Impact of autoimmune thyroiditis on primary hyperparathyroidism

Aim. Primary hyperparathyroidism (PHPT) often coexists with thyroid diseases. Current guidelines advise preoperative ultrasound (US) examination of the thyroid gland for thyroid nodular disease or concomitant malignancy but not evaluation for autoimmune thyroiditis (AIT). The impact of autoimmune thyroiditis on the clinical presentation and intraoperative course of PHPT is not clear. Material and methods. We retrospectively assessed the medical records of 21 patients with PHPT who underwent parathyroidectomy. Clinical, biochemical, ultrasonographic and intraoperative data were evaluated. Results. There was a longer duration of parathyroidectomy in patients with AIT than in those without (113.3 min vs. 93.9 min, P=0.03). A lower rate of kidney stones was noted in patients with autoimmune thyroiditis (44.4% vs. 0%, P=0.03). Patients with AIT were more symptomatic, but this was not significant. There was no difference between the two groups in the prevalence of osteoporosis or thyroid nodular disease. Conclusions. A significantly longer duration of parathyroidectomy was seen in PHPT patients with AIT. Patients with PHPT undergoing surgery should be investigated for autoimmune thyroiditis, as this may affect surgical planning

Thyroid sonography as an extension of the bedside examination in hyperthyroidism

In this mini-review, we discuss the role of thyroid sonography as a ‘point-of-care’ tool for assessing and managing patients with (suspected) hyperthyroidism who present to the endocrine outpatient clinic. A thyroid ultrasound may aid in distinguishing between hyperthyroidism and destructive thyroiditis. The presence of intense vascularity (‘thyroid inferno’) on the power Doppler has a very high positive predictive value in identifying hyperthyroidism. It may also allow for the sub-classification of hyperthyroidism into autoimmune and nodular hyperthyroidism. It is important to identify the presence of thyroid nodules at an early stage, as this may influence management. Toxic nodules requires definitive treatment, as well as the presence of nodules in Graves’ disease because of increased risk of malignancy. Current guidelines on hyperthyroidism do not clearly state thyroid sonography as a first line investigation, although recent authoritative reviews point in that direction. Given the aforementioned benefits of thyroid sonography, alongside the reduced costs and widespread availability of high-resolution (including portable) ultrasound devices, there is an argument for thyroid sonography to be applied as a first line investigation for all patients with hyperthyroidism. Endocrinologists trained in thyroid sonography could perform this as an extension of their clinical examination when patients first present with hyperthyroidism at the endocrine clinic

Thyroid Nodules and Obesity

A widely discussed topic in the pathophysiology of thyroid nodules is the role of obesity, a state that leads to increased systemic inflammatory markers. Leptin plays a vital role in forming thyroid nodules and cancer through several mechanisms. Together with chronic inflammation, there is an augmentation in the secretion of tumor necrosis factor (TNF) and the cytokine interleukin 6 (IL-6), which contributed to cancer development, progression and metastasis. In addition, leptin exerts a modulatory action in the growth, proliferation and invasion of thyroid carcinoma cell lines via activating various signal pathways, such as Janus kinase/signal transducer and activator of transcription, mitogen-activated protein kinase (MAPK) and/or phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt). Through several proposed mechanisms, aberrant endogenous estrogen levels have been suggested to play a vital role in the development of both benign and malignant nodules. Metabolic syndrome triggers the development of thyroid nodules by stimulating thyroid proliferation and angiogenesis due to hyperinsulinemia, hyperglycemia and dyslipidemia. Insulin resistance influences the distribution and structure of the thyroid blood vessels. Insulin growth factor 1 (IGF-1) and insulin affect the regulation of the expression of thyroid genes and the proliferation and differentiation of thyroid cells. TSH can promote the differentiation of pre-adipocytes to mature adipocytes but also, in the presence of insulin, TSH possesses mitogenic properties. This review aims to summarize the underlying mechanisms explaining the role of obesity in the pathophysiology of thyroid nodules and discuss potential clinical implications

Lymph Node Metastasis and Extrathyroidal Extension in Papillary Thyroid Microcarcinoma in Cyprus: Suspicious Subcentimeter Nodules Should Undergo FNA When Multifocality is Suspected

Objective. To determine the prevalence of lymph node (LN) metastasis and extrathyroidal extension (ETE) in patients with papillary thyroid microcarcinoma (PTMC) in Cyprus and to evaluate the role of preoperative ultrasound (U/S) examination. Methods. A retrospective study of 102 patients who underwent thyroidectomy for PTMC in a 2-year period. Preoperatively, all patients had a thyroid and neck U/S examination with LN mapping. Tumor size according to the largest diameter, number of foci, LN metastasis, and ETE data was collected from the histopathological report and was compared to the preoperative U/S reports. Results. LN metastasis was present in 23.5% of patients. 15.7% had central, 3.9% had lateral, and 3.9% had both central and lateral LN metastasis. ETE was present in 27.5% of patients. 21.6% had multifocal disease, and in this group, 40.9% had LN metastasis and 36.4% had ETE. Multifocality (p=0.03), size of tumor (p=0.05), and ETE (p≤0.001) were significantly associated with LN metastasis. The prevalence of LN metastasis in multifocal PTMC ≤5 mm was the same with multifocal PTMC >5 mm. The preoperative U/S sensitivity for the suspicious lateral neck and central LN was 100%, and the specificity was 100%. The preoperative U/S sensitivity for nodules suspicious for ETE was 53.6%, and the specificity was 100%. Conclusion. The presence of LN metastasis and ETE in our PTMC patients in Cyprus is frequent. Neck U/S mapping is a highly reliable and accurate tool in identifying metastatic nodes. LN metastasis is associated with ETE and multifocality. Suspicious subcentimeter nodules should undergo FNA irrespective of size when multifocality is suspected

Parameters impacting excessive weight gain in patients treated for hyperthyroidism

Background: Overshoot of weight regain following the treatment of hyperthyroidism is well described. Notwithstanding, there is a large interindividual variability in the observed weight changes. This study aims to identify parameters predicting excessive weight gain in hyperthyroidism patients.Methods: In a retrospective study of a prospectively completed database, we recruited consecutive patients with overt hyperthyroidism and compared those with excessive weight gain (≥10%, Group A) to those with less gain (<10%, Group B) based on initial anthropometrics, demographics, and disease-related characteristics, using appropriate statistical tests.Results: We recruited 91 patients (70.3% females, median age 50 years) treated for hyperthyroidism with a median follow-up of 2 years. Excessive weight gain (GpA) was observed in 50% of patients. GpA had significantly higher ft4 levels and disease-related weight loss at presentation.Conclusion: The severity of thyrotoxicosis and the disease-related weight loss were predictive of excessive weight gain post-treatment. This information alongside the presentation BMI may allow risk stratification for excessive weight gain, hereby permitting early intervention strategies

Body weight change trajectories following the treatment of hyperthyroidism: a prospective cohort study

We attach tables with findings, tables and figures relating to our methods and study design, as well as figures relating to our study findings.</p