Preoperative detection of insulinomas: two case reports

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Medical hypothesis: can gonadotropins influence thyroid volume in women with PCOS?

It has been reported that luteinizing hormone (LH) had thyropropic effect on rat and human thyroid membrane. It has been known that patients with PCOS have elevated LH levels in comparison to healthy controls. The goiter prevalence is more common in women than in men regardless of population. The higher incidence of thyroid diseases in women has been previously attributed to higher estradiol levels. Estradiol has been shown to enhance proliferative and mitogenic activities of thyroid cells. However, in recent years chronic estradiol treatment has been shown to reduce volume densities of thyroid follicles, follicular epithelium and thyroid gland volume. It is thought to be due to LH suppression. Therefore we suggested that increased LH levels might provide a stimulus for growth on thyroid and alter thyroid function. Therefore patients with PCOS who had elevated LH levels should be treated by combined estradiol pills such as estrogen-progestin contraceptives for suppression of LH secretion. Further studies are needed to evaluate the association between LH, LH suppression and thyroid volume in patients with PCOS

Evaluation of Residual Thyroid Tissue with Tc-99m MIBI in Differential Thyroid Carcinoma Patients: A Case Report

Tc-99m pertechnetate thyroid scintigraphy is used in the routine for the evaluation of residual tissue after total thyroidectomy operations in differentiating thyroid carcinoma. Tc-99m methoxy isobutyl isonitrile (Tc99m MIBI) was first developed as a myocardial perfusion agent and is also used for tumor imaging. Tc-99m MIBI is taken up by the functioning thyroid tissue and washed-out fast. We present a case of differentiated thyroid carcinoma where uptake out the thyroid bed was not detectable by Tc-99m pertechnetate thyroid scintigraphy but with Tc-99m MIBI scintigraphy in the postoperative period

Heart-Type Fatty Acid Binding Protein (H-FABP): Relationship with arterial ıntima-media thickness and role as diagnostic marker for atherosclerosis in patients with ımpaired glucose metabolism

<p>Abstract</p> <p>Background</p> <p>Heart type fatty acid binding protein (H-FABP) has been closely associated with acute coronary syndrome, cardiac abnormalities, stroke, and obstructive sleep disorder in previous studies. The aim of this study was to evaluate and compare the serum H-FABP levels and carotid artery intima-media thickness (CIMT) between patients with prediabetes and control subjects.</p> <p>Research design and methods</p> <p>We measured serum H-FABP levels in 58 prediabetic patients, 29 with impaired fasting glucose (IFG) and 29 with impaired glucose tolerance (IGT) and 28 age-, sex- and body mass index-matched control subjects using a sandwich enzyme-linked immunosorbent assay (ELISA), and in order to measure CIMT, all participants underwent high-resolution B-mode ultrasonography.</p> <p>Results</p> <p>Serum H-FABP levels were significantly elevated in pre-diabetic patients when compared with that of control subjects (IFG: 32.5 ± 34.2 ng/dL, IGT: 45.4 ± 45.8 ng/dL, control: 16.8 ± 14.9 ng/dL; p = 0.011). The difference in means of H-FABP levels between patients with IGT or IFG and control subjects was significant (p = 0.010 and p = 0.009, respectively). CIMT was higher in the pre-diabetic groups compared with the control group (IFG: 0.6 ± 0.1, IGT: 0.6 ± 0.1, control: 0.5 ± 0.1; p < 0.001), and H-FABP level was positively correlated with CIMT (p < 0.001, rho = 0.626).</p> <p>Conclusion</p> <p>Our results indicate that patients with pre-diabetes are at increased risk for cardiovascular disease. In addition, serum H-FABP levels could represent a useful marker for myocardial performance in patients with IFG and IGT.</p

The value of routine measurement of serum calcitonin on insufficient, indeterminate, and suspicious thyroid nodule cytology

Routine calcitonin measurement in patients with nodular thyroid disease is rather controversial. The aim of this study was to evaluate the contribution of serum calcitonin measurement in the diagnostic evaluation of thyroid nodules with insufficient, indeterminate, or suspicious cytology. Out of 1668 patients who underwent thyroidectomy with the diagnosis of nodular thyroid disease and were screened, 873 patients with insufficient, indeterminate, or suspicious fine needle aspiration biopsy results were included in the study. From the total number of patients in this study, 10 (1.1%) were diagnosed as medullary thyroid cancer (MTC) using histopathology. The calcitonin level was detected to be above the assay-specific cut-off in 23 (2.6%) patients ranging between 6.5 - 4450 pg/mL. While hypercalcitoninemia was detected in all 10 MTC patients, a false positive elevation of serum calcitonin was detected in 13 patients (1.5%). Of the MTC group, 7 patients had cytology results that were suspicious for malignancy (Bethesda V), one patient’s cytology showed atypia of undetermined significance (Bethesda III) and two patient’s cytology results were suspicious for follicular neoplasm (Bethesda IV). Among the cases with non-diagnostic cytology (Bethesda I), none of the patients were diagnosed with MTC. In conclusion, routine serum calcitonin measurement can be performed in selected cases rather than in all nodular thyroid patients. While it is reasonable to perform routine calcitonin measurement in patients with Bethesda IV and Bethesda V, this measurement was not useful in Bethesda I patients. In Bethesda III patients, patient-based decisions can be made according to their calcitonin measurement.

Medical hypothesis: can gonadotropins influence thyroid volume in women with PCOS?

Abstract It has been reported that luteinizing hormone (LH) had thyropropic effect on rat and human thyroid membrane. It has been known that patients with PCOS have elevated LH levels in comparison to healthy controls. The goiter prevalence is more common in women than in men regardless of population. The higher incidence of thyroid diseases in women has been previously attributed to higher estradiol levels. Estradiol has been shown to enhance proliferative and mitogenic activities of thyroid cells. However, in recent years chronic estradiol treatment has been shown to reduce volume densities of thyroid follicles, follicular epithelium and thyroid gland volume. It is thought to be due to LH suppression. Therefore we suggested that increased LH levels might provide a stimulus for growth on thyroid and alter thyroid function. Therefore patients with PCOS who had elevated LH levels should be treated by combined estradiol pills such as estrogen-progestin contraceptives for suppression of LH secretion. Further studies are needed to evaluate the association between LH, LH suppression and thyroid volume in patients with PCOS.</p

The effects of salt consumption habits on iodine status and thyroid functions during pregnancy

Background/aim: Iodine is the basic substrate for thyroid hormone synthesis and is vital for the general population and especially pregnant women. Iodine deficiency may cause severe health problems for a foetus. This study aimed to determine the relationship, if any, between iodine level and thyroid function tests, and to determine the relationship between consumption of salt types and its effects on thyroid function tests in the first trimester of pregnancy. Materials and methods: Three hundred and six pregnant women in the first trimester of pregnancy, who had known no thyroid disease history and had not received iodine supportive therapy, were included in the study. All patients were questioned for their preferred table salt or rock salt in daily use and urine iodine concentrations (UICs) were analysed in spot urine. The results were evaluated statistically according to salt usage preferences. Results: The median age of patients in the study was 27.8 (+/- 5.4). In terms of salt consumption habits, 235 (76.8%) of patients reported using table salt, and 71 (23.2%) reported using rock salt. Iodine deficiency was found in 75.81% (n = 232) of all cases according to urinalysis. Median UICs of table salt group were significantly higher than rock salt group (123.7 mu g/L and 70.9 mu g/L respectively, P < 0.001). Conclusion: Although large-scale salt iodination began long time ago, iodine deficiency is still a serious health problem among pregnant women. According to this study, use of rock salt is associated with low urinary iodine concentration in pregnant women and TSH values within the reference limits are not a good indicator for determining the iodine level

Thyroid Hormone Resistance In Two Patients With Papillary Thyroid Microcarcinoma And Their Brafv600E Mutation Status

Resistance to thyroid hormone (RTH) is a rare autosomal dominant hereditary disorder. Here in, we report two patients with RTH in whom differentiated thyroid cancer was diagnosed. Two patients were admitted to our clinic and their laboratory results were elevated thyroid hormone levels with unsuppressed TSH. We considered this situation thyroid hormone resistance in the light of laboratory and clinical datas. Thyroid nodule was palpated on physical examination. Thyroid ultrasonography showed multiple nodules in both lobes. Total thyroidectomy was performed. The pathological findings were consistent with papillary thyroid microcarcinoma. BRAFV600E mutation analysis results were negative. RTH is very rare and might be overlooked. There is no consensus on how to overcome the persistently high TSH in patients with RTH and differentiated thyroid cancer (DTC). Further studies are needed to explain the relationship between RTH and DTC which might be helpful for the treatment of these patients