 21 to 54 mm with an average length of 42 ± 12 mm. Water cylinder diameters corresponding to the central slice through the patient thyroid ranged from 18 to 32 cm with a mean of 25 ± 5 cm. The average CTDIvol (32-cm phantom) used to perform these scans was 26 ± 6 mGy, but the use of an AEC increased the tube current by an average of 44 % at the thyroid mid-point. Thyroid doses ranged from 29 to 80 mGy, with an average of 55 ± 19 mGy. A 20-y-old female receiving the highest thyroid dose of 80 mGy would have a thyroid cancer risk of nearly 0.1 %, but radiation risks decreased very rapidly with increasing patient age. The key factors that affect thyroid doses in neck CT examinations are the radiation intensity at the thyroid location and the size of the patient. The corresponding patient thyroid cancer risk is markedly influenced by patient sex and age.

Clinical features of a new disease concept, IgG4-related thyroiditis

Objectives: Immunoglobulin (Ig)G4-related disease is a recently proposed systemic disorder that includes autoimmune pancreatitis (AIP), Mikulicz’s disease, and various other organ lesions. In the present retrospective study, we examined whether thyroid lesions should also be included in IgG4-related disease (Ig4-RD) under the new term IgG4-related thyroiditis.Method: We enrolled 114 patients with Ig4-RD, including 92 patients with AIP, 15 patients with Mikulicz’s disease, and seven patients with IgG4-related cholangitis, and analysed clinical findings, function, serum values of activity markers, computed tomography (CT) images, and histology of the thyroid gland.Results: Among the 22 patients (19%) in our cohort who were found to have hypothyroidism [thyroid stimulating hormone (TSH) > 4 mIU/L], 11 patients had clinical hypothyroidism [free thyroxine (FT4) < 1 ng/dL] and 11 patients had subclinical hypothyroidism (FT4 ≥ 1 ng/dL). Serum concentrations of IgG, IgG4, circulating immune complex (CIC), and β2-microglobulin (β2-MG) were significantly higher in the hypothyroidism group compared with the remaining 92 euthyroid patients, and serum C3 concentration was significantly lower. After prednisolone treatment, TSH values had decreased significantly (p = 0.005) in this group and FT4 values had increased significantly (p = 0.047). CT images showed that the thyroid glands of patients with clinical hypothyroidism had a significantly greater volume than those of the euthyroid and other groups. Pathological analysis of one resected thyroid gland disclosed a focused lesion with infiltration of lymphocytes and IgG4-bearing plasma cells and loss of thyroid follicles.Conclusions: Thyroid lesions associated with hypothyroidism can be considered as a new disease termed IgG4-related thyroiditis. Awareness of this condition should lead to appropriate corticosteroid treatment that may prevent progression to a fibrous state.

The dosimetric impact of supraclavicular nodal irradiation on the thyroid gland in patients with breast cancer

PurposeThe thyroid is not routinely considered an organ at risk in supraclavicular (SC) nodal radiation therapy (RT) for breast cancer. We compared the dosimetric impact of the following 2 RT planning techniques on the thyroid: (1) conventional single anterior field to encompass the SC nodal volume defined clinically; and (2) 3-dimensional conformal radiation therapy (3DCRT) planning to encompass the computed tomography (CT)-contoured SC nodal volume. Methods and MaterialsThe thyroid, SC nodal volumes, and organs at risk were contoured on the planning CT of 20 patients who received 50 Gy in 2-Gy daily fractions to the breast or chest wall, and SC nodes. Comparisons of dosimetric parameters between the techniques were performed: thyroid, mean and maximum dose, V5, V30, and V50 (percentage of thyroid receiving ≥5 Gy, ≥30 Gy, and ≥50 Gy, respectively); SC nodal volume, homogeneity index (HI, percentage volume receiving 95%-107% of prescribed dose); and maximum doses of spinal cord and brachial plexus. Anatomic characteristics that influenced the dose distributions were investigated. ResultsThe 3DCRT planning technique significantly increased all thyroid dosimetric measures (mean dose 17.2 Gy vs 26.7 Gy; maximum dose 48.5 Gy vs 51.9 Gy; V5 45.7% vs 64.9%; V30 33.7% vs 48%; and V50 0.6% vs 26.7%; P < .001). It improved HI for the SC nodal volumes (P < .001) but resulted in higher maximum doses to the spinal cord (6.1 Gy vs 30 Gy) and brachial plexus (43.2 Gy vs 51.4 Gy). The thyroid volume and depth of SC nodes did not influence the thyroid dose distribution. The depth of SC nodes impacted on the HI of SC nodal volumes in the conventional technique (P = .004). ConclusionsThe 3DCRT planning improved dosimetric coverage of the SC nodal volume but increased thyroid radiation doses. The potential adverse effects of incidental thyroid irradiation should be considered while improving dosimetric coverage in SC nodal irradiation for breast cancer.

Resistant thyrotoxicosis: A case of sarcoidosis of thyroid

Autoimmune endocrinopathies and, less commonly, thyroid autoimmune disease have been reported in patients with sarcoidosis. Similarities exist in the pathogenesis of these two conditions. Concomitant sarcoidosis in the thyroid gland in patients with Graves’ disease may contribute to the resistance to antithyroid drugs and radioiodine therapy. We present the clinical, laboratory, imaging, and pathologic findings of a patient with Graves’ disease who was unresponsive to medical management. This 37-year-old man presented with thyrotoxicosis. Thyroid hormone assays and 99mTechnitium findings were consistent with Graves’ disease. He was also found to have hilar lymphadenopathy. Patient failed to achieve remission with high doses of antithyroid drugs and 2 sessions of radioiodine ablative therapy. Histopathology of lymph nodesdisclosed noncaseating granulomas, consistent with sarcoidosis. Patient's thyrotoxicosis subsided only following steroid administration. The histopathology of the thyroid gland on aspiration and the subsidence of symptoms with steroids reiterate the possibility of thyroid sarcoidosis. This diagnosis needs biopsy for confirmation, which our patient didn't consent for.

Delayed Surgery for Parathyroid Adenoma Misdiagnosed as a Thyroid Nodule and Treated with Radiofrequency Ablation

Primary hyperparathyroidism occurs as a result of isolated parathyroid adenoma in 80% to 85% of all cases. A 99mtechnetium (99mTc) sestamibi scan or neck ultrasonography is used to localize the neoplasm prior to surgical intervention. A 53-year-old female was referred for the exclusion of metabolic bone disease. She presented with low back pain that had persisted for the past 6 months and elevated serum alkaline phosphatase (1,253 IU/L). Four years previously, she had been diagnosed at a local hospital with a 2.3-cm thyroid nodule, which was determined to be pathologically benign. Radiofrequency ablation was performed at the same hospital because the nodule was still growing during the follow-up period 2 years before the visit to our hospital, and the procedure was unsuccessful in reducing the size of the nodule. The results of the laboratory tests in our hospital were as follows: serum calcium, 14.6 mg/dL; phosphorus, 3.5 mg/dL; and intact parathyroid hormone (iPTH), 1,911 pg/mL. Neck ultrasonography and 99mTc sestamibi scan detected a 5-cm parathyroid neoplasm in the left lower lobe of the patient's thyroid; left parathyroidectomy was performed. This case indicated that thyroid ultrasonographers and pathologists need to be experienced enough to differentiate a parathyroid neoplasm from a thyroid nodule; 99mTc sestamibi scan, serum calcium, and iPTH levels can help to establish the diagnosis of parathyroid neoplasm.

Letter to the Editor Amiodarone-induced thyrotoxicosis with paroxysmal supraventricular (ectopic atrial) tachycardia: and review of the literature

Letter to the Editor Amiodarone-induced thyrotoxicosis with paroxysmal supraventricular (ectopic atrial) tachycardia: and review of the literature

Optimal Bent Length of Lightwand for Intubation in Adults: A Randomized, Prospective, Comparative Study

To evaluate the effect on intubation success of different bent lengths of a lightwand (a malleable illuminating stylet used for intubation), based on the patient's thyroid prominence-to-mandibular angle distance (TMD), thyroid prominence-to-incisor distance (TID) and gender. This prospective, randomized, blinded study included patients undergoing elective surgery. In group A, the bent length was determined based on the patient's gender. In groups B and C, the bent length was calculated according to the patient's TMD or TID, respectively. Intubation success rate, time required for intubation, haemodynamics and complications postintubation were documented. A total of 246 patients were recruited and randomly assigned to one of the study groups. There were no significant differences in number of intubation attempts and success rate among the three groups. The mean time required for intubation was significantly shorter in group A than in the other groups. There were no major complications in any group. Gender-determined bent length was more suitable for lightwand-guided intubation than TID or TMD. For most patients, the optimal bent length was in the range of 6.0-6.9 cm.

Vascular endothelial growth factor polymorphisms increase the risk of developing Graves' disease

BackgroundGraves' disease (GD) is a consequence of genetic and environmental factors. Vascular endothelial growth factor (VEGF) is a strong angiogenic and mitogenic factor, which plays a key role in lymphocyte infiltration, and hypervascularization in the thyroid gland of patients with GD. AimThe aim of this study is to investigate the relationship between GD and A-2578C, T-460C and G+405C single nucleotide polymorphisms (SNPs) of VEGF gene, as well as to evaluate whether there are any relationships between genotypes and some clinical/laboratory parameters of GD. MethodsWe analyzed the genotype and allele distributions of the above mentioned SNPs in 167 patients with established GD diagnosis and 203 healthy controls by real-time PCR combined with melting curve analysis using fluorescence-labeled hybridization probes. ResultsThe distribution of VEGF A-2578C and T-460C genotypes and allele frequencies in control and GD groups were not significantly different. With regard to the +405 polymorphism, the frequency of C allele was 1.8-fold increased in GD patients compared to controls, and the CC genotype was associated with a 4.6-fold increased disease risk. There was no relationship between some clinical/laboratory parameters with G+405C polymorphism. However, in −2578C allele carrying GD patients the anti-thyroid antibody levels were increased according to wild homozygous. Additionally, −2578C and −460T alleles were related with early (at age before 40) disease onset. ConclusionVEGF +405 polymorphism may be a risk factor for GD, while the −2578 SNP is related with increased autoantibody production.

유두상 갑상선 암종이 동반된 부갑상선 증식증 1예

Primary hyperparathyroidism (pHPT) and concomitant thyroid cancer is rare. The possibility of a coincidental appearance of pHPT and nonmedullary thyroid cancer is often neglected. We report a 50-year-old man with primary hyperparathyroidism with incidental papillary thyroid cancer. In this patient, preoperative imaging studies revealed the presences of a parathyroid tumor at left thyroid bed and both thyroid nodules. After left inferior parathyroidectomy, frozen section pathology suggested parathyroid hyperplasia. We performed left hemithyroid- ectomy and right paratracheal exploration. Frozen section biopsy of right paratracheal lymph node revealed metastatic lymph node of papillary thyroid cancer, so we performed total thyroidectomy with subtotal parathyroidectomy, and central compartment neck dissection. Permanent pathology revealed parathyroid hyperplasia with concurrent papillary thyroid carcinoma. A head and neck endocrine surgeon needs to be aware of the possible coexistence of thyroid and parathyroid pathologies and have to evaluate the thyroid gland in patients undergoing surgery for parathyroid disease. (J Clinical Otolaryngol 2012;23:125–130)

Fetal microchimeric cells in blood and thyroid glands of women with an autoimmune thyroid disease

Persistence of fetal microchimeric cells may result in the development of autoimmune thyroid diseases (AITD) such as Hashimoto thyroiditis (HT) or Graves disease (GD). In women, HT and GD show an increased incidence in the years following parturition. Although fetal cells have already been shown to be more common in the thyroid glands of patients with an AITD compared with controls, these cells haven’t been described in blood of these patients. Our study detected fetal cells in blood of all patients with an AITD. Moreover, fetal cells were immune cells potentially capable of initiating a graft vs. host reaction and suggest a potential role of these cells in the pathogenesis of AITD. Our study indicates the value and need for further research in this field.