Pub Date : 2017-01-01Epub Date: 2017-07-04DOI: 10.1155/2017/7843972
Osei Sarfo-Kantanka, Ishmael Kyei, Fred Stephen Sarfo, Eunice Oparebea Ansah
Background: Ghana began mandatory iodization of salt in 1996. This study compares the prevalence of thyroid disorders before and after the introduction of iodization.
Methods: This is a retrospective study of thyroid cases from the middle belt of Ghana between 1982 and 2014. To demonstrate a link between iodization and hyperthyroidism and autoimmunity, we compared the prevalence of hyperthyroidism and autoimmune thyroid disorders before and after the iodization programme.
Results: A total of 10,484 (7548 females, 2936 males) cases were recorded. The rate of thyroid cases seen was 343/100,000. Nontoxic nodular goiters (25.7%) and toxic nodular goiters (22.5%) represented the second commonest thyroid disorders recorded. The prevalence of hyperthyroid disorders seen after 1996 was significantly higher than the prevalence seen before the iodization (40.0 versus 21.1%, p < 0.001). The prevalence of autoimmune disorders recorded after iodization was significantly higher than that before the iodization programme started (22.3% versus 9.6%, p < 0.001).
Conclusions: This study has revealed a significant increase in thyroid admissions in Central Ghana over the decades. A connection between iodine fortification and iodine-induced hyperthyroidism and between iodine fortification and autoimmune thyroiditis has been shown in this study.
{"title":"Thyroid Disorders in Central Ghana: The Influence of 20 Years of Iodization.","authors":"Osei Sarfo-Kantanka, Ishmael Kyei, Fred Stephen Sarfo, Eunice Oparebea Ansah","doi":"10.1155/2017/7843972","DOIUrl":"https://doi.org/10.1155/2017/7843972","url":null,"abstract":"<p><strong>Background: </strong>Ghana began mandatory iodization of salt in 1996. This study compares the prevalence of thyroid disorders before and after the introduction of iodization.</p><p><strong>Methods: </strong>This is a retrospective study of thyroid cases from the middle belt of Ghana between 1982 and 2014. To demonstrate a link between iodization and hyperthyroidism and autoimmunity, we compared the prevalence of hyperthyroidism and autoimmune thyroid disorders before and after the iodization programme.</p><p><strong>Results: </strong>A total of 10,484 (7548 females, 2936 males) cases were recorded. The rate of thyroid cases seen was 343/100,000. Nontoxic nodular goiters (25.7%) and toxic nodular goiters (22.5%) represented the second commonest thyroid disorders recorded. The prevalence of hyperthyroid disorders seen after 1996 was significantly higher than the prevalence seen before the iodization (40.0 versus 21.1%, <i>p</i> < 0.001). The prevalence of autoimmune disorders recorded after iodization was significantly higher than that before the iodization programme started (22.3% versus 9.6%, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>This study has revealed a significant increase in thyroid admissions in Central Ghana over the decades. A connection between iodine fortification and iodine-induced hyperthyroidism and between iodine fortification and autoimmune thyroiditis has been shown in this study.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/7843972","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35200033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-02-14DOI: 10.1155/2017/4601365
Norman J Blumenthal, Creswell J Eastman
Background. Hypothyroidism and raised thyroid antibody levels have been associated with adverse obstetrical outcomes. Several studies have investigated causal associations, but results have been inconsistent and few studies have reported the effects of thyroxine replacement therapy on pregnancy outcomes in hypothyroid patients. Objective. The primary study objective was to determine the outcome of pregnancies in women diagnosed with overt and subclinical hypothyroidism (SCH) (serum TSH > 2.5 mIU/L) and those with elevated circulating thyroid autoantibody levels in the first trimester of pregnancy and after the institution of appropriate thyroxine replacement therapy to maintain the serum TSH ≤ 2.5 mIU/L. Study Design. This prospective observational study was undertaken between 2013 and 2016. Blood samples were taken from 1025 women at presentation for thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (TGAb), and thyroid peroxidase antibodies (TPOAb). Those with a TSH > 2.5 mIU/L were treated with thyroxine and managed appropriately to ensure that the TSH was maintained ≤2.5 mIU/L. Outcomes in these patients were compared to those in euthyroid patients. Maternal antenatal complications and perinatal outcomes were recorded. Results. There were a total of 1025 patients of whom 382 (37.5%) were nulliparous. 10.1% had a TSH level > 2.5 mIU/L and 18.2% had at least one raised thyroid antibody level. No differences in adverse outcomes of pregnancy were evident in women treated for SCH or overt hypothyroidism compared to the euthyroid group. There was also no association between raised thyroid antibodies and adverse pregnancy outcomes in either group. Conclusion. There were no adverse outcomes of pregnancy found in pregnant women who had been diagnosed and treated with thyroxine for SCH at the time of presentation when compared to euthyroid patients. There was also no relationship with thyroid antibodies and adverse pregnancy outcomes in the two groups. It is not possible to unequivocally advocate for thyroxine replacement in pregnant women with subclinical and overt hypothyroidism until large scale randomized controlled trials are performed.
{"title":"Beneficial Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism.","authors":"Norman J Blumenthal, Creswell J Eastman","doi":"10.1155/2017/4601365","DOIUrl":"https://doi.org/10.1155/2017/4601365","url":null,"abstract":"<p><p><i>Background</i>. Hypothyroidism and raised thyroid antibody levels have been associated with adverse obstetrical outcomes. Several studies have investigated causal associations, but results have been inconsistent and few studies have reported the effects of thyroxine replacement therapy on pregnancy outcomes in hypothyroid patients. <i>Objective</i>. The primary study objective was to determine the outcome of pregnancies in women diagnosed with overt and subclinical hypothyroidism (SCH) (serum TSH > 2.5 mIU/L) and those with elevated circulating thyroid autoantibody levels in the first trimester of pregnancy and after the institution of appropriate thyroxine replacement therapy to maintain the serum TSH ≤ 2.5 mIU/L. <i>Study Design</i>. This prospective observational study was undertaken between 2013 and 2016. Blood samples were taken from 1025 women at presentation for thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (TGAb), and thyroid peroxidase antibodies (TPOAb). Those with a TSH > 2.5 mIU/L were treated with thyroxine and managed appropriately to ensure that the TSH was maintained ≤2.5 mIU/L. Outcomes in these patients were compared to those in euthyroid patients. Maternal antenatal complications and perinatal outcomes were recorded. <i>Results</i>. There were a total of 1025 patients of whom 382 (37.5%) were nulliparous. 10.1% had a TSH level > 2.5 mIU/L and 18.2% had at least one raised thyroid antibody level. No differences in adverse outcomes of pregnancy were evident in women treated for SCH or overt hypothyroidism compared to the euthyroid group. There was also no association between raised thyroid antibodies and adverse pregnancy outcomes in either group. <i>Conclusion</i>. There were no adverse outcomes of pregnancy found in pregnant women who had been diagnosed and treated with thyroxine for SCH at the time of presentation when compared to euthyroid patients. There was also no relationship with thyroid antibodies and adverse pregnancy outcomes in the two groups. It is not possible to unequivocally advocate for thyroxine replacement in pregnant women with subclinical and overt hypothyroidism until large scale randomized controlled trials are performed.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/4601365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34806039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-11-28DOI: 10.1155/2017/2793205
Clebson Pantoja Pimentel, Erik Artur Cortinhas-Alves, Edivaldo Herculano Correa de Oliveira, Luiz Carlos Santana-da-Silva
Background. Recent data have suggested that polymorphisms in the length of the polyalanine tract (polyA) of FOXE1 gene may act as a susceptibility factor for thyroid dysgenesis. The main purpose of this study was to investigate the influence of polyA of FOXE1 gene on the risk of thyroid dysgenesis. Method. A case-control study was conducted in a sample of 90 Brazilian patients with thyroid dysgenesis and 131 controls without family history of thyroid disease. Genomic DNA was isolated from peripheral blood samples and the genotype of each individual was determined by automated sequencing. Results. More than 90% of genotypes found in the group of patients with thyroid dysgenesis and in controls subjects were represented by sizes 14 and 16 polymorphisms in the following combinations: 14/14, 14/16, and 16/16. Genotypes 14/16 and 16/16 were more frequent in the control group, while genotype 14/14 was more frequent in the group of patients with thyroid dysgenesis. There was no difference between agenesis group and control group. Genotype 14/14 when compared to genotypes 14/16 and 16/16A showed an association with thyroid dysgenesis. Conclusion. PolyA of FOXE1 gene alters the risk of thyroid dysgenesis, which may explain in part the etiology of this disease.
{"title":"Does the Polymorphism in the Length of the Polyalanine Tract of <i>FOXE1</i> Gene Influence the Risk of Thyroid Dysgenesis Occurrence?","authors":"Clebson Pantoja Pimentel, Erik Artur Cortinhas-Alves, Edivaldo Herculano Correa de Oliveira, Luiz Carlos Santana-da-Silva","doi":"10.1155/2017/2793205","DOIUrl":"https://doi.org/10.1155/2017/2793205","url":null,"abstract":"<p><p><i>Background.</i> Recent data have suggested that polymorphisms in the length of the polyalanine tract (polyA) of <i>FOXE1</i> gene may act as a susceptibility factor for thyroid dysgenesis. The main purpose of this study was to investigate the influence of polyA of <i>FOXE1</i> gene on the risk of thyroid dysgenesis. <i>Method.</i> A case-control study was conducted in a sample of 90 Brazilian patients with thyroid dysgenesis and 131 controls without family history of thyroid disease. Genomic DNA was isolated from peripheral blood samples and the genotype of each individual was determined by automated sequencing. <i>Results.</i> More than 90% of genotypes found in the group of patients with thyroid dysgenesis and in controls subjects were represented by sizes 14 and 16 polymorphisms in the following combinations: 14/14, 14/16, and 16/16. Genotypes 14/16 and 16/16 were more frequent in the control group, while genotype 14/14 was more frequent in the group of patients with thyroid dysgenesis. There was no difference between agenesis group and control group. Genotype 14/14 when compared to genotypes 14/16 and 16/16A showed an association with thyroid dysgenesis. <i>Conclusion.</i> PolyA of <i>FOXE1</i> gene alters the risk of thyroid dysgenesis, which may explain in part the etiology of this disease.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/2793205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35861416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thyroid cysts are usually benign lesions that when voluminous may induce cosmetic concerns or local discomfort. Percutaneous ethanol injection (PEI) has been demonstrated to be effective for shrinkage of such cysts. In this retrospective study, we evaluated the efficacy, pain perception, and health-related quality of life (HRQL) in patients submitted to PEI for pure cystic lesions. We reviewed the data of 101 patients who underwent ≤3 PEI. In the whole group of patients, the volume reduction was 66% after the first, 74.4% after the second, and 79.4% after the third PEI treatment. 55.4% had a cystic volume ≤ 10 ml; 85.7% of cysts ≤ 10 ml were cured by just one PEI. The number of PEI was significantly higher in the >30.0 ml group; this latter group obtained the smallest percent reduction versus baseline after the first PEI when compared with smaller cysts. The sensation of pain reported during PEI was absent in 78.3% of cases, and HRQL significantly improved from pre- to the posttreatment. PEI is a safe and effective technique for pure cystic lesions. In addition, HRQL significantly improves, providing a further support for this procedure.
{"title":"Outcome, Pain Perception, and Health-Related Quality of Life in Patients Submitted to Percutaneous Ethanol Injection for Simple Thyroid Cysts.","authors":"Roberto Negro, Ermenegildo Colosimo, Gabriele Greco","doi":"10.1155/2017/9536479","DOIUrl":"https://doi.org/10.1155/2017/9536479","url":null,"abstract":"<p><p>Thyroid cysts are usually benign lesions that when voluminous may induce cosmetic concerns or local discomfort. Percutaneous ethanol injection (PEI) has been demonstrated to be effective for shrinkage of such cysts. In this retrospective study, we evaluated the efficacy, pain perception, and health-related quality of life (HRQL) in patients submitted to PEI for pure cystic lesions. We reviewed the data of 101 patients who underwent ≤3 PEI. In the whole group of patients, the volume reduction was 66% after the first, 74.4% after the second, and 79.4% after the third PEI treatment. 55.4% had a cystic volume ≤ 10 ml; 85.7% of cysts ≤ 10 ml were cured by just one PEI. The number of PEI was significantly higher in the >30.0 ml group; this latter group obtained the smallest percent reduction versus baseline after the first PEI when compared with smaller cysts. The sensation of pain reported during PEI was absent in 78.3% of cases, and HRQL significantly improved from pre- to the posttreatment. PEI is a safe and effective technique for pure cystic lesions. In addition, HRQL significantly improves, providing a further support for this procedure.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/9536479","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35292658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-05-22DOI: 10.1155/2017/5739806
Hassan M Al-Musa
Aim of study: To assess serum thyroid hormones levels among Saudi adults and to correlate participants' serum levels with their grades of body mass index (BMI).
Methodology: A total of 278 adult subjects were recruited. Participants were categorized according to their BMI grades into normal weight (BMI < 25 kg/m2), overweight (BMI 25-29.9 kg/m2), or obese (BMI ≥ 30 kg/m2). Serum thyroid hormones levels were assessed at the central laboratory of Aseer Central Hospital, Abha City, by chemiluminescence immunoassay.
Results: More than three-fourths of participants were either overweight (31.3%) or obese (44.6%). Mean TSH serum levels showed a significantly increasing trend with increasing BMI (p < 0.001). A negative trend was observed regarding participants' mean serum levels of fT4 with their BMI, but there were no significant differences in mean serum fT4 levels according to BMI. Moreover, no significant differences were observed in serum fT3 levels according to BMI.
Conclusions: Mean TSH serum levels increase with BMI increase. Further largescale multicentric and longitudinal studies are necessary to prove the association between serum levels of thyroid hormones and BMI of euthyroid adults.
{"title":"Impact of Obesity on Serum Levels of Thyroid Hormones among Euthyroid Saudi Adults.","authors":"Hassan M Al-Musa","doi":"10.1155/2017/5739806","DOIUrl":"10.1155/2017/5739806","url":null,"abstract":"<p><strong>Aim of study: </strong>To assess serum thyroid hormones levels among Saudi adults and to correlate participants' serum levels with their grades of body mass index (BMI).</p><p><strong>Methodology: </strong>A total of 278 adult subjects were recruited. Participants were categorized according to their BMI grades into normal weight (BMI < 25 kg/m<sup>2</sup>), overweight (BMI 25-29.9 kg/m<sup>2</sup>), or obese (BMI ≥ 30 kg/m<sup>2</sup>). Serum thyroid hormones levels were assessed at the central laboratory of Aseer Central Hospital, Abha City, by chemiluminescence immunoassay.</p><p><strong>Results: </strong>More than three-fourths of participants were either overweight (31.3%) or obese (44.6%). Mean TSH serum levels showed a significantly increasing trend with increasing BMI (<i>p</i> < 0.001). A negative trend was observed regarding participants' mean serum levels of fT4 with their BMI, but there were no significant differences in mean serum fT4 levels according to BMI. Moreover, no significant differences were observed in serum fT3 levels according to BMI.</p><p><strong>Conclusions: </strong>Mean TSH serum levels increase with BMI increase. Further largescale multicentric and longitudinal studies are necessary to prove the association between serum levels of thyroid hormones and BMI of euthyroid adults.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/5739806","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35101431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Incidental hypermetabolic thyroid lesions on Positron Emission Tomography have significant clinical value and may harbor malignancy. In this study we evaluated laboratory, radiologic, and pathologic characteristics of incidental hypermetabolic thyroid lesions.
Materials and methods: We evaluated 18 patients prospectively with various malignancies and hypermetabolic thyroid incidentaloma. The thyroid function tests, ultrasound assessment, and guided FNA biopsy were performed on all cases.
Results: We included 9 male and 9 female patients with mean age of 51 years. Most common malignancy was colon cancer. Metabolic activity quantification using maximum standard uptake value demonstrated range between 1.4 and 65.4 with mean value of 9.4. We found highest metabolic activity in patients with lung adenocarcinoma, B-cell lymphoma, and colon adenocarcinoma. On ultrasound exam most thyroid lesions were of solid, hypoechoic, noncalcified nature with either normal or peripheral increased vascularity. FNA biopsy report was benign in 15 cases and malignant or highly suggestive for malignancy in 3 other cases. Two of the three malignant cases demonstrated metabolic activity higher than average SUV max.
Conclusion: Most thyroid hypermetabolic incidentalomas are benign lesions, while higher values of SUV max are in favor of malignancy. This mandates further evaluation of incidentally found thyroid hypermetabolic lesions on routine PET/CT scans.
{"title":"Hypermetabolic Thyroid Incidentaloma on Positron Emission Tomography: Review of Laboratory, Radiologic, and Pathologic Characteristics.","authors":"Mehrdad Bakhshayesh Karam, Abtin Doroudinia, Farzaneh Joukar, Kobra Nadi, Atosa Dorudinia, Payam Mehrian, Abbas Yousefikoma","doi":"10.1155/2017/7176934","DOIUrl":"https://doi.org/10.1155/2017/7176934","url":null,"abstract":"<p><strong>Introduction: </strong>Incidental hypermetabolic thyroid lesions on Positron Emission Tomography have significant clinical value and may harbor malignancy. In this study we evaluated laboratory, radiologic, and pathologic characteristics of incidental hypermetabolic thyroid lesions.</p><p><strong>Materials and methods: </strong>We evaluated 18 patients prospectively with various malignancies and hypermetabolic thyroid incidentaloma. The thyroid function tests, ultrasound assessment, and guided FNA biopsy were performed on all cases.</p><p><strong>Results: </strong>We included 9 male and 9 female patients with mean age of 51 years. Most common malignancy was colon cancer. Metabolic activity quantification using maximum standard uptake value demonstrated range between 1.4 and 65.4 with mean value of 9.4. We found highest metabolic activity in patients with lung adenocarcinoma, B-cell lymphoma, and colon adenocarcinoma. On ultrasound exam most thyroid lesions were of solid, hypoechoic, noncalcified nature with either normal or peripheral increased vascularity. FNA biopsy report was benign in 15 cases and malignant or highly suggestive for malignancy in 3 other cases. Two of the three malignant cases demonstrated metabolic activity higher than average SUV max.</p><p><strong>Conclusion: </strong>Most thyroid hypermetabolic incidentalomas are benign lesions, while higher values of SUV max are in favor of malignancy. This mandates further evaluation of incidentally found thyroid hypermetabolic lesions on routine PET/CT scans.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/7176934","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35514353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-09-14DOI: 10.1155/2017/1924974
Danilo Bianchini Höfling, Suemi Marui, Carlos Alberto Buchpiguel, Giovanni Guido Cerri, Maria Cristina Chammas
Background: The end-diastolic velocity (EDV) of thyroid arteries reflects peripheral blood flow resistance.
Objective: The aim was to evaluate EDV correlations with other Doppler sonography parameters and with clinical and biochemical variables in a sample of patients with hypothyroidism caused by chronic autoimmune thyroiditis (CAT).
Methods: A sample of 48 CAT hypothyroid patients receiving treatment with stable doses of levothyroxine was selected. The participants underwent clinical evaluation and measurement of serum thyrotropin (TSH), total triiodothyronine (T3), total thyroxine (T4), free T4, thyroid peroxidase antibodies (anti-TPO), and antithyroglobulin antibodies (anti-Tg) and Doppler sonography.
Results: The EDV of the inferior thyroid arteries (ITA-EDV) was strongly and positively correlated with the peak systolic velocity of the inferior thyroid arteries (ITA-PSV, r = 0.919), thyroid volume (r = 0.711), and thyroid visual vascularization pattern (TVP, r = 0.687). There was no correlation between ITA-EDV and the clinical variables, hormones, anti-TPO, or anti-Tg.
Conclusion: The strong correlation of ITA-EDV with ITA-PSV, TVP, and volume suggests that increased vascularization in CAT may be associated with a reduction in thyroid blood flow resistance, possibly due to an angiogenesis-induced increase in the total vascular cross-sectional area of the parenchyma.
背景:甲状腺动脉舒张末流速(EDV)反映外周血阻力。目的:评价慢性自身免疫性甲状腺炎(CAT)引起的甲状腺功能减退患者的EDV与其他多普勒超声参数以及与临床和生化变量的相关性。方法:选择48例接受稳定剂量左甲状腺素治疗的CAT型甲状腺功能减退患者。临床评估和测定血清促甲状腺素(TSH)、总三碘甲状腺原氨酸(T3)、总甲状腺素(T4)、游离T4、甲状腺过氧化物酶抗体(抗tpo)、抗甲状腺球蛋白抗体(抗tg)和多普勒超声。结果:甲状腺下动脉EDV (ITA-EDV)与甲状腺下动脉收缩峰值速度(ITA-PSV, r = 0.919)、甲状腺体积(r = 0.711)、甲状腺视血管化模式(TVP, r = 0.687)呈显著正相关。ITA-EDV与临床变量、激素、抗tpo或抗tg均无相关性。结论:ITA-EDV与ITA-PSV、TVP和体积的强相关性表明,CAT血管化的增加可能与甲状腺血流阻力的降低有关,这可能是由于血管生成诱导的实质血管总横截面积的增加。
{"title":"The End-Diastolic Velocity of Thyroid Arteries Is Strongly Correlated with the Peak Systolic Velocity and Gland Volume in Patients with Autoimmune Thyroiditis.","authors":"Danilo Bianchini Höfling, Suemi Marui, Carlos Alberto Buchpiguel, Giovanni Guido Cerri, Maria Cristina Chammas","doi":"10.1155/2017/1924974","DOIUrl":"https://doi.org/10.1155/2017/1924974","url":null,"abstract":"<p><strong>Background: </strong>The end-diastolic velocity (EDV) of thyroid arteries reflects peripheral blood flow resistance.</p><p><strong>Objective: </strong>The aim was to evaluate EDV correlations with other Doppler sonography parameters and with clinical and biochemical variables in a sample of patients with hypothyroidism caused by chronic autoimmune thyroiditis (CAT).</p><p><strong>Methods: </strong>A sample of 48 CAT hypothyroid patients receiving treatment with stable doses of levothyroxine was selected. The participants underwent clinical evaluation and measurement of serum thyrotropin (TSH), total triiodothyronine (T3), total thyroxine (T4), free T4, thyroid peroxidase antibodies (anti-TPO), and antithyroglobulin antibodies (anti-Tg) and Doppler sonography.</p><p><strong>Results: </strong>The EDV of the inferior thyroid arteries (ITA-EDV) was strongly and positively correlated with the peak systolic velocity of the inferior thyroid arteries (ITA-PSV, <i>r</i> = 0.919), thyroid volume (<i>r</i> = 0.711), and thyroid visual vascularization pattern (TVP, <i>r</i> = 0.687). There was no correlation between ITA-EDV and the clinical variables, hormones, anti-TPO, or anti-Tg.</p><p><strong>Conclusion: </strong>The strong correlation of ITA-EDV with ITA-PSV, TVP, and volume suggests that increased vascularization in CAT may be associated with a reduction in thyroid blood flow resistance, possibly due to an angiogenesis-induced increase in the total vascular cross-sectional area of the parenchyma.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/1924974","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35537549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: In 2016, the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME) released updated guidelines for the diagnosis and management of thyroid nodules. The aim of this study was to evaluate the AACE/AME recommendations for FNA in clinical practice, by comparing the (US) stratification risk and indications for FNA with cytologic results.
Methods: From May to December 2016, we collected the cytologic results from FNAs of nodules that were classified using a three-tier US category system (low, intermediate, and high risk).
Results: We obtained 859 FNAs from 598 patients: 341 (39.7%) from low, 489 (56.9%) from intermediate, and 29 (3.4%) from high risk nodules. Of these, 88.5% and 74.9% of low and intermediate risk nodules, respectively, were cytologically benign, whereas 84.6% of high risk nodules had a moderate-to-elevated risk of malignancy or were malignant. If FNAs had been limited to intermediate risk nodules >20 mm, we would have missed 13/17 (76.5%) nodules that had moderate-to-elevated risk of malignancy or were malignant (11/13 were malignant based on histology).
Conclusions: A nonnegligible number of cytologically malignant nodules or nodules that were suspected to be malignant would be missed if intermediate US risk nodules <20 mm were not biopsied.
{"title":"Ultrasound Risk Categories for Thyroid Nodules and Cytology Results: A Single Institution's Experience after the Adoption of the 2016 Update of Medical Guidelines by the American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi.","authors":"Roberto Negro, Gabriele Greco, Ermenegildo Colosimo","doi":"10.1155/2017/8135415","DOIUrl":"https://doi.org/10.1155/2017/8135415","url":null,"abstract":"<p><strong>Objectives: </strong>In 2016, the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME) released updated guidelines for the diagnosis and management of thyroid nodules. The aim of this study was to evaluate the AACE/AME recommendations for FNA in clinical practice, by comparing the (US) stratification risk and indications for FNA with cytologic results.</p><p><strong>Methods: </strong>From May to December 2016, we collected the cytologic results from FNAs of nodules that were classified using a three-tier US category system (low, intermediate, and high risk).</p><p><strong>Results: </strong>We obtained 859 FNAs from 598 patients: 341 (39.7%) from low, 489 (56.9%) from intermediate, and 29 (3.4%) from high risk nodules. Of these, 88.5% and 74.9% of low and intermediate risk nodules, respectively, were cytologically benign, whereas 84.6% of high risk nodules had a moderate-to-elevated risk of malignancy or were malignant. If FNAs had been limited to intermediate risk nodules >20 mm, we would have missed 13/17 (76.5%) nodules that had moderate-to-elevated risk of malignancy or were malignant (11/13 were malignant based on histology).</p><p><strong>Conclusions: </strong>A nonnegligible number of cytologically malignant nodules or nodules that were suspected to be malignant would be missed if intermediate US risk nodules <20 mm were not biopsied.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/8135415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35200034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-10-19DOI: 10.1155/2017/9807543
Eleonora Farina, Fabio Monari, Paolo Castellucci, Fabrizio Romani, Andrea Repaci, Arianna Farina, Giuseppe Zanirato Rambaldi, Giovanni Frezza, Renzo Mazzarotto, Silvia Cammelli, Luca Tagliaferri, Rosa Autorino, Francesco Deodato, Gabriella Macchia, Savino Cilla, Vincenzo Valentini, Stefano Fanti, Alessio G Morganti
Introduction: To evaluate the clinical response rate after a postoperative 18F-FDG PET/CT guided external beam radiotherapy (EBRT) in Iodine-refractory differentiated thyroid cancer.
Material and methods: Patients with thyroid cancer locally recurrent after total thyroidectomy plus metabolic radiotherapy and treated with radical EBRT were included. Inclusion criteria were detectable thyroglobulin (Tg), negative postmetabolic radiotherapy whole body scintigraphy, and no surgical indications. The pretreatment 18F-FDG PET/CT resulted positive in all cases (loggia, lymph nodes, and lung). EBRT was delivered with IMRT-SIB technique. A 18F-FDG PET/CT revaluation and Tg dosage were performed 3 months after the treatment.
Results: Sixteen consecutive patients were included in this analysis (median follow-up: 6-44 months). Post-EBRT 18F-FDG PET/CT showed CR in 43.7%, PR in 31.2%, SD in 25.0% patients, and PD due to lung metastases in 12.5%. Overall response rate was 75.0% (CI 95%: 41.4-93.3%). Tg levels decreased in 75.0% with a median Δ of 68.0%. Two-year PFS and OS rates were 80.0% and 93.0%, respectively. Acute G3 toxicity occurred in 18.7% and late G2 toxicity in 12.5%.
Conclusions: 18F-FDG PET/CT was useful in target definition for radiotherapy planning, identifying positive areas not detected with 131I scintigraphy. IMRT based EBRT was feasible and our results encourage future prospective studies. This clinical trial is registered with ID: NCT03191643.
{"title":"<sup>18</sup>F-FDG Pet-Guided External Beam Radiotherapy in Iodine-Refractory Differentiated Thyroid Cancer: A Pilot Study.","authors":"Eleonora Farina, Fabio Monari, Paolo Castellucci, Fabrizio Romani, Andrea Repaci, Arianna Farina, Giuseppe Zanirato Rambaldi, Giovanni Frezza, Renzo Mazzarotto, Silvia Cammelli, Luca Tagliaferri, Rosa Autorino, Francesco Deodato, Gabriella Macchia, Savino Cilla, Vincenzo Valentini, Stefano Fanti, Alessio G Morganti","doi":"10.1155/2017/9807543","DOIUrl":"https://doi.org/10.1155/2017/9807543","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the clinical response rate after a postoperative <sup>18</sup>F-FDG PET/CT guided external beam radiotherapy (EBRT) in Iodine-refractory differentiated thyroid cancer.</p><p><strong>Material and methods: </strong>Patients with thyroid cancer locally recurrent after total thyroidectomy plus metabolic radiotherapy and treated with radical EBRT were included. Inclusion criteria were detectable thyroglobulin (Tg), negative postmetabolic radiotherapy whole body scintigraphy, and no surgical indications. The pretreatment <sup>18</sup>F-FDG PET/CT resulted positive in all cases (loggia, lymph nodes, and lung). EBRT was delivered with IMRT-SIB technique. A <sup>18</sup>F-FDG PET/CT revaluation and Tg dosage were performed 3 months after the treatment.</p><p><strong>Results: </strong>Sixteen consecutive patients were included in this analysis (median follow-up: 6-44 months). Post-EBRT <sup>18</sup>F-FDG PET/CT showed CR in 43.7%, PR in 31.2%, SD in 25.0% patients, and PD due to lung metastases in 12.5%. Overall response rate was 75.0% (CI 95%: 41.4-93.3%). Tg levels decreased in 75.0% with a median Δ of 68.0%. Two-year PFS and OS rates were 80.0% and 93.0%, respectively. Acute G3 toxicity occurred in 18.7% and late G2 toxicity in 12.5%.</p><p><strong>Conclusions: </strong><sup>18</sup>F-FDG PET/CT was useful in target definition for radiotherapy planning, identifying positive areas not detected with <sup>131</sup>I scintigraphy. IMRT based EBRT was feasible and our results encourage future prospective studies. This clinical trial is registered with ID: NCT03191643.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/9807543","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35216686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-12-12DOI: 10.1155/2017/4259183
Cheuk-Lik Wong, Ho-Kee Vicki Tam, Chun-Kit Vincent Fok, Pong-Kai Ellen Lam, Lai-Ming Fung
Background: Atrial fibrillation (AF) is one of the commonest cardiovascular manifestations of thyrotoxicosis. A significant proportion of patients have persistent AF which may have long term consequences, for example, ischemic stroke.
Methods: We performed a retrospective cohort study in a regional hospital from January 2004 to June 2016 to examine the clinical characteristics and outcomes of thyrotoxic patients who presented with atrial fibrillation and to investigate possible factors associated with persistent atrial fibrillation and ischemic stoke.
Results: Among 1918 patients who had a diagnosis of thyrotoxicosis, 133 (6.9%) patients presented with AF. Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, p = 0.506). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, p = 0.023) and had a trend towards higher CHA2DS2-VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, p = 0.153). History of smoking (adjusted odds ratio 4.9, 95% CI [1.8,14.0], p = 0.002), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI [1.2,5.5], p = 0.014), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI [1.2,3.5], p = 0.008) were associated with persistence of AF on multivariate analysis.
Conclusion: Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.
背景:心房颤动(AF)是甲状腺毒症最常见的心血管表现之一。相当比例的患者有持续性房颤,这可能有长期后果,例如缺血性中风。方法:2004年1月至2016年6月在某地区医院进行回顾性队列研究,分析甲状腺毒性心房颤动患者的临床特征和预后,探讨持续性心房颤动和缺血性卒中的可能相关因素。结果:在诊断为甲状腺毒症的1918例患者中,133例(6.9%)出现房颤。89例(66.9%)患者发生自发性窦性转换,其中85例(94%)患者在实现甲状腺功能正常之前或后6个月内发生窦性转换。其余44例(33.1%)患有持续性房颤。持续性房颤患者的缺血性卒中发生率高于自发性窦性房颤患者(15.9% vs 10.1%;Log-rank 0.442, p = 0.506)。缺血性脑卒中患者年龄较大(71±11岁比62±16岁,p = 0.023), CHA2DS2-VASc评分有较高的趋势(2.9±1.7比2.3±1.7,p = 0.153)。多因素分析显示,吸烟史(校正优势比4.9,95% CI [1.8,14.0], p = 0.002)、左房内径较大(校正奇比2.6,95% CI [1.2,5.5], p = 0.014)、诊断时游离甲状腺素水平相对较低(校正奇比2.1,95% CI [1.2,3.5], p = 0.008)与房颤持续存在相关。结论:三分之一的患者持续存在甲状腺毒性房颤,在甲状腺功能亢进6个月后不太可能发生自发性窦性转换。顽固性甲状腺毒性房颤患者及老年房颤患者缺血性卒中发生率较高。伴有持续性房颤相关因素的患者,尤其是老年人,6个月以上应密切监测,及时启动抗凝治疗,降低缺血性卒中风险。
{"title":"Thyrotoxic Atrial Fibrillation: Factors Associated with Persistence and Risk of Ischemic Stroke.","authors":"Cheuk-Lik Wong, Ho-Kee Vicki Tam, Chun-Kit Vincent Fok, Pong-Kai Ellen Lam, Lai-Ming Fung","doi":"10.1155/2017/4259183","DOIUrl":"https://doi.org/10.1155/2017/4259183","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is one of the commonest cardiovascular manifestations of thyrotoxicosis. A significant proportion of patients have persistent AF which may have long term consequences, for example, ischemic stroke.</p><p><strong>Methods: </strong>We performed a retrospective cohort study in a regional hospital from January 2004 to June 2016 to examine the clinical characteristics and outcomes of thyrotoxic patients who presented with atrial fibrillation and to investigate possible factors associated with persistent atrial fibrillation and ischemic stoke.</p><p><strong>Results: </strong>Among 1918 patients who had a diagnosis of thyrotoxicosis, 133 (6.9%) patients presented with AF. Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, <i>p</i> = 0.506). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, <i>p</i> = 0.023) and had a trend towards higher CHA<sub>2</sub>DS<sub>2</sub>-VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, <i>p</i> = 0.153). History of smoking (adjusted odds ratio 4.9, 95% CI [1.8,14.0], <i>p</i> = 0.002), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI [1.2,5.5], <i>p</i> = 0.014), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI [1.2,3.5], <i>p</i> = 0.008) were associated with persistence of AF on multivariate analysis.</p><p><strong>Conclusion: </strong>Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/4259183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35774880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}