Tireotropin i hormoni štitnjače u eutireoidnom Hashimotovu tireoiditisu

Little is known about thyrotropin (TSH) and thyroid hormones in euthyroid Hashimoto’s thyroiditis (HT), thus the aim was to investigate TSH and thyroid hormone economy in euthyroid HT and its relation to thyroid function. Ninety-five patients with euthyroid HT with normal TSH and thyroid hormones on the last follow up between 2009 and 2011 were investigated. Previous observation period ranged from 1.5 to 4.8 (mean 2.8) years, and they had never been treated with levothyroxine. The results of TSH and thyroid hormones were compared with 210 healthy subjects and expressed as median (25%-75%). According to TSH value, the subjects were divided into quartiles: TSH 0.4-0.99 (1q), 1.0-1.99 (2q), 2.0-2.99 (3q) and 3.0-4.0 mIU /L (4q). Euthyroid HT patients had higher TSH (2.53 [1.79-3.14] vs.1.95 [1.24-2.72], p<0.001). T4 and T3 were not different. The distribution of TSH in HT patients was significantly shifted to the right; 71% of patients were in the 3q and 4q groups. When HT patients with higher TSH (3q and 4q) were compared with those with lower TSH (1q and 2q), significant differences emerged in TSH (3.01 [2.48-3.48] vs.1.45 [1.07-1.71] mIU /L), T4 (99.0 [88.2-112.0] vs.112.0 [105.0-122.0] nmol/L) and T3 (1.78 [1.48-2.05] vs. 2.10 [1.85-2.21] nmol/L; p<0.01). TPO values were similar in both groups. A gradually increasing proportion of euthyroid HT patients with at least one supranormal TSH during the observation period were found: 0% in 1q, 10% in 2q, 15% in 3q and 44% in 4q TSH group. Euthyroid HT patients maintain euthyroidism only under strenuous TSH stimulation. The patients with high normal TSH are identified as those with a major risk of hypothyroidism in the near future.Malo je poznato o vrijednostima tireoptropina (TSH) i hormona štitnjače u eutireoidnom Hashimotovu tireoiditisu (HT) te je cilj bio istražiti razinu TSH i hormona štitnjače u HT i njihov odnos prema funkciji štitnjače. Ispitano je 95 bolesnika s eutireoidnim HT s normalnim TSH i hormonima štitnjače na posljednjoj kontroli između 2009. i 2011. godine. Prethodno razdoblje promatranja variralo je od 1,5 do 4,8 (u prosjeku 2,8) godina, bolesnici nisu nikada liječeni levotiroksinom. Rezultati TSH i hormona štitnjače uspoređeni su s onima u 210 zdravih osoba i prikazani kao medijan (25%-75%). Prema vrijednosti TSH ispitanici su podijeljeni u kvartile: TSH 0,4-0,99 (1q), 1,0-1,99 (2q), 2,0-2,99 (3q) i 3,0-4,0 mIU /L (4q). Eutireoidni bolesnici s HT imali su viši TSH (2,53 [1,79-3,14] prema 1,95 [1,24-2,72], p<0,001). T4 i T3 se nisu razlikovali. Raspodjela TSH u HT izrazito je pomaknuta udesno. Ukupno je 71% bolesnika bilo u skupini 3q i 4q. Kada se usporede HT bolesnici s višim (3q i 4q) i nižim TSH (1q i 2q) nalaze se značajne razlike u TSH (3,01 [2,48-3,48] prema 1,45 [1,07-1,71] mIU /L), T4 (99,0 [88,2-112,0] prema 112,0 [105,0-122,0] nmol/L) i T3 (1,78 [1,48- 2,05] prema 2,10 [1,85-2,21] nmol/L; p<0,01). Vrijednosti TPO bile su slične u obje skupine HT bolesnika. Opažen je postupni porast postotka eutireoidnih HT bolesnika s najmanje jednom povišenom vrijednošću TSH tijekom razdoblja promatranja: 0% u skupini 1q, 10% u 2q, 15% in 3q i 44% u skupini 4q. Eutireoidni bolesnici s HT održavaju eutireozu jedino uz povećanu stimulaciju pomoću TSH. Bolesnici s visoko normalnim TSH imaju najveći rizik nastupa hipotireoze u bliskoj budućnosti

Tumor mozga kao prototip teškog moždanog oštećenja u bolesnika sa “sindromom niskog t3”

The purpose of our study was to contribute to better understanding of cerebrospinal fluid (CSF) as a valuable biological material in the research of brain tumors within the “low T3 syndrome”, and to discuss the role of thyroid hormones in the central nervous system in subjects with severe cerebral lesions. We studied the levels of total triiodothyronine (tT3), total thyroxine (tT4), free triiodothyronine (fT3), free thyroxine (fT4), reverse triiodothyronine (rT3) and thyrotropin (TSH) in serum, and fT3, fT4, rT3 and TSH levels in CSF of patients with brain tumor, and compared the results with control group. Study results indicated a statistically significantly higher level of rT3 in serum and CSF of brain tumor patients vs. control group (p<0.05). The rT3/fT3 ratio was highest in CSF and serum of brain tumor patients, yielding a statistically significant difference (p<0.05). These results could suggest higher permeability of the blood brain barrier in brain tumor patients. We also assume that rT3, in the framework of “cerebral low T3 syndrome”, is also generated through local intracerebral conversion. Disruption of this process in severe cerebral lesion can lead to increased rT3 concentrations, i.e. development of the “low T3 syndrome”.Cilj studije bio je doprinijeti boljem poznavanju cerebrospinalne tekućine kao vrijednog biološkog materijala u istraživanju moždanih tumora i “sindroma niskog T3”, te razmotriti ulogu hormona štitnjače unutar središnjega živčanog sustava kod bolesnika s ozbiljnim moždanim oštećenjem. Analizirali smo razinu ukupnog trijodtironina (tT3), ukupnog tiroksina (tT4), slobodnog trijodtironina (fT3), slobodnog tiroksina (fT4), reverznog trijodtironina (rT3) i tireotropina (TSH) u serumu i razinu fT3, fT4, rT3 i TSH u cerebrospinalnoj tekućini u bolesnika s tumorom mozga te dobivene rezultate usporedili s kontrolnom skupinom ispitanika. Rezultati su ukazali na statistički značajno veću razinu rT3 u serumu i cerebrospinalnoj tekućini u bolesnika s tumorom mozga u usporedbi s kontrolnom skupinom (p<0,05). Odnos rT3/fT3 bio je također statistički značajno veći kod bolesnika s tumorom mozga (p<0,05). Naše istraživanje moglo bi ukazivati na veću propustljivost krvno-moždane barijere u bolesnika s tumorom mozga. Također pretpostavljamo da se u bolesnika s tumorom mozga rT3 pojačano stvara kroz aktivniju intracerebralnu pretvorbu. Svakako, naši rezultati trebaju biti potvrđeni i daljnjim podrobnijim istraživanjima

Incidentno povišena vrijednost tireotropina u inače dobro liječenih hipotireoidnih bolesnika ne zahtijeva povišenje doze levotiroksina

In 20 properly treated hypothyroid patients with normal thyrotropin (TSH) values during previous observation, TSH was incidentally mildly/moderately elevated (4.5-8.0 mIU/L; normal values 0.4-4.0) on the last follow up. However, they were continuously treated with the same levothyroxine (LT 4) dose (mean: 95 μg) and six months later all TSH values normalized. The authors suggest that the physicians, in response to incidentally increased TSH value in otherwise properly treated hypothyroid patients, refrain from prompt increasing the LT 4 dose unless TSH values are persistently elevated or/and progressing.Kod 20 hipotireoidnih bolesnika koji su prethodno dobro liječeni uz uredne vrijednosti tireotropina (TSH) na posljednjoj kontroli nađena je blago do umjereno povišena vrijednost TSH (4,5-8,0 mIU/L: n.v. 0,4-4,0). Ipak je nastavljeno liječenje istom dozom levotiroksina (LT 4), u prosjeku 95 μg, a nakon 6 mjeseci vrijednosti TSH su se normalizirale. Autori preporučuju da se liječnik suočen s incidentno povišenom vrijednošću TSH u inače dobro liječenih hipotireoidnih bolesnika suzdrži od povišenja doze LT 4 ako vrijednost TSH nije trajno povišena i/ili u progresiji

Internal jugular vein thrombosis caused by invasive pharyngeal cancer: a case report and literature review

INTRODUCTION: Internal jugular vein (IJV) thrombosis is a potentially life-threating disease and can occur at any level. Variety of factors can induce thrombosis, but it is most often found following IJV catheterization, neck dissection, injuries, infectious disease, in ovarian hyperstimulation syndrome or in malignant neoplasms. Unlike thyroid cancer, in which thrombosis of the jugular vein have been relatively often described, thrombosis of the internal jugular vein in head and neck squamous cell cancer is extremely rare. OBJECTIVE: We report a unique case of a very advanced, locally invasive pharyngeal tumor causing thrombosis of the internal jugular vein. Literature review of the described topic was also conducted. MATERIAL AND METHODS: A crossreferenced PubMed and Scopus (EMBASE) search was performed and relevant data were extracted accordingly. The search was performed using the following key-words and Boolean operators: “head and neck cancer AND squamous cell cancer AND internal jugular vein thrombosis”. RESULTS: According to PubMed and Scopus search only two similar cases were found. The first patient had supraglottic SCC with N3 lymph node invading IJV. The second patient developed SCC of the thyroid gland with a large IJV thrombosis. Both patients were treated bimodally, but developed recurrences and died soon after the treatment. In our case, patient was treated with radical surgery. Radical dissection of the right side of the neck and selective dissection of the left side of neck levels II-IV were performed. Furthermore, total laryngectomy, subtotal pharyngectomy and total thyroidectomy en bloc were performed. Reconstruction was made with a free fasciocutaneous anterolateral thigh flap. Despite the patient\u27s poor general condition, IJV thrombosis, bulbus and sigmoid sinus thrombosis, and several comorbidities, he was considered for curative therapy and is still alive, in good general shape, 7 months after the surgery. DISCUSSION: The choice of treatment for this kind of patients is not standardized due to its rare occurrence. Even though IJV thrombosis carries a high chance of distant metastasis and local recurrence and consequently causing poor survival, the question arises what the best therapeutic option is. More documented cases are undoubtedly required to draw a more solid conclusio

Internal jugular vein thrombosis caused by invasive pharyngeal cancer: a case report and literature review

INTRODUCTION: Internal jugular vein (IJV) thrombosis is a potentially life-threating disease and can occur at any level. Variety of factors can induce thrombosis, but it is most often found following IJV catheterization, neck dissection, injuries, infectious disease, in ovarian hyperstimulation syndrome or in malignant neoplasms. Unlike thyroid cancer, in which thrombosis of the jugular vein have been relatively often described, thrombosis of the internal jugular vein in head and neck squamous cell cancer is extremely rare. OBJECTIVE: We report a unique case of a very advanced, locally invasive pharyngeal tumor causing thrombosis of the internal jugular vein. Literature review of the described topic was also conducted. MATERIAL AND METHODS: A crossreferenced PubMed and Scopus (EMBASE) search was performed and relevant data were extracted accordingly. The search was performed using the following key-words and Boolean operators: “head and neck cancer AND squamous cell cancer AND internal jugular vein thrombosis”. RESULTS: According to PubMed and Scopus search only two similar cases were found. The first patient had supraglottic SCC with N3 lymph node invading IJV. The second patient developed SCC of the thyroid gland with a large IJV thrombosis. Both patients were treated bimodally, but developed recurrences and died soon after the treatment. In our case, patient was treated with radical surgery. Radical dissection of the right side of the neck and selective dissection of the left side of neck levels II-IV were performed. Furthermore, total laryngectomy, subtotal pharyngectomy and total thyroidectomy en bloc were performed. Reconstruction was made with a free fasciocutaneous anterolateral thigh flap. Despite the patient\u27s poor general condition, IJV thrombosis, bulbus and sigmoid sinus thrombosis, and several comorbidities, he was considered for curative therapy and is still alive, in good general shape, 7 months after the surgery. DISCUSSION: The choice of treatment for this kind of patients is not standardized due to its rare occurrence. Even though IJV thrombosis carries a high chance of distant metastasis and local recurrence and consequently causing poor survival, the question arises what the best therapeutic option is. More documented cases are undoubtedly required to draw a more solid conclusio

Zašto bolesnica s Gravesovom bolešću ostaje eutiroidna/blago hipertiroidna nakon totalne tiroidektomije - uloga antitijela na tirotropinske receptore (TRAb) i vestigalnih ostataka tiroglosalnog trakta

A young female patient suffering from Graves. disease is presented, who raised some diagnostic and therapeutic dilemmas after being diagnosed with subclinical hyperthyroidism following total thyroidectomy. This 20-year-old female patient, carrier of HLA B8 DR3 genes, was referred to our hospital for total thyroidectomy after developing severe leukopenia on both methimazole and propylthiouracil therapy. A high postoperative titer of thyrotropin receptor antibodies and positive scintigraphy finding of the pyramidal lobe and remnant thyroid tissue in the left thyroid lobe led to the administration of radioiodine. Despite further enlargement of the remnant thyroid tissue on post-radioiodine scintiscanning, the patient is currently euthyroid, with normal thyroid-stimulating hormone levels; however, her long-term prognosis remains uncertain.Opisan je slučaj bolesnice operirane zbog hipertireoze na podlozi Gravesove bolesti, u koje se na početno primijenjenu medikamentnu terapiju razvila granulocitopenija. Iako je kod bolesnice bila planirana totalna tireoidektomija, s obzirom na prijeoperacijski neprepoznat lobus piramidalis učinjena je tek djelomična resekcija štitnjače. Poslijeoperacijski se kao posljedica autoimune aktivacije ostatnog tkiva štitnjače antitijelima na tirotropinske receptore (TRAb) razvila hipertireoza, pa je daljnji tijek bolesti još uvijek nesiguran

Ameloblastom donje čeljusti u bolesnice s Turnerovim sindromom - prikaz slučaja

Ameloblastom je benigni tumor koji nastaje iz odontogenih epitelnih stanica. Pokazuje lokalno agresivni način rasta, uz razaranje koštanoga tkiva gornje ili donje čeljusti. Javlja se u svim dobnim skupinama. Ameloblastom najčešće zahvaća donju (80%), a rjeđe gornju čeljust. Klinički se očituje kao bezbolna oteklina koja ima sklonost rasta, s posljedičnom pojavom deformacije lica i čeljusti, malokluzije, trizmusa, te boli. U literaturi je opisana povezanost ameloblastoma s nizom sindroma poput Gorlinovog, sindromom epidermalnog nevusa, Simpson-Golabi-Behmelovog te Williamsovog sindroma, no njegova veza s Turnerovim sindromom nije opisana. Prikazujemo slučaj bolesnice s ameloblastomom donje čeljusti. Bolesnica s Turnerovim sindromom javila se u ORL ambulantu radi otekline u području desne parotidomaseterične regije. Kod bolesnice je učinjena radiološka obrada koja je ukazala na cistični oseodestruktivni proces lokaliziran u trupu, te ramusu desne strane donje čeljusti. Tijekom operativnog zahvata nailazi se na razorenu desnu polovicu tijela, razoren uzlazni krak i kondilarni nastavak donje čeljusti. Učinjena je segmentalna mandibulektomija transcervikalnim pristupom s posljedičnim defektom tipa IIc po Brownu. Kod bolesnice je bila planirana rekonstrukcija donje čeljusti slobodnim osealnim režnjem lisne kosti, od koje se odustalo radi nepodobne vaskularne anatomije obje potkoljenice. Isti aberantni anatomski uzorak opisan je MSCT angiografijom i na obje duboke kružne ilijačne arterije, onemogućujući primjenjivost slobodnog režnja crijevne kosti. Patohistološka analiza potvrdila je da se radi o ameloblastomu, folikularnom tipu. Liječenje ameloblastoma je prvenstveno kirurško. Opseg kirurške resekcije ovisi o stupnju i mjestu zahvaćenosti čeljusti procesom. Konzervativnije metode kirurškog liječenja, poput kiretaže ili enukleacije, nisu preporučljive radi visokog rizika od recidiva (60-80%). Operativnom zahvatu potrebno je pristupiti što ranije zbog manjeg opsega zahvaćenosti čeljusti i posljedično manjeg opsega resekcije. Postoperativno je potrebno klinički, te radiološki pratiti bolesnika minimalno 10 godina radi visokih stopa recidiva bolesti. Iako postoji dokazana povezanost ameloblastoma s nizom sindroma, ista nije dokazana u Turnerovu sindromu

Ameloblastom donje čeljusti u bolesnice s Turnerovim sindromom - prikaz slučaja

Ameloblastom je benigni tumor koji nastaje iz odontogenih epitelnih stanica. Pokazuje lokalno agresivni način rasta, uz razaranje koštanoga tkiva gornje ili donje čeljusti. Javlja se u svim dobnim skupinama. Ameloblastom najčešće zahvaća donju (80%), a rjeđe gornju čeljust. Klinički se očituje kao bezbolna oteklina koja ima sklonost rasta, s posljedičnom pojavom deformacije lica i čeljusti, malokluzije, trizmusa, te boli. U literaturi je opisana povezanost ameloblastoma s nizom sindroma poput Gorlinovog, sindromom epidermalnog nevusa, Simpson-Golabi-Behmelovog te Williamsovog sindroma, no njegova veza s Turnerovim sindromom nije opisana. Prikazujemo slučaj bolesnice s ameloblastomom donje čeljusti. Bolesnica s Turnerovim sindromom javila se u ORL ambulantu radi otekline u području desne parotidomaseterične regije. Kod bolesnice je učinjena radiološka obrada koja je ukazala na cistični oseodestruktivni proces lokaliziran u trupu, te ramusu desne strane donje čeljusti. Tijekom operativnog zahvata nailazi se na razorenu desnu polovicu tijela, razoren uzlazni krak i kondilarni nastavak donje čeljusti. Učinjena je segmentalna mandibulektomija transcervikalnim pristupom s posljedičnim defektom tipa IIc po Brownu. Kod bolesnice je bila planirana rekonstrukcija donje čeljusti slobodnim osealnim režnjem lisne kosti, od koje se odustalo radi nepodobne vaskularne anatomije obje potkoljenice. Isti aberantni anatomski uzorak opisan je MSCT angiografijom i na obje duboke kružne ilijačne arterije, onemogućujući primjenjivost slobodnog režnja crijevne kosti. Patohistološka analiza potvrdila je da se radi o ameloblastomu, folikularnom tipu. Liječenje ameloblastoma je prvenstveno kirurško. Opseg kirurške resekcije ovisi o stupnju i mjestu zahvaćenosti čeljusti procesom. Konzervativnije metode kirurškog liječenja, poput kiretaže ili enukleacije, nisu preporučljive radi visokog rizika od recidiva (60-80%). Operativnom zahvatu potrebno je pristupiti što ranije zbog manjeg opsega zahvaćenosti čeljusti i posljedično manjeg opsega resekcije. Postoperativno je potrebno klinički, te radiološki pratiti bolesnika minimalno 10 godina radi visokih stopa recidiva bolesti. Iako postoji dokazana povezanost ameloblastoma s nizom sindroma, ista nije dokazana u Turnerovu sindromu