Endocrine Abstracts

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic disease (Covid-19) has caused millions of deaths worldwide, thus a massive SARS-CoV-2 vaccination campaign has been launched since the end of 2020. Viruses and vaccines can induce adverse thyroid effects; SARS-CoV-2 infection and vaccines have been associated with several thyroid disorders, especially subacute thyroiditis (SAT) and Graves’ disease (GD). We aimed to study the occurrence o...

Background: Hyperthyroidism caused by autonomous functioning thyroid nodules (ATN) is usually treated with I-131. Recently, radiofrequency ablation (RFA) has emerged as a promising alternative but it is not yet incorporated in guidelines.Aims: Assessment of efficacy of RFA treatment in patients with hyperthyroidism caused by ATN and factors that may affect treatment success.Methods: Retrospective analysis of patients treated for hy...

Background and Aim: Hepatic thyroid hormone (TH) signalling plays an important role in onset and progression of liver diseases. Patients with altered thyroid hormone regulation in the liver, leading to a local hypothyroid, are at higher risk of developing non-alcoholic fatty liver disease (NAFLD). Treatment with thyroid hormones proved to be a promising therapy for these patients, slowing the progression of NAFLD to non-alcoholic steatohepatitis (NASH), a more advanced stage o...

Recent progress in surgical technology has resulted in new techniques as transoral endoscopic thyroidectomy (TOETVA) that is an option for patients’ cosmetic requests. We evaluated patients with thyroid cancer who underwent thyroidectomy by TOETVA approach and their follow-up. Retrospective study, 5 patients were included, Bethesda classification in FNAC resulted: 2 patients with VI category (CAT), 2: V CAT and 1: III CAT. All patients were operated by TOETVA between 2020...

Introduction: In thyrotoxicosis, the clinical syndrome of excess circulating thyroid hormones, differentiation must be made between thyrotoxicosis with increased or decreased radio-iodine tracer uptake on thyroid scintigraphy. A cause of thyrotoxicosis with decreased radio-iodine uptake is iodine excess. In patients not taking any medication and without any history of recent radiological imaging studies, the confirmation of iodine excess as the cause of the thyrotoxicosis is d...

Objective: Pregnant women with autoimmune (subclinical) hypothyroidism have an increased risk of developing gestational diabetes mellitus (GDM). However, this association remains controversial in euthyroid women with thyroid autoimmunity (TAI). Therefore, the aim of the study was to determine the association between TAI and GDM in euthyroid women in a logistic regression analysis with adjustments for baseline/demographic parameters.Methods: Cross-section...

Introduction: Physicians in our hospital notified the laboratory staff of a number of patients at the outpatient clinic with increased free T4 (fT4) concentrations without (complete) suppression of thyroid stimulating hormone (TSH). This phenomenon appeared to occur more frequently following implementation of a new automated fT4 immunoassay. The discordance between fT4 and TSH concentrations may be explained by analytical issues (not further explained here), incorrect referenc...

Background: Our hospital is located 40 km from the nuclear power plants(Tokyo Electric Dai-ichi; NPP) exploded in northern east Japan disaster (2010.3). After the explosion, yearly radiation dose reached to 1-10 mSV in our city and 10-50 mSV in most poluted areas (next to our city). In former ESE congress, we reported cytological analysis of nodular goiter (NOD). In the present study, patients’ thyroid autoimmunity was analyzed whether there is any difference between pre-...

Background: Given the general lack of descriptive epidemiological studies on thyroid storm, we aimed to estimate the incidence rate and case fatality of thyroid storm in Germany based on a large claims database.Methods: Using the German Pharmacoepidemiological Research Database (GePaRD) we identified patients with at least one inpatient discharge diagnosis of thyroid storm (International Statistical Classification of Diseases and Related Health Problems,...

Background: This is the first study, that aimed: a) to compare immune response, namely the kinetics of neutralizing antibodies (Nabs), after vaccination with BNT162b2 mRNA vaccine between patients with autoimmune thyroiditis and controls, and b) to investigate changes in thyroid function in healthy subjects with no history of thyroid dysfunction before and after vaccination.Methods: The entire study consisted of two sub-studies. In the first sub-study, N...

Despite being the most successful definitive treatment for GD and offering the best response in terms of quality of life, thyroidectomy is rarely performed worldwide. Few studies evaluate its complication rate and potential prognostic factors for complications. We report our last ten years’ experience. Incidence of temporary and permanent hypoparathyroidism, temporary and permanent recurrent laryngeal nerve (RLN) injury and incidental malignancy were recorded, looking for...

Introduction: subacute thyroiditis (SAT) is an inflammatory disease of the thyroid gland causing transient thyrotoxicosis, characterized by neck pain and symptoms of thyroid hormones excess. Viral infections are considered the main trigger of SAT. SAT has also been described after vaccination against H1 N1 vaccine, seasonal influenza virus vaccine, Human Papillomavirus vaccine, and hepatitis B vaccination; more recently, a rising number of cases of SAT following SARS-CoV-2 vac...

Background: Early diagnosis and surveillance of Graves’ Orbitopathy (GO) is essential to prevent severe, sight-threatening complications and long-term disability; therefore, it is highly desirable to identify risk factors and early predictors of severe disease. GO is clinically assessed using the Clinical Activity Score (CAS) and the EUGOGO Severity Scale (ESS), which are subjective, qualitative tests that are used to evaluate the activity and severity at the anterior orb...

Introduction: Myxedema coma is the ultimate stage of severe long-standing hypothyroidism, representing a true endocrinological emergency. Many precipitating factors have been identified, including the initiation of certain drugs.Case report: An 89-year-old woman was admitted to our emergency department due to an inaugural seizure. There was a history of progressive functional deterioration in the last 7 weeks, short after being diagnosed with lymph node ...

Introduction: Moderate to severe thyroid eye disease (TED) has a significant impact on quality of life. In some cases, TED is resistant to systemic glucocorticoids, the mainstay of treatment since the 1950s, requiring alternative therapies. We describe here a patient with active severe TED who is refractory to various treatments.Case presentation: A 48-year-old non-smoker male, with a long history of psoriasis, vitiligo and atrophic gastritis, presented ...

Introduction: Amiodarone-induced thyrotoxicosis (AIT) occurs in up to 6% of patients taking this medication in iodine sufficient areas and in up to 10% of patients in iodine deficient areas and has a high rate of mortality, that can reach 50% in untreated severe forms. There are two main types (1 and 2) described, although usually we find mixed types, with both components. Below, we describe the cases of two brothers that developed severe mixed forms of amiodarone-induced thyr...

Introduction: The standard management of Graves’ disease includes initial use of antithyroid drugs, while radioactive iodine ablation or thyroid surgery are later definitive treatment options. Management of thyrotoxicosis secondary to the use of amiodarone can be challenging as patients may not promptly respond to antithyroid or corticosteroid therapy, and thyrotoxicosis may be more harmful in those patients owing to the underlying cardiac disease. In rare thyrotoxicosis ...

Background: Cytology is the gold standard method for the differential diagnosis of thyroid nodules, though 25−30% of them are classified as indeterminate and, in some cases, surgery is required for a definitive diagnosis. Aim: In order to reduce unnecessary thyroid surgeries, we set up a ‘thyroid risk score’ (TRS) to increase the diagnostic accuracy in a large series of patients with indeterminate cytology and to apply it to a validation ...

Background: The indication of ablation with I131 in low-risk DTC is controversial. The exact dose needed for thyroid remnant ablation is still a matter of debate in low-risk DTC patients. However, low dose has been found to be equally effective as high dose in terms of recurrence rate in recent studies. Taking this into account the current trend is to administer lower doses, although some studies describe a higher rate of retreatment.Aims: 1. To examine ...

Background: Indeterminate thyroid nodules pose a diagnostic dilemma and the patients often undergo unnecessary surgeries or repeat surgery. Currently different molecular methods for detection of driver mutations are being used for better characterisation of these nodules. These methods are costly and not widely available all over the world. Currently use of liquid biopsy by measurement of cell-free DNA (cfDNA) levels from plasma has been useful in diagnosis and follow up of ca...

Background: Alpelisib is a novel phosphotidylinositol 3-kinase (PI3K) inhibitor which, in combination with fulvestrant, has been shown to increase progression-free survival in patients with HR+/HER2-/PI3KCA mutated advanced breast cancer[1]. Hyperglycaemia, including alpelisib-induced diabetic ketoacidosis is a known adverse effect, along with rash, diarrhoea and stomatitis. No other associated endocrinopathy has been reported to date. Case presentation: We present th...

Introduction: Hypothyroidism is a very common condition, and its treatment is relatively easy with levothyroxine (LT4). However, cases of resistant hypothyroidism were reported despite high doses of levothyroxine. The aim of this study was to evaluate the usefulness of the levothyroxine absorption test to confirm or exclude a disorder of thyroid hormone absorption.Methods: This was a retrospective study including patients who were admitted to our departm...

ABSTRACT WITHDRAWN...

Introduction: Poorly controlled hypothyroidism is a chronic disease frequently associated with an impaired quality of life (QoL). However, persistent symptoms may be observed in well-controlled hypothyroid patients, impacting their QoL. The aim of our study was to assess the QoL in patients with well-controlled primary hypothyroidism and to evaluate the relationship between the TSH level and the QoL.Methods: A cross-sectional study was conducted in the o...

SAT due to viral infections is a cause of thyrotoxicosis, neck pain and tenderness on palpation. In the COVID-19 era, SAT seems to be a manifestation of the disease which occurs during SARS-CoV-2 infection. In 2021, some SAT cases were reported after COVID-19 vaccination. We reviewed the incidence of SAT from 2000 to 2021. In the Savona district vaccination of the general population started in February 2021 and progressively involved fragile, healthy elderly, adult and young-a...

Objective: Subclinical hypothyroidism (ScH) is a common condition and may be associated with dyslipidemia. We investigated the effect of levothyroxine therapy (L-T4) on lipid parameters in patients with a mild form of subclinical hypothyroidism according to the presence of thyroid peroxidase antibodies (anti-TPO antibodies). Material and methods: Fifty-seven patients with newly diagnosed ScH (TSH levels between upper reference value and 10 mIU/l with nor...

Introduction: Autoimmune Thyroid Diseases (AITD) are one of the most prevalent autoimmune diseases in industrialized countries (5% of population). The two main phenotypes of AITD, Hashimoto thyroiditis (HT) and Graves’ disease (GD), are both characterized by the presence of circulating thyroid antibodies and infiltration by autoreactive lymphocytes in the thyroid gland and sometimes the orbit. One of the most studied mechanisms underlying AITD is the imbalance between imm...

Background: Overt newly diagnosed hyperthyroidism is frequently associated with mild anemia. However, there are limited data on long term evolution under methimazole treatment. Our aim was to study the baseline characteristics and evolution of anemia in the hyperthyroidism setting.Methods: We retrospectively assessed 58 consecutive patients [46 (79.3%) women] presenting with newly diagnosed overt thyrotoxicosis (43 Graves disease, 9 toxic nodular goiters...

Purpose: To evaluate if patients with low- or intermediate-risk differentiated thyroid cancer (DTC) can be discharged to primary care.Material and Methods: The clinical records and evolution of 346 patients with DTC who had undergone surgery between 1995 and 2020 with a follow-up after a mean of 7.6 ± 6.1 years were retrospectively reviewed. All had a low or intermediate risk of recurrence as defined under the 2015 ATA risk stratification system and...

Background: Fine needle aspiration (FNA) is the diagnostic procedure of choice in the evaluation of thyroid nodules. Nodules with indeterminate cytological categories, Tir3A and Tir3B according to Italian cytological classification, pose diagnostic challenges in clinical practice and are frequently submitted to diagnostic surgery. CytoFoam Core (CF) (Diapath, Martinengo, Italy) uses an absorbent foam device inserted into the needle hub to collect the cytological sample aspirat...

Introduction: Thyroid cancer remains a relatively rare entity. Radiological scoring systems aim to stratify the risk of malignancy based on morphological criteria.The objective of this study was to develop a new score based on ultrasound criteria to predict thyroid nodule malignancy risk.Patients and methods: This was a retrospective study including 200 thyroid nodules (100 malignant nodules and 100 benign nodules). The report of the thyroid ultrasound a...

Background: The clinical manifestations of thyrotoxicosis do not always correlate with the extent of thyroid biochemical abnormalities. Here, we report the case of a COVID-19 positive patient who presented with congestive heart failure as a first-time presentation of thyrotoxicosis. Case report: A 40-year-old female presented to Emergency Department with two days history of lower limb oedema and abdominal distension. She denied dyspnoea, chest pain, palp...

Background: Levothyroxine (LT4-Rx) is one of the most prescribed drugs worldwide and the vast majority of patients receive long-term treatment. However, in a recent study of 291 subjects we found that 60% of this cohort were euthyroid two months after LT4-Rx discontinuation1.Aim of the study: A prospective clinical cohort follow-up study was carried out. In 688 subjects (82% females) aged 48.01±15.96 (range 17-84years) with 8.59±6.98...

Introduction: Despite hypothyroidism being seen in patients with kidney disease, it is rarely the underlying cause. We present a rare case of chronic kidney disease (CKD) secondary to severe hypothyroidism that was totally reversed on commencement of Levothyroxine. The mechanism is multifactorial, and importantly involves the pre-renal and direct renal effects of thyroid hormones.Case report: A 37-year-old Caucasian male presented to the endocrine clinic...

Introduction: Massive anti-SARS-CoV-2 vaccination campaigns have been established as the cornerstone of confronting the current COVID-19 pandemic. Subacute thyroiditis (SAT) comprises an inflammatory process in the thyroid gland, mostly due to viral infections of the upper respiratory tract, although it may rarely occur after vaccine administration. To date, a few cases of SAT related to anti-SARS-CoV-2 vaccines have been reported globally. Hereby, we present the case of a pat...

Background: Hypothyroidism is associated with multiple heart diseases such as tricuspid regurgitation (TR). We aimed to investigate in the prognosis of TR induced by hypothyroidism.Methods: We conducted a cohort study included all patients with severe primary TR. Long term prognosis of TR induced by hypothyroidism was compared to the prognosis of other severe primary TR causes.Results: Among 43 patients with severe primary TR, 19 p...

A rare complication of thyrotoxicosis among Asians is Thyrotoxic Periodic Paralysis (TPP), with an incidence of approximately 2% in patients with thyrotoxicosis from any cause. TPP is characterized by sudden onset of hypokalemia and muscle paralysis. Hypokalemia in TPP results from an intracellular shift of potassium induced by the thyroid hormone sensitization of Na+ /K+ −ATPase rather than depletion of total body potassium. Treatment of TPP includ...

Background: The combination of a toxic adenoma and Graves’ disease compose the Marine-Lenhart syndrome. This condition is estimated to occur in 0.8-2.7% of Graves’ disease patients and only few cases are reported in the literature.Patient findings: A 29-year-old female patient was referred to our outpatient clinic due to subclinical hyperthyroidism and a newly discovered thyroid nodule on the right thyroid lobe. She had no thyreotoxic symptoms ...

Background: Patients who require levothyroxine (LT4) supplementation after total thyroidectomy often have difficulty achieving target TSH levels. Several studies have attempted to develop a dosing schedule considering different factors such as age, gender, weight, or body mass index (BMI) as potential determinants of the correct dose of LT4. The objective of this study is to determine if a scheme that uses the percentage of body fat (%BF) measured by CUN-BAE is more accurate t...

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine pathology in women with a high prevalence varying between 5 and 20%. Autoimmune thyroid diseases (AITD) are the most prevalent organ-specific autoimmune diseases, particularly in young women. The purpose of our study was to determine the prevalence of AITD in a group of patients with PCOS compared to a control group.Patients and Methods: 103 women were recruited into the study, aged bet...

Introduction: Overt thyroid dysfunction in pregnancy without an early diagnosis and treatment may lead to an increased risk of adverse maternal and fetal outcomes. In this study, our goal was to assess the results of the development of a laboratory alerting system for the diagnosis of thyroid dysfunction in the first trimester of pregnancy. Material and methods: Observational retrospective study evaluating clinical and biochemical data from pregnant wome...

Methodology: Between Jan’20 to Jan’21, 364 patients on thyroid replacement therapy were included in the study and analysed retrospectively. They were divided in 2 groups. T4 group (189 on levothyroxine therapy {T4} therapy) & T3 group (175 on levothyroxine/liothyronine combination therapy {T3/T4}. Hypothyroidism was defined as TSH >4.2 mIU/ml on > 2 occasions > 2 weeks apart irrespective of their thyroid antibody (anti-TPO Ab) status or TSH > 4.2 ...

Subclinical hypothyroidism (SCH) represents a mild or compensated form of primary hypothyroidism. Although the relationship between SH and lipid profile have been reported in several studies, the results are conflicting. The objective of the present study is to assess dyslipidemia among patients with SCH. Our study included 107 patients vs 108 sex matched controls. Clinical information and medical history were obtained through a questionnary from all SCH patients and normal co...

A 61-year-old lady presented to her general practitioner in July 2018 with weight loss, loose stools, hair loss, increased anxiety and dry eyes over several weeks. Blood tests revealed Graves’ thyrotoxicosis (TSH< 0.10 mU/l, (RR) 0.30-5.50 mU/l; Free T4 (fT4) 26.1 pmol/l, RR 11.5−22.7 pmol/l; Free T3 (fT3) 11.8 pmol/l, RR 0.0-7.0 pmol/l, thyroid receptor antibodies >40.0U/l, RR 0.0-1.8 U/l; thyroid peroxidase antibodies 173.0 iu/ml, RR 0.0-33.9 iu/ml). There...

Background: Thyroid hormones may affect bone calcium metabolism either by a direct action on osteoclasts or by acting on osteoblasts which mediate osteoclastic bone resorption. Hyperthyroidism induces an accelerated bone loss, causing hypercalcemia and may thereby increase the risk of low energy fractures. Increased IL-6 levels and hyperadrenergic state due to thyrotoxicosis, are also implicated in hypercalcemia.Case: A 33 year old who is a known case of...

Background: The COVID-19 outbreak in Italy forced the health system to cancel all non-urgent outpatient activities, to avoid further spreading of the disease inside the healthcare facilities. At our institution, for cancer patients the hospital allowed treatments and consultations: the medical team, however, identified patients whose procedures could be postponed. Even after May 2020, the capacity for non-urgent thyroid surgeries was reduced. These events enhanced our efforts ...

A normal thyroid status is crucial for normal tissue and organ functioning, including temperature homeostasis. The tissue-specific actions of TH on body temperature regulation and thermogenesis are largely modulated via thyroid hormone receptor TRα. Consequently, mice expressing a mutant TRα display bradycardia and a reduced body temperature at 22°C ambient temperature due to excessive heat loss via the tail. To test whether this peripheral heat loss is the sole...

Objective: Since the relationship between thymic hyperplasia (TH) and Graves’ Disease (GD) is of paramount importance for diagnostic and therapeutic choices, a wider knowledge of this association is required for endocrinologists in routine clinical practice. Our aim was to assess the prevalence, the clinical features, and the response to treatment of GD-related TH in an Academic referral centre.Methods: All consecutive cases of GD-related TH at Univ...

Background: Hypothyroidism has profound effects on cardiac function, however, the effect of over- and undertreatment of hypothyroidism on hospitalization outcomes of patients with acute exacerbation of heart failure (HF) has not been evaluated yet.Methods: We conducted retrospective cohort analyses of outcomes among 231 consecutive patients with treated hypothyroidism who were admitted to the internal medicine departments of Shamir Medical Center with HF...

Several reports of Graves’ disease (GD) onset after COVID-19 vaccination were recently published. The mechanism underlying GD occurrence in these cases could be related to the autoimmune syndrome induced by adjuvants (ASIA), a condition triggered by several vaccine adjuvants and excipients leading to dysfunctional immune response causing different conditions and endocrinopathies in genetically predisposed subjects. In Italy, population campaign for COVID-19 vaccination st...

The management of loco-regional metastases in patients with differentiated thyroid carcinoma is still debated. Current American Thyroid Association guidelines state that in this context the main goal is to differentiate between low-volume metastatic disease that will progress and that remaining stable over time.Aim of our study was to evaluate the behavior of suspicious or cytologically confirmed lymph node metastases, detected after initial treatment (i...

Objective: Destructive thyroiditis is the most common endocrine immune related adverse event (iRAEs) in patients treated with anti-PD1/PD-L1 agents. Given its self-limited course, current guidelines recommend no treatment for this iRAE. Nevertheless in patients with enlarged thyroid volume and a poor performance status, thyrotoxicosis may be particularly severe and harmful. Aim of the study is to evaluate if steroid treatment might be useful in improving thyrotoxicosis in subj...

Objective: Euthyroid patients undergoing thyroidectomy were reported to gain weight than their matched counterparts. The etiology is still unknown. Serum adiponectin and leptin levels are related to fat mass and thyroid hormones. We aimed to evaluate the influence of thyroidectomy on body composition, serum adiponectin, leptin levels in euthyroid obese and non-obese patients who underwent total thyroidectomy for goiter.Methods: We conducted a prospective...

Aim of the study: recurrence or persistence of hyperthyroidism occur in 15-25% of cases after radioiodine therapy (RAI) in Graves’ disease (GD). Our study aimed to establish prognostic factors affecting RAI outcome and to investigate if a tailored dosimetric approach based on the application of the “effective biological dose” (BED) offered a higher chance of success.Materials and methods: our cohort comprised 365 GD patients (280 women and...

Introduction: Graves’ disease (GD) is an autoimmune thyroiditis frequently associated with development of Graves’ orbitopathy (GO). GD patients have lower vitamin D levels compared to the general population. Whether low vitamin D levels are associated with GO is still controversial. The aim of our study was to assess the vitamin D levels in patients with GO and the clinical outcome.Methods: This is a single-center observational study in an outp...

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon severe systemic hypersensitivity drug reaction. Several studies have described the occurrence of newly developed endocrine autoimmune diseases following DRESS syndrome resolution. However, little attention has been paid by endocrinologists to this disorder. Here, we report a case of a patient with Graves’ disease following DRESS syndrome.Clinical case: ...

Background: Graves’ Disease (GD) is one of the most common organ specific autoimmune disorders, being characterized by an abnormal production of stimulating autoantibodies to the thyrotropin receptor (TSHR). Some studies demonstrated that genetic polymorphisms in certain cytokines, namely interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), are associated with a greater susceptibility of developing GD. Our aim was to evaluate ...

McCune-Albright syndrome (MAS) is a rare mosaic disorder caused by a postzygotic activating mutation in the GNAS gene encoding the G protein alpha subunit. Although clinical manifestations may be heterogeneous, MAS is often characterized by the triad of fibrous dysplasia, café-au-lait skin pigmentations and hyperfunctioning endocrinopathy. We report here a 58-year old woman who presented for evaluation of hyperthyroidism, associated with nodular thyroid disease and elevat...

Introduction: Hyperpigmentation is a clinical sign that can be associated with different endocrine disorders. It is commonly seen in Addison’s disease and has rarely been reported in Graves’ disease. The exact physio pathological mechanism of this sign is not well established in hyperthyroidism. We describe two cases of Graves’ disease accompanied by diffuse hyperpigmentation.Case report: Case 1 was a 63-year-old female ad...

Background: Cervical lymph node metastases at histology are common findings in differentiated thyroid cancer (DTC); however, their impact on clinical outcome is debated.Material and method: 1332 DTC patients, performed the first 131 I treatment between January 2010 and September 2012 and were divided into 2 groups: absence (Nx/N0) or presence (N1) of lymph node metastases at histology. The latter group was further split in central compartment ...

Background: Serum calcitonin (CT) is a very sensitive test for the diagnosis of medullary thyroid carcinoma (MTC). However, its routine dosage in patients with nodular thyroid disease is not recommended by all scientific societies. In addition, to optimize costs, it is only suggested in the case of suspicious nodules on ultrasound, indeterminate nodules at cytology or nodular goiter before surgery. The aim of the study is to evaluate the serum CT in a series of consecutive MTC...

Introduction: The recurrence rate of intermediate-risk differentiated thyroid carcinoma (DTC) ranges between 5% and 20% and the therapeutic strategy requires further evaluations.Aim: We therefore investigated the potential risk factors for post-treatment recurrence of intermediate-risk DTC at 1 and 3 years from diagnosis.Methods: This retrospective observational study included 121 patients who underwent thyroidectomy for intermedia...

Objective: Our institution (University Hospital “L. Vanvitelli“ - Naples, Italy) is a high-volume (HV) center in Naples metropolitan area and many patients are referred there to repeat thyroid fine-needle aspiration cytology (FNAC) after initial FNAC performed in low-volume institutions (LV). The aims of the study were to 1) to examine the inter-observer agreement between HV and LV institutions according to the Italian thyroid cytology system, and 2) explore how the ...

Introduction: Finding the optimal levothyroxine (LT4) dose regime to ameliorate the abnormally low levels of natural thyroid hormones, especially for thyroidectomized patients, is still challenging. Many researchers have studied various LT4 dosage regimen clinically; and ultimately, they proposed multiple variables affecting LT4 requirements including age, gender, body weight, body mass index (BMI), and body surface area (BSA). However, prescribing the most appropriate LT4 dos...

Thyroid C-cells, as a second type of endocrine cell population within thyroid, produce and secrete peptide hormone calcitonin (CT). This hypocalcemic hormone acts as an inhibitor of bone resorption. The aging is a complex process that alters various cellular functions. Therefore, the aim of this study was to examine the aging-related changes in the structure and function of CT-producing thyroid C-cells in male Wistar rats, using histomorphometric, ultrastructural and biochemic...

Background: Glucose metabolism derangements (GMD) and thyroid nodules (TN) are the most frequent endocrine disorders. A relationship between these conditions has been suggested, but data are still controversial and no evidence was reported regarding sex differences.Aim: To evaluate the distribution of impaired fasting glucose (IFG), normal glucose tolerance (NGT), impaired glucose tolerance (IGT), type 2 diabetes (T2DM) and TN according to sex.<p cla...

Non-thyroidal-illness syndrome (NTIS) is present in chronic diseases and considered an adaptive mechanism. However oxidative stress is linked to NTIS in a vicious circle, due to deiodinases alteration and negative effects of low T3 on antioxidant levels or activity. Moreover there is a tissue-specific thyroid hormone transport, receptor binding and hormone metabolism. Muscle is one of the main targets of thyroid hormone; on the other hand, Irisin is a novel discovered myokine ...

Hyperthyroidism is common and in iodine-sufficient parts of the world the prevalence of overt hyperthyroidism is estimated to be 0.2% to 1.3%. The treatment options include antithyroid medication (ATD), thyroid surgery, or Radioactive iodine (RAI). The latter is increasingly used as a first line definitive treatment for hyperthyroidism. We reviewed the outcomes of patients who received RAI at our tertiary nuclear medicine department over a 4-year period (May 2015 to Dec 2019) ...

Introduction: Alemtuzumab is a humanized anti-CD52 monoclonal antibody approved for the treatment of relapsing−remitting multiple sclerosis (RRMS). Through an immune reconstitution mechanism, it leads to thyroid autoimmunity in 35% of cases, with Graves’ disease (GD) being the most common presentation. Alemtuzumab-induced GD exhibits distinctive clinical and immunological features, with rarely reported cases of fluctuating thyroid status with documented both blockin...

Background: Thyroid nodules (TN) are common. Their prevalence increases with age. A thyroid incidentaloma (TI) is defined as a non-palpable TN detected fortuitously during a radiological investigation performed for reasons unrelated to the thyroid gland. Although they are mostly benign, the risk of malignancy is estimated from 7% to 15% of nodules. The objective of this study is to investigate the characteristics of TI in a cohort of patients admitted in an internal medicine d...

Introduction: Metabolic syndrome (MetS) consists of a constellation of metabolic abnormalities which include central obesity, hyperglycemia plus insulin resistance, high triglycerides plus low high-density lipoprotein (HDL) cholesterol and hypertension. A developing collection of proof proposes that metabolic condition is related to endocrine problems including thyroid brokenness. Thyroid brokenness in metabolic condition patients might additionally add to cardiovascular illne...

Background: The consequences of overt hypothyroidism on the central nervous system are well known. Interestingly, there is less proof in regards to the impacts of subclinical hypothyroidism (SCH) on the cognitive functions among elderly subjects. Studies from various countries including India have shown a variable association between SCH and cognitive dysfunction. This study planned to survey the event of cognitive impairment among the older Indian subjects who were introducin...

Background: The thyroid pyramidal lobe (TPL) represents a normal anatomical variation of the thyroid gland. Intraoperative TPL identification is of paramount significance, taking into account that the remnant TPL leads to higher thyroglobulin, could contain thyroid carcinoma foci and lead to recurrence.Methods: We conducted a prospective single-center, single-operator study to identify TPL in 500 consecutive patients undergoing thyroid ultrasound for any...

Introduction: Graves’ disease (GD) is caused by TSH receptor antibodies (TRAbs) which stimulate thyroid activity. Initial treatment usually relies on antithyroid drugs (ATDs), mainly methimazole, carbimazole or propylthiouracil (PTU). These drugs inhibit the enzyme thyroperoxidase, blocking the synthesis of T3 and T4. Definitive therapeutic options include radioactive iodine and total thyroidectomy which are usually reserved for patients who do not tolerate or respond to ...

Introduction: Pazopanib is a tyrosine kinase inhibitor (TKI) considered to be a first-line treatment in adult patients with metastatic clear cell renal cell carcinoma (ccRCC). Thyroid dysfunction, namely hypothyroidism, is now recognized as being an important but potentially manageable side effect induced by such therapy. With this case we aimed to recall an endocrinological complication that can emerge during treatment with TKIs and highlight the importance of a thorough foll...

Introduction: Hypothyroidism caused by autoimmune thyroiditis (AIT) is a disease that can originate physical, psychological and behavioral symptoms. Quality of life (QoL) and psychopathologial symptoms in thyroid diseases and its relation with thyroid function remains unclear. In hypothyroidism there is a discussion about the normal range of TSH and Free T4 values and in which way its fluctuation influences the patient in its daily activities.Objective: ...

Introduction: Type 5 phosphodiesterase (PDE5) inhibitors (PDE5i) lead to intracellular cyclic-guanosine monophosphate (cGMP) increase and are used for clinical treatment of erectile dysfunction. Studies found that cGMP may up/downregulate the growth of certain endocrine tumor cells, suggesting that the use of PDE5i could impact the risk of certain tumors, such as colorectal cancer.Aim: We evaluated if PDE5i may impact thyroid cancer cell growth in vi...

The ability of thyroid hormones to regulate body temperature is well established. While the active hormone T3 can act peripherally to induce thermogenesis in fat and muscle, it also acts centrally in the brain to increase body temperature through the sympathetic nervous system. Most remarkably, recent studies show that T3 treatment in mice causes an elevated body temperature even at 10°C, far below thermoneutrality, suggesting that the T3 effect constitutes pyrexia rather...

Aim: Neopterin has been found to be associated with disease activity in various infectious, inflammatory, and autoimmune diseases. It is an indicator of immune response as it is released after activation of monocytes and macrophages by IFN-γ. It was aimed to measure neopterin levels in Graves’ disease, which is a T cell-mediated autoimmune disease of the thyroid gland.Materials and Methods: Twelve healthy individuals (6 women, 6 men), 13 Graves...

Introduction: Several levothyroxine (LT4) monotherapy dose regimen have been already proposed by different medical scientists which may result in various daily LT4 doses. Comparing the consequences of such dose regimen are rather difficult since they have to be applied on either the same patient or a large study groups. Therefore, a straight forward method would be to simulate the plasma level of thyroid hormones of virtual-patients treated by various dose regimen.<p class...

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has led to unparalleled burden on national and global healthcare systems. Vaccines were viewed as way of combating Covid 19 pandemic. This led to development and implementation of vaccination programmes worldwide. Several vaccines have been approved for use in worldwide including Pfizer-BioNTech, Oxford-AstraZeneca vaccine and Moderna vaccine. Disturbingly, the speed at which these va...

Purpose: Thyroid cancer (TC) is the most common endocrine cancer worldwide, affecting mainly women of the reproductive age. However, no data exist with regard to its association with endometrial or uterine disorders. The aim of this study was to assess the risk of hyperproliferative pathology of the reproductive system in female TC survivors.Methods: This was a cross-sectional study in female patients, aged 20-45 years, diagnosed with papillary TC (PTC) ...

Introduction: Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor (1-2% of all thyroid carcinomas), which arises from calcitonin-producing C cells. Calcitonin (CT) and carcinoembryonic antigen (CEA) are used as tumor markers in the follow-up of patients with MTC. Non-secretory forms of MTC are very rare, accounting for less than 1% of the cases.Case Report: A 53-year-old man underwent left thyroid lobectomy for a 1.1 cm thyroid nodule subjec...

Introduction: The update of 2015 American Thyroid Association (ATA) guidelines recommend that radioactive iodine (RAI) ablation therapy should be used in line with patients’ risk stratification. However, there is no consensus on benefits of post-operative RAI ablation in patients with low risk differentiated thyroid cancer (DTC). The aim of this study is to compare the outcomes of patients with low risk DCT submitted to RAI ablation with those who were not.<p class="a...

Background: To minimize potential harm from overtreatment of low-risk thyroid cancers, the 2015 American Thyroid Association (ATA) Guidelines recommend that radioactive iodine (RAI) ablation should not be routinely used in low-risk differentiated thyroid carcinoma (DTC). The present study aims to evaluate trends in RAI therapy in a tertiary center after the update of these Guidelines.Methods: Data from patients followed in a tertiary center with low-risk...

Introduction: Graves orbitopathy (GO) is an inflammatory condition of the orbital fat and muscles and affect 30-50% of patients with Graves’ disease. The first-line treatment of moderate to severe GO according to EUGOGO is intravenous glucocorticoids, but 20-30% of the cases appear to be corticosteroid resistant or refractory. Promising results have been described with Tocilizumab (TCZ) as a second-line moderate to severe GO treatment.Case presentat...

Introduction: Graves’ disease (GD) is a systemic autoimmune disease characterized by lymphocyte activation and synthesis of anti-TSH receptor antibodies (TRABs). Higher values of TRABs are associated with a higher risk of Graves’ ophthalmopathy and dermatopathy. Iodine-131 therapy (RAI) is one of the well-established options in GD, but it can cause a transient increase in TRABs.Objectives: To evaluate the evolution of TRABs after RAI; to identi...

Introduction: Development and progression of cancers is multifactorial encompassing several mechanisms that aid its proliferation. One of the hallmarks of cancer progression is inhibition of the immune system. Cancer cells can activate different immune checkpoint are pathways that harbour inhibitory or stimulatory mechanisms that enabled self-tolerance and assist with immune response. Through activation of immune checkpoint pathways cancers can suppress immune response against...

Introduction: The SARS-CoV-2 virus has severely affected humanity. The disease causes pneumonia which may be severe. In many cases, patients, especially if there are comorbidities, may have a fatal outcome. The disease affects all organs and the variability of its manifestations has attracted intense scientific interest. Aim: The aim of the study was to describe the case of a patient who developed subacute thyroiditis after infection with the SARS-CoV-2 ...

Introduction: Multiple specialities teach and perform ultrasound-guided fine-needle aspiration biopsy (USG-FNA) of thyroid nodules, including Radiology, Endocrinology, and Pathology. Contrasts in cytopathology results might connect with various USG-FNA procedures just as contrasts in the knobs assessed. This study planned to play out a nitty-gritty investigation of USG-FNA results among these different showing administrations at a solitary scholarly clinical focus.<p class...

Thyroid disease during pregnancy is associated with adverse pregnancy outcomes and suboptimal fetal development. During the last decades, guidelines for diagnosing thyroid disease during pregnancy have changed considerably, and there has been increased awareness. This study aimed to describe the prevalence of thyroid disease treatment over time among pregnant women in Norway. We combined historical data from the Medical Birth Registry of Norway and the Norwegian Prescription D...

Objectives: Mutations in the DICER1 gene represent driver events in development of pediatric thyroid nodules, malignant as well as benign. The occurrence of these mutations has been reported in differentiated thyroid carcinomas, poorly differentiated thyroid carcinomas, non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs), multinodular goiters and follicular adenomas. The aim of this study was to detect mutations in DICER1 g...

Background: Thyroid dysfunctions are among the most common immune-related adverse events (irAEs) following the administration of immune checkpoint inhibitors (ICIs) for malignancies. The pathogenesis of thyroid irAEs remains unclear and the clinical course can be multifaceted.Aim: Aims of this study were a) to describe the incidence and the clinical course of thyroid irAEs b) to determine the association between thyroid irAEs and overall survival (OS).</...

Background: The coronavirus disease 2019 (COVID-19) can involve multiple organs and systems, including the endocrine system. In particular, thyroid dysfunctions are frequently seen in COVID-19 patients. The aim of this study was to evaluate thyroid function in hospitalized COVID-19 patients and to correlate thyroid function with inflammatory status, blood count parameters and mortality.Materials and methods: Data of COVID-19 patients admitted to the hosp...

Context: Significant uncertainty exists about the diagnostic accuracy of ultrasonographic (US) features used to predict the risk of thyroid cancer in the pediatric population. Moreover, there are not specific indications for thyroid nodule evaluation in patients during the transition age.Objective: The meta-analysis aimed to address the following question: which thyroid nodule US features have the highest accuracy in predicting malignancy in the transiti...

Background: Various components of metabolic syndrome (MS) significantly increase the risk of thyroid cancer (TC). Moreover, thyroid cancer survivors (TCS) are at increased risk of new components of MS (MSC). The role of thyroid function in this context has not yet been determined. We investigated changes in selected MSC and their association with thyroid function during a two-year follow-up among TCS.Materials and Methods: This retrospective, nested case...

Objectives: 1.-Characterization of patients with tall cell variant papillary thyroid carcinoma (TCV-PTC) at diagnosis (Dx) compared to patients with classic papillary thyroid carcinoma (c-PTC);2.-Evaluation of response to therapy (RT) in the (TCV-PTC) cohortExperimental design: Retrospective observational studyMaterials and methods: Patients submitted to surgery for PTC in our institution since 2010 were eval...

Introduction: IgG4-related thyroiditis (IgG4-RTD) is a rare fibroinflammatory disorder. It is characterized by dense lymphocyte infiltration (mainly IgG4+ plasma cells), enlargement and dysfunction of the thyroid gland. IgG4-RTD includes mostly cases of Hashimoto’s (HT) but also of Riedel’s and Graves’ thyroiditis. Diagnosis is set according to imaging and histopathological criteria. Papillary thyroid carcinoma (PTC) is the most common form of thyroid cancer (~9...

Introduction: Congenital central hypothyroidism (CH), is characterized by low levels of thyroid hormones and TSH. It is not possible to diagnose this condition by neonatal screening programs based on TSH measurements, hence it is often missed. The assumption that CH is usually a mild condition has been refuted, and more than 50% of all newborns with CH have moderate to severe disease. Early diagnosis and treatment lead to better neurodevelopmental outcomes. Isolated CH is a ra...

Introduction: Thyroid nodules have a high prevalence in the adult population (20-76%). In 2018, the American College of Radiology proposed an ultrasound classification score of thyroid nodules - Thyroid Imaging Reporting and Data System-TIRADS, with 88% of sensitivity and 49% of specificity to predict malignancy. Since then, several studies report sensitivity values of 70.6-97% and specificity of 30-98%. We pretend to compared TIRADS score with cytologic results based on Bethe...

Introduction: SARS-CoV2 infection or vaccination against SARS-CoV2 has been linked to the onset or recurrence of Autoimmune and subacute thyroiditis resulting in thyroid dysfunction.Case: We describe a case of Thyroid eye disease temporally associated with SARS-CoV 2 infection in a 48 year old female with a one-year history of subclinical hypothyroidism without interval thyroid hormone replacement or SARS-CoV2 vaccination. Two months following PCR confir...

Objectives: Alemtuzumab, a monoclonal antibody against CD52, is used in the treatment of multiple sclerosis. A side effect to the treatment is development of autoimmune thyroid disease. The aim was to evaluate the rate, type and course of thyroid disease in Danish patients with multiple sclerosis (MS) previously treated with Alemtuzumab.Methods: The study was a retrospective cohort study of patients treated with first series of alemtuzumab for multiple s...

Introduction: Hyperthyroidism and thyrotoxicosis can have multiple etiologies, varying from the most frequent described in clinical practice (Graves disease, toxic nodular goiter, thyroiditis) to very rare causes such as anaplastic thyroid cancer, thyroid lymphoma, amyloidosis or even secondary malignancy of the thyroid gland.Case report: A 53 year old man presented to our department for progressive goiter enlargement in the last two months which was acc...

Introduction: Moyamoya disease is a rare angiopathy characterized by a progressive stenosis of the intracranial internal carotid arteries (ICA). First described in 1957, its pathophysiological mechanisms are still not well understood. Its association with various systemic diseases is termed moyamoya syndromeObservation: A 21-year-old female patient, with a family history of hypothyroidism, was admitted initially with stroke. The clinical examination reve...

Introduction: The prevalence of hypothyroidism overtly ranges from 5% to 11%. Though Hypothyroidism is less common in males as compared to females but deficiency of thyroid hormone affects almost all metabolic organs of the body, which includes changes in growth hormone, steroid metabolism, sexual function, antioxidative function.Aim: − The aim of our study was to assess the levels of total testosterone LH, FSH levels in males with overt hypothyroi...

Introduction: Adolescent and young adult differentiated thyroid cancers are frequently under diagnosed forms. They would be characterized by their aggressiveness and the presence of particular histological forms. The aim of the study was to describe the characteristics of thyroid carcinoma in adolescents and young adults by analyzing the clinical, histological, therapeutic and evolutionary characteristics.Materials and methods: We conducted a retrospecti...

Objectives: Patients suffering from pulmonary or/and neoplastic disease are at higher risk of developing serious illness from SARS-CoV-2. TC patients with lung metastases are classified as high-risk for severe CoV-2 disease. Aim of this study was to investigate SARS-CoV-2 prevalence and severity in this particular subgroup of patients.Methods: Out of 28 patients with metastatic Differentiated Thyroid Cancer (DTC) and 21 patients with met...

Presence of primary hyperparathyroidism (PHPT) in patients with thyroid disease has been previously reported. However, co-existence of PTHPT and papillary thyroid cancer (PTC) has been reported very rarely, mainly in the form of isolated case reports. Since the pathophysiological mechanisms of the two diseases are theoretically quite different, no causal relation between these diseases has been inferred. The aim of this study was to investigate the presence of PHTP in individu...

Background: In the last decades mini-invasive techniques have been proposed to reduce costs and complications of emithyroidectomy and thyroidectomy, both for benign nodular goiter and thyroid microcarcinoma, and image-guided laser and radiofrequency ablation are the most used.Purpose: To investigate short and long-term efficacy of image-guided laser and radiofrequency ablation as therapy options for benign nodular goiter.Methods: F...

Background: 3D-modelling is a computer-generated simulation technique that allows the users to interact with a three-dimensional environment and provide an immersive experience to understand minuscule details which becomes especially important when understanding the anatomical relations of endocrinology organs. During the COVID-19 pandemic, medical lectures were shifted to online mode which diminished the opportunity of cadaveric-based teaching that is routinely done for first...

Background: The relationships between thyroid hormones (TH) and platelets (PLT) have not been fully established. Physiological concentrations of L-thyroxine (T4) activate human PLT resulting in ATP release and aggregation. On the other hand, subclinical hypothyroidism has been frequently associated with hypercoagulability, in particular mean platelet volume (MPV), a marker of platelet activation, has been found higher in patients with subclinical hypothyroidism. A possible pro...

Background: Subacute thyroiditis is an inflammatory condition of the thyroid with characteristic presentations and clinical course. Patients with the classic, painful (DeQuervain′s; Granulomatous) thyroiditis, (PFSAT) typically present with painful swelling of the thyroid. At times, the pain begins and may be confined to the one lobe, but usually spreads rapidly to involve the rest of the gland. Pain may radiate to the jaw or the ears. Malaise, fatigue, myalgia and arthr...

Background: Increased rates of autoimmune diseases (ADs) have been reported in association with Hashimoto′s thyroiditis (HT); however, the risk factors for coexisting ADs in HT patients have been poorly investigated.Objective: To evaluate the prevalence and factors associated with AD comorbidities in patients with HT.Materials and Methods: We recruited 687 patients (626 F and 61 M, mean age at diagnosis 39 ± 14.06 yr, F:...

Background: The influence of hyperinsulinemia and insulin resistance on thyroid function is debatable. Insulin, as an anabolic hormone, may also play a role in thyroid hypertrophy and nodular goitre development. Some recent reports focus on the possible interplay between thyroid function and glucose status in pregnancy, including gestational diabetes mellitus.Aim: The study aimed to assess the relationship between insulin resistance indices and thyroid f...

Case report: A 52-year-old woman developed painful anterior neck swelling seven days after receiving the first COVID-19 vaccine AstraZeneca (AZ). Investigations showed TSH 0.14 mIU/l, CRP 34 mg/l and TRAb 0.3 IU/l. A neck Doppler ultrasound scan on day 15 showed features of thyroiditis. On day 21, she was hyperthyroid with TSH <0.02 mIU/l and free T4 70.3 pmol/l. COVID-19 test was negative, and she was advised to start Carbimazole and propranolol but took only the beta-blo...

Aim: Dose corrected for thyroid gland size is one of the methods used to determine radioactive iodine (RAI) activity for patients with Graves disease (GD). This study was aimed to investigate the real-world success rate of this method and the predictors of success after first treatment.Methods: This is a retrospective study of 80 patients with GD treated between 2014 and 2020 in a tertiary referral hospital in Almada, Portugal. The successful group was d...

Background: Lymphocytic infiltration and inflammation in autoimmune thyroid diseases (AITDs) results in accumulation of HA, contributing to the pathogenesis of both thyroidal and extra-thyroidal (ophthalmopathy, pretibial dermopathy and mixedema) manifestations of AITDs. HA fragments, originating from native HA during tissue inflammation and injury, in turn promote the expression of different mediators of oxidative stress and inflammation, by interacting with the Toll-like rec...

Background: Subacute thyroiditis, autoimmune thyroiditis and an atypical form of thyroiditis due to primary injury of the thyroid gland by SARS Cov2 itself are complications of COVID-19. Angiotensin-converting enzyme 2 is also expressed in the thyroid gland. On the other hand, both untreated thyrotoxicosis and COVID-19 affects heart, generating cardiac complications.Case report: A 36-year-old woman resident in an iodine sufficient area, heavy smoker, pre...

Introduction: Thyroid hormones have an impact on the function and structure of the cardiac muscle.Aim: Investigate the prevalence and risk factors of structural and functional cardiac complications in patients with hyperthyroidism.Methods: We conducted a cross-sectional study on 30 patients with uncontrolled hyperthyroidism. Clinical, biological and therapeutic data were collected. A trans-thoracic echocardiography (TTE) and lung u...

Introduction: Myxedema coma is the end stage of untreated or inadequately treated hypothyroidism. It has an estimated incidence of 0.22 per million per year. The clinical picture is often that of an elderly obese female, presenting in midwinter with increased lethargy, somnolence and confusion. The presentation is one of severe hypothyroidism, with or without coma.Such cases are predominantly based on a primary thyroid disorder such as Hashimoto′s ...

Radioiodine refractory differentiated thyroid cancer can be effectively treated with multi-tyrosine-kinase inhibitors (mTKI). Due to their pleiotropic mechanism of action, these drugs may cause different side effects. Hypocalcaemia has been reported in up to 35% of patients treated with mTKI, but little is known about its pathophysiology and clinical relevance. We report the case of a 78 years old woman treated for a multifocal papillary thyroid cancer, infiltrating perithyroi...

Introduction: Pre-operative localization of parathyroid adenoma is generally done by two localization studies: ultrasonography (US) and parathyroid scintigraphy using 99 m-techentium sestamibi SPECT with CT (Tc-MIBI SPECT/CT), which also report on Incidental thyroid nodules. The aim of our retrospective study was to determine the incidence, characteristics and outcomes of these incidental thyroid findings during parathyroid imaging.Method: A database of ...

Introduction: Oncocytic thyroid carcinoma is rare. It is an aggressive tumor, with high nodal and distant metastatic potential.Purpose of the study: to describe the epidemiological, clinical and anatomopathological particularities of oncocytic carcinomas of the thyroid.Method: Descriptive retrospective study, including patients followed in thyroid carcinoma consultation at the Endocrinology Department of the CHU Ibn Rochd in Casabl...

Introduction: NIFTP (non invasive follicular neoplasm of the thyroid with papillary-like nuclear features, formerly noninvasive encapsulated follicular variant of papillary thyroid carcinoma) has been removed from the carcinoma category due to its indolent nature and its good prognosis. The purpose of our study was to identify preoperative ultrasound and cytological differences between NIFTP and papillary thyroid carcinoma (PTC).Materials and methods: re...

Background: Various molecular mechanisms play a role in the pathogenesis of papillary thyroid cancer(PTC). Understanding the underlying pathogenesis and genetic changes is needed to improve clinical outcomes in PTC. In this study, it was aimed to determine the frequency of, BRAF V600E TERT promoter and NRAS mutations in Turkish patients with papillary thyroid cancer, the relationship of mutations between clinicopathological features and distant met...

Introduction: To determine the risk of recurrence in DTC, different clinical factors have been used (presence of adenopathies, extrathyroid extension, histology\..). The objective was to examine whether the value of early postoperative Tg concentration may also predict long-term recurrence of DTC.Material and Methods: The study included 249 consecutive patients (78.3% women, mean age 50.72 ± 14.26 years) with DTC who were initially treated by total ...

The vast majority of thyroid cancers are solid. Predominantly cystic tumors occur in <3% cases. Guidelines report as US characteristics consistently associated with a higher risk of malignancy eccentric position of the solid component, acute angle interface and microcalcifications and as less robustly associated lobulated margins and increased vascularity of the solid portion. We reviewed the US characteristics of predominantly cystic papillary carcinomas confirmed on hist...

Introduction: Medullary thyroid carcinoma (MTC) is an aggressive neuroendocrine tumor derived from C cells that is responsible for approximately 5% of the gland malignancies, most of them occuring sporadically. Lymph node metastasis may occur early in disease pathogenesis and is one of the most important negative prognostic factor. Surgery is the only curative therapy while other chemotherapeutic options are limited. Neuroendocrine differentiated C cells may express somatostat...

Introduction: Hematologic abnormalities are frequently observed during hyperthyroidism and are related to complex multifactorial pathogenic mechanisms that are still poorly understood and may affect the three hematopoietic lineages in isolation or in combination. These abnormalities are exceptionally revealing and are usually subclinical. For the endocrinologist, they raise the problem of the risk of their aggravation under the hematotoxic effect of synthetic antithyroid drugs...

Most cases of gynecomastia are idiopathic. Among the most frequently identified etiologies are: persistent pubertal gynecomastia, hypogonadism, anabolic steroids and other pharmaceutical drugs use. In the literature, ginecomastia is a well-recognized manifestation of thyrotoxicosis in male patients (in the range of 10% to 40%). However, it is extremely rare in clinical practice as the initial presentation of thyrotoxicosis. The two main factors that contribute to gynecomastia ...

Introduction: Thyroid nodule is a frequent condition, being diagnosed in up to 70% of subjects who had undergone thyroid ultrasound. Around 90-95% of them became being benign and, if the do not cause compressive symptoms or esthetical problems, they do not need specific therapy, only clinical follow up. Traditionally, thyroidectomy has been the main therapeutic option in these cases. Radiofrequency and ethanol ablations are recently introduced non-invasive therapies that permi...

Background: Hypothyroidism is a clinical state resulting from underproduction of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). Most cases are due to primary hypothyroidism, a failure of the thyroid gland to produce thyroid hormones. Primary hypothyroidism is defined as thyroid-stimulating hormone (TSH) concentrations above the reference range and free thyroxine concentrations below the reference range. Patients with hypothyroidism usually present with puffy ey...

Introduction: Thyroid hormones represent a biomarker of heart rhythm disorders and pathophysiological origins remain unknown. Some of these disorders like atrial fibrillation (AF) are major issues particularly in asymptomatic patients with in Hyperthyroidism and cause of thromboembolic complications.Aim: Taking into account the uncertainty of prevalence of cardiac rhythm disorders, we aimed to investigate the prevalence of rhythmic cardiac complications ...

A. Background/Significance: Autoimmune polyglandular syndrome Type II (APS-II) is a rare polyendocrinopathy with a prevalence of 1 to 2 in 100.000, instigated by immune-mediated destruction of several organs. Knowledge of APS-II is crucial, especially in the early detection of polyglandular disorder among patients with endocrine autoimmunity. B. Case: This case is of a 40-year-old male who initially presented with Grave′s disease after showing sign...

Introduction: Graves orbitopathy is the major extrathyroidal manifestation of Graves Disease (GD). The approach depends on its clinical activity and severity. Treatment and referral to specialized centers, with Endocrinology and Ophthalmology, has a strong impact on the prognosis of Graves’ Disease (GD) and GO.Cases report: We report four cases of DG with OG. Their characteristics and clinical evolution are shown in Table 1.<table boarder="1" ce...

Introduction: Refractory hypothyroidism is known as the persistence of clinical and biological signs of hypothyroidism after 6 weeks of treatment or therapeutic adjustment, despite a dose exceeding 1.9μg/Kg/d of Levothyroxine. Several etiologies may be incriminated.Observation: A 36-year-old patient, followed for Gougerot-sjogren syndrome, having benefited from a thyroidectomy in 2015 in a context of biological hyperthyroidism, on Levothyroxine (LT4...