Comparison of the prevalence and sonographic features of thyroid nodules accompanying autoimmune thyroid diseases

Introduction: The coexistence of thyroid nodules and autoimmune thyroid disease (ATD) has been widely reported. The aim of our study was to retrospectively evaluate the prevalence and sonographic features of malignancy of thyroid nodules in ATD patients. Material and methods: We retrospectively analysed data from 500 patients with ATD in our hospital. We recorded ultrasonographic, histopathological and laboratory features of these patients. Thyroid ultrasonography was performed on all the patients, as well as fine needle aspiration biopsy (FNAB) of the thyroid nodule, when required. Patients underwent operations depending on the result of the FNAB. Results: Of the 500 with ATD (400 female and 100 male; mean age = 42.4 years), 300 (60%) had Hashimoto&#8217;s thyroiditis (HT) and 200 (40%) presented with Graves&#8217; disease (GD). The frequency of thyroid nodules was statistically significantly higher in those with GD (37.8%) than in those with HT (24.3%) (p < 0.001). One hundred and forty-nine nodules underwent FNAB (37.8%, 76 out of 200 had GD and 24.3%; 73 out of 300 had HT). The results of the cytological examination were: non-diagnostic cytology, benign, malignant and indeterminate in 19.4%, 73.8%, 2% and 4.5% of the nodules, respectively. When 55 GD and 32 HT patients, on whom total thyroidectomy had been carried out, were evaluated, the incidence of thyroid carcinoma was similar between patients with GD (n = 3, 5.5%) and HT (n = 2, 6.3%) (p > 0.05). Conclusions: We observed that the prevalence of thyroid nodules in patients with GD was higher than patients with HT. However, in general, the characteristics of the nodules and FNAB results were similar in both ATDs. (Pol J Endocrinol 2010; 61 (6): 658-664)Wstęp: W licznych doniesieniach stwierdza się współwystępowanie guzków tarczycy i autoimmunologicznych chorób tarczycy. Celem pracy była retrospektywna ocena występowania i sonograficznych cech złośliwości guzków tarczycy u pajcentów z autoimmunologicznymi chorobami tarczycy (ATD, autoimmune thyroid disease). Materiał i metody: Analizie retrospektywnej poddano dane 500 pacjentów z ATD, u których przeprowadzono badania ultrasonograficzne, histopatologiczne i laboratoryjne. U wszystkich pacjentów wykonano badanie ultrasonograficzne oraz, w zależności od wymagań, biopsję aspiracyjną cienkoigłową (BAC). Pacjentów poddano operacji w zależności od wyniku BAC. Wyniki: Spośród 500 pacjentów z ATD (400 kobiet i 100 mężczyzn, średnia wieku: 42,4 lat), u 300 (60%) stwierdzono zapalenie tarczycy Hashimoto (HT, Hashimoto thyroids), a u 200 (40%) chorobę Gravesa (GD, Graves disease). U pacjentów z GD stwierdzono statystycznie wyższą częstość występowania guzków tarczycy (37%) w porównaniu z pacjentami z HT (24,3%) (p < 0,001). Wykonano BAC 149 guzków, w 37,8% (76 z 200) przypadków z GD i w 24,3% ( 73 z 300) z HT. Wyniki badania cytologicznego: cytologia niediagnostyczna (19,4%), guzki łagodne (73,8%), guzki złośliwe (2%) i guzki o pośredniej złośliwości (4,5%). Spośród 55 pacjentów z GD i 32 z HT, u których wykonano tyroidektomię totalną, stwierdzono podobną częstość występowania raka tarczycy - u pacjentów z GD (n = 3, 5,5%), a u pacjentów z HT (n = 2, 6,3%) (p > 0,05). Wnioski: Zaobserwowano wyższą częstość występowania guzków tarczycy u pacjentów z GD w porównaniu z pacjentami z HT. Natomiast charakterystyka guzków i wyniki BAC nie różniły sie w obu typach ATD. (Endokrynol Pol 2010; 61 (6): 658-664

Idiopathic Spontaneous Adrenal Hemorrhage in the Third Trimester of Pregnancy

Spontaneous adrenal hemorrhage (SAH) is seen in the absence of trauma or adrenal tumor in adrenal glands. The incidence of SAH has been reported from 0.14% to 1.1% and it usually involves the right gland. During pregnancy, idiopathic unilateral SAH has been reported rarely. We present a case which comes to emergency department with an acute abdominal pain and the test results showed spontaneous left SAH

Fatigue is Related to Insulin Use by Acting Via Depressive Mood in Patients with Diabetes Mellitus

Objective: Fatigue is a common symptom in diabetes mellitus. The aim of this study was to determine the factors leading to fatigue and to investigate the effect of insulin use on fatigue among the diabetic population. Material and Methods: One-hundred diabetic patients attending the diabetes clinic of Cerrahpasa Medical Faculty between October 2017-January 2018 and 42 healthy controls were evaluated in this cross-sectional study. Questionnaires including demographic and disease characteristics, Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), quality of life scale (SF-36), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI) were used. Results: Ages (47.6 +/- 14.8 and 45.7 +/- 14.1 years; p=0.47) and body mass indices (26.6 +/- 4.1 and 25.3 +/- 3.5 kg/m(2); p=0.08) of 100 patients with diabetes (Type 1 Diabetes/Type 2 Diabetes=29/71) and 42 healthy volunteers were similar. The diabetic group had worse FIS total (p=0.05), FIS psychological (p=0.04) scores and SF-36 scores compared to the healthy controls. When the patients with diabetes were divided into two groups according to insulin use and compared with healthy controls, the ESS and PSQI were similar but all FIS parameters (total p=0.005, cognitive p=0.007, physical p=0.01, psychological p=0.009) and BDI (p=0.05) were significantly worse in patients with insulin use than non-insulin and control groups. The relationship between fatigue and insulin use was independent of glycemic control and duration of diabetes but was affected by the BDI (p=0.001). Conclusion: Insulin use leads to fatigue in patients with diabetes, regardless of diabetes type, and this effect is influenced by depressive mood. Psychotherapeutic approaches prior to insulin treatment might yield fruitful results

Comparison of octreotide LAR and lanreotide autogel as post-operative medical treatment in acromegaly

WOS: 000308817000016PubMed: 21863263Long-acting somatostatin analogs are frequently used as adjuvant treatment of acromegaly patients after noncurative surgery. This sudy aims to compare the efficacy of octreotide long-acting release (OCT) and lanreotide Autogel (LAN) in acromegaly patients. Sixty-eight patients not cured by transsphenoidal endoscopic or microscopic pituitary surgery between 2003 and 2009 were retrospectively analyzed (25 men; 43 women; mean age 41.1 +/- A 10.9 years [range 18-65 years]). The patients were assigned randomly to OCT (n = 36) and LAN (n = 32) groups. Evaluations included insulin-like growth factor I (IGF-I) and growth hormone (GH) after oral glucose tolerance test (OGTT) 3, 6, 12 and 18 months after starting medical treatment; pituitary magnetic resonance imaging was performed before treatment and after 3 and 12 months. Patients achieving IGF-I levels within the age and gender normal range and GH level < 1 mu g/l following OGTT were considered a 'biochemical cure'. Mean IGF-I and GH values and tumor volumes (cm(3)) in the LAN and OCT groups were similar in the post-operative period before initiation of medical treatment. A statistically significant decrease in GH and IGF-I levels was obtained for both treatment groups at each follow-up visit compared to the previous value. Tumor shrinkage after 12 months of treatment was statistically significant in both groups but the percentage tumor shrinkage (28.5% vs. 34.9%, P = 0.166) and rate of patients achieving biochemical cure (63.9 and 78.1%, P = 0.454) were similar between OCT and LAN groups, respectively. OCT and LAN treatment options have similar efficacy for ensuring biochemical cure and tumor shrinkage in acromegaly patients who had noncurative surgery.Ipsen (Paris, France)Editorial assistance was provided by Martin Gilmour at ESP Bioscience (Crowthorne, UK) and funded by Ipsen (Paris, France). We have not received any funding support for the study

Antioxidant effect of acetyl-l-carnitine against cisplatin-induced cardiotoxicity

Objective Cisplatin (CDDP) toxicity is a dose-limiting clinical problem in clinical practice, mainly because of nephrotoxicity or ototoxicity. However, the mechanism of CDDP-induced cardiotoxicity is poorly understood. Acetyl-l-carnitine (ALCAR) is an antioxidant agent with protective effects against the side effects of various chemotherapeutics. CDDP-induced cardiotoxicity and the protective role of ALCAR were evaluated in this study. Methods Morphological changes were evaluated in hematoxylin and eosin-stained sections, and immunohistochemistry for caspase-3, superoxide dismutase-2 (SOD-2), inducible nitrite oxide synthase (iNOS), cyclooxygenase-2, and Bcl-2 was performed using the hearts of athymic nude mice carrying xenograft neuroblastoma tumors. Mice were randomized (six/group) to the control, CDDP (16 mg/kg), and ALCAR (200 mg/kg)+CDDP (16 mg/kg) groups. Results were analyzed using nonparametric tests. Results No difference was observed in the rates of cardiac necrosis, dilated/congested blood vessels, hemorrhage, polymorphonuclear leukocyte infiltration, edema, and pyknotic nuclei among the groups. SOD-2 expression was increased in the CDDP group but not in the ALCAR+CDDP group. iNOS, Bcl-2, and caspase-3 levels were not significantly different among the groups. Conclusions ALCAR might be a candidate protective agent for CDDP-induced cardiotoxicity. SOD-2, as a member of the oxidant system, should be evaluated in further studies as a biomarker of cardiotoxicity

Comparing acromegalic patients to healthy controls with respect to intraocular pressure, central corneal thickness, and optic disc topography findings

Aims: The aim was to compare the intraocular pressure (IOP), central corneal thickness (CCT), and optic disc topography findings of biochemically controlled acromegalic patients and the control group and to evaluate the effect of the duration of acromegaly and serum growth hormone and insulin-like growth factor-1 (IGF-1) levels on these ocular parameters. Materials and Methods: IOP measurement with Goldmann applanation tonometry, CCT measurement with ultrasonic pachymetry, and topographic analysis with Heidelberg retinal tomograph III were performed on 35 biochemically controlled acromegalic patients and 36 age- and gender-matched controls. Results: Mean IOP and CCT were 14.7 ± 2.9 mmHg and 559.5 ± 44.9 μm in the acromegaly patients and 13.0 ± 1.6 mmHg and 547.1 ± 26.7 μm in controls (P = 0.006 and P = 0.15, respectively). A significant moderate correlation was found between the duration of acromegaly and CCT (r = 0.391) and IOP (r = 0.367). Mean retinal nerve fiber layer (RNFL) thickness was significantly lower in the acromegalic patients (0.25 ± 0.05 mm) as compared to controls (0.31 ± 0.09 mm) (P = 0.01). A significant moderate correlation was detected between IGF-1 level and disc area (r = 0.362), cup area (r = 0.389) and cup volume (r = 0.491). Conclusion: Biochemically controlled acromegalic patients showed significantly higher CCT and IOP levels and lower RNFL thickness compared to healthy controls and the duration of disease was correlated with CCT and IOP levels

A Case of Thyrotoxic Hypokalemia Periodic Paralysis

Hypokalemic periodic paralysis is a rare disease characterized by reversible attacks of muscle weakness accompanied by episodic hypokalemia. The most common causes of Hypokalemic periodic paralysis are familial periodic paralysis, thyrotoxic periodic paralysis and sporadic periodic paralysis, respectively. There are generally some precipitating factors such as stress, vigorous exercise and high carbohydrate food consumption which all ease the occurrence of attacks. The duration of attacks range from 2-36 hours and can be shortened by K+ supplementation in appropriate situations. 28 years old male, admitted to our clinic with severe weakness at his legs and arms, on laboratory examination severe hypocalemia due to overt thyrotoksicosis detected. After antithyroid drug therapy his symptoms and hypocalemia resolved. After three months of therapy he underwent total thyroidectomy because of incompliance to medical therapy. Here we present the case, because of its rarely seen and difficult diagnose if not suspect. [Med-Science 2014; 3(4.000): 1762-5

Relationship of paratracheal lymph nodes with the progression of chronic autoimmune thyroiditis: 5-year follow-up results

Background/aim: To examine changes in paratracheal lymph nodes (PLNs) and the relationship with the course of the disease in patients with chronic autoimmune thyroiditis (CAT) 5 years after diagnosis. Materials and methods: A total of 169 patients with newly diagnosed CAT and 53 healthy subjects were included in the study. All patients underwent ultrasonographic (US) examinations of the thyroid, paratracheal regions, and examined thyroid function tests. Eighty-four patients who were euthyroid at baseline and who were contacted 5 years after the diagnosis were reevaluated by US and thyroid function tests. Results: The PLNs frequency was significantly higher in the CAT group than the controls (75.1 \% vs. 30.1 \%, P < 0.001). Among the 84 patients who were euthyroid at the time of diagnosis and were contacted again after 5 years, 15 developed hypothyroidism. Initially, PLNs were present in all patients who developed hypothyroidism and were significantly higher than in those who remained euthyroid (respectively 100\% vs. 68.7\%, P = 0.009). PLN presence and PLN volume in patients who were euthyroid at baseline predicted hypothyroidism at the end of 5 years. Conclusion: PLNs may be used as an indicator of disease progression. In addition, patient age and baseline TSH levels are other factors that predict the development of hypothyroidism in time