Detection of recurrent nerve paralysis: Development of a Computer Aided Diagnosis system

International audienceRecurrent nerve paralysis (RP) is one of the most frequent complications of thyroid surgery. It reduces vocal fold mobility. Nasal endoscopy, a mini-invasive procedure, is the reference procedure to detect RP, and is based on the examination of vocal fold mobility. A new approach based on laryngeal ultrasound acquisition and using a dedicated data analysis was designed to help with the automated detection of RP. One hundred and fifty subjects were enrolled for this feasibility study: 50 controls, 50 patients with RP and 50 patients without RP, according to nasal endoscopy. The ultrasound protocol was based on a ten seconds B-mode acquisition in an axial plane during normal breathing. Image processing included three steps: 1) the detection of two consecutive closing and opening images corresponding to extreme positions of vocal folds in the sequence of B-mode images; 2) the positioning of three landmarks and the robust tracking of these points using multi-pyramidal refined optical flow approaches; 3) the estimation of quantitative parameters indicating left and right fractions of mobility and motion symmetry. Results provided by the first two image processing steps were compared to those obtained by an expert. Motion symmetry and fraction of mobility indices were systematically computed using the automated procedures. Associated sensitivity and specificity values for detecting RP were then calculated. To optimize the performances of the system, a mixed CAD system, which integrates the automatic steps of image processing and a possible correction of its results by a trained operator was developed. Laryngeal ultrasound combined with appropriate image processing helped in the diagnosis of recurrent nerve paralysis and could be proposed as a first–line method

Characteristics of specialists treating hypothyroid patients:the “THESIS” collaborative

Introduction: Thyroid specialists influence how hypothyroid patients are treated, including patients managed in primary care. Given that physician characteristics influence patient care, this study aimed to explore thyroid specialist profiles and associations with geo-economic factors. Methods: Thyroid specialists from 28 countries were invited to respond to a questionnaire, Treatment of Hypothyroidism in Europe by Specialists: an International Survey (THESIS). Geographic regions were defined according to the United Nations Statistics Division. The national economic status was estimated using World Bank data on the gross national income per capita (GNI per capita). Results: 5,695 valid responses were received (response rate 33·0%). The mean age was 49 years, and 65·0% were female. The proportion of female respondents was lowest in Northern (45·6%) and highest in Eastern Europe (77·2%) (p &lt;0·001). Respondent work volume, university affiliation and private practice differed significantly between countries (p&lt;0·001). Age and GNI per capita were correlated inversely with the proportion of female respondents (p&lt;0·01). GNI per capita was inversely related to the proportion of respondents working exclusively in private practice (p&lt;0·011) and the proportion of respondents who treated &gt;100 patients annually (p&lt;0·01). Discussion: THESIS has demonstrated differences in characteristics of thyroid specialists at national and regional levels, strongly associated with GNI per capita. Hypothyroid patients in middle-income countries are more likely to encounter female thyroid specialists working in private practice, with a high workload, compared to high-income countries. Whether these differences influence the quality of care and patient satisfaction is unknown, but merits further study.</p

Genome-wide association analyses identify new Brugada syndrome risk loci and highlight a new mechanism of sodium channel regulation in disease susceptibility.

Brugada syndrome (BrS) is a cardiac arrhythmia disorder associated with sudden death in young adults. With the exception of SCN5A, encoding the cardiac sodium channel Na1.5, susceptibility genes remain largely unknown. Here we performed a genome-wide association meta-analysis comprising 2,820 unrelated cases with BrS and 10,001 controls, and identified 21 association signals at 12 loci (10 new). Single nucleotide polymorphism (SNP)-heritability estimates indicate a strong polygenic influence. Polygenic risk score analyses based on the 21 susceptibility variants demonstrate varying cumulative contribution of common risk alleles among different patient subgroups, as well as genetic associations with cardiac electrical traits and disorders in the general population. The predominance of cardiac transcription factor loci indicates that transcriptional regulation is a key feature of BrS pathogenesis. Furthermore, functional studies conducted on MAPRE2, encoding the microtubule plus-end binding protein EB2, point to microtubule-related trafficking effects on Na1.5 expression as a new underlying molecular mechanism. Taken together, these findings broaden our understanding of the genetic architecture of BrS and provide new insights into its molecular underpinnings

PERFORMANCES DIAGNOSTIQUES DES EXAMENS COMPLEMENTAIRES DANS LA PRISE EN CHARGE DES NODULES THYROIDIENS

PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les cytologies thyroïdiennes douteuses (analyse descriptive et éléments prédictifs de malignité)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Thyroid Incidentalomas:Epidemiology Risk Stratification with Ultrasound and Workup

A thyroid incidentaloma is an unexpected, asymptomatic thyroid tumor fortuitously discovered during the investigation of an unrelated condition. The prevalence rate is 67% with ultrasonography (US) imaging, 15% with computed tomography (CT) or magnetic resonance imaging (MRI) of the neck, and 1-2% with fluorodeoxyglucose (FDG) positron emission tomography. In the absence of a history of external beam radiation or familial medullary thyroid cancer, the risk of malignancy ranges between 5 and 13% when discovered with US, CT or MRI, but is much higher if based on focal FDG uptake (30%). All patients with a thyroid incidentaloma, independent of the mode of detection, should undergo a dedicated neck US with risk stratification: US imaging allows a quantitative risk stratification of malignancy in thyroid nodules, named ‘reporting system’ or ‘TIRADs' (thyroid imaging reporting and data system). The reported sensitivity ranges from 87 to 95% for the detection of carcinomas and the negative predictive value from 88 to 99.8%. We suggest that the indications for fine-needle aspiration be based mainly on size and US risk stratification. However, the diagnosis and workup of thyroid incidentalomas leads to superfluous surgery for benign conditions, and excess diagnosis and treatment of papillary microcarcinomas, the vast majority of which would cause no harm. Recognizing this must form the basis of any decision as to supplementary investigations and whether to offer therapy, in a close dialogue between patient and physician. The current use of minimally invasive nonsurgical ablation options, as alternatives to surgery, is highlighted

Serum thyrotropin and free thyroxine reference ranges as defined in a disease-free sample of French middle-aged adults

Background: The goal of this study was to provide reference ranges for thyrotropin (TSH) and free thyroxine (fT4) based on data collected from a disease-free sample of French middle-aged adults. Methods: A total of 3218 subjects participating in the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) study had measurements for TSH, fT4 and urinary iodine concentrations. Thyroid volume and structure were evaluated using standardized ultrasonography. We selected a disease-free sample which included 2338 subjects (1313 females aged 35–60 years and 1025 males aged 45–60 years) with normal thyroid imaging, no previously reported thyroid disease or use of thyroid medication, and no risk factors for thyroid dysfunction. Distribution of TSH and fT4 was estimated in males and females. Results: The median (central 95% range) TSH serum concentrations for females were 1.79 mU/L (0.29–5.21 mU/L) for ages 35–44 years and 1.98 mU/L (0.27–6.94 mU/L) for ages 45–60 years (p&#60;0.0001, for age). The median (central 95% range) for males 45–60-year-old was 1.63 mU/L (0.28–4.54 mU/L) (p&#60;0.0001, for sex). Sex- and age-specific mean fT4 concentrations did not differ significantly (p=0.06) between males and females and (p=0.08) between female age groups. However, median fT4 concentrations between 45–60-year-old males and females differed (p&#60;0.001). Conclusions: In middle-aged adults, the TSH distribution was associated with gender and, among females, with age. Stratification according to gender and age should be considered when TSH ranges are used in the diagnosis, treatment and monitoring of thyroid disease. Clin Chem Lab Med 2009;47:1497–505.Peer Reviewe

European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS

Thyroid ultrasound (US) is a key examination for the management of thyroid nodules. Thyroid US is easily accessible, noninvasive, and cost-effective, and is a mandatory step in the workup of thyroid nodules. The main disadvantage of the method is that it is operator dependent. Thyroid US assessment of the risk of malignancy is crucial in patients with nodules, in order to select those who should have a fine needle aspiration (FNA) biopsy performed. Due to the pivotal role of thyroid US in the management of patients with nodules, the European Thyroid Association convened a panel of international experts to set up European guidelines on US risk stratification of thyroid nodules. Based on a review of the literature and on the American Association of Clinical Endocrinologists, American Thyroid Association, and Korean guidelines, the panel created the novel European Thyroid Imaging and Reporting Data System, called EU-TIRADS. This comprises a thyroid US lexicon; a standardized report; definitions of benign and low-, intermediate-, and high-risk nodules, with the estimated risks of malignancy in each category; and indications for FNA. Illustrated by numerous US images, the EU-TIRADS aims to serve physicians in their clinical practice, to enhance the interobserver reproducibility of descriptions, and to simplify communication of the results

2018 European thyroid association guideline for the management of graves' hyperthyroidism

Graves' disease (GD) is a systemic autoimmune disorder characterized by the infiltration of thyroid antigen-specific T cells into thyroid-stimulating hormone receptor (TSH-R)-expressing tissues. Stimulatory autoantibodies (Ab) in GD activate the TSH-R leading to thyroid hyperplasia and unregulated thyroid hormone production and secretion. Diagnosis of GD is straightforward in a patient with biochemically confirmed thyrotoxicosis, positive TSH-R-Ab, a hypervascular and hypoechoic thyroid gland (ultrasound), and associated orbitopathy. In GD, measurement of TSH-R-Ab is recommended for an accurate diagnosis/differential diagnosis, prior to stopping antithyroid drug (ATD) treatment and during pregnancy. Graves' hyperthyroidism is treated by decreasing thyroid hormone synthesis with the use of ATD, or by reducing the amount of thyroid tissue with radioactive iodine (RAI) treatment or total thyroidectomy. Patients with newly diagnosed Graves' hyperthyroidism are usually medically treated for 12-18 months with methimazole (MMI) as the preferred drug. In children with GD, a 24- to 36-month course of MMI is recommended. Patients with persistently high TSH-R-Ab at 12-18 months can continue MMI treatment, repeating the TSH-R-Ab measurement after an additional 12 months, or opt for therapy with RAI or thyroidectomy. Women treated with MMI should be switched to propylthiouracil when planning pregnancy and during the first trimester of pregnancy. If a patient relapses after completing a course of ATD, definitive treatment is recommended; however, continued long-term low-dose MMI can be considered. Thyroidectomy should be performed by an experienced high-volume thyroid surgeon. RAI is contraindicated in Graves' patients with active/severe orbitopathy, and steroid prophylaxis is warranted in Graves' patients with mild/active orbitopathy receiving RAI.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Maladies thyroïdiennes dans la cohorte SU.VI.MAX :estimation de l’incidence et des facteurs de risque associés, France, 1994-2002

info:eu-repo/semantics/nonPublishe