Endocrine Abstracts

Introduction: Hypothyroidism is associated with a spectrum of symptoms affecting almost all bodily functions. We present a case of severe hypothyroidism with multiple body cavity effusions, volvulus of sigma creating ileus.Case report: A 70 year old female was admitted to emergency department with dyspnea, and acute abdominal pain. Physical examination was notable for anasarca, abdominal fluid wave, lower extremity pitting edema, hypotension. She did not...

Introduction: Hyperfunctioning thyroid nodules (toxic adenomas) comprise one of the most common causes of hyperthyroidism and are usually treated with therapeutic radioiodine administration (RAI). Coexistence of such nodules with Graves’ disease (GD) is a rare disorder (Marine-Lenhart syndrome) with a reported prevalence of approximately 2.7–4.1% in GD patients. We present a rare variant of this condition, featuring the case of a patient with hyperfunctioning nodul...

Background: Primary hypothyroidism diagnosis is mainly based on the TSH (thyroid-stimulating hormone) and free thyroxine (T4) levels. Following treatment initiation, the main lab test used for dose adjustment is TSH. However, there could be potential issues with TSH measurement.Case report: A young lady, 36, presented to our clinic in January 2019, being treated with Levothyroxine 175 mg daily, and having clinical signs and symptoms of thyrotoxicosis: ta...

Introduction: Clinical presentation of hypothyroidism is frequently insidious. Of the many non specific clinical signs of hypothyroidism, ascites is one of the less common manifestations reported and the diagnosis is often made late with this condition. Herein, we present the cases of isolated ascites revealing hypothyroidism in order to drow attention to hypothyroidism as an etiology of an unexplained isolated ascites.Observation: A 61-year-old diabetic...

Objectives: Assessment of the utility of supplementing the iodine intake during pregnancy in women with chronic autoimmune thyroiditis (CAT) coming from the perimarine territory of Romania.Material and method: The study included 28 pregnant women in the first trimester of pregnancy, diagnosed with CAT. The following variables were evaluated: TSH, FT4, ATPO. The iodine status of pregnant women was analyzed by 2 methods: 1 – the value of the urinary ...

Introduction: Graves’ disease is an autoimmune disease that affects the thyroid gland and leads to a state of hyperthyroidism. This disease is caused by the production of antibodies that bind to and activate the thyroid-stimulating hormone (TSH) receptor. In some cases, Grave’ disease may be associated with other organ-specific or systemic autoimmune disorders. One of the most frequent multisystemic autoimmune disorders is Systemic lupus erythematosus (SLE). Many s...

The treatment of hypothyroidism is straightforward,replacing with orally L-thyroxine(LT4).However,some factors including malabsorption,pancreas and liver disorders,drug interactions,etc.,may impair the absorption of LT4,and cause therapy failures.In these circumstances,high doses of different oral formulae or parenterally given LT4 may be a solution. Here,we present a case of primary hypothyroidism,resistant to high doses of oral LT4 replacement but,responsive parenteral LT4 a...

3-iodothyronamine (T1AM) is rapidly catabolized to iodothyroacetic acid after few hours by serum proteins. To avoid a rapid metabolism during any treatment, DMEM devoid of FBS has been used, inducing changes in the cell culture environmental. We evaluated the uptake and the metabolism of different concentrations of T1AM, in presence of supplemented medium, and the presence of 3-iodothyroacetic aldehyde (Ald), a putative intermediate of T1AM catabolism to TA1.<p ...

Introduction: Subclinical hyperthyroidism is a syndrome with vague clinical symptoms. It may cause tachycardia, loss of weight or no symptoms at all. Subclinical hyperthyroidism may occur in middle age and in the elderly. It may be related to the occurrence of atrial fibrillation. Subclinical hyperthyroidism may be the result of an autonomous goiter, may occur in the course of follow-up of hypothyroidism, as the needs for treatment may vary over time and substantially diminish...

Introduction: The aim of the study was to evaluate the relevance of autoimmunity in the cytological results for the thyroid nodules referred to FNAB (fine-needle aspiration biopsy).Materials and methods: Our study included 590 patients who underwent FNAC in 615 nodules between December 2015 and January 2019. Besides demographic data and routine endocrine investigations (thyroid hormonal status, presence of autoimmunity, the actual or past use of levothyr...

In Bulgaria there are epidemiological data for the population of 20–80 years for the frequency of thyroid dysfunction – 6.3% hypothyroidism and 3.7% hyperthyroidism (Bulgarian Society of Endocrinology, 2012). So far, there is no national data on the incidence of thyroid disorders in pregnant women, which is a major lack of the health care system and the purpose of this study is to fill this gap.Material and Methods: We studied 547 pregnant Bu...

Background: Thyroid nodule is the most common endocrine disorder with the prevalence of more than 50% in adults. Majority of nodules are small in size and can be detected only by various imaging methods. Thyroid nodules are usually benign, asymptomatic, and do not need treatment. Growing and large symptomatic thyroid nodules are usually treated with thyroidectomy. Novel minimally invasive ablation techniques can be alternative to surgery. Percutaneous laser ablation is causing...

Women with positive thyroid autoimmunity are considered at risk of developing hypothyroidism in pregnancy, so monitoring thyroid function is recommended.Objective: To assess the risk of gestational hypothyroidism in pregnant women with autoimmune thyroid disease and normal thyrotropin (TSH) at the beginning of pregnancy.Methods: Retrospective review of data from pregnant women attended between April 2016 and October 2019. Women wit...

Background: Amiodarone induced thyrotoxicosis (AIT) is one of the most important and severe complications caused by amiodarone therapy. The multidisciplinary medical cooperation and combined therapeutic strategies are necessary in some cases.Aim: Analysis of patients suffered from AIT with focus on clinical picture, laboratory findings and possible therapeutic options.Methods and results: We performed retrospective analysis of 35 c...

Background: Graves’ disease (GD) is a common autoimmune disease of unknown origin. Evidence of an association between autoimmune thyroid diseases and viral infections is, however, emerging. Human leukocyte antigen (HLA) class I presents both virally and self-derived antigens to circulating immune cells and plays a crucial role in the defense against viral infections. This study aimed to investigate the presence of enterovirus and HLA class I expression in a large GD coho...

Introduction: Hypothyroidism remains a global problem with prevalence of 1–2% in iodine replete areas of the world. Primary or Autoimmune Hypothyroidism remains the most common type of hypothyroidism worldwide. Central (secondary) hypothyroidism (CH) because of pituitary/hypothalamic disorders is a rare cause of hypothyroidism with reported prevalence of 1:20.000 to 1:80.000 in the general population1. This makes CH about 1000 fold rarer than primary hypothyro...

Introduction: Exposure to air pollution and in particular to nitrogen dioxide (NO2) or particulate pollutants less than 2.5 µm (PM2.5) or 10 µm (PM10) in diameter has been linked to thyroid (dys)function in pregnant women. The environmental degradation that has occurred in recent years in the region of Athens led us to a local study of air pollution against thyroid function in pregnant women in Athens. We hypothesized that there may be a dose-effect relati...

Background: Primary hypothyroidism is one of the most common endocrine disorder, prevalence is in the ranges of 3.8–10.9%. It has been estimated that about 42 million people in India suffer from thyroid diseases. At one end,with easier availability of the assays and better affordability we are now able to diagnose and treat hypothyroidism much earlier. At the other end, we are seeing patients with TSH > 100 at diagnosis, most of them done as a part of routine screeni...

Aim: Hyperthyroidism can affect pregnancy outcomes based on activity of the disease, ongoing use of anti-thyroid drugs (ATD) and TSH receptor antibody (TRAB) positivity. The aim of our audit was to analyse the outcomes of fetal monitoring in pregnant women with previous or current history of active hyperthyroidismMethods: The data on all patients with hyperthyroidism and pregnancy over 3 years was collected. The local guidelines recommend TRAB check at 2...

Aim: Most research teams analyze the evolution of patients with Hashimoto thyroiditis (HT) on syndromic basis (e.g., the thyroid function), not on pathogenic basis (the autoantibodies). Thus, most researchers refer to thyroid hormone evolution. In this study we re-analyzed (first in 2018) how evolve the antithyroid autoantibodies. Therefore, we analyzed the antithyroperoxydase antibodies (ATPO) evolutive patterns in patients with HT.Method: 1. ATPO level...

Objectives: Assess the response of benign thyroid nodules to HIFU treatment depending on their volume and localization. Know if the treatment is painful when sedation is not used.Methods: 66 patients with benign thyroid nodules (Bethesda Category II) were treated with HIFU (Echopulse Theraclion). They were grouped in 3 categories by maximal nodule diameter as assessed by echography. Group 1: nodule diameter between 14 and 20 mm; Group 2: between 21 and 3...

Introduction: Thyroid nodules are a very common finding in sonographies (20–75% people). Criteria for clinical management and for cytological diagnosis (-Bethesda system) are well standardized. In spite of this, a gap of knowledge exists as far as management of Bethesda 4 is concerned.Aim: Evaluate the clinical approach of Bethesda 4 (B4) result in a thyroid cytology.Material and Methods: Retrospective study of thyroid nodule...

Objectives: Thyroid screening in pregnancy has in Slovakia started in 2009 on the basis of a ministerial guidance for diagnosis and therapy of autoimmune diseases of thyroid gland in pregnant women. (source: Vestník MZ SR 39., 2009, pp. 33–39). Its effectiveness was analysed in 2016 and compared with a similar analysis from 2011. The analysis was aimed to verify the implementation rate of the Guidance in practice.Methods: Records from pregnant...

Introduction: Chemotherapy, as a systemic therapy, is one of the most effective modalities for cancer treatment. However, the use of chemotherapeutic drugs in patients with breast cancer can lead to thyroid dysfunction. The aim of our work is to determine the influence of adjuvant chemotherapy on thyroid function in female patients with breast cancer after radical mastectomy and before radiotherapy.Materials and methods: Our study was conducted on 40 Egy...

Background: Distant metastases develop in approximately 5–10% of patients with differentiated thyroid cancer (DTC). Nearly 70% of this subset will become radioiodine refractory (RAI-R) with a poor prognosis. Recently, the multikinase inhibitors (MKIs) showed promising results of treating these patients. It has become crucial to identify RAI-R DTC early. This study was conducted to identify the predictors of RAI-R disease in patients with distant metastasis secondary to d...

Introduction: Differentiated thyroid cancer (DTC) prognosis is usually favorable, even when metastatic radioiodine avid disease is present. Radioiodine-refractory disease, usually a sign of higher aggressiveness, can be detected by 18F-FDG-PET/CT. There is a reverse relationship between iodine and FDG accumulation in thyroid cancer lesions, the so-called ‘‘flip-flop’’ phenomenon: when thyroid cancer cells dedifferentiate they tend to lose the...

Fine-needle aspiration (FNA) is the best available technique for preoperative diagnosis of malignancy in thyroid nodules. Although its efficiency has been well described, the learning curve is underreported. We aimed to describe the learning curve of a new FNA facility (endocrinologist/pathologist) in a university based hospital.Methods: In February 2018 a new FNA facility was formed in our hospital comprising an endocrinologist with high experience in t...

Objective: There is a risk of malignancy in 5–10 percent of all thyroid nodules. The most common type of thyroid cancer is papillary thyroid cancer (PTC).There are some risk factors has been found in differentiated thyroid cancers like high iodine intake. However, in people with severe or moderate iodine nutritional deficiency (<75 µg/day),an increased risk of thyroid cancer was found 2.6 times higher than those with optimal iodine nutrition (150–299 &#181...

Introduction: Next-generation sequencing (NGS) in thyroid cancer allows for high-throughput sequencing analysis of various genetic alterations and provides a useful information of tumor biology. NGS Studies on follicular differentiated thyroid cancer have been scanty from Indian subcontinent. In this context, we set out study the prevalence of a genetic panel wide somatic mutations in thyroid cancer.Material and Methods: This prospective study was conduc...

Introduction: Papillary thyroid carcinoma (PTC) is the most common type of differentiated thyroid cancer, accounting for about 80% of all cases of thyroid cancer. 20 – year survival rate is about 90%. However, PTC can be aggressive – up to 30% of the patients have local renewal or systemic spread.Our objective was to evaluated the clinicopathological factors of recurrence in completely resected PTC patients.Methods: A r...

Introduction: The connection between the pharynx and thyroid is close, so in the situations of concomitance: thyroid nodules and pharynx infiltration is very difficult to establish the primary lesion. Extralaryngeal spread of laryngopharyngeal cancer to the thyroid gland can occur by three pathways: direct extension, lymphatic spread or hematogenous spread. Of these three mechanisms, direct extension is the main mechanism because of the close anatomical relationship of the thy...

Introduction: Anaplastic thyroid carcinoma also known as undifferentiated carcinoma is a rare and highly aggressive malignant tumor. It continues to rank as one of the deadliest diseases worldwide and carries a very poor prognosis. It is an aggressive locoregional disease with a high metastatic capacity. There is no agreement with regards to the best treatment.Material and Methods: We reporteded 6 cases of anaplastic thyroid carcinomas treated in the ENT...

Introduction: Medullary thyroid carcinoma (MTC) represents 3–10% of all thyroid cancer. The presence of papillary thyroid microcarcinoma (mPTC) in patients undergoing thyroidectomy for multinodular goiter has been reported as 3–7%.The occurrence of multiple thyroid cancers of different origin in one individual patient is a rare event. We report the case of synchronous papillary and medullary thyroid cancer developed in heterogynous recurrent ...

Objectives: In recent studies, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are being investigated as prognostic and diagnostic markers for many malignancies, including thyroid cancer. The aim of our study was to investigate if a relationship exists between NLR and PLR and thyroid cancer.Materials and methods: We retrospectively analysed the files of 953 patients who underwent thyroidectomy in our surgery department between...

Introduction: Thyroid nodules (TN) are common entities usually discovered during a physical exam or by chance with ultrasound (US) procedures performed for reasons different from thyroid check. The majority of nodules are benign, notwithstanding the growing incidence of thyroid cancer (TC), which increases much largely as compared to all other tumours each year and will be, presumably, the most incident malignancy in women after breast cancer. The clinical challenge relies on ...

Based on the medical records of 311 patients with medullary thyroid carcinoma (MTC) treated in the period 1979–2018, using the Kaplan-Meier method, it was found that the sporadic form and male patients are negative predictors of disease. Other is essential for patients with sporadic form of MTC, because sex has no prognostic value in patients with hereditary forms of the disease. The presence of metastases in regional lymph nodes or distant metastases is a poor prognosti...

Introduction: Medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) are two distinct neoplasms originating from follicular and parafolicular-C cells, respectively. These pathologies have always been considered different from each other in terms of their incidence, their cell origin and their histopathological features. Concurrent occurrence of MTC and PTC in the same patient is an unusual event and its occurrence as true mixed medullary-follicular-derived car...

Objectives: We studied whether the postoperative serum thyroglobulin (TG) basal levels before treatment with I131 (baseline TG) could be related with the response to treatment. We consider the excellent response as the absence of clinical, biochemical disease (undetectable TG and anti-thyroglobulin antibodies AcTG negative) and/or structural disease.Material and Methods: This is an observational study that includes 100 patients with differentiated thyroi...

Introduction: Primary thyroid lymphoma (PTL) represents about 1–5% of thyroid malignancies and < 2% of extra-nodal lymphoma. The most common subtype is diffuse large B-cell lymphoma (DLBCL) (~ 50% of cases), followed by mucosa-associated lymphoid tissue (MALT) lymphoma, both non-Hodgkin’ lymphomas. sophageal perforation is a very rare complication during the course of PTL, characterized by poor prognosis.Case presentation: A 65-year-...

Background: Nonivasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and hyalinizing trabecular tumor (HTT) are a rare follicular- derived thyroid neoplasmas with indolent clinical behavior. These tumors are encapsulated or clearly delimited and distinguished by detail using histopathological criteria.Method: Description of two cases of these rarer tumors, classified on FNAB Bethesda III AUS/FLUS in the BSRTC 2017 and diagnosed...

Introduction: The treatment of central hypothyroidism with a combination of levothyroxine (T4) and liothyronine (T3) is not recommended for most patients since it does not show an advantage over T4L monotherapy. However, in certain patients who remain symptomatic under replacement therapy with T4L and thyroid stimulating hormone (TSH) within the reference values, combined treatment with T4 and T3 can be tested.Clinical case: Male, 39 years old, medical h...

Introduction: Thyroid ectopy is uncommon pathology. The lingual area is the most frequent localization. The medaistinal localization is rare. We report in this article two cases illustrating this location.1st clinical case66-year-old woman operated on for benign breast cysts consulted for progressive chest pain. The clinical examination was without abnormalities. The standard biological assessment was normal. Cervicothoracic CT sca...

Multiple endocrine neoplasia type 2 (MEN2) is a hereditary condition with an autosomal dominant type of inheritance. It is evident that MEN2 is characterized by the presence of Medullary Thyroid Cancer (MTC) as a permanent symptom, the combination of which with pheochromocytoma and parathyroid syndrome is referred to as MEN-2A syndrome. The aim of our study was the creation of a database of patients with MTC and analysis of the data.Materials and methods...

The medical and social significance of the Multiple Endocrine Neoplasia type 2 (MEN2) is due to the severity of the manifestations of the disease components, namely the tumor process progression, a high risk of vascular accidents, pathological fractures of the femoral neck/spine, gastrointestinal bleeding, chronic renal failure. Late detection of pathology is associated with high mortality due to medullary thyroid cancer (MTC). Thus, the aim of the study was to establish the c...

Aims: Thyroid function changes are common endocrine disturbance among patients with chronic kidney disease (CKD), including those receiving renal replacement therapy (RRT). The purpose of the study was to study the effect of RRT on thyroid function in patients with type 1 diabetes (T1D).Materials and methods: Thyroid hormone examination was performed before and after hemodialysis procedures (HD) in 9 patients with T1D (3 men and 6 women). Mean age was 41...

To date, up to 35% of the young population (25–60 years) in developed countries are subject to anxiety disorders. The use of anti-anxiety agents in clinical practice does not always lead to a lasting effect. The study included patients who initially consulted a neurologist or psychotherapist. With panic attacks. On the Anxiety and Depression Rating Scale (HADS), all patients received 11 points or more. The use of anti-anxiety drugs gave a short-term effect with subsequen...

Introduction: Hepcidin is an acute-phase protein and a key regulator of iron homeostasis. Anemia frequently occurs in patients with hyperthyroidism, while hepcidin may be a potential link.Objectives: Prospective evaluation of hepcidin serum concentration and other parameters related to Fe homeostasis in group of hyperthyroid patients in the course of Graves’ disease (GD) at diagnosis and after restoration of euthyroidism.Pati...

Background: Subacute thyroiditis is an inflammatory condition, most likely of viral origin, which typically presents wit low anterior neck pain, fever and transient thyrotoxicosis. Ultrasonography (US) usually shows a diffuse thyroid enlargement with ill-defined hypoechoic areas.Case: A 55-year old women was admitted in the emergency room, with 2 weeks of anterior neck pain, cervical compressive symptoms of dysphagia, fever and palpitations. On physical ...

Introduction: The basic characteristics of metabolism in pregnancy are changes from anabolic to catabolic conditions. During early gestation, the fetus is dependent on maternal thyroid hormones that cross the placenta. Thyroid disease in pregnancy is a common clinical problem, at least 2–3% of women have thyroid dysfunction. Pre-conceptual education and appropriate diagnosis and treatment of thyroid dysfunction in early pregnancy are of great importance, with the aim of ...

Introduction: The study describes volume changes of thyroid gland in patients with Graves’disease (GD) after radioactive iodine treatment in the University hospital in Hradec Kralove.Patients and Methods: Retrospectively, we analyzed 66 patients with GD (57 women and 9 men, mean age 52 ± 13.4 years). Volume of thyroid gland was measured before and 1 year after application of radioactive iodine.Results: Total decrease of ...

Background: Immune checkpoint inhibitors (ICI), anticancer therapy blocking specific molecules expressed in tumor microenvironment, are associated to several endocrine side effects. In particular, the use of PD-1/PD-L1 inhibitors is related to a higher incidence of thyroid dysfunction. The most frequent form of thyrotoxicosis is a destructive thyroiditis, which can evolve into hypothyroidism.Patient findings:We report the case of an 85 years-old patient,...

Introduction: The association of thyroid nodules and connective tissue diseases (CTD) is not uncommon. The purpose of our work was to describe the clinical, biological and ultrasound characteristics of thyroid nodules during CTD.Materials and methods: It was a retrospective study (2015–2019) including records of patients with CTD and thyroid nodule in an internal medicine department at Ben Arous regional hospital. Informations regarding thyroid fun...

Aim/introduction: The main purpose of this work was to describe a clinical case of thyrotoxicosis with concomitant HASHARON hemoglobinopathy scrutinizing whether the latter could hinder radioiodine therapy (RIT).Materials and methods: Patient H., 53 years old, diagnosed with moderate toxic diffuse multinodular goiter. Clinical manifestation of the disease were in summer 2018 (TSH – 0 mIU/ml). Medication with thyrozole (20 mg) was initiated. Thyroto...

Introduction: Periodontal disease (PD) is a disease with infectious determinism, initiating inflammatory and autoimmune processes, in intricate evolutionary stages, affecting 10% to 60% of adults.Objectives: Between chronic autoimmune thyroiditis (CAT) and PD there are observations regarding pathogenic interconditioning.Material and methodGroup 1 (n = 109 patients) comprised 84 women and 25 men. ...

Introduction: Patients with Down syndrome are vulnerable to autoimmune thyroid disease and progression from Graves’ disease (GD) to Hashimoto’ thyroiditis or vice-versa may be more frequently seen in this population, specially at a younger age. In the last years questions have been raised regarding the distinction of this metamorphic scenario from a single entity: autoimmune thyroiditis with TRAbs that trigger opposite functional actions.Case...

Introduction: Graves’ disease (GD) is an autoimmune thyroiditis frequently associated with development of Graves’ orbitopathy (GO). As a consequence, patients with GO experience impairment of quality of life (QoL) and social function. The aim of our study was to assess quality of life in patients with GO.Methods: This is a single-center observational study in an outpatient clinic of autoimmune endocrinopathies at a Tertiary, General, Universi...

The purpose was to study the possibility of various diagnostic methods in patients with large goiter. In 2016–2018 years 628 people with thyroid diseases was operated. In 69 cases the volume of the thyroid was 100–1200 cm3. The correlation between thyroid volume and age is weak (0.074033), the duration of the disease is high (0.732455). Evaluation of clinical signs was not difficult, but the examination data and symptoms did not give a adequate picture o...

Background: Hypothyroidism is a common endocrine disorder. Common causes are autoimmune disease such as Hashimoto’ thyroiditis, surgical removal of the thyroid, drug induced and radioactive iodine (RAI) ablation.Aim: The aim of our study was to determine the etiology of hypothyroidism in Nepalese patients.Method: This is a retrospective study conducted in our opd from May 2015 to April 2019 in which data was collected from th...

Background: Immune checkpoint inhibitors, including anti-programmed cell death-1 (PD-1) antibodies, have become promising treatments for a variety of advanced malignancies. Nivolumab, an anti–PD-1 monoclonal Ab, is an effective treatment of unresectable metastatic melanoma, non–small cell lung cancer, renal cell carcinoma, head and neck cancer, Hodgkin lymphoma, and gastric cancer. These medicines can cause immune-related adverse events (irAEs), including endocrino...

Background: The incidence of endocrine complications among patients with HIV infection has decreased over the last years owing to widespread administration of combined Antiretroviral Therapy (cART) at early stages of the disease. We conducted a prospective observational study aiming to characterize the effects of cART on thyroid function in a cohort of newly diagnosed treatment-naive male patients.Materials and methods: Male subjects diagnosed with HIV i...

Introduction: Radioactive iodine (131I) therapy is a safe and cost-effective choice in Graves’ disease (GD). Usually only one treatment with 131I is sufficient, however, individual characteristics of the disease can lead to its recurrence. The aim of this study is to determinate the risk factors that influence the recurrence of GD after 131I.Materials and methods: Retrospective cohort study in 528 patients with GD who did <sup...

Introduction: An abnormally positioned thymus may either be aberrant or ectopic. Aberrant cervical thymus (ACT) is located along the normal pathway of descent of the thymus, with an attachment to mediastinal thymus via thymic tissue or fibrous cord in 50% of the cases. ACT is usually diagnosed within the first and second decade of life, and most lesions are cystic.Case report: We report a case of 9-year-old woman was referred to our hospital for the oper...

Introduction: Levothyroxine is the treatment of hypothyroidism, achieving normal thyroid stimulating hormone (TSH) levels. The optimal dose of Levothyroxine may be affected by several factors such as age, gender, body weight, patient’ compliance, some medical disorders and drugs intake. Persistent hypothyroidism secondary to non compliance is rare and represents a diagnostic challenge.The aim of this study was to describe cases with refractory hypo...

Introduction: Graves’ disease (GD) is an autoimmune disorder of the thyroid gland, which is characterisied by a breakdown in immune tolerance. The lymphocytic infiltration of the thyroid leads to production of autioantibodies targeting thyroid stimulating hormone receptor (TSHR). The clinical course of GD varies among patients and it is difficult to predict the relapse risk after antithyroid therapy withdrawal. It is believed that GD occurs due to genetic suspectibility ...

The aim of this study was to assess thyroid homeostasis in patients with liver cirrhosis (LC) of non-viral etiology and analyze the association between serum thyroid parameters and A/C polymorphism in the deiodinase type 1 (DIO1) gene in these patients.Material and Methods: The study was conducted on 70 subjects: 50 patients with (LC) and 20 healthy controls. The thyroid homeostasis was evaluated by using «thyroid function tests», measurement o...

Introduction: Cardiothyreosis or thyrotoxic heart disease is the most dangerous complication of hyperthyroidism. This rare complication can be revealing and occurs mostly to fragile patients ; eldery or individuals with preexisting cardiac troubles.Observation: We report the case of a 59 years old male without medical history, who consulted the emergency for dyspnea and palpitations due to atrial fibrillation ( ACFA ) not well tolerated with both respira...

Introduction: Grave´s disease (GD) is the most prevalent cause of hyperthyroidism, leading to inflammation of the thyroid gland and sometimes to an enlargement of the nearest lymph nodes caused by that same inflammatory process. Peripheral lymphadenopathy of doubtful cause presents a diagnostic dilemma. There are many potential causes: biopsy is sometimes the best way to reach a definitive diagnosis. Tuberculous adenitis is usually regional and mainly affects nodes of the...

Introduction: Subacute thyroiditis (SAT) is the inflammatory disease of thyroid gland, which commonly affects middle-aged females. SAT is rarely seen in extreme age groups. Herein, we reported an 82-year-old patient presenting recurrent SAT.Case report: An 82-year-old female patient presented fever, neck pain, weakness, and dizziness. She had hypertension and peripheral vascular disease. She had a 2-week of symptom history and admitted to emergency servi...

Objective: Thyroid hormones are powerful mediators of numerous physiological and metabolic processes, including blood clotting, and thyroid dysfunction can adversely affect various stages in the coagulation cascade. Mean platelet volume (MPV) is used to measure platelet size and may indicate platelet activity. Studies have reported that increased MPV is associated with atherosclerotic lesions and cardiovascular diseases, and conflicting results have been reported for the relat...

Objectives: Between 2010 to 2018, the number of patients with thyroid disease in the Slovak Republic grew by 43.4%. We investigated the development of physical, laboratory, USG thyroid examinations and economic costs over the period 2010–2017.Methods: The study was conducted using data from patient records of the General Health Insurance Company, which registered approximately 3,497,265 policyholders (66.13%) in 2010 and 3,238,500 policyholders (62...

Introduction: The adenoma- carcinoma sequence in thyroid nodules is an enigmatic phenomenon. Genomics is the only definitive modality to resolve this hypothesis. Adenomas and papillary carcinomas tend to have mutations in RAS and highly specific BRAF gene respectively. In this context, we set out study the prevalence of these somatic mutations in surgical tissue samples.Material and Methods: This prospective study was conducted on surgically managed thyr...

Introduction: Tyrosine kinase inhibitors (TKI) demonstrated clinically significant activity in radio iodine (RAI)-refractory differentiated thyroid cancer (DTC) and in locally recurrent, unresectable and metastatic medullary thyroid cancer (MTC). The natural history of MTC and DCT is quite variable with rates of disease progression ranging from a few months to many years. TKI can be associated with progression-free survival, but is not curative and the side effects may have a ...

Clear cell renal carcinoma (CCRC) is a tumor with great metastatic capacity, although the presence of metastases in the thyroid gland is very uncommon. Therefore it is important to know the oncological background of the patient and to perform a complete immunohistochemical analysis of the thyroid lesion to obtain a correct diagnosis. Thyroidectomy can be considered in patients with no other metastasis or in those who present compressive symptoms as a palliative measure. We pre...

Medullary thyroid carcinoma (MTC) is a rare type of tumor that originates from parafollicular C-cells and accounts for 3–4% of all malignant thyroid neoplasms. MTC presents as sporadic (75–80%) or inherited tumors (20–25%). Hereditary MTC is part of multiple endocrine neoplasia type 2 (MEN2). Aim of the study was to describe clinical presentation, prognosis and therapy of sporadic MTC patients. Sixty-seven patients (pts) with histologically confirmed MTC refe...

Introduction: Anaplastic thyroid carcinoma (ATC) is the most aggressive and invasive histological type of thyroid carcinomas. Frequently, upon diagnosis obstructive symptoms and loco-regional metastasis have already occurred. Presence of distant metastasis in the skeletal muscle in ATC is rare; and there are less than five documented cases reported worldwide.Case: A 68-year-old Filipino Male, presents with two-month history of pain on the right thigh. He...

Introduction: Papillary carcinoma is the most common form of well-differentiated thyroid cancer (80% of the total). In recent years there has been a significant progressive increase in prevalence.Objectives: The aim of the study was to evaluate the clinical characteristics of the newly diagnosed papillary thyroid carcinoma at the Sanitary Area of Jerez, as well as to analyze its incidence in recent years.Material and Methods: An ob...

Introduction: Anaplastic thyroid carcinoma are highly aggressive solid tumors, with a median survival of less than 6 months after diagnosis. They typically occur in patients who are 65 years of age or older. On the other hand, papillary thyroid carcinoma and follicular thyroid carcinoma are generally indolent, with very few progressive cases.Case report: A 64-year-old patient with no significant pathological history, known with goiter for about 40 years ...

Introduction: Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) are distinct neoplasms, associated with different histological findings. Their coexistence in the same patient is a rare event, requiring a different clinical approach.Clinical case: A 72-year-old patient with no family history of thyroid disease, underwent total thyroidectomy in February 2019, due to toxic multinodular goitre, with no evidence of postoperative complica...

Introduction: As the incidence of thyroid cancer is increasing, so are the cases of recurrence with RAI refractory metastasis of thyroid differentiated cancer. We present such a caseCase report: A 77-year-old female with a medical history of papillary thyroid carcinoma recurrence 10 years after surgery with successful 3 RAI sessions and normal thyroid cancer markers after treatment until her recurrence a year ago, with TSH unstimulated thyroglobulin of 1...

Introduction: Solitary fibrous tumor (SFT) is a sporadic tumor, commonly found in the pleural cavity. It is like a large well-circumscribed mass, arising from mesenchymal tissue, with spindle cells proliferation, arranged in various patterns. SFT of the thyroid is exceptionally rare, with only about 28 cases being reported in the international literaterature.A 34-year-old woman presented in the Department of Endocrinology with the diagnosis of a multinod...

Objective: Incidentally discovered thyroid microcarcinomas (TMc) are tumors with a maximal diameter ≥1 cm, indetified during a detailed histopathology examination following a thyroidectomy performed for reasons not pertaining to malignancies of the thyroid gland.Methods: We included 1555 patients who underwent a total thyroidectomy for benign disease between January 2005 and December 2018. Patients with post-surgical pathology consistent with thyro...

Background: Thyroid nodules are common with annual increasing trends worldwide. 5% to 15% of the thyroid nodules is thyroid cancer. The prevalence of thyroid nodule is 3%–7% prevalence by palpation and 19%–67% by high resolution ultrasound. Thyroid nodules are more prevalent in women and older age group. More than 95% of all thyroid nodules are benign.Aim: The aim of this study is to assess the clinical profile of patients with solitary thyro...

Introduction: The coexistence of papillary thyroid cancer (PTC) and medullary TC (MTC) is rare. Previous retrospective studies have shown a prevalence up to 19%. The aim of our study was to assess the prevalence of PTC in patients with sporadic MTC.Methods: This is a single-center retrospective study of an endocrinology outpatient clinic at a Tertiary, General, University Hospital. Patients who had undergone total thyroidectomy with central neck compartm...

Background: Thyroid cancer is the most common malignant disease of the endocrine system. Thyroid cancer represents above 1% of all malignancies. There is a paucity of data on thyroid cancer in Nepalese patients.Aim: The aim of this study is to explore clinical profile of thyroid cancer patients diagnosed and managed in our center.Methods: A total of 70 patients with thyroid cancer were included in the sample from March 2013 to Dece...

Background: AUS/FLUS (atypia/follicular lesion of undetermined significance) carries a malignancy risk reaching up to 50%. Based on the reported malignancy rate in a given population, the clinical practice towards such a category varies. We hereby identify clinical parameters for risk stratification to aid in decision making for either surgical referral or a clinical follow up.Our aim is to calculate the malignancy risk in Bethesda III category and to id...

Objectives: Thyroid malignancy constitutes the sixth common cancer type in the United Arab Emirates (UAE). There are no epidemiological data outlining the prevalence of cancer in thyroid nodules, nor previous analysis of ultra-sonographic features correlating with thyroid malignancy in the UAE. This study aimed to estimate the prevalence of thyroid malignancy in patients with thyroid nodules and to describe the ultra-sonographic characteristics of thyroid nodules harbouring ma...

Introduction: Oral metastases are exceptional, representing about 1% of cancers of the oral region. The most common primary tumors are the lung in men and the breast in women. Thyroid carcinoma accounts for approximately 3% of all oral metastatic carcinomas.We are reporting a case.Observation: 65-year-old woman, followed for 35 years for a toxic large goiter at the expense of the right lobe under medical treatment, which consults f...

Background: Graves’ disease is an autoimmune disease that is characterized by production of excess thyroid hormones by thyroid gland, which is called hyperthyroidism. Generally, clinical presentations of Graves’ disease range from asymptomatic disease to overt symptomatic hyperthyroidism with heat intolerance, tremor, palpitation, weight loss, and increased appetite. Single-cell lineage haematological abnormalities, such as anemia, leukopenia, and thrombocytopenia,...

Introduction: In the area of Immunotherapy, immunological checkpoints, such as CTLA-4, PD-1 or PD-L1, are membrane proteins involved in the immune response that, when inhibited, cause an increase in T cell activity and a consequent anti-tumor effect. However, this inhibition can also cause adverse effects, including endocrinopathies, such as thyroid dysfunction and hypophysitis.Clinical case: 59-year-old man, diagnosed with lung cancer, treated with nivo...

Graves’ orbitopathy, is a rare and potentially sight-threatening ocular disease that sometimes occurs in patients with euthyroid or hypothyroid chronic autoimmune thyroiditis. We relate a case of a man with 53 years that have diabetes and hipertension and regular clinical exams with endocrinologist and oftalmologist. He developed a bilateral exoftalmia, larger at right eye, in 3 months of follow up, without another signs of thyrotoxicosis. After 2 years of follow up, the...

Introduction: Acromegaly is characterized by a pituitary adenoma with excess secretion of GH and IGF-1 hormones. More than 90% of the cases are diagnosed as macroadenomas, after 5 to 10 years of clinical manifestation.Case report: We present the case of a 49 years old man with minor thalassemia, hospitalized in endocrinology department for a routine check of chronic autoimmune thyroiditis. A careful anamnesis showed that in the last year the patient was ...

Introduction: Thyroid cancer is the most common malignant endocrine tumour and represents 1% of all malignancies. Cancer Research UK in 2015 reported 3528 new cases and 382 deaths with annual incidence of 5.1 and 1.9 per 100,000 women and men respectively. The incidence is increasing globally, mostly due to papillary thyroid cancer.Ultrasound is the preferred examination with recommended U1-U5 grading system +/- fine-needle aspiration cytology (FNAC)...

The British Thyroid Association executive committee advised in 2015 that there was insufficient evidence that levothyroxine(T4) and liothyronine(T3) combination therapy was superior to levothyroxine monotherapy, which remains the standard treatment of primary hypothyroidism. It was considered an experimental approach in symptomatic patients on T4 therapy with a TSH level within normal range.We present a 47-year-old lady who had been diagnosed with primar...

Introduction: Thyrotropic hormone (TSH), triiodothyronine (fT3) and thyroxine (fT4) affect adipocytes and HMG-CoA hepatic reductase, indirectly regulating the body’s lipid metabolism. This mechanism is already known, however the principles of regulating lipid metabolism through thyroid metabolism constitute an important and a desirable element of scientific research in thyreology. Thyrotropic hormone (TSH), triiodothyronine (fT3) and thyroxine (fT4) affect adipocytes and...

Introduction: During nephrotic syndromes, thyroid function abnormalities may be observed. Hypothyroidism due to loss of thyroid hormones or their binding proteins can be seen but remains a rare complication of nephrotic syndrome. We report the case of 22 year old patient admitted for massive proteinura with nephrotic syndrome that was complicated with hypothyroidism.Case report: We report the case of 22 year old patient who presented with generalized ede...

Introduction: The Quervain’s disease is an infrequent subacute thyroiditis (ST) that results in granulomatous infiltration of the gland’s parenchyma. Is usually diagnosed clinically based on cervical pain, systemic symptoms, altered thyroid function tests (TFTs) and history of upper respiratory tract infection. It is a benign self-limited condition that may share US features with malignancy which may result in improper therapy, including lobectomy.<p class="abs...

Background: Subacute thyroiditis (SAT) is a transient thyrotoxic state characterized by suppressed TSH and low uptake of iodine 123 on thyroid scanning. SAT is a self limiting, possibly viral and inflammatory thyroid disorder that is usually associated with thyroid pain and systemic symptoms. Many factors can cause SAT. Infections are considered the most common cause. Vaccines can also lead to SAT.Case report: A 46-year-old male with a history of type 1 ...

Introduction: Thyroid papillary microcarcinoma is a subtype of papillary carcinoma that included tumors with less than 10 mm diameter. Its therapeutic management is still a subject of controversy.Material and Methods: We conducted a retrospective study over 20 cases of papillary thyroid microcarcinoma at the ENT department of Tahar Sfar Hospital in Mahdia over 17 years (2000–2017).Results: We report 20 cases of papillary thyr...

Introduction: Chronic lymphocytic thyroiditis is an autoimmune pathology affecting 5% of the population. Treatment is most often medical based on hormone treatment. Sometimes thyroiditis will be associated with benign or malignant nodular pathologies requiring the use of surgery. The objective of this study is to describe the diagnostic, therapeutic and evolutionary features of this entity.Materials and methods: It is a retrospective study bringing 28 ca...

Background: Branchial cleft cysts account for almost 20 percent of pediatric neck masses. They are usually present in late childhood or early adulthood, when a previously unrecognized cyst becomes infected. First branchial cleft cysts typically appear on the face near the auricle. Second branchial cleft cysts are the most common and they are usually located just inferior to the angle of the mandible and anterior to the sternocleidomastoid muscle. Third branchial cleft cysts ar...

A 47-year-old male farmer presented to our endocrinology clinic in 2001 with progressive polyuria for half a year. He had a past history of left intracranial hemorrhage with right hemiparesis due to traumatic injury in November 1998 but recovered thereafter. He complained of urine output more than 10 000 c.c. per day. Routine urine check with SP. GRAVITY < 1.005 was noted ( Normal range: 1.005–1.030 ). Serum osmolality was 299 mosm/KgH2O (Normal range: 275...

Graves’ disease is the most common cause of hyperthyroidism. It is well established that hyperthyroidism promotes a hypermetabolic state characterized by increased resting energy expenditure, increased lipolysis and gluconeogenesis. We describe a rare complication of thyrotoxicosis in a patient with type II diabetes on insulin, with no previous thyroid history. An 83 year old woman with type 2 diabetes on biphasic insulin presented with symptoms of polyuria, polydipsia a...

Background: Graves’ disease in combination with thyroid nodules is more common in women. However, more than one in three patients has carcinoma. Unfortunately, thyroid cancer is most frequently detected accidentally after a thyroidectomy for Graves’ disease, despite the wide possibilities of modern diagnostic methods.Clinical case: A 55-year women complained of discomfort in the neck, sweating, irritability, palpitation. From anamnesis: in 20...

Background: Acromegaly is a chronic rare disease induced by persistent hypersecretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in adult patients. Several studies have associated acromegaly with an increased risk for developing different benign or malignant tumors.Case presentation: A 33-year old female patient was diagnosed with acromegaly due to a large pituitary macroadenoma, in 2009. In the same period, she was also diagnosed wi...

Introduction: The auto immune’s diseases are also involved in the heart’s failure. Grave disease(GD) is an autoimmune thyroid disease that often linked by pericarditis. We report a case of an acute pericarditis that was also presumed to be associated with GD.Case report: A 59 years old who 10 pack years smoker. admitted for chest pain and shortness breathstage 3NYHA. At the investigation there was a progessive emaciation of 12 kg within 7 mon...

Background: Hyperthyroidism as well as hypothyroidism have been associated with oxidative stress, caused by an imbalance between pro-oxidants and antioxidants. Oxidative stress may damage the genomic apparatus and other cellular structures. Urinary excretion of 8-oxo-7.8-dihydroguanosine (8-oxoGuo) and 8-oxo-7.8-dihydro-2’-deoxyguanosine (8-oxodG), respectively, represent global RNA and DNA oxidation, thus reflecting oxidatively generated modification of nucleic acids in...

Background: Increasing of the level of circulating Antithyroid autoantibodies suggested about autoimmune destruction in thyroid gland and not always depends from thyroid status. We aimed to study the frequency of circulating antithyroid autoantibodies (ATAB) in people with the different thyroid diseases.Material and Methods: In 25 people with high level of circulating ATAB blood serum TSH, T3, T4, glucose, ALAT, protein, albumin levels were measured. Thy...

Subclinical hyperthyroidism (ScHyper) is a condition with suppressed TSH, and normal free T3 and free T4 hormones, affecting 10% of the population. There are two subgroups of patients, the first group with TSH lower than 0.1 U/l, and the second group with mildly suppressed TSH between 0.1 and the lower assay reference limit. The patients from the first group should be treated, but there is no evidence for therapy for the second group of patients.We prese...

Introduction: Pregnant women are at risk for selenium deficiency, which is known to maintain adequate function of immune system and thyroprotective enzymes. Same, iodine is an essential micronutrient for thyroid hormone synthesis and important endocrine regulator of early brain development. Our previous study revealed that 81% of pregnant women in Latvia have insufficient levels of iodine. The aim of the present study was to evaluate iodine and selenium supply during pregnancy...

Introduction: Hypothyroidism during pregnancy has been asociated with adverse maternal and neonatal outcomes. During pregnancy, maternal levothyroxine (LT4) dose requirements increase. The aim of this study is to determine the increase of LT4 doses during pregnancy in pregestational hypothyroid women.Methods: We included 76 hypothyroid pregnant women. We analyzed analytical and clinical characteristics of these patients, as well as the increase of LT4 re...

Used for the first time in 1941 in the United States by Hertz and Roberts for the treatment of hyperthyroidism in Grave’s Disease, radioactive active therapy (RAI) has been able to gain its place within the already existing therapeutic arsenal by being efficient, easy to use and minimally invasive. Our work is a retrospective study of 46 patients collected at the Department of Endocrinology, over a period of 7 years and half from January 1, 2011 to June 30, 2018. The pur...

Introduction: Autoimmune polyendocrine syndrome ( APS ) is a rare, inherited disorder, characterized by autoimmune thyroiditis with another organ specific autoimmune disease.ObservationWe report the case of 55 years old woman, descendant of a first degree consanguineous marriage, who presented at the age of 35 a premature ovarian insufficiency and alopecia. Eight months later, she developed a goiter with hyperthyroidism and the dia...

Introduction: Thyroid physiology changes during pregnancy so the use of pregnancy-specific reference ranges for TSH and FT4 in order to adequately diagnose gestational thyroid disease is necessary. According to literature, in twin pregnancy, TSH can be in low levels during first trimester due to a much higher and more sustained peak of hCG (TSH-like activity of human chorionic gonadotropin) but it will be normalized at the end of the second trimester or within 22 weeks. Hypere...

Introduction: Patient with co existing oncological disease can easily be misunderstood by endocrinological pathology as hypothyroid, both representing similar appearances. The aim of this case report is to stress the importance of multidisciplinary teamwork, meaning of follow up, and increase knowledge about side effects of hormonal therapy which could affect endocrine system.Case report: A patient 55 years old female complaining about weakness, dry skin...

Introduction: Dumping syndrome is a phenomenon produced by the alteration of the pyloric sphincter. It occurs in 20% of pyloroplasty or distal gastrectomies. The syndrome is attributed to the rapid emptying of the chyme in the intestine. The osmotic gradient attracts fluid to the intestine, and this releases vasoactive hormones, such as serotonin or vasoactive intestinal polypeptide.Case report: We present a 82-year-old woman with gastric intervention in...

Introduction: The change in thyroid parameters is described in the case of antiepileptic treatment in the pediatric population, due to interferences within the hypothalamo-pituitary-thyroid axis and due to the increase in the rate of hepatic metabolism of thyroid hormones.Case presentation: We present the case of a 10-year-old boy who addressed our outpatient pediatric endocrinology department for endocrine evaluation in the context of weight growth abou...

Aim: To assess the thyroid and reproductive system status in 222 women with normal menstrual cycles.Material and Methods: Patients were referred for thyroid ultrasonography and concurrent breast ultrasonography. The 160 women were divided into two groups, based on the nature of the thyroid pathology.Results: The 1st group included 90 women with autoimmune thyroiditis (AIT), the median age was 36.00 [25.00; 50.00] years, the 2nd gro...

Background: The association between spondylarthritis and thyroid diseases is unclear. Few studies have examined this association and results remain unknown. We aimed to assess the frequency of thyroid disorders among patients with spondylarthritis.Methods: We performed a cross-sectional study including 50 patients with spondyloarthritis (SA) diagnosed according to ASAS criteria. The disease activity was assessed using ASDAS Free Thyroxine(FT4) and thyroi...

A 56 year old lady was investigated by her GP for arthralgia and found to be thyrotoxic (TSH < 0.01 mU/l, free T4 34.8 (10–20 pmol/l), TPO 50 (<35 IU/ml)). She gave a history of anterior uveitis some 20 years earlier. She was commenced on carbimazole and referred to the endocrinology clinic, where her thyroid function rapidly normalised and a biochemical diagnosis of subacute thyroiditis was made. Thyroid pertechnatate scan showed reduced uptake throughout the gl...

Thyroid cancer in children at the age of 0–14 year is a rare case and according to 2018 y. sta-tistics, it comprise 4% of total endocrine system cancer. This article describes clinical case of 14 years old boy with the solid form of thyroid carcinoma and the diagnosis was based on the surgical tissue examination. According to planned ultrasound investigation 2 cm nodule was revealed in the left lobe of thyroid gland without involvement in lymph nodules. Blood test of TSH...

Background: Hürthle cell carcinoma or oncocytic carcinoma of the thyroid gland is an unusual and relatively rare type of differentiated thyroid cancer. It accounts for only about 3–10% of all differentiated thyroid cancers. Its diagnosis as well as its management remains a subject of controversies.Aim: The purpose of this paper is to describe clinical presentation as well as the difficulties we can affront within the diagnosis and the treatmen...

Thirty five patients (33 women, 2 men) age 26–67 who had calcifications in the thyroid gland in a result of ultrasound examination, the levels of parathyroid hormone, vitamin D and microliters (Ca++, Mg++ and Phosphorus) have been determined as well. The level of 25(OH) in the studied groups were significantly reduced and was within the following range; 14 ± 7 ng/ml. Twenty five patients had hyperparathyroidism, which indicated ...