Thyroid

Radiation thyroiditis resulting from radioactive iodine-131 treatment for Graves’ disease is an uncommon complication. Although a majority of patients are asymptomatic or manifest mild symptoms that can be managed conservatively, published literature describing severe radiation thyroiditis resulting in significant morbidity is lacking. We herein report on six patients with severe radiation thyroiditis that resulted in hospitalisation, including an unusual complication of myopericarditis.

Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive care facility. Studies have shown that replacement of thyroid hormone through ryles tube with a loading dose and maintenance therapy is as efficacious as intravenous therapy. In many countries T3 i...

Objective: To compare the accuracy and reliability of Free T4 or TSH determination as the single initial screening test in assessment of thyroid function. Methods: Retrospective review of 3,022 thyroid function tests (free T4 and TSH) performed during a 12 month period in a laboratory at a major academic medical center was conducted. A probable diagnostic category for each test was determined by a retrospective detailed review of medical records of subjects with discrepant serum free T4 and TSH concentrations. Results: In 284 tests (9.4%) the appropriate diagnosis could not be arrived at if serum TSH concentration alone was used for interpretation of thyroid function. Alternatively, serum free T4 concentration alone was unable to provide accurate diagnosis in 132 (4.4%) subjects. Multivariate analysis determined that free T4 is more reliable than TSH as an initial test for the diagnosis of thyroid function as expressed by odds ratio (OR) 2.14 with confidence interval (CI) 1.96-2.34, p< 0.01. The sensitivity and specificity for diagnosis of thyroid disorder were superior for Serum free T4 concentration (91% and 94%) respectively when compared with serum TSH level (84% and 86%). However, the sensitivity and specificity for both laboratory tests assessed in conjunction improved further (98% for both) in comparison to either of the tests evaluated individually in diagnosis of thyroid disorder. Archives of Internal Medicine Research 2 Conclusions: Free T4 may be more accurate and reliable than TSH as a single initial screening laboratory test in assessment of thyroid function. However, both performed simultaneously increases the reliability and accuracy in determination of thyroid functional state.

What you are about to read is a new theory about the cause, and prevention, of thyroid disease. We believe a simple lifestyle issue that characterizes modern life is leading to thyroid dysfunction. It’s something you can test for yourself, on yourself. And the concept itself will change the way science thinks about thyroid function.

Inflammation Mastery, 4th Edition is printed in beautiful full-color and is loaded with images, diagrams, photos, and colorful emphasis. Thousands of citations are provided in the footnotes for easy access. See PDF document for table of contents, samples, and index.

Thyroid is the major disorder occurs due to the lack of thyroid hormone among women than man. The test report of thyroid includes number of attributes such as TSH, T3, TT4, T4U and more. Manually determining the disorder for number of peoples test report is not easier. So, using the data mining approach will made this task simpler by predicting the disorder from the large dataset. Traditionally, Linear Discriminant Analysis (LDA) data mining technique is used to predict the thyroid disorder. In our proposed work, the random forest approach is utilized to predict the hypothyroid disorder by collecting the dataset from UCI repository. The performance measure is calculated from the confusion matrix with the accuracy. The experimental result is obtained from the Weka tool.

Case Presentation: A 72-year-old man presented to the
hospital with acute onset headache, diplopia, and vomiting.
Examination was notable for hypertension and partial
left third and sixth cranial nerve palsies. No stigmata of
Cushing’s syndrome were observed. MRI revealed a 2.9 cm
pituitary macroadenoma with acute hemorrhage extending
into the left cavernous sinus. Evaluation of anterior
pituitary function approximately 30 hr after admission
revealed serum cortisol 56.4 μg/dL (8.7-22.4) and ACTH
337 pg/mL (7-69). TSH (0.92 mIU/L, 0.34-5.60), free T4
(1.0 ng/dL, 0.5-1.3), and IGF-1 (167 ng/mL, 36-215) were
unremarkable, though prolactin level was low (1.0 ng/mL,
2.6-13.2). Over the next 4 d, serum cortisol ranged from
50-60 μg/dL, and 24 hr urine free cortisol was 1,883 μg
(< 60). At hospital discharge 7 d after admission, cortisol
(24.6 μg/dL) and ACTH (148 pg/mL) were falling, and at
15 d from admission early hypopituitarism had occurred
[8 AM cortisol 5.7 μg/dL, ACTH 15 pg/mL, TSH 0.55
mIU/L, free T4 0.6 ng/dL, IGF-1 65 ng/mL, LH 2.2 mIU/
mL (1.2-8.6), testosterone 76 ng/dL (270-1070)]. The
adenoma was resected 6 wk after initial presentation, and
postoperative histology revealed neuroendocrine cells in
a background of fibrosis and pigment-laden macrophages
but no staining for ACTH.
Discussion: Pituitary apoplexy usually occurs due to
hemorrhage or infarction of an adenoma. Hypopituitarism
often occurs either at time of presentation due to
compromise of anterior pituitary blood flow or before the event due to mass effect of the adenoma. Secondary
adrenal insufficiency is reported in approximately
70% of pituitary apoplexy cases, but significant
hypercortisolemia is rare. Literature review identified
only one published case of hypercortisolemia during
apoplexy in the setting of Cushing’s disease. In this
case, hemorrhage of a corticotroph adenoma is unlikely
as corticotroph macroadenomas are rare, the patient had
no symptoms or signs of Cushing’s syndrome, and no
immunohistochemical staining for ACTH was detected
on histological evaluation of the tumor. Elevations of
ACTH and cortisol most likely reflect stress activation of
the hypothalamic-pituitary-adrenal axis, with subsequent
central hypogonadism and declines in other pituitary
functions reflecting subacute onset of hypopituitarism.
Conclusion: This case illustrates that pituitary apoplexy
may provoke a stress glucocorticoid response if corticotrophs
remain viable. There is little published to predict subsequent anterior pituitary function after hemorrhage when initial
cortisol levels are elevated, though low prolactin level
appears to have been a marker for eventual hypopituitarism
as in more typical cases of apoplexy.

17.10 – 17.20 pm
Role of Ultrasonography in characterising benign and malignant thyroid nodules
Ayman Elsayed (short oral presentation)
Diana Princess Of Wales Hospital, Northern Lincolnshire and Goole NHS foundation Trust, Radiology Department, North East Lincolnshire, United Kingdom
Co-Authors: Awad M, Abdulquader H
OBJECTIVES
: The aim of our study is to evaluate
the role of Ultrasonography (US) in predicting
benign and malignant thyroid nodules by corre-lating US findings with US- guided Fine Needle
Aspiration Biopsy (FNAB) and post operative
pathology results.
MATERIALS AND METHODS
: In this study we
looked retrospectively at four hundred and eight US and US-guided FNAB reports done for three hundred and forty consecutive patients; referred to the radiology department for evaluation of thy-
roid lumps in a five-year period. We reviewed
the US features including colour Doppler of the
thyroid nodules and correlated them with US
guided FNAB results and post operative histol-
ogy. All US scans and US guided FNAB were performed by the same consultant radiologist
and the FNAB were reported by two consultant cyto-pathologists.
RESULTS
: US characteristics including size, shape, contour, echogenicity, micro- and mac-
ro-calcifications and vascularity were evaluated
for every nodule sampled and correlated with benign and malignant pathology. Results were
studied statistically.
CONCLUSIONS
: Our study suggests US characCONCLUSIONS
: Our study suggests US characteristics of benign and malignant thyroid nodules
with review of the literature.

The way you use your voice affects the health of your thyroid.  This is because the thyroid gland is stimulated by vocal vibrations, being located adjacent to the voice box.  Shouting can over-stimulate the thyroid, just as being too quiet can under-stimulate it.  This link between the voice and thyroid stimulation can explain some cases of hypo- and hyper-thyroidism, and offers a non-medical option for the treatment of these conditions.

In absence of clear description, a newly emerged pathological condition or a diseaseshould be compared with any established disease as per Ayurvedic thought on the basis of similarities between their Nidan (causative factors),Samprapti (pathogenesis) &Lakshans (clinical features). This comparative study is very essential to determine the therapeutic and preventive aspect of any newly emerged disease. Hypothyroidism is one of the most important disorders of thyroid gland emerging now a days. In this disorder there is decreased synthesis of thyroid hormones like T3 & T4. In absence of any clear reference to this disorder in our ancient compendiums, hypothyroidism can be compared with Pandu Roga. Pandu Roga is one of the most important diseases described in the ancient Ayurved compendiums. This disease is occurred due to vitiation of Pitta Dosha, which afflicts Rasa, Rakta & Mamsa Dhatu. Pandu Rogaand hypothyroidism are identical on the basis of their causative factors, pathogenesis & clinical features. Hypothyroidism can be occurred due to several causes among which iodine deficiency and autoimmune thyroiditis are the most common. Likewise, Pandu Roga has two different pathogenesis like Dhatukshaya(can be compared with iodine deficiency) and Avaran (can be compared with autoimmune reaction). Apart from these, several clinical features like Daurvalya (weakness), Shishiradweshi (aversion to cold), Avipaka (anorexia), Gatrasadan (muscle cramp) etc are also very identical between these two disorders. In this study, literary information regarding the similarities between Pandu Roga and hypothyroidism has been verified through clinical study. A comparative discussion has been carried out between the causative factors, pathogenesis and clinical features of Pandu Roga and hypothyroidism. This study has also been carried out to evaluate the efficacy of stipulated PanduRogahara management in 15 patients of hypothyroidism, comprising Virechan Karma by Trivrit Churna at a dose of 3 grams before lunch & dinner with warm water along with powder Punarnava Mandoor at a dose of 250 mg with honey after lunch and dinner. Both the therapeutic procedure was continued for 60 days. After 60 days the effect of the stipulated therapeutic procedure has been evaluated in 14 patients with 1 dropout,on the basis of subjective and objective parameters. All the findings have been statistically analyzed using paired 't' test. The obtained results have been interpreted as – p <0.05 is significant & p <0.001 is highly significant. The results showed 'p' value< 0.001 after 60 days in most of the parameters (subjective and objective), which indicates that, the Pandu Rogahara Chikitsa which has been followed in this study is very efficacious to combat Pandu Roga and subsequently to combat hypothyroidism..

The benefits of pranayama for positive health are well known. Even though there are many studies published on the effectiveness of pranayama, there are very few papers, which actually have systematically studied the physiological mechanisms involved, causing the benefits of pranayama, especially with respect to the cardiac function. This article attempts to have a detailed look at the physiology behind deep breathing. The article also conjectures that voluntary, deep breathing with attention may have a role to play in faster recovery from surgeries, and prevent or delay the onset of Alzheimer's disease, Parkinson's disease and may be, even cancer. Detailed, controlled studies are needed to prove or disprove these conjectures.

This paper provides the reader with an overview of our current knowledge of hypothalamic-pituitary-thyroid feedback from
a cybernetic standpoint. Over the past decades we have gained a plethora of information from biochemical, clinical, and
epidemiological investigation, especially on the role of TSH and other thyrotropic agonists as critical components of this complex
relationship. Integrating these data into a systems perspective delivers new insights into static and dynamic behaviour of thyroid
homeostasis. Explicit usage of this information with mathematical methods promises to deliver a better understanding of
thyrotropic feedback control and new options for personalised diagnosis of thyroid dysfunction and targeted therapy, also by
permitting a new perspective on the conundrum of the TSH reference range.

Resumen La glándula tiroides, es uno de los órganos endocrinos encargado de la regulación de diferentes procesos metabólicos, sintetiza las hormonas tiroideas, tiroxina y triyodo-tironina, necesarias para el funcionamiento del organismo. El hipotiroidismo, es una condición en la cual la glándula tiroides no puede producir la suficiente cantidad de hormonas tiroideas necesarias para cumplir con el requerimiento tisular, es el desor-den más común de la tiroides y una de las principales alteraciones endocrinas. Las causas más comunes son la deficiencia de yodo y la tiroiditis autoinmune linfocítica crónica. El cuadro clínico del hipotiroidismo es bastante amplio afectando diferentes órganos y sistemas. El manejo de esta patología se hace con reemplazo hormonal, para ello levotiroxina es la indicación. El hipertiroidismo por su parte, hace referencia al incremento sostenido de las hormonas tiroideas debido al aumento de biosíntesis y secreción de la tiroides. Entre las principales causas se encuentra la enfermedad de Graves Basedow (EG). Su presentación clínica es amplia y varía de asintomática a una tormenta tiroidea que compromete la vida del paciente. El tratamiento está ba-sado en medicamentos antitiroideos pero también se han diseñado otras alternativas como yodo radioactivo y tiroidectomía. También las enfermedades que afectan direc-tamente la tiroides, como el cáncer, son de gran importancia; la evidencia obtenida en numerosos estudios sugiere que los polimorfismos genéticos influencian el riesgo de carcinogénesis y que la susceptibilidad genética es un factor importante para el desarrollo del cáncer. Los avances genéticos en esta patología han permitido una compresión mas a fondo de las diferencias en el comportamiento de los trastornos tiroideos entre una persona y otra, así mismo han generado un nuevo punto de partida para el tratamiento farmacológico.

The American Thyroid Association appointed a panel of experts to revise the original guidelines: &quot;Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association&quot;, based on a review of the relevant literature. Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality. The original &quot;Medullary Thyroid Cancer: Management Guidelines of the American Thyroid Association&quot; provided abundant source material and an excellent organizational structure that served as the basis for the current revisions. The primary focus of this revision is on the diagnosis and treatment of patients with sporadic and hereditary MTC. The panel developed 68 evidence-based recommendations to assist clinicians in the care of pati...

Background Thyroid swellings enlarge caudally into the mediastinum behind the sternum. Pre-sternal swelling of thyroid origin is very rare. We present our case of pre-sternal thyroid swelling which was albeit a surprisingly rare site of papillary thyroid carcinoma recurrence and review of pre-sternal thyroid swellings reported till date. Case summary A 60 year old female presented with a painless, progressive swelling on the anterior part of the chest for the past 2 years. A 15 cm × 8 cm vertically aligned, non tender, well defined swelling was present on the pre-sternal region, with consistency ranging from soft to firm. The swelling was fixed to the underlying tissues and a fixed level IV lymph node was palpable on the right side. Ultrasonography revealed a large mass of 15 × 7 cm with multiple cystic areas. Fine needle aspiration cytology was inconclusive twice. Patient had undergone a total thyroidectomy for papillary carcinoma 10 years back. Computed tomography findings reveale...