Toxic Multinodular Goiter Research Articles

Transient Hypocalcemia After Total Thyroidectomy: The Obesity Paradox at Work?

IntroductionWith increasing rates of obesity worldwide, a correlation between high body mass index (BMI) and postoperative morbidity after thyroid surgery remains unclear. Postoperative transient hypocalcemia is common after total thyroidectomy due to interruption of parathyroid function. This study examines the relationship between BMI and hypocalcemia after total thyroidectomy. Materials and methodsA retrospective review of prospectively collected data for 1135 patients who underwent total thyroidectomy for cancer, multinodular goiter (MNG), or Graves’ disease between June 2009 and November 2020 at a single institution was performed. BMI groups followed the World Health Organization classification. Hypocalcemia was defined as serum calcium ≤8 mg/dL. Calcium levels measured on postoperative day 0 and the following morning were compared between the BMI groups. ResultsOf 1135 total thyroidectomy patients, 85% were women. The mean age and standard deviation of patients was 49 (± 13) y, with most of Hispanic origin (64%). Overall, 41.5% of patients had cancer, 45% nontoxic MNG, 5.8% toxic MNG, and 12% Graves' disease. Stratified by BMI, 27% of patients were normal, 34% overweight, and 39% obese. Overall, overweight and obese patients experienced less transient hypocalcemia at both time points compared to normal patients postoperatively (P = 0.01 and P = 0.009). Furthermore, overweight and obese patients with Graves’ disease experienced less transient hypocalcemia at both time points (P = 0.04 and P = 0.05). There was no statistical difference in other groups. ConclusionsA protective role of higher BMI or “obesity paradox” for postoperative hypocalcemia may exist in those obese patients after total thyroidectomy.

Efficacy of Radioiodine Therapy in Patients With Primary Hyperthyroidism: An Institutional Review From Pakistan.

BackgroundRadioactive iodine (RAI) is the treatment of choice for most patients with primary hyperthyroidism. The most common etiologies of hyperthyroidism are Graves' disease (GD), toxic adenoma (TA), and toxic multinodular goiter (TMNG). A single dose of RAI is usually sufficient to cure hyperthyroidism. The aim of this study was to assess the effectiveness of RAI therapy for patients diagnosed with primary hyperthyroidism.Methods and materialsPatients diagnosed with hyperthyroidism who received RAI therapy between 2008 and 2018 were included in the study. The data was acquired from the hospital's electronic medical record system. Following the RAI treatment, a cure was defined as the development of euthyroidism or hypothyroidism after a single fixed-dose without antithyroid medication within one year of RAI therapy. In addition, a simple logistics regression model was used to identify the prognostic factors that may lead to better outcomes.ResultsA total of 112 patients diagnosed with hyperthyroidism with a mean age of 47 ± 14 were included in this study. The majority of the patients were female, 79 (70.5%). Within one year of RAI therapy, 84 (75%) patients achieved a cure that is either hypothyroid or euthyroid status. RAI dose was higher in responsive patients (18.50 ± 4.10 millicurie [mCi] versus 16.50 ± 4.10 mCi) than in non-responsive patients. The mean RAI doses were 16.05 ± 2.99 mCi in GD, 19.81 ± 4.40 mCi in TMNG, and 20.50 ± 3.30 mCi in TA, with a statistically significant p-value of 0.001. In the univariable logistic regression model, RAI dose was a significant prognostic factor of the responsive group (OR: 1.15, CI [1.01-1.31], p-value 0.03).ConclusionOur data presented that RAI therapy is effective for primary hyperthyroidism. We achieved remission with a single fixed-dose in the majority of patients. Most of our patients were cured within three months of RAI therapy. In addition, the RAI dose was higher in the responsive group as compared to the non-responsive group.

A case of uniportal VATS thymectomy for Thymoma associated with myasthenia gravis and toxic multinodular goiter.

BackgroundThymoma is a rare neoplasm, which may be associated with autoimmune disorders, the occurrence of hyperthyroidism in the patients with thymoma is rare.Clinical presentationHere we present an extremely rare case of a 56-year-old female patient who was discovered to have malignant thymoma with associated myasthenia gravis and hyperthyroidism due to toxic multinodular goiter. Our patient started to complain of difficulty breathing and swallowing, Chest CT scan was done and revealed an anterior mediastinal mass, measures about 4.1 × 3.1 × 2.2 cm with enlarged lymph node mostly representing thymoma.Complete thymectomy was performed via uniportal video-assisted thoracoscopic surgery, and the patient's postoperative recovery was uneventful. Microscopic histopathology findings corresponded to thymoma type B1.ConclusionThe coexistence of thymoma, MG and toxic multinodular goiter is extremely rare. MG should always be suspected in a patient with thymoma. VATS thymectomy has been increasingly used to treat thymoma as it has several advantages over open surgery.

Empiric radioiodine for hyperthyroidism: Outcomes, prescribing patterns, and its place in the modern era of theranostics.

The modern era of radioiodine (I-131) theranostics for metastatic differentiated thyroid cancer requires us to rationalize the role of traditional empiric prescription in nonmalignant thyroid disease. We currently practice empiric I-131 prescription for treatment of hyperthyroidism. This study aims to assess outcomes after treatment of hyperthyroidism by empiric I-131 prescription at our centre, evaluate factors that impact on outcomes and prescribing practice, and gain insight into whether there is a place for theranostically-guided prescription in hyperthyroidism. A retrospective review was undertaken of all patients with Graves' disease, toxic multinodular goitre (MNG) and toxic adenoma treated with I-131 between 2016 and 2021. Associations between clinical or scintigraphic variables and remission (euthyroid or hypothyroid) or persistence of hyperthyroidism at follow-up were performed using standard t test as well as Pearson's product correlation. Of 146 patients with a mean follow-up of 13.6 months, 80.8% achieved remission of hyperthyroidism. This was highest in toxic nodules (90.1%), compared with Graves' disease (73.8%) and toxic MNG (75.5%). In patients with Graves' disease, higher administered activity was associated with remission (p = .035). There was a weak inverse correlation between the Tc-99m pertechnetate uptake vs prescribed activity in Graves' disease (r = -0.33; p = .009). Only one patient (0.7%) had an I-131 induced flare of thyrotoxicosis. Traditional empiric I-131 prescription is a safe and effective treatment of hyperthyroidism and suitable for most patients. However, there may be a role for personalized I-131 prescription by theranostic guidance in selected patients with high thyroid hyperactivity.

Predictors of Hypothyroidism Following Empirical Dose Radioiodine in Toxic Thyroid Nodules: Real-Life Experience

ObjectiveWe aimed to determine the factors predicting hypothyroidism after radioactive iodine (RAI) treatment in patients with toxic adenoma and toxic multinodular goiter. MethodsWe retrospectively collected the data of 237 patients with toxic multinodular goiter or toxic adenoma who had consecutively received RAI treatment between 2014 and 2020 at 2 medical centers. Patients who received the second RAI treatment and whose medical records could not be accessed were excluded from the study. Finally, 133 patients were included in the study. RAI was administered at an empirical dose of 15 or 20 mCi. ResultsThe median age of the 133 participants was 69 years (interquartile range, 62-75 years), and 64.7% of the participants were women. A total of 42.1% of the patients had toxic adenoma, whereas 57.9% of patients had toxic multinodular goiter. The median follow-up was 24 months (interquartile range, 11-38 months). During the follow-up, 61.7% of patients became euthyroid, 30.8% developed hypothyroidism, and 7.5% remained hyperthyroid. The median month of hypothyroidism onset was 4 months (interquartile range, 2-9 months). Regression analysis revealed 2 factors that could predict hypothyroidism: thyroid-stimulating hormone (odds ratio, 2.548; 95% CI, 1.042-6.231; P = .04) and thyroid volume (odds ratio, 0.930; 95% CI, 0.885-0.978; P = .005). ConclusionOverall, 30.8% of the cases developed hypothyroidism after the RAI treatment. Approximately 78% of hypothyroidism developed within the first 10 months. The risk of hypothyroidism was higher in patients with higher thyroid-stimulating hormone and smaller thyroid volume.

Radioiodine treatment outcome by dosimetric parameters and renal function in hyperthyroidism

BackgroundHyperthyroidism has been treated with radioiodine therapy for eight decades, with known benefits and side-effects. No consensus exists on which activity dosage and pre-therapeutic measurements are required for optimal treatment, balancing risk of incomplete response, therapy-induced hypothyroidism and radiation exposure. A retrospective analysis was performed to assess these questions.MethodsData was collected on radioiodine treatment outcomes for 904 patients treated for Graves' disease or toxic nodular goitres at our institution during 2016–2020. The prescribed absorbed doses were 120 Gy (Graves’ disease), 200 Gy (toxic multinodular goitre) and 300 Gy (solitary toxic adenoma). Univariate analysis and multivariate regression modelling were used to find factors linked to treatment outcome.ResultsThe cure rate of hyperthyroidism after one administration of radioiodine was 79% for Graves' disease, 94% for toxic multinodular goitre and 98% for solitary toxic adenoma. Thyroid mass, uptake and effective half-life were all significantly associated with cure in Graves’ disease, but not in toxic multinodular goitre. The rates of therapy-induced hypothyroidism were 20% and 29% for toxic multinodular goitre and solitary toxic adenoma. Neither the cure rate nor the hypothyroidism rate was found to be superior among patients with individualised effective half-life measurements in toxic nodular goitres. Poor renal function was associated with dubious iodine uptake measurements but was not found to correlate with worse outcome.ConclusionsMultiple measurements of individual iodine uptake for kinetics estimation may be unnecessary, and a population-based value can be used instead. Patients with renal impairment had similar outcome as other patients, but with a higher risk of dubious uptake measurements.

Navigating the Debate on Managing Large (≥4 cm) Thyroid Nodules.

Purpose Discordant practice guidelines for managing large thyroid nodules may result in unnecessary surgeries and costs. Recent data suggest similar false-negative rates in fine needle aspiration (FNA) biopsies between small (<4 cm) and large (≥4 cm) nodules, indicating that monitoring rather than surgery may be appropriate for large biopsy-negative nodules. We investigated the management of thyroid nodules ≥4 cm to determine the proportion of surgeries not necessary for diagnostic purposes and examined for potential predictors. Methods This was a retrospective cohort study of patients who received a FNA of nodule(s) ≥4 cm between 11/1/2014 and 10/31/2019 at the University of Vermont Medical Center. A surgery was considered unnecessary if the FNA result was benign in the absence of any of the following: compressive symptoms, family history of thyroid cancer in a first degree relative, history of neck irradiation, toxic nodule or toxic multinodular goiter, or substernal extension. Data were analyzed with Wilcoxon rank sum tests, chi square, or Fisher's exact tests. Results 177 patients had a ≥4 cm nodule during the timeframe and half (54.2%) had surgery. Patients who underwent surgery were significantly younger (51.5 years vs. 62 years; P < 0.001), more likely to report obstructive symptoms (34.4% vs. 12.1%; P < 0.001) and had a larger nodule size (5.0 cm vs. 4.7 cm; P=0.26). Forty-one patients with benign (Bethesda II) FNA results had surgery, all with negative surgical pathology. Thirteen percentage (23/177) of surgeries were potentially not necessary for diagnostic purposes. Conclusion Approximately half of our patients with ≥4 cm nodules had surgery, with 13% having surgery not necessary for diagnostic purposes revealing opportunities for improving care and costs.

PAPILLARY THYROID CARCINOMA CONCOMITANT WITH THYROTOXICOSIS

Contrary to the preconceived belief, the occurrence of hyperthyroidism in patients with thyroid cancer is gaining in incidence. The research team retrospectively analysed studies such as serum TSH and T4 levels, thyroid ultrasound results, and the histopathology reports of 9 patients (age range 20-67) from Mardaleishvili Medical Center. All patients were diagnosed with PTC. 7 patients had microcarcinoma (mean 6.1mm) and 2 – large tumors (mean 14mm). Graves’ disease was found in 5 patients, toxic nodular goiter in 3 and one patient’s record was lacking comorbid disease information. One patient had confirmed lymph node involvement. All patients underwent total thyroidectomy. Overall, all 9 patients with hyperthyroidism were subsequently diagnosed with thyroid cancer. Management of such patients has questioned the validity of the guidelines published by the ATA and emphasizes the fact that malignancy should not be excluded in patients with thyrotoxicosis.

Retrospective Evaluation of the Efficiency of Therapeutic Plasmapheresis in Thyrotoxic Patients

Background: Therapeutic plasma exchange (TPE) is a treatment method that can be used to provide euthyroidism before permanent treatment in patients with severe thyrotoxicosis, in cases of thyroid storm and in cases where antithyroid drug (ATD) cannot be used due to side effects or ineffectiveness. This study presented our results and experience on TPE in thyrotoxic patients.&#x0D; Material and Methods: The data of 10 patients who underwent plasmapheresis for thyrotoxicosis in Bursa Uludag University Faculty of Medicine Endocrinology Clinic were retrospectively analyzed and compared with the literature.&#x0D; Results: Ten patients, 6 female and 4 male, were included. The cause of hyperthyroidism was Graves’ disease in 8 patients and toxic multinodular goiter (TMNG) in 2 patients. It was observed that the reason for applying plasmapheresis in the patients was primarily due to toxic hepatitis. The mean number of plasmapheresis required to maintain euthyroidism was 4 (1-8). While no difference was found between the thyroid-stimulating hormone (TSH) results before and after TPE, free T4 (fT4) and free T3 (fT3) values were statistically significantly lower after TPE. It was observed that the leukocytes were considerably higher after TPE and the sodium and calcium values were markedly lower after TPE in the patients. After TPE, 7 patients underwent total thyroidectomy, 1 patient received radioactive iodine (RAI) treatment, and 2 were discharged with ATD treatment.&#x0D; Conclusions: TPE is an effective and safe treatment option that can be applied in cases where it is necessary to provide rapid euthyroidism before permanent treatments or non-thyroid surgical procedures or to treat life-threatening thyrotoxicosis. It requires experience in application and follow-up and provides rapid euthyroidism when performed in experienced centres.

Homoeopathic management of multinodular goitre: A case report

A goitre simply means an enlarged thyroid and can either be a simple goitre or a multinodular goitre where there are multiple nodules. Multinodular goitres can be either a toxic multinodular goitre or non-toxic. It is not known what causes multinodular goitres in most cases, but iodine deficiency and certain genetic factors have been shown to lead to multinodular goitres. Homoeopathy always renders a better response in such conditions; one such case report is submitted below. Patient visited the outpatient department mainly for complaints of pain in the right side of neck, which is aggravated while swallowing and moving her neck to sides for the past 4-5 months. After dissatisfying outcome with modern medicine, patient resorted to homoeopathic treatment. A detailed case-taking and repertorization was done and Phosphorous was given in moderate potency, and repetition was based on the response of the medicine upon patient. Within 1 year 4 months of homoeopathic treatment, the patient has become free from her complains at the time of last follow-up visit in OPD.

FT3 index/TSH index ratio and free thyroid hormone index in the differential diagnosis of thyrotoxicosis

Aim: Common causes of thyrotoxicosis are hyperthyroidism and destructive thyroiditis. Hyperthyroidism is a condition characterized by high serum thyroid hormone levels as a result of over-synthesis of thyroid hormones, the most common causes of which are Graves' disease (GD) and toxic nodular goiter (TNG). Subacute thyroiditis (SAT) causes thyrotoxicosis due to the circulating thyroid hormones of destructive thyroiditis. Differential diagnosis is important because GD, TNG and SAT treatment approaches are different. The aim of this study was to analyze whether it is possible to make a differential diagnosis for these conditions by examining free thyroid hormones, fT3/fT4 ratio, fT3 index/TSH index (fT3I/TSHI) ratio and Free Thyroid Hormone Index (FTHI).&#x0D; Material and Method: This retrospective study included 150 patients who were diagnosed with GD, TNG and SAT. The fT3 index (fT3I) was calculated as the ratio between the fT3 value and the fT3 upper limit of normal value (fT3I=fT3/4 pg/ml). The fT4 index (fT4I) was calculated as the ratio between the fT4 value and the fT4 upper limit of normal value (fT4I=fT4/1.23 mg/dl). The TSH index (TSHI) was calculated as the ratio between TSH value and the TSH lower limit of normal limit (TSHI=TSH/0.38 mIU/L). The FTHI index was calculated using the formula of (fT3 level/fT3 upper limit of normal) / (fT4 level/fT4 upper limit of normal).&#x0D; Results: The fT3, fT3/fT4 ratio and FTHI were found to be higher in hyperthyroid patients compared to subacute thyroiditis patients. fT4 and fT3I/TSHI levels were similar in hyperthyroid patients and SAT patients (p=0.49, p=0.11, respectively ). The cut-off level of FTHI for hyperthyroidism was determined as 0.97 with sensitivity of 75% and specificity of 76.3% (AUC=0.833, p&lt; 0.001). When hyperthyroidic patients were divided into two groups as GD and TNG, no significant difference was found in fT3/fT4 ratio (p:0.99). The fT3 (p

The prevalence and significance of nonuniform thyroid radio-isotope uptake in patients with Graves' disease.

ObjectiveTo evaluate the prevalence and clinical significance of nonuniform technetium (99mTc) uptake among patients with Graves’ disease (GD).Design, Patients and MeasurementsPatients with GD, referred between July 2005 and March 2018, had Tc99‐ uptake scans and TSH‐receptor antibody (TRAb) measured before antithyroid drug (ATD) therapy. Risk of relapse after ATD cessation was monitored until June 2021 and compared between GD patients based on uptake patterns.ResultsOf the 276 GD patients (mean age, 49.8 years; 84% female), 25 (9.0%) had nonuniform Tc99 uptake. At diagnosis, individuals with nonuniform uptake were older (mean age of 61.8 vs. 48.5 years, p < .001), had lower mean thyroid hormone levels (free thyroxine: 36.3 vs. 45.4 pmol/L, p = .04 and free triiodothyronine: 10.0 vs. 17.8 pmol/L, p < .001) and median TRAb levels (4.2 vs. 6.6 U/L, p = .04) compared with those with a uniform uptake. Older age was a significant predictor for the presence of nonuniform uptake in GD patients; odds ratio (95% confidence intervals) of 1.07 (1.03 – 1.10). The risk of relapse was similar in both groups after a median (IQR) follow‐up of 41 (13–74) months after ATD cessation (56.0% vs. 46.3%, respectively); hazard ratio (95% confidence intervals) of 1.74 (0.96–3.15).ConclusionsNonuniform radio‐isotope uptake is seen in 1 in 11 patients with GD which could be misdiagnosed as toxic multinodular goitre if TRAb levels are not measured. Treatment of GD patients with nonuniform radio‐isotope uptake with ATD therapy as first‐line appears to be equally effective as compared with those with uniform uptake. TRAb testing should be the main diagnostic test for patients with suspected GD with radio‐labelled uptake scans being reserved for those who are TRAb negative.

Radioactive Iodine for the Treatment of Subclinical Thyrotoxicosis Grade 1 and 2: Outcome of up to 18-Year Follow Up.

BackgroundSubclinical thyrotoxicosis (SCT) is associated with significant morbidity and mortality, specifically increased risk of atrial fibrillation and cardiovascular death. The management is ill-defined due to the scarcity of randomised controlled studies. Some clinicians recommend radioiodine (RAI) treatment however its long-term outcome is unknown. Therefore, further data is needed to provide robust evidence-based guidelines.MethodsA prospective, single-protocol analysis of the outcome of SCT patients (Grade 1; 0.1-0.4 mIU/L and Grade 2; <0.1 mIU/L) treated with mean dose of 427 MBq of I131, followed up for up to 18 years. Thyroid function tests were measured at 4-6 weeks, 3-, 6-, and 12-months post-RAI, and annually thereafter. Cure was defined as achieving a euthyroid/hypothyroid state.ResultsSeventy-eight patients with a median age of 68 years (range 36-84) and varying aetiology [55 toxic multinodular goitre (TMNG), 10 toxic nodule (TN) and 13 Graves’ disease (GD)] were followed up for a median period of 7.5 years (range 1-18). The cure rate was 100%. The rates of hypothyroidism in TMNG, TN and GD were 23.6%, 30% and 38.5% respectively. The median time to hypothyroidism was 6 and 12 months in GD and TMNG/TN respectively. No differences in outcome between Grade 1 versus Grade 2 were observed.ConclusionRAI using single mean dose of 427 MBq is effective and safe, irrespective of aetiology or grade of TSH suppression. GD patients become hypothyroid within the first year, whilst TMNG/TN for up to 9-years. Thus after 12 months of follow up, annual thyroid function monitoring is advised.

Epidemiology of benign thyroid disorders in the adult population of the Republic of Belarus: analysis of nationwide statistics 2009 to 2019

Nowadays, the Republic of Belarus belongs to the countries with sufficient iodine supply, which made it possible to reduce the incidence of non-toxic goiter and congenital hypothyroidism. However, even a slight change in iodine consumption influences the pattern of thyroid diseases. In addition to iodine deficiency, other environmental conditions, aswell as genetic factors, play a significant role in the etiology of thyroid diseases. To analyze the dynamics of the main epidemiological indicators of benign thyroid diseases from 2009 to 2019 in theadult population of the Republic of Belarus, using the data of official state statistics. The indicators of the incidence and prevalence of benign thyroid diseases were studied on the basis of state statistics for 2009-2019. To analyze the dynamics of the studied indicators, regression analysis was used with the construction of linear and polynomial models. A decrease in the incidence and prevalence of diffuse euthyroid goiter and an increase in the incidence and prevalence of nodular euthyroid goiter, thyroiditis, acquired hypothyroidism, Graves' disease, as well as the incidence of nodular toxic goiter were revealed. Obtained data indicate, that there is an increase in the prevalence of most of the studied thyroid diseases, despite the adequate iodine supply. The above justifies the need for further study of the causes of the identified trends, as well as the necessity of developing new methods of diagnosis and treatment of thyroid diseases.

Clinical Efficacy And Cure Rate Of Fixed Dose Radioactive Iodine For The Treatment Of Hyperthyroidism: A Single Centre Study

Abstract Introduction Iodine-131 is an effective treatment for thyrotoxicosis. In 2019, the National Institute for Clinical Excellence (NICE) guidelines suggested offering radioactive iodine as first-line definitive treatment for adults with Graves’ disease, toxic nodular and multinodular goitre unless it is unsuitable or anti-thyroid drugs are likely to achieve remission. The aim of this study was to evaluate the clinical outcome one year after using fixed dose Iodine-131 for hyperthyroidism and to identify any associated factors. Methods Electronic patient records were studied retrospectively for all patients who were treated with radioiodine therapy for hyperthyroidism between July 2017 and March 2020 at a district general hospital in the UK. Response to radioiodine therapy was assessed at 6 and 12 months by a dedicated thyroid nurse-led virtual follow-up. Results We identified 67 patients with a mean age of 55.9 years (range 18–84); 48 (72%) females, 19 (28%) males. Of these, 57 (85%) patients were cured at 12 months (93.7% in non-Graves’, 82.3% in Graves’ group). Gender, diagnosis, and pre-treatment disease interval were not significantly associated with treatment success. Non-Graves’ patients had a significantly shorter time to discharge than Graves’ patients receiving Iodine-131 (8 vs 10.3 months, p=0.0174). Conclusions The results of the present study demonstrate that a single fixed dose of Iodine-131 therapy is highly effective and comparable to outcomes from calculated dose therapy in literature. We propose the routine use of scoring system to calculate risk of relapse for all newly diagnosed hyperthyroid patients to tailor treatment modality.

Abstract 84: Clinical and aetiological spectrum of thyrotoxic patients: A multi-centre analysis

Background: Thyrotoxicosis may present with variety of symptoms and aetiologies. Its aetiology can be ascertained on the basis of history, clinical presentations, biochemistry and imaging, to manage thyrotoxicosis appropriately.Aims and objectives: To study clinical profile and aetiology among thyrotoxic patients.Results: We collected data of newly diagnosed thyrotoxic patients at 3 endocrinology clinics over 1 year (01/09/2016-31/08/2017). Total 263 patients were included in the study at New Delhi (109), Gurugram (99), Lucknow (55). Thyrotoxicosis was more common in females (70.8%) than males (29.2%). Thyroiditis (subacute 110, 85.9%, painless 9, 7% and postpartum 5, 3.9%) was present in 128 (48.7%) patients, 115 (43.7%) had Graves’ disease and 20 (7.6%) had nodular thyrotoxicosis (7 Solitary toxic nodule, 13 toxic multinodular goitre). Graves’ disease was most common cause of thyrotoxicosis in New Delhi (53.2%) and Lucknow (58.2%), while subacute thyroiditis in Gurugram (71.7%). Family history of thyroid disease was more prevalent in patients with Graves’ disease (48.7%) than nodular thyrotoxicosis (25%) and thyroiditis (11.7%). Thyrotoxicosis symptoms like excessive sweating (52.8%) and weight loss (47.7%) was more common with thyroiditis, while tremors (60.4%), diarrhea (56.5%), insomnia (50.9%), were more common with Graves’ disease.Conclusion: Graves’ disease and subacute thyroiditis constitute the majority of patients suffering from thyrotoxcosis. Proper clinical evaluation and investigations are key to manage these patients.

Hyperthyroidism and Thyroid Cancer in the Congolese Hospital Setting

Background: Hyperthyroidism was long considered a protective factor for the development of thyroid cancer. The association between hyperactive thyroid and cancer was rare. More recent studies have highlighted an association between hyperthyroidism and development of cancers, especially thyroid cancer. Given the lack of publication on the association of hyperthyroidism and thyroid cancer in the Democratic Republic of Congo (DRC), the present study was carried out to confirm the existence of this association in Congolese hospitals. Methods: This is a retrospective and descriptive study, which involved 106 cases of thyroid cancer recorded in the anatomopathology registers of four laboratories in the city of Kinshasa between 2005 and 2019. The p-value &lt;0.05 was considered as the threshold of statistical significance. Results: Out of 106 cases of thyroid cancer, the association of hyperthyroidism and thyroid cancer was found in 5 cases (4.7%) (3.6% for women vs. 9% for men). The mean age of patients with this association was 51 ± 11 years. Papillary carcinoma (two cases), follicular carcinoma (two cases) and lymphoma (one case) were the types of cancer encountered. Etiologically, toxic multinodular goiter (four cases: 80%) and toxic adenoma (one case: 2%) were found. Conclusion: There is an association between hyperthyroidism and thyroid cancer in the Congolese hospital setting. There is a predominance of the female gender. There were an equal number of papillary and follicular carcinomas. With this study, we hope to encourage clinicians to thoroughly evaluate any suspicious nodule associated with hyperthyroidism.

Hyperthyroidism and Thyroid Cancer in the Congolese Hospital Setting

Background: Hyperthyroidism was long considered a protective factor for the development of thyroid cancer. The association between hyperactive thyroid and cancer was rare. More recent studies have highlighted an association between hyperthyroidism and development of cancers, especially thyroid cancer. Given the lack of publication on the association of hyperthyroidism and thyroid cancer in the Democratic Republic of Congo (DRC), the present study was carried out to confirm the existence of this association in Congolese hospitals. Methods: This is a retrospective and descriptive study, which involved 106 cases of thyroid cancer recorded in the anatomopathology registers of four laboratories in the city of Kinshasa between 2005 and 2019. The p-value &lt;0.05 was considered as the threshold of statistical significance. Results: Out of 106 cases of thyroid cancer, the association of hyperthyroidism and thyroid cancer was found in 5 cases (4.7%) (3.6% for women vs. 9% for men). The mean age of patients with this association was 51 ± 11 years. Papillary carcinoma (two cases), follicular carcinoma (two cases) and lymphoma (one case) were the types of cancer encountered. Etiologically, toxic multinodular goiter (four cases: 80%) and toxic adenoma (one case: 2%) were found. Conclusion: There is an association between hyperthyroidism and thyroid cancer in the Congolese hospital setting. There is a predominance of the female gender. There were an equal number of papillary and follicular carcinomas. With this study, we hope to encourage clinicians to thoroughly evaluate any suspicious nodule associated with hyperthyroidism.

Efficacy of preoperative therapeutic plasma exchange in patients with hyperthyroidism and factors affecting the number of sessions

Achieving preoperative euthyroidism in patients with hyperthyroidism for whom antithyroid drugs (ATDs) cannot be used for treatment is a serious clinical problem. We aimed to evaluate the effectiveness of therapeutic plasma exchange (TPE) in hyperthyroid patients scheduled for surgery and predictive factors for a high number of TPE sessions. We retrospectively analyzed the data of 21 patients with hyperthyroidism who were treated with TPE for preoperative euthyroidism in our institution. Pre- and post-TPE thyroid function tests were compared to assess efficacy. Binary logistic regression analysis was applied to determine predictors of patients requiring a high number of TPE sessions. All patients (20 patients with Graves' disease and 1 patient with toxic multinodular goiter; 12 women and 9 men; mean age 35.71 ± 12.38 years) had severe hyperthyroidism before TPE. The changes before and after TPE in fT3, fT4, and TSH levels were statistically significant (p < 0.001, p < 0.001, p = 0.002, respectively). The median number of TPE sessions was 8 (range: 1-24). Levels of fT3 before TPE were significantly higher in patients for whom higher numbers of TPE sessions were required (≥8) (OR: 1.427, 95% CI: 1.038-1.961, p = 0.028). Receiver operating characteristic curve analysis revealed an optimum cut-off value of 12.8 pg/ml for fT3 before TPE (91% sensitivity, 80% specificity, area under the curve: 0.927). TPE should be considered as an effective alternative treatment option that can be used to rapidly achieve euthyroidism before surgery when ATDs cannot be used. Pre-TPE fT3 levels of >12.8 pg/ml may be an independent factor predicting the need for higher numbers of TPE sessions (≥8).

Eventual Exploration of Thyroidal Surgical Treatment and its Obstacle Proportion Between Hundred Designated Instances

Aim: In this eventual descriptive research the aim is to evaluate various obstacle of pancreatectomy and how to minimize the possible obstacles. Place and duration: For three years duration from December 2016 to November 2019, the research was led on 100 victims with thyroidal gland treated in the Department of Surgical treatment Unit II, Sir Ganga Ram Hospital Lahore. Methodology: Details have been added in a proforma. This research covers all thyroidal goiter instances and were hospitalized. Results: 10 had diff use toxic goitre; 3 victims had toxic multinodular goitre and 1 had toxic adenoma. 100 victims were operated in the above period. 90 women and 10 men; therefore, the ratio of women to men was observed in this research as 9: 1. 60 of these victims had non-toxic multi-molecular goiter; 22 simple diff use goitre; Conclusion: An experienced surgeon should perform thyroidal surgical treatment to prevent obstacles. Thyroidal goiter is a common surgical disorder. We concluded that all victims should be carefully inspected and thoroughly examined. Keywords: Toxic nodule, pancreatectomy Multi-nodular goiter.