Toxic Multinodular Goiter Research Articles

Analiza farmakoterapijskog pristupa kod pacijenata obolelih od hipertireoze

Introduction: Hyperthyroidism represents a condition that occurs due to increased synthesis of thyroid hormones (T3, T4). In 90% of all cases it is caused by: Graves' disease, toxic multinodular goiter and toxic adenoma. Therapy of hyperthyroidism includes medication, radioiodine treatment and surgery. The most prescribed antithyroid drugs belong to the thioamide group (thiamazole and propylthiouracil). Aim: The aim of this study was to analyze the preoperative pharmacotherapeutic approach with the use of 3 drugs from the thioamide group (PTU® (propylthiouracil), Thyrozol® (thiamazole) and Tiastat® (thiamazole) in relation to the demographic and clinical characteristics of patients with hyperthyroidism. Material and methods: The study was conducted as a retrospective study among 62 patients aged 18 to 84 years, who reported to the Center for Endocrine Surgery KCS for the operative treatment of hyperthyroidism in period 2014-2019. Results: Diagnosis of Graves' disease was detected in 35.48% of patients, where 32.26% had toxic multinodular goiter, and 32.26% toxic adenoma. The most patients were prescribed Tiastat® (45.16%), 29.03% of them were prescribed PTU®, and 25.8% of them Thyrozol®. The most of patients suffering from Graves' disease were treated with Tiastat®, those suffering from toxic adenoma with PTU® and toxic multinodular goiter with Tiastat®. The most commonly used doses were 100 mg/day for PTU®, 20 mg/day for Tiastat® and 20 and 30 mg/ day for Thyrozol®. Total thyroidectomy is most commonly performed in patients treated with Tiastat® and hemithyroidectomy in those treated with PTU®. It was observed that there was a statistically significant difference (p < 0.05) in the use of individual drugs regarding to diagnosis, total daily dose of drug, body mass index and type of surgical procedure. Conclusion: The most of patients were prescribed Tiastat®. Pharmacotherapeutic approach in paients with hyperthyroidism is in accordance with the national guidelines.

Histopathological Evidence of Thyroid Dermopathy and its Correlation with Thyroid-Associated Orbitopathy in Patients with Graves' Disease having Normally Appearing Pretibial Skin: A Case-Control Study.

Objective:Thyroid dermopathy (TD), reportedly encountered in less than 5% of patients with Graves’ disease (GD), is supposed to coexist only with thyroid-associated orbitopathy (TAO). However, clinically inapparent TD, detected non-invasively by thermal imaging or ultrasonography, seems to be present in a larger proportion of GD. Histopathological examination (HPE), though considered as gold standard for detecting TD, has not been performed widely to identify subclinical TD in GD.Materials and Methods:In this single-centre, cross-sectional, case-control study, 50 patients with GD (cases) and normal appearing pretibial skin were compared with 45 age- and sex-matched individuals (39 healthy volunteers, 3 with toxic multinodular goitre and 3 with solitary toxic nodule) (control). All patients were evaluated clinically for presence of TAO. Punch biopsy specimens were obtained from the pretibial skin in all 95 participants. Tissue sections were examined under light microscopy for mucin deposition, splitting of collagen fibrils and perivascular lymphocytic infiltration.Results:Sixty per cent of patients with GD demonstrated at least one of the above three histological features, while 52% had any combination of two features and 46% harboured all the three features. Mucin deposition, splitting of collagen fibrils and lymphocytic infiltration were found overall in 52%, 54% and 52% of GD, respectively; 4.4–11.1% of controls also had some evidence of TD on HPE. Subclinical TD was not related to age, duration of disease and TAO in our study.Conclusions:TD, particularly in its subclinical form, Seems to be widely prevalent in GD (46–60%) and exists even in absence of TAO. HPE, though more sensitive than the various non-invasive tests, is not specific (ranges from 89% to 95%) for TD. However, HPE can accurately diagnose TD in appropriate clinical background.

Comparison of clinical efficacy of antithyroid drugs, radioactive iodine, and thyroidectomy for treatment of patients with graves' disease, toxic thyroid adenoma, and toxic multinodular goiter

Comparison of clinical efficacy of antithyroid drugs, radioactive iodine, and thyroidectomy for treatment of patients with graves' disease, toxic thyroid adenoma, and toxic multinodular goiter

Is hemithyroidectomy sufficient in unilateral benign nodular goitre?

Multinodular goiter is a common disease. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to reduce complication and hormone replacement therapy. However, completion thyroidectomy may be required later. The aim of the study was to evaluate the role of completion thyroidectomy in patients who develop nodules after hemithyroidectomy, and we aimed to find the ratio of patients who required hormone replacement for permanent hypothyroidism. Patients who underwent hemithyroidectomy for benign nodular goitre between January 2012 and June 2017 were analyzed. The age of the patients, gender, number of nodules and dimension of the largest nodule, preoperative fine needle aspiration biopsy results, and postoperative histopathology findings were recorded. The need for completion thyroidectomy and need for postoperative L-thyroxine treatment were based on these parameters. A total of 170 patients were included in the study. During the follow-up period new nodule or progression in existing nodule was observed in 23% (39 patients) of the cases. Permanent hypothyroidism requiring L-thyroxine treatment was observed in 31% (53 patients) of the cases. In this study, young age, multiple nodules and toxic nodular goitre diagnosis were noted to be independent risk factors that contributed to progression diseases in cases operated for benign nodular goitre. Due to low reoperation risk and acceptable permanent hypothyroidism rates, hemithyroidectomy is a viable option for benign goitre cases. The patients should be on follow-up for possible complications, especially hypothyroidism, for at least a year.

Recurrent and Metastatic Papillary Thyroid Microcarcinoma Presenting as Toxic Multinodular Goiter

Recurrent and Metastatic Papillary Thyroid Microcarcinoma Presenting as Toxic Multinodular Goiter

AACE2021-A-1020: Toxic Multinodular Goiter: Epidemiological, Clinical, Biochemical and Radiological Features

Toxic multinodular goiter is one of the important causes for retrogradation of patients’ health. For this reason, the purpose of this study is to identify the incidence of toxic multinodular in patients admitted to Sultan Qaboos University Hospital (SQUH) and to describe epidemiological, clinical, biochemical and radiological characteristics for toxic multinodular goiter patients. A retrospective study was conducted among Omani patients and the collected data were searched for all patients who had abnormal thyroid function test and admitted to thyroid clinic at SQUH, it included patients age above 20 with abnormal thyroid scan or patients with goiter or symptoms of hyperthyroidism at time of clinical presentation. However, we excluded pregnant women, thyroid cancer patients, and those who present with hypothyroidism. A total of 66 patients were included base on the diagnosis of TMG on biochemical, thyroid ultrasound scan and thyroid uptake scan for 930 patients demonstrated in SQUH at specified duration. We discovered that the incidence rate of toxic multinodular goiter was 71 new cases per 1000 people done thyroid uptake scan. The male to female ratio was 1:12 with mean and median age 50 (SD ± 14.3), the disease was founded in females with (92.4%) of total patients. The most reported symptom was palpitations and the most sign was goiter and tenderness. The presence of thyroid nodules was founded in (97%) of patients with TMG. In thyroid scintigraphy, (50%) of a total of 66 patients were founded to have normal Tc-99 uptake. Thyroid hormones test showed that the majority of patients (51.5%) appeared with normal level of FT4 and (68.2%) had suppressed in their TSH level. In pathological findings, (79.5%) of 39 patients who done FNA were found to be benign with Bethesda II classifications. the managements offer to our patients was carbimazole with (47%), radioactive iodine treatment was given to (13.6%) of patients and surgery was proceed in (15.2%) of patients. Toxic multinodular goiter is a common thyroid disorder in our environment, presenting with hyperthyroidism and neck swelling. Our study showed that TMG IS more common in females compared to males with palpitation as the most common clinical presentation followed by multiple nodules. The treatment offered to our patients was carbimazole as first line, while radiotherapy was the most common permanent cure. Surgery was performed in patients with huge neck swelling and obstructive symptoms.

Surgical hyperthyroidism: Epidemiological aspect and management difficulties in the visceral surgery department of the Donka National Hospital

Introduction: The aim of this study was to assess the epidemiological aspect and the difficulties associated with the surgical management of hyperthyroidism in our context. Hyperthyroidism is an over function of the thyroid gland resulting in thyrotoxicosis. Thyroidectomy is one of the Main treatments. It also uses synthetic antithyroid drugs, radioactive iodine. Methodology: We carried out a descriptive 6-year retrospective from January 1, 2011 to December 31, 2017 inclusively. Our study variables were qualitative and quantitative, Results: During our study, 26 cases were collected between January 2011 and August 2017 with a predominance of 73% female and an average age of 52, 78 years. The clinic was dominated by the signs of thyrotoxicosis which were found in all patients. The exploration identified 14 cases of toxic multi-hetero nodular goiter, ie 53.84%; 9 cases of basal disease 34, 66% and 3 cases of toxic adenoma 11, 54%. Medical preparation was required in all our patients Total thyroidectomy was performed in one patient, i.e. 4%, and Lobo isthmectomy in 24 patients, ie 96%. Postoperatively, complications were collected: 1 case of intraoperative hemorrhage 20%; 1 case of postoperative hematoma 20%; 1 case of dysphonia 20%. Conclusion: Surgery for toxic goiter known to be hemorrhagic and adherent should be performed after obtaining euthyroidism and double vigilance to minimize the morbidity represented mainly by laryngeal paralysis and hyperparathyroidism

Thyrotoxicosis treatment with lithium corbanate. Cases reported

Treatment of thyrotoxicosis caused by Graves’ disease or multinodular toxic goiter, is not difficult, in most cases, since the prescription of thionamides allows to normalize the level of thyroid hormones quickly and safety. But in a number of cases this therapy might be associated with serious side effects (agranulocytosis, toxic hepatitis, cholestasis), severe allergic reactions and also individual intolerance on thionamides. In such cases lithium carbonate is used, especially in severe thyrotoxic syndrome. It is known, that lithium can accumulate in the thyroid gland at a concentration 3–4 times higher than in the plasma. Perhaps, lithium uses Na+/I- ions. It can inhibit the synthesis and secretion thyroid hormones of thyroid gland. The article presents the cases reported the use of lithium carbonate in thyrotoxicosis treatment before thyroidectomy. Administering low doses of carbonate lithium (900 mg/ per day) renders significant decrease or normalization of thyroid hormones concentration within 7–14 days, thus it let perform thyroidectomy on the patients. No side effects have been identified with such a short course of lithium carbonate treatment.

Lateral neck ectopic thyroid carcinoma: Rare location for ectopic malignancy.

Lateral neck ectopic thyroid tissue remains a rare entity that can be affected by any lesion involving the gland. The origin of lateral neck ectopic thyroid carcinomas still debated between a metastatic disease secondary to thyroid primary tumor and primary malignancy on the ectopic tissue. Anyway, it should indicate an exploration of the gland.We report the case of a 36 years old female with one year history of hyperthyroidism who was admitted for multinodular grade II goiter with a firm mass in the left level II of the lateral neck. The thyroid scintigraphy demonstrated multiple functioning nodules corresponding to toxic multinodular goiter; in addition to two cold hypofunctional nodules. The cervical ultrasound showed a voluminous multinodular goiter classified as EU TIRADS 5. The surgical procedure exposed a multinodular mass, lateral to the internal jugular vein, with the appearance and structure of the thyroid gland and no connection to it. The thyroid gland was exposed next through a collar incision. Each mass was dissected and removed individually. The histopathology examination of the thyroid gland found papillary carcinoma extracapsular extension. The pathology results of the other mass reported multiple colloid nodules with cystic component, papillary in appearance, with the same cancer proliferation, compatible with ectopic thyroid tissue with papillary carcinoma. No lymph node tissue was found. The patient was sent for complementary RAItherapy.We report a rare case of lateral neck ectopic thyroid papillary carcinoma that supplements and supports the lacking literature data concerning the management of this rare entity.

Thyroid Gland Disease as a Comorbid Condition in COPD.

Introduction Chronic obstructive pulmonary disease (COPD) is one of the most common causes of morbidity and mortality worldwide. The disease is characterized by progressive airway inflammation, which not only affects the airways but also has systemic effects that are associated with comorbidities. Although comorbid conditions such as hypertension and coronary artery disease are very well-known in COPD patients, diseases of the thyroid gland have not been sufficiently studied. Therefore, thyroid diseases are not considered among the comorbid conditions of COPD. The purpose of this study was to determine the thyroid gland disease (TGD) prevalence in COPD and associated factors. Materials and Method. The study included 309 (297 (96%) male) patients. The patients were subjected to spirometry and thyroid function tests (TFT) in the stable period. The thyroid gland disease they were diagnosed with was recorded after face-to-face meetings and examining their files. Results The mean age of the patients who were included in the study was 65.9 ± 9.8 (40-90). Thyroid disease was determined in 68 (22%) individuals. There were hypothyroidism in 7 (2%), euthyroidism in 45 (15%), and hyperthyroidism in 16 (%5) patients. No relationship was found between the severity of airflow limitation and the prevalence of TGD. Conclusion Thyroid abnormalities are commonly observed in COPD. The most frequently encountered TGDs are euthyroid multinodular goiter, euthyroid sick syndrome (ESS), and toxic multinodular goiter.

Does Marine Lenhart Syndrome really exist?

Primary hyperthyroidism is the result of overproduction of thyroid hormone resulting in the classic symptoms of tachycardia, weight loss, diaphoresis, and hyperdefecation. There are multiple common causes to include Graves’ disease, toxic multinodular goiter, and solitary toxic adenomas. Marine Lenhart Syndrome (MLS) is a rare cause of hyperthyroidism, caused by a coexistence of constitutively active thyroid nodules and Graves’ disease. In the original document of Marine and Lenhart, there is no distinction made between the autoimmune phenomenon of Graves’ disease and the solitary toxic nodule of Plummer’s disease. Rather they are both considered to be the manifestation of the same disease. However, in the current era of radionuclide technology, a clear distinction of MLS can be seen with diffuse uptake in the thyroid gland and focused enhancement in the toxic nodules. Therefore what was previously described as one entity is now distinct as Graves’ disease and Plummer’s disease. It is also becoming increasingly clear within the literature that there is also a new phenomenon of post-radioiodine immunogenic hyperthyroidism in patients with toxic nodules and elevated autoantibodies. Therefore in order to properly treat and manage patients, a new definition of MLS may need to be proposed.

FOXP3 and IL-10 overexpression: A novel diagnostic biomarker in Iraqi patients having hyperthyroidism treated with radioactive iodine

BackgroundThyroid gland diseases are public health problem worldwide. Further studies are still needed to investigate novel markers for prognosis of thyroid glands after internal radiation exposure. MethodologyqPCR was used to quantitatively determine the expression of FOXP3 and IL-10 transcripts in human whole blood samples of hyperthyroidism and normal health control individuals. ResultsLow level of FOXP3 gene expression (P < 0.01) observed in blood samples of Graves' disease and toxic multinodular goiter patients in comparison to the normal healthy control individuals. Results showed that FOXP3 gene expression increased significantly (P < 0.01) after one and four months of treatment with two doses of RAI-131 (10 and 20 mCi respectively). In contrast, high expression of IL-10 observed in Graves' disease patients, it increased significantly (P < 0.01) after one month of treatment, while it decreased significantly after four months of treatment. There was a significant correlation (P < 0.01) between FOXP3 and IL-10 gene expression before and after one month of treatment with RAI-131 (r = 0.152, and 0.446, respectively). ConclusionFOXP3 and IL-10 gene expression levels in patients having Hyperthyroidism might be effective diagnostic biomarker. The increase in IL-10 and FOXP3 after radiotherapy enhances immunological response of T cell and immune system. It optimizes the opportunity of detection and remission of autoimmune thyroid disease.

Fixed 30 mCi (1110 MBq) 131I-iodine therapy in autonomously functioning nodules: Single toxic nodule as a predictive factor of success.

ABSTRACTAims:The aim of this study is to evaluate the efficacy of a fixed 30 mCi (1110 MBq) 131I-iodine dose for the treatment of hyperthyroidism due to uninodular or multinodular toxic goiter and identify predictors of success.Materials and Methods:Fifty-nine patients diagnosed with nonautoimmune toxic goiter were treated with a fixed 30 mCi dose of 131I-iodine and were followed at a tertiary service between 2000 and 2016. The therapy was considered successful if the patient reached euthyroidism or hypothyroidism without needing an extra 131I-iodine dose or antithyroid drugs for at least 1 year after the radioiodine therapy (RIT).Results:Patients with a single toxic nodule were younger at diagnosis (52 vs. 63 years; P = 0.007), presented a shorter disease duration until RIT (2 vs. 3.5 years; P = 0.007), smaller total thyroid volume (20 vs. 82 cm3; P = 0.044), and lower pre-RIT thyroid uptake (P = 0.043) than patients with multinodular goiter. No significant difference was seen with antithyroid drug use, thyroid-stimulating hormone and free thyroxine level, and follow-up after RIT. After RIT, 47 patients (79.66%) met the success criteria, and 12 (20.33%) remained hyperthyroid. Among the success group, 32 (68.08%) reached euthyroidism, while 31.92% developed hypothyroidism after 1 year. Patients with single toxic nodules who achieved success after RIT presented smaller nodules (2.8 vs. 5.75 cm; P = 0.043), while the pre-RIT thyroid uptake was higher among patients with multinodular toxic goiter who achieved success after RIT (5.5% vs. 1.5%; P = 0.007). A higher success rate was observed among patients with a single toxic nodule than those with a toxic multinodular goiter (92.3% vs. 55%; P = 0.001), and a single toxic nodule presentation was found to be an independent predictor of success (P = 0.009).Conclusions:The fixed 30 mCi 131I-iodine dose was particularly effective in the group of patients with single autonomously functioning nodule rather than the group with multiple nodules. A single toxic nodule was an independent predictor of treatment success.

Time to Euthyroidism and Its Determinants Among Thyrotoxicosis Patients on Anti-Thyroid Drug Who Attend to Medical and Ambulatory Clinics of South Tigrai General Hospitals.

PurposeTo determine the time to euthyroidism and its determinants among thyrotoxicosis patients on anti-thyroid drug attending the medical and ambulatory clinics of South Tigrai General Hospitals, Ethiopia, 2015–2020.MethodsA multi-center retrospective cohort study was conducted from March 30, 2020, to July 30, 2020, among adult thyrotoxicosis patients who received anti-thyroid medications in the medical and chronic ambulatory clinics of South Tigrai General Hospitals, Ethiopia. Epi-data manager version 3.1 software was used for data entry and then exported to STATA version 15 for windows for analysis. Cox proportional hazards regression model was used to determine the determinants of time to euthyroidism and the summary measures of the adjusted hazard ratio with a 95% CI were presented, and P-value < 0.05 used to declare the statistical significance.ResultsOne hundred and seventy-five (51.9%) thyrotoxicosis patients become euthyroid with the median time to euthyroidism of 9 months, IQR (6–12) months, with a total of 5542 person-months of observation. Age greater than 40 years (AHR = 0.7; 95% CI 0.54–0.96), toxic multi-nodular goiter (AHR = 0.69; 95% CI 0.60–0.87), World Health Organization goiter size three (AHR = 0.78; 95% CI 0.54–0.82) and baseline free thyroxin (AHR = 0.96; 95% CI 0.80–0.99) were the independent determinants of delayed time to euthyroidism.ConclusionThe time to euthyroidism was longer than the expected time. High baseline free thyroxin, toxic multinodular goiter, elderly patients, and patients with World Health Organization goiter size three were determinants of delayed time to euthyroidism.

Assessment of risk factors for post-operative hypocalcemia after thyroid surgery

Background and Aim: Early Hypocalcemia is the most frequent complication after thyroid surgery. Several studies have tried to identify factors affecting hypocalcemia following thyroid surgery. Present study was done to evaluate risk factors for post-operative hypocalcemia after thyroid surgery. Material and Methods: This prospective study was conducted in the department of general surgery Tertiary care institute of Gujarat for the duration of 1 year in 80 patients who had undergone total, near-total thyroidectomy. Ultrasound imaging of the thyroid gland and the neck was conducted in order. Patients undergoing total/near-total thyroidectomy had their data collected through careful history collection, rigorous clinical examination, appropriate radiographic, hematological studies including serum calcium and serum albumin, operative findings, and post-operative hypocalcemia follow-up. Results: Out of the total 80 surgeries done, 20 were hemithyroidectomy and 60 were total thyroidectomy. 37 patients with swelling/goiter, 16 patients with toxic features, and 14 patients with thyroiditis underwent thyroidectom. Based on the histopathological report, Hashimoto thyroiditis was higher in the study. 4 in 11 patients with toxic multinodular goiter had hypocalcemia, followed by 5 cases with Thyroid adenomas, 1 case with Graves’ disease had hypocalcemia after thyroidectomy. 22 patients had hypocalcemia after thyroidectomy. Conclusion: The findings reveal that the only variables that influence early hypocalcemia development are sex, surgical method, and perioperative changes in serum calcium. Thus, prophylactic and therapeutic management may be quite similar to the recommendations in primary total thyroidectomies.

Hyperthyroidism in adolescents.

The term 'hyperthyroidism' refers to a form of thyrotoxicosis due to inappropriate high synthesis and secretion of thyroid hormone(s) by the thyroid. The leading cause of hyperthyroidism in adolescents is Graves’ disease (GD); however, one should also consider other potential causes, such as toxic nodular goitre (single or multinodular), and other rare disorders leading to excessive production and release of thyroid hormones. The term 'thyrotoxicosis' refers to a clinical state resulting from inappropriate high thyroid hormone action in tissues, generally due to inappropriate high tissue thyroid hormone levels. Thyrotoxicosis is a condition with multiple aetiologies, manifestations, and potential modes of therapy. By definition, the extrathyroidal sources of excessive amounts of thyroid hormones, such as iatrogenic thyrotoxicosis, factitious ingestion of thyroid hormone, or struma ovarii, do not include hyperthyroidism. The aetiology of hyperthyroidism/and thyrotoxicosis should be determined. Although the diagnosis is apparent based on the clinical presentation and initial biochemical evaluation, additional diagnostic testing is indicated. This testing should include: (1) measurement of thyroid-stimulating hormone receptor (TSHR) antibodies (TRAb); (2) analysis of thyroidal echogenicity and blood flow on ultrasonography; or (3) determination of radioactive iodine uptake (RAIU). A 123I or 99mTc pertechnetate scan is recommended when the clinical presentation suggests toxic nodular goitre. A question arises regarding whether diagnostic workup and treatment (antithyroid drugs, radioiodine, surgery, and others) should be the same in children and adolescents as in adults, as well as whether there are the same goals of treatment in adolescents as in adults, in female patients vs in male patients, and in reproductive or in postreproductive age. In this aspect, different treatment modalities might be preferred to achieve euthyroidism and to avoid potential risks from the treatment. The vast majority of patients with thyroid disorders require life-long treatment; therefore, the collaboration of different specialists is warranted to achieve these goals and improve patients’ quality of life.

Re-vised Wayne′s Thyrotoxicosis Diagnostic Index for Clinical Diagnosis of Hyperthyroidism

Background: Thyrotoxicosis denotes thyroid hormone excess from any cause. Hyperthyroidism specifically refers to endogenous thyroid gland over-activity most commonly caused by grave′s disease, toxic multi-nodular goiter, or toxic adenoma. Signs and symptoms vary between people and during pregnancy. This study attempt to help our hyperthyroid patients to circumvent the cost of thyroid function tests, a relatively heavy financial burden for the average Iraqi citizen now a days, also when thyroid function tests results are at variance with clinical suspicion. Aim: To design a protocol for clinical diagnosis of hyperthyroidism utilizing the Wayne′s Thyrotoxicosis Diagnostic Index (WTDI) as a base line. Material and Methods: This study was conducted on 100 thyrotoxic patients diagnosed by hormonal assay and 100 clinically euthyroid subjects of similar sex and age, attending Kirkuk General Hospital and private clinic over a period of two years from June 2012 -- June 2014 .We took a history and physical examination pertinent to hyperthyroidism for each patient and each subject including all component of the WTDI .The main outcome measures obtained both patients and subjects measured using sensitivity, specificity ,and predictive values of each symptom and sign. The WTDI was utilized for assessing the clinical findings of patient and subject. Result: Two symptoms and ten physical signs, including two new signs that were not part of WTDI-the velvety skin and the wide pulse pressure, attained confirmatory value in ruling -in the diagnosis of hyperthyroidism. Two symptoms and four signs did attain a confirmatory value in ruling - out diagnosis when absent. Both hot hands and tachycardia reached rule-in and rule -out states. 95 of the 100 patients entered the thyrotoxicosis zone of the WTDI by attaining more than or equal to 19 points. By offering two points and one point to the velvety skin and the wide pulse pressure respectively, all the 100 patients attained more than or equal to 19 points. The highest score attained by any of the 100 subjects was 14 points; the mentioned addition would at most bring the highest score among subjects to 17 points; less than the diagnostic score of WTDI. Conclusions: WTDI with minor modification is worth adopting for diagnosing thyrotoxicosis and on follow up re-assessment of patient during medical treatment when a patient could not bear the cost of the thyroid function tests with the possible exception of some patients like pregnant women who may need a more elaborated evaluation.

Eye symptoms in patients with benign thyroid diseases

Thyroid diseases may cause a variety of functional and structural body changes, including eye and vision abnormalities, which can have a negative impact on a patient’s well-being. However, only a few studies on the impact of other benign thyroid diseases on the visual process are available in the literature. In this study, using the Polish version of the thyroid-specific quality of life (ThyPROpl) questionnaire, we aimed to determine the self-reported influence of benign thyroid diseases (e.g., nodular goiter, toxic nodular goiter, Graves’ disease, thyroid orbitopathy, Hashimoto’s thyroiditis, and surgical hypothyroidism) on patients’ eyes and vision. This was a prospective study. In total, 374 randomly selected euthyroid patients and 255 control subjects responded to the ThyPROpl questionnaire and the results were evaluated. Nearly 69% of the respondents reported that the most frequent condition was “reduced sight.” Men most often reported wet/tearing eyes (66%). The occurrence of eyelid sacks or swollen eyelids (64%), ophthalmalgia (62%), and eye dryness (61%) was marked almost as often. In total, 29% of the patients reported diplopia, and it was found to be most prevalent among those with thyroid orbitopathy. Other complaints were similarly prevalent among all the subgroups. A positive correlation was also observed between the scores of the “eye symptoms” and other ailments. Except for swelling around the lower eyelids, patients with thyroid diseases more frequently experienced all of the ocular complaints analyzed in this study compared with controls. This study showed that eye complaints are common in patients with benign thyroid diseases and ocular disturbances have a negative impact on the overall quality of life of patients.

PTH after Thyroidectomy as a Predictor of Post-Operative Hypocalcemia.

Post-thyroidectomy hypocalcemia is a frequent complication with significant morbidity, and has been shown to increase hospital stay and readmission rates. The evaluation of serum parathyroid hormone (PTH) levels after thyroidectomy represents a reliable method to predict post-thyroidectomy hypocalcemia, but it remains infrequently used. This retrospective study investigates serum PTH values 3 h after thyroidectomy as a predictor of hypocalcemia. In this study, we enrolled 141 patients aged between 27 and 71 years eligible for total thyroidectomy who presented with multinodular goiter, suspicious nodule on cytological examination, Graves’ disease, or toxic multinodular goiter. Three hours after total thyroidectomy, 53 patients (37.6%) showed a reduction in serum PTH. Of these patients 75.5% developed hypocalcemia by 24 h after surgery and 100% were hypocalcemic after 48 h (p < 0.001). There was no significant difference attributable to the different thyroid diseases, nor to the age of the patients. PTH at 3 h after total thyroidectomy accurately predicts post-operative hypocalcemia. The early detection of patients at risk of developing post-operative hypocalcemia allows for prompt supplementation of calcium and Vitamin D in order to prevent symptoms and allows for a safe and timely discharge.

Персоніфікований підхід до періопераційного анестезіологічного менеджменту тиреоїдектомій у пацієнтів із синдромом тиреотоксикозу

Актуальність. Робота присвячена вирішенню актуального завдання сучасної тиреоїдної хірургії — поліпшенню результатів хірургічного лікування пацієнтів із синдромом тиреотоксикозу. Мета дослідження — розробити персоніфікований підхід до вибору методу загальної анестезії (ЗА) та періопераційного знеболювання із застосуванням комплексу збалансованої аналгезії та сучасних методів контролю за перебігом анестезії. Матеріали та методи. На першій стадії проведено ретроспективний і проспективний аналіз (2016–2017) 440 випадків і карт пацієнтів з тиреотоксикозом, які перебували на стаціонарному лікуванні з приводу тиреоїдектомії в 2015–2017 рр., для ідентифікації супутньої патології, визначення особливостей загальної анестезії залежно від виду анестезії та її ускладнень. Друга стадія полягала в проспективному дослідженні за участю 175 пацієнтів із тиреотоксикозом після тиреоїдектомії. Результати. Синдром тиреотоксикозу погіршує фізичний статус пацієнта за критеріями Американської асоціації анестезіологів. Як інгаляційна, так і тотальна внутрішньовенна анестезія негативно впливають на показники гемодинаміки та доставку кисню. Встановлено, що поєднана анестезія із білатеральною блокадою поверхневого шийного сплетення на тлі застосування інгаляційної низькопотокової або тотальної внутрішньовенної анестезії забезпечує кращий рівень знеболювання порівняно з моноанестезією. Найкращою антиеметичною схемою є використання ЗА на тлі базової анестезії пропофолом із додаванням метоклопраміду перед індукцією анестезії. Індивідуалізація подання та корекція дози газового або внутрішньовенного анестетиків під контролем BIS­моніторингу дають змогу досягнути персоніфікації загальної анестезії. Найбільш економічно доцільним є використання ІА севофлураном за мінімально­потоковим контуром (FGF = 400 мл/хв). Висновки. Розроблено алгоритм анестезіологічного менеджменту в пацієнтів із синдромом тиреотоксикозу при тиреоїдектоміях із обґрунтуванням використання інгаляційної низькопотокової або тотальної внутрішньовенної анестезії. Отримані нові вірогідні дані дозволили розробити персоніфікований підхід до вибору методу загальної анестезії та періопераційного знеболювання із застосуванням комплексу ЗА та сучасних методів контролю за перебігом анестезії.