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.

Glutaric Aciduria Type I Diagnosis Case with Normal Glutaryl Carnitine and Urine Organic Acid Analysis

Glutaric aciduria Type I (GA-I) is a rare inherited metabolic disease, deficiency of glutaryl-CoA dehydrogenase results in accumulation of the putatively neurotoxic metabolites glutaric and 3-hydroxyglutaric acid (GA, 3-OH-GA) in body tissues, particularly within the brain. Here we presented a 3-year-old girl with hypotonia and dystonia diagnosed with GA-I although the repeated analysis of the carnitine profile and organic acid analyses were normal. The patient has motor, mental retardation, hypotonia. Her weight standard deviation score (SDS) was -1.86 SDS, height SDS was -0.55 SDS, head circumference SDS was -1.01. The physical examination was normal except severe hypotonia. Spot blood carnitine profile, blood amino acid, urine organic acid, lactic acid and pyruvic acid were normal in repeated analysis. Dystonia and spastic tetraparesis developed on her follow-up. Cranial magnetic resonance imaging revealed bilateral cortical atrophy and bilateral striatal and caudate nucleus T2 flair hyperintensities. In GCDH gene analysis p.Y123C (c.368A>G)/p.L340F (c.368A>G) mutation was found. There was no history of encephalopathy. The patient treated with levodopa and trihexyphenidyl and lysine-restricted diet. In the presence of bilateral striatal involvement and cortical atrophy and dystonia, GA-I should be kept in mind. Blood carnitine profile and urine organic acid analyses may not be consistent. It is important to evaluate the cases for genetic investigation

The Relationship Between Hand Function and Activities of Daily Living in Patients with Hypothyroidism

Objective: This study aimed to evaluate hand function and hand function-related factors in patients with hypothyroidism and to investigate the relationship between hand function and activities of daily living. Methods: This cross-sectional study included 103 patients with hypothyroidism (53 with Hashimoto thyroiditis, 50 with postoperative hypothyroidism) and 50 controls. Hand function was evaluated with the Duruoz Hand Index, and the Nottingham Extended Activities of Daily Living Scale was used to assess activities of daily living. Results: The mean Duruoz Hand Index scores were higher in the Hashimoto group (1.70 +/- 4.71) (P =.02) and postsurgical group (2.16 +/- 4.37) (P =.002) than in the control group (0.24 +/- 1.02). The median Nottingham Extended Activities of Daily Living Scale score was 65 (45-66) in patients with Hashimoto thyroiditis, 63 (43-66) in patients with postsurgical hypothyroidism, and 66 (46-66) in the control group (P =.009). The difference was statistically significant between the control group and Hashimoto (P =.037) and postsurgical (P =.001) groups. The cut-off value of the Nottingham Extended Activities of Daily Living Scale determined with receiver operating characteristics analysis for poor and good activities of daily living status was 63.5 with a sensitivity of 70% and a specificity of 54% (area under the curve: 0.643, 95% Cl: 0.553-0.733, P =.004) for this study. Logistic regression analysis showed that Duruoz Hand Index (B = -0.695, P =.011) and female gender (B = -2.477, P =.028) were predictive variables for activities of daily living (R-2 = 0.43). Conclusion: Hand function was worse, and activities of daily living were lower in patients with hypothyroidism. Since poor hand function may affect activities of daily living, clinicians should routinely assess hand function and activities of daily living in patients with hypothyroidism. A multidisciplinary approach including rehabilitation programs, must be considered if hand dysfunction is detected

Evaluation of serum anti-Mullerian hormone levels in women with Hashimoto thyroiditis in the reproductive age

Abstract Background: Autoimmune thyroid disease in women is associated with subfertility and early pregnancy loss, and patients with primary ovarian insufficiency have a high prevalence of thyroid autoimmune disorders. The aim of this study was to investigate the association between Hashimoto thyroiditis (HT) and ovarian reserve.Methods: Levels of serum thyroid stimulating hormones, thyroid autoantibodies, and anti-Müllerian hormone (AMH) were measured in women with HT and a healthy control group between 2018 and 2019. Result: Evaluation was made of 108 premenopausal women with HT. A control group was formed of 172 healthy female subjects with normal anti-thyroid antibody levels and thyroid function. Serum AMH levels were determined to be significantly lower in the HT group compared to the control group.Conclusion: Ovarian reserve evaluated by serum AMH concentration is affected by thyroid autoimmunity independently of anti-thyroid antibodies type or titers.</jats:p