Ultrasonography Of Thyroid Gland Research Articles

Primary hydatid cyst of the thyroid glands: two case reports and a review of the literature

IntroductionAlthough hydatid cyst remains one of the prevalent parasitic infections in humans, hydatid cyst of the thyroid is extremely rare, even in endemic areas. Here we present two cases of thyroid hydatid cysts.Case presentationA 35 and a 50 year-old Iranian female with a positive history of animal contact were presented with a neck lump without any compressive symptoms. A physical exam revealed neck masses that elevated with swallowing. Thyroid gland ultrasonography showed cystic thyroid lesions, and fine needle aspiration (FNA) suggested a thyroid hydatic cyst. Thyroid lobectomy and isthmectomy were done for the first patient, and near-total thyroidectomy was done for the other. The pathology report confirmed the diagnosis of a hydatid cyst. None of the patients had hydatid cysts in other sites. Patients were discharged without an antiparasitic drug, and no recurrence was detected at the six-month follow-up.ConclusionIt is necessary to consider hydatid cysts in the differential diagnosis of cystic lesions of the thyroid gland in endemic areas, especially in people with a positive history of animal contact.

Subacute thyroiditis and thyroid inflammatory nodule secondary to COVID-19: a primary care case report.

To describe a case of subacute thyroiditis (SAT) secondary to COVID-19 in the primary health care (PHC). A 51-year-old woman was treated in a PHC facility for flu-like symptoms for 5 days and pain in the lower neck. Symptomatic drugs were prescribed, and the patient was tested for COVID-19. On reassessment, the patient presented a painful oedema on the thyroid gland, dysphagia, and improvement in flu-like symptoms. Nonsteroidal anti-inflammatories were prescribed, and thyroid function analysis and inflammatory markers were collected. Reassessment after 1 week showed positive polymerase chain reaction-rapid test for COVID-19, partial improvement of neck pain, alterations in thyroid hormone tests (suppressed thyroid stimulating hormone and slightly elevated T4), and elevated C-reactive protein. Thyroid gland ultrasonography (USG), anti-thyroglobulin, and anti-thyroid peroxidise (anti-TPO) antibodies were requested and prednisone was prescribed. Anti-thyroglobulin and anti-TPO antibodies were negative; thyroid USG showed a solid nodule in the left lobe (approximately 4 cm), classified as TIRADS-4. The patient was sent to the Endocrinology Service, and a thyroid fine needle aspiration was requested. USG prior to the examination evidenced a complete regression of the nodule, which was diagnosed as an inflammatory pseudo nodule. We presented the case of a patient who was treated in a PHC facility for rare findings of SAT secondary to mild COVID-19, concomitant with a thyroid nodule that had complete remission after approximately 3 months and was interpreted as an inflammatory pseudo nodule secondary to SAT. PHC professionals should be aware of this condition and conduct adequate follow-up of these patients.

Post-COVID simultaneous onset of Graves' disease and ocular myasthenia gravis in a patient with a complex ocular motility impairment.

A 74-years-old man experienced severe diplopia one month after recovery from an uncomplicated SARS-CoV-2 infection. Neurological examination was normal whereas ophthalmological examination showed bilateral exophthalmos with a complex ocular motility disorder characterized by a pseudo-internuclear ophthalmoplegia after fatigue associated to impairment of elevation and infraduction. Antibodies against TSH and acetylcholine receptors were positive; subsequent hormonal tests, ultrasonography of thyroid gland, single fiber electromyography and orbit MRI confirmed the diagnosis of concomitant Graves Disease (GD) and Myasthenia Gravis (MG). The coexistence between MG and GD is not rare but simultaneous onset after viral infection is very unsual. The complex ocular disorder simulated a deficit of the oculomotor nerve nuclei, and on clinical examination it posed some problems in the diagnosis. We suggest that recent SARS-COV-2 infection may have triggered a complex autoimmune response.

Metabolic syndrome and its components are associated with thyroid volume in adolescents

ObjectiveTo explore the association between metabolic syndrome (MetS) and its component and thyroid volume in Chinese adolescents, and to compare the detection rate of MetS under the three different diagnostic criteria.MethodsA total of 1097 school students (610 males and 487 females, ages 12–15 years) were enrolled. All the participants underwent physical examination, biochemical test, and thyroid gland ultrasonography. The thyroid volume of normal, overweight and obese group was compared. We also analyzed the association between the number of MetS components and thyroid volume. Linear and multiple linear regression were applied to explore the association between metabolic parameters and thyroid volume.ResultsThe thyroid volume of the males in overweight (t = 3.784, P < 0.001) and obese group (t = 5.068, P < 0.001) was significantly larger than that in normal group; the thyroid volume of the females in overweight group (t = 4.627,P < 0.001) was significantly larger than that of normal group. As the number of MetS components increased, the thyroid volume also increased significantly (F = 10.64, P < 0.01). Height, weight, body mass index (BMI), waist circumference, hip circumference, systolic blood pressure, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), uric acid and triglyceride were all positively associated with thyroid volume in the adolescents (P all < 0.001). Meanwhile, there was a negative association between high-density lipoprotein cholesterol (HDL-C) and thyroid volume (P < 0.001). According to multiple linear regression, waist circumference (β = 0.029, 95 %CI: 0.015 ~ 0.042; P < 0.01) and waist height ratio (β = 3.317, 95 %CI: 1.661 ~ 4.973; P < 0.01) were predict factors of thyroid volume. No statistical difference was found in the detection rates of metabolic syndrome under the three diagnostic criteria.ConclusionsOverweight, obesity and metabolic syndrome was associated with adolescent thyroid volume. Central obesity may be an independent risk factor for thyroid enlargement in adolescents.

Rapid Differential Diagnosis of Thyrotoxicosis Using T3/T4 Ratio, FT3/FT4 Ratio and Color Doppler of Thyroid Gland.

Context:Establishing the etiology of thyrotoxicosis is of utmost importance to plan the appropriate line of therapy. However, certain scenarios such as absence of pathognomonic clinical features of Graves’ disease in some patients, or non-availability of radionuclide scanning and newer generation TRAb assays especially in resource-poor settings, necessitates utilization of other, simple and effective measures to differentiate between the two common causes of thyrotoxicosis, Graves’ disease (GD) and Destructive thyroiditis (DT).Aims:The aim of this work was to study the role of FT3/FT4 ratio, T3/T4 ratio and color flow Doppler ultrasound in treatment-naïve patients with thyrotoxicosis, in comparison to Tc-99m pertechnetate thyroid scanning in the differentiation of thyrotoxicosis due to GD and DT.Materials and Methods:Clinical data was collected from all study subjects. Thyroid function tests including FT3, FT4, T3, T4 and TSH, TSH Receptor Antibody (TRAb), Technetium Tc 99m pertechnetate scan and the mean peak systolic velocity in inferior thyroid artery (mean PSV-ITA) by color Doppler ultrasonography of thyroid gland was done in all patients.Results:A total of 83 treatment-naïve patients with thyrotoxicosis (61 with GD and 22 with DT) were studied. Mean PSV-ITA, T3/T4 ratio and FT3/FT4 ratio showed a sensitivity of 85.2%, 73.8%, and 77.04%, and a specificity of 90.9%, 72.7%, and 59.09%, respectively. The three parameters in combination yielded a positive predictive value of 100% in the diagnosis of Graves’ disease.Conclusion:Results of this study show that inferior thyroid artery blood flow, T3/T4 ratio and FT3/FT4 ratio are useful parameters in the differentiation between GD and DT.

L-selenomethionine supplementation in children and adolescents with autoimmune thyroiditis: A randomized double-blind placebo-controlled clinical trial.

Although a beneficial effect of selenium (Se) administration has been proposed in adults with autoimmune thyroiditis (AT), there is a paucity of similar data in children and adolescents. The purpose of the study was to investigate whether administration of a high dose of organic Se (200μg daily as l-selenomethionine) has an effect on antithyroid antibody titres in children and adolescents with AT. Seventy-one (71) children and adolescents, with a mean age of 11.3±0.3years (range 4.5-17.8), diagnosed with AT (antibodies against thyroid peroxidase [anti-TPO] and/or thyroglobulin [anti-Tg] ≥60IU/mL, euthyroidism or treated hypothyroidism and goitre in thyroid gland ultrasonography) were randomized to receive 200μg l-selenomethionine or placebo daily for 6months. Blood samples were drawn for measurement of serum fT4, TSH, anti-TPO and anti-Tg levels, and thyroid gland ultrasonography was performed at the entry to the study and after 6months of treatment. At the end of the study, a statistically significantly higher reduction in anti-Tg levels was observed in the Se group compared to the placebo group (Δ: -70.9±22.1 vs -6.7±60.6IU/mL, P=0.021). Although anti-TPO levels were also decreased in the Se group, this change was not statistically different from that of the control group (Δ: -116.2±68.4 vs +262.8±255.5IU/mL, P=0.219). No significant difference in thyroid gland volume was observed between the two study groups (P>0.05). In this original study, organic Se supplementation appears to reduce anti-Tg levels in children and adolescents with AT.

Doppler indices of superior thyroid artery in clinically euthyroid adults.

Context:Ultrasonography of thyroid gland is a frequently performed investigation. Many of the diffuse thyroid pathologies are associated with altered vascularity. In view of potential applications and scant available data, there is a need to find normal values of Doppler indices of superior thyroid artery (STA).Aims:To find the normal range of Doppler indices like mean peak systolic velocity (PSV), resistivity index (RI), and pulsatility index (PI) of STA in clinically euthyroid adult individuals.Settings and Design:Prospective cross-sectional observational study.Materials and Methods:A study was done in the Department of Radiodiagnosis of a tertiary care hospital, involving clinically euthyroid adult volunteers. Ultrasonography of the thyroid gland with Doppler of bilateral STAs was performed and mean values of PSV, RI, and PI were calculated.Results:A total of 208 subjects, with a mean age of 37.7 years, underwent Doppler evaluation of STA; 148 of them were women and 60 were men. The mean PSV obtained was 16.94 ± 5.3 cm/s. Mean PI and RI were 0.93 ± 0.31 and 0.5 ± 0.13, respectively. There was no significant difference in the values obtained among both the genders.Conclusion:Mean values of Doppler indices of STA in euthyroid individuals have been found in this study.

APPLICATION OF PEPTIDES FOR COMPLEX TREATMENT OF AUTOIMMUNE THYROIDITIS

Background: Improvement the existing methods of treatment of autoimmune thyroiditis by using complex application of low molecular weight peptides. Methods: We have conducted a study of the effectiveness of treatment in 218 patients with autoimmune thyroiditis aged from 39 - 51 years. All peptide preparations used in this study, were developed by the St. Petersburg Institute of Bioregulation and Gerontology, and are essentially complexes of low molecular weight peptides with a molecular weight up to 5000 Da, isolated from thyroid and pineal glands of young animals. We measured: indicators of the thyroid hormones levels, indicators of the antibodies levels, indicators of high-fidelity infrared thermography and ultrasonography of thyroid gland. Results: It was revealed that application of a complex of peptides of thyroid and pineal glands in patients with autoimmune thyroiditis helped to improve general health and laboratory indicators. This complex also caused an antibodies level reduction and the positive changes in thyroid gland, detected by ultrasonography. Conclusions: It is preferable to apply the complex of peptides of thyroid and pineal glands, as part of complex treatment as well as for prevention of diseases in middle and senior age. The existing conventional treatment regimens of autoimmune thyroiditis require the inclusion of these high-performance schemes, physiological peptide preparations targeted action aimed at increasing the reserve capacity of the organs and tissues involved in the pathological process.

Bilateral Hurthle cell adenoma of thyroid: a rare case report

&lt;p class="abstract"&gt;Hurthle cell of adenoma of thyroid gland is rare neoplasms of the thyroid. Size more than 4 cm is rare finding and moreover the occurrence of a multifocal Hurthle cell adenoma is not supported by antecedents in literature. Sonography fails to identify its potentials for malignancy while fine needle aspiration cytology couldn’t differentiate it from Hurthle cell carcinoma of thyroid. The management of Hurthle cell adenoma and Hurthle cell carcinoma is quite different and hence diagnostic dilemma should be sorted out early. A 26 year old female presented with bilateral thyroid swelling. Ultrasonography of thyroid gland showed complex solid cystic nodules in bilateral thyroid lobes with right thyroid lobe measuring 4.1×3.4×2.5 cm and left thyroid lobe measure 3.1×1.7×1.6 cm. Fine needle aspiration cytology (FNAC) was suggestive of papillary malignancy with extensive Hurthle cell changes (Class V, Bethesda classification). The patient underwent total thyroidectomy with bilateral parathyroid gland preservation. Histopathology revealed it as Hurthle cell adenoma (HCA) involving bilateral lobe and multifocal in nature. The treatment of choice for Hurthle cell carcinoma is total thyroidectomy with neck dissection depending on the nature of the lesions. However the treatment of Hurthle cell adenoma is only hemithyroidectomy or lobectomy as it is a benign condition. Differentiation of these two entirely different conditions warrants more studies&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Thyroid gland papillary microcarcinomas diagnosed by extraglandular mass findings

Thyroid papillary microcarcinomas not only present with neck lympathic metastasis but also may occur in thyroglossal cysts or ectopic thyroid glands. The aim of this case report is to discuss two cases of thyroid papillary carcinomas with no mass detectable by thyroid gland ultrasonography but diagnosed with the biopsy of cervical lymphatic metastasis and occurred in ground of lateral sided thyroglossal cyst. It must be kept in mind that, in cervical metastasis and even laterally sided cystic masses, these symptoms may be associated with thyroid papillary carcinoma.

TRAb negative entities of hyperthyroid syndrome: Our experience of the past 5 years

Over the past five years, since we moved to private practice, we continued with testing of TSH receptor antibodies. So far we have carried out 775 tests and examined 260 patients. We used TRAb human, BRAHMs. We carried out our research on 192 patients with untreated immune hyperthyroidism and 37 with the disease in remission. As the subject of this study was TRAb negative hyperthyroidism, the examination of this group of patients was comprehensive. The largest was a group of patients with Plummer disease (13 in total - 4 with toxic adenoma, 7 with multinodular toxic goiter and 2 with disseminated thyroid autonomy).Nine experienced thyroid destruction (eight with painful thyroiditis, one with post-partal thyroiditis and one with thyroid infarction). Five patients had amiodaron induced hyperthyroidism. Diagnosis was based on the following criteria: clinical features and symptoms, 'free' thyroxin concentration, concentration of ultrasensitive TSH, ultrasonography of thyroid gland and scinigraphy with Tc 99m pertehnetat. The analysis of each method was used for diagnosis and differential diagnosis of each type of occurrences of TRAb negative hyperthyroidism.

Relationship between iodine intake and the prevalence of thyroid disease in Urumqi, Xinjiang

Objective To evaluate the relationship between iodine intake and the prevalence of thyroid diseases in Urumqi.Methods A total of 1693 subjects were investigated.Serum thyroid hormones,thyroid autoantibodies,and urinary iodine concentration were determined,and type B ultrasonography of thyroid gland was performed in all participants.Result The urinary iodine level revealed that 9.5％ of the subjects were iodine deficient and 30.0％ iodine excessive.The average median urinary iodine was 254.9 μg/L.Serum total T4 level in the idione adequate and more than adequate groups was significantly higher than the other 2 groups [ ( 9.02±2.63 ) vs (7.69±2.85)、(8.45 ±2.13 ) μg/dl,both P＜0.05 ],and serum TSH level in the idione deficient group was significantly higher than the other 2 groups [ (3.00±1.86) vs (2.37±1.91),(2.27±1.86) mIU/L,both P＜0.01 ].There was no significant statistical difference in positive rates of thyroid autoantibodies,morbidities of thyroid dysfunction and goiter among 3 groups.Conclusion The iodine deficient situation has been corrected in Urumqi.There is no difference in morbidities of thyroid diseases in population with different iodine intakes. Key words: Idoine; Thyroid function; Thyroid nodule

Zur sonographischen Differenzialdiagnose des Schilddrüsenknotens

Esophagography is the standard diagnostic method for diverticulum of the pharyngoesophageal junction. Less known is detection of the diverticulum during thyroid gland ultrasonography. Thyroid nodules located near the left trachea with a hyperechogenic border, beneath which a hypoechogenic zone and an echogenic center are seen, are highly suspicious for diverticulum of the hypopharynx/esophagus and should be investigated further. Postoperative follow-up is facilitated by the rapid sonographic involution of the preoperatively described nodule.

The preva-lence and pattern of autoimmune thyroid disease in young patients with type 1 diabetes mellitus

This study whose purpose was to examine the prevalence and pattern of autoimmune disease of the thyroid gland (TG) in young patients with type I diabetes mellitus (DM1) involved 288 individuals with DM1 whose age was 5.5 to 30years; the average duration of DM1 was 5.5+4.7 years. In all the patients, thyroid ultrasonography was performed, thyroid antibodies (Abs) [thyroid peroxidase antibodies (TPO-Abs) and thyroglobulin antibodies (TG-Abs)] were determined, thyroid function was evaluated by measuring the level of thyroid-stimulating hormone (TSH) and free reactions of thyroid hormones were assessed. The detection rates of TPO-Abs and TG-Abs were 22.2 and 20.5%, respectively, which was substantially greater than those in apparently healthy individuals matched by age and gender. The frequency of positive thyroid Abs was significantly higher in females. Age at the moment of examination and the duration of DM1 were not found to have an impact on the detection rate of thyroid Abs. The ultrasound signs of autoimmune thyroid diseases were revealed in 19.1% of the cases. 10.0% of the patients with DM1 were found to have these or those TG dysfunctions the most common of which was subclinical hypothyroidism (6.60%). A comprehensive TG assessment in the young patients with DM1 demonstrated the typical signs of autoimmune thyroid disease in 14.2% of the examinees. In the patients with autoimmune thyroid disease, the thyroid was significantly larger and the levels of TSH, TPO-Abs, and TG-Abs were higher than the patients without autoimmune thyroid disease and those at risk for the latter. The proportion of females was significantly higher among the patients 19 with concomitant autoimmune thyroid disease than that among those without the signs of this condition. It has been concluded that the high incidence of autoimmune thyroid disease in young patients with DM1 permits the authors to recommend a screening for its early detection, which involves the measurement of the serum level of TPO-Abs and TG ultrasonography in all females with first detected DM1.

Measurement of thyroid volume in children using a portable ultrasound machine: a technical note.

The data on thyroid volume measurements that determines prevalence of goitre in children is very important for public health consideration as the presence of goitre in children effectively reflects the status of iodine deficiency disorders (IDD) in the general population. Ultrasound is an excellent modality to evaluate thyroid size. Local experience in using a portable ultrasound machine to measure thyroid volume is presented. The thyroid anatomy and techniques of ultrasound assessment are highlighted. Proper training of public health doctors to perform thyroid gland ultrasonography is crucial to ensure that the thyroid volume data collected would be more accurate and reliable for the planning of health programmes to eliminate IDD in the particular areas.

Decrease of prostaglandin I2 binding sites in thyroid cancer

The properties of specific prostaglandin I2 (prostacyclin, PGI2) binding sites in normal thyroid tissue have been characterised. Tissue samples obtained intraoperatively from patients with 'cold' solitary thyroid nodules (as preoperatively selected by thyroid gland scintigraphy, thyroid gland ultrasonography and Papanicolaou cytology following fine needle aspiration of the nodule area) have been used for thyroid membrane preparation. Employing [3H]iloprost, a chemically stable PGI2-analogue as a radioligand, saturation experiments for comparative binding studies have been attempted. Scatchard analysis of the binding data obtained for normal thyroid parenchyma distant to the nodule area revealed heterogeneity of the [3H]iloprost sites exhibiting a high-affinity binding capacity (Bmax) of 613.2 +/- 130.4 fmol mg-1 membrane protein and a low-affinity binding capacity of 5.1 +/- 1.6 pmol mg-1 membrane protein. The equilibrium dissociation constant (Kd) amounted to 18.9 +/- 8.9 nM and to 131.5 +/- 39.2 nM, respectively. Scatchard analysis of the binding data obtained for benign thyroid adenoma indicated significant lower binding capacities exhibiting a Bmax of 325.8 +/- 110.0 fmol mg-1 membrane protein (Kd: 31.0 +/- 7.5 nM) for the high-affinity sites and of 3.9 +/- 2.5 pmol mg-1 membrane protein (Kd: 364.9 +/- 183.6) for the low affinity sites. In cancer tissue a selective loss of the low affinity sites and a significant diminution of the high-affinity sites was observed: in well differentiated cancer the high-affinity sites showed a Bmax of 299.7 +/- 46.0 fmol mg-1 membrane protein (Kd: 38.9 +/- 7.3 nM), in anaplastic cancer, less differentiated papillar and follicular cancers of 180.6 +/- 25.1 fmol mg-1 membrane protein (Kd: 54.6 +/- 16.7 nM). Well differentiated papillar and follicular cancers did not differ from each other.(ABSTRACT TRUNCATED AT 250 WORDS)