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   Table of Contents - Current issue
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January-April 2021
Volume 18 | Issue 1
Page Nos. 1-44

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ORIGINAL ARTICLES  

Primary hypothyroidism on follow-up in a cohort of Indian patients with subacute thyroiditis p. 1
Pramila Kalra, KM Prasanna Kumar
DOI:10.4103/trp.trp_72_20  
Objectives: Subacute thyroiditis (SAT) is a temporary dysfunction of the thyroid gland and is commonly due to its viral infection. Permanent hypothyroidism after recovery from SAT has been reported in various studies. Methodology: This was a prospective study conducted in two tertiary care centers in South India to follow-up these cases for the development of permanent primary hypothyroidism at 1-year follow-up after recovery from SAT. Results: The total number of cases followed up was 146, including 103 females (70.5%) and 43 males (29.5%). Females' mean age was 33.03 ± 11.7 years, and males' mean age was 40.17 ± 11.84 years. Seven patients reported the second attack of thyroiditis. The mean thyroid-stimulating hormone (TSH) recorded at baseline was 0.042 ± 0.056 µIU/ml. Permanent hypothyroidism was seen in 19.86% of the cases at a 1-year follow-up and was found to be higher in patients with lower TSH at baseline. The females and males were affected at a younger age as compared to other studies. The incidence of permanent hypothyroidism was found to be higher as compared to some but lesser compared to a few others. The iodine supplementation could also be one of the postulates for this higher incidence of hypothyroidism. The severity of thyrotoxicosis was a significant determinant of the future development of hypothyroidism. Conclusions: The patients with SAT need to be followed up for the development of permanent hypothyroidism. The prevalence of hypothyroidism at 1 year was 19.86% after an attack of thyroiditis.
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Effect of metformin therapy on thyroid-stimulating hormone levels in women with polycystic ovarian syndrome p. 6
Vinay Dhanpal, Mala Dharmalingam, Pramila Kalra
DOI:10.4103/trp.trp_58_20  
Introduction: Metformin has been shown to decrease thyroid-stimulating hormone (TSH) levels without effect on total T4 and total T3 levels, especially in patients with underlying thyroid dysfunction. The Aim of the Study: To evaluate the effect of metformin therapy on TSH levels in polycystic ovarian syndrome (PCOS) patients who were euthyroid with or without treatment. Design of the Study Nonrandomized prospective intervention trial. Materials and Methods: The study included all euthyroid PCOS patients of the reproductive age group diagnosed according to the modified Rotterdam criteria and the patients were divided into two groups. The first group was put on lifestyle modification alone (Group-I), whereas the second group was put on lifestyle modification and metformin therapy (Group-II). In both groups of patients, TSH, total T4, and total T3 levels were done at baseline and after 3 months of follow-up. Results: A total of 105 patients with PCOS were nonrandomly assigned to Group I (n = 53) and Group II (n = 52). The baseline parameters (age, body mass index, TSH, and Homeostatic Model Assessment for Insulin Resistance) were similar. Thirty-six patients in Group I and 39 in Group II were followed up for 3 months. The change in TSH levels in both groups was not significant at follow-up (Group I [2.56 ± 0.87 vs. 3.01 ± 1.54; P = 0.102] and Group II [2.90 ± 0.81 vs. 2.76 ± 1.26;P = 0.503]). In a subgroup analysis in patients who had thyroid dysfunction, there was a significant decrease in TSH levels in Group II (3.10 ± 0.54 vs. 2.57 ± 0.50;P = 0.031). Conclusion: Metformin significantly decreased TSH levels in women with PCOS with underlying thyroid dysfunction, while it did not show any effect on women without underlying thyroid dysfunction.
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Newborn screening for congenital hypothyroidism: A local perspective from Himachal Pradesh, India p. 11
Vinay Gupta, Ashwani Sood, Mangla Sood
DOI:10.4103/trp.trp_70_20  
Background: Incidence of congenital hypothyroidism (CH) varies across countries and different geographic regions. Aims and Objectives: This study was conducted to find prevalence of CH in iodine-deficient district of North Indian hilly state Himachal Pradesh, India. Materiala and Methods: A prospective analysis of cord blood thyroid-stimulating hormone (TSH) and T4 hormone values on 4057 neonates was done in the delivery hospital. Results: No CH was detected among 3964 neonates; with limitation of losing 93 newborns with high cord blood TSH >20 uIU/l who could not be recalled for serum testing. Conclusion: With known benefits of CH screening, a properly implemented neonatal screening program for CH at all levels of health care is definitely the need of the hour.
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Long-term hypocalcemia prediction post thyroidectomy p. 14
Deepak Janardhan, Sandeep Suresh, PG Balagopal, Nebu Abraham George, KM Jagathnath Krishna
DOI:10.4103/trp.trp_71_20  
Introduction: Hypocalcemia is a common sequela of total thyroidectomy and is usually transient (30%), only a few develop permanent hypoparathyroidism. Till date, no effective risk stratification score to predict hypocalcemia is available that can predict postoperative hypocalcemia. Materials and Methods: This was a prospective observational study including all patients who underwent total or completion thyroidectomy with initial parathormone (PTH) within the normal range in our institution during a 1 year period. Postoperative 6th h PTH fall was noted in all patients and cutoff point for the prediction of long-term hypocalcemia (LTHP) was determined using a paired t-test. Results: Postoperatively, calcium supplementation was initiated in 52% of patients. In 7.6% of patients who had a fall in PTH to more than 80% of preoperative value, calcium supplementation could not be tapered even after 3 months postoperatively. About 66% of patients <20 years of age developed hypocalcemia in the postoperative period. Patients who developed delayed hypocalcemia with initial normal calcium levels had fall in PTH of at least 45%. For individuals below 20 years, a PTH fall of 56% or more required calcium supplementation. The various variables studied failed to attain statistical significance. Conclusions: More than 82% fall in 6th h postoperative PTH predicts long-term hypocalcemia. Post total thyroidectomy, adolescent individuals are at a higher risk of developing hypocalcemia; hence, early calcium supplementation is recommended based on fall in PTH. Weighted score to predict LTHP could not be developed, as none of the risk factors evaluated were statistically significant.
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Thyroid disorders in arsenic prevalent area in Bangladesh p. 19
Mohammad Moin Shahid, Khadiza Begum, Kaniz Rahman, Hosnea Ara, Sharmin Ferdousi, Richmond Ronald Gomes
DOI:10.4103/trp.trp_4_21  
Background and Objectives: Due to geographical position and geological nature, Bangladesh (BD) has been the worst affected country in the world by arsenic contamination. The aim of this study was to highlight the association of chronic arsenic intoxication with thyroid disorders (TDs). Materials and Methods: This cross-sectional study was conducted from March 2019 to February 2020 at Ad-din Women's Medical College and Hospital. One thousand one hundred and thirty-seven patients were randomly selected, who visited the outpatient departments of medicine faculty with thyroid-stimulating hormone test report. Rest of the thyroid function tests were done if required. Considering the arsenic level in irrigation and drinking water, 64 districts of BD were divided into two regions “arsenic prevalent area” and “less arsenic prevalent area” and patients hailing from those areas were divided as Group 1 and Group 2, respectively. All patients were subjected to history taking and physical examination. Chi-square test and one-way ANOVA test were used to compare the variables. Results: Prevalence of TD were significantly higher in Group 1 (60.14%; P = 0.001) and so was the prevalence of goiter (19%;P = 0.021). Older (31.17 ± 9.81;P = 0.001) and female patients (94.92%;P = 0.001) were more prone to develop TD. Conclusion: It will require more studies at larger scale for better understanding of the association of thyroid disorders with chronic arsenic intoxication.
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Thyroid disorders in children and adolescents: Systematic mapping of global research over the past three decades p. 23
Devi Dayal, Brij Mohan Gupta, Atul Gupta
DOI:10.4103/trp.trp_5_21  
Background: Several countries research thyroid problems in children and adolescents. However, a scientometric assessment of global research in this field is unavailable. Aim: We aimed to provide a comprehensive assessment of research in thyroid disorders in children during 1990–2019. Methods: The data on pediatric thyroid disorders (PTDs) publications were retrieved from the Scopus database and analyzed using select bibliometric tools. Results: There were 4658 publications over the 30-year period registering an average annual and 15-year cumulative growth of 6.9% and 149.4%, respectively, and averaging 24.0 citations per paper. Of the 144 participating countries, the top ten contributed 69.9% of the global share. The most productive countries were the USA, Italy, and UK, whereas Netherlands, Canada, and the USA were the most impactful. Of the 745 participating organizations and 1275 authors, the top 20 of each contributed 26.2% and 7.9% of publication share, and 42.8% and 14.6% of citation share, respectively. The top three most productive organizations were INSERM, France, National Institute of Health, USA, and National Cancer Research Institute, USA, whereas the top three most productive authors were S. Yamashita, L. Persani, and G. Weber. Journal of Clinical Endocrinology and Metabolism, Journal of Pediatric Endocrinology and Metabolism, and Thyroid were the journals that published most research in PTDs. Conclusions: There is a substantial recent increase in the quantity of research on PTDs dominated by the North-American and Western-European countries. The vast disparities in pediatric thyroid research between high- and low-income countries need to be addressed through collaborations.
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CASE REPORTS Top

Reversible thyrotropin elevation in case of primary Addison's disease p. 31
Rajesh Rajput, Karamvir Yadav, Surender Kumar, Suyasha Saini, Ayush Gupta
DOI:10.4103/trp.trp_68_20  
The association of Addison's disease and chronic lymphocytic thyroiditis is a well-known disease complex, historically known as Schmidt disease. Here, we present the case of a patient who presented with primary Addison's disease and on further evaluation was also found to have a subclinical hypothyroidism without a positive marker of autoimmunity. The coexistence of these endocrine disorders simultaneously without thyroid peroxidase antibody positivity and steroid replacement alone in such a case resulting in complete recovery of thyroid function had not described in the literature.
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A case of acute liver injury induced by methimazole p. 34
Karthika Niveditha, Arun S Menon, Harish Kumar, Malini Eapen, Rajesh Gopalakrishna
DOI:10.4103/trp.trp_73_20  
Antithyroid drugs, methimazole, and propylthiouracil have been reported to cause hepatotoxicity. We report the case of a patient with methimazole induced liver injury who presented within a few weeks of commencement of the drug. She presented with a cholestatic picture and responded well to discontinuation of the drug and administration of steroids.
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Acute suppurative thyroiditis: An unusual complication p. 37
Dipratim Das, Partha Chakraborty, Madhurima Ganguly, Pankaj Kumar Halder
DOI:10.4103/trp.trp_7_21  
Acute thyroiditis is rare and usually subsides with medical therapy. An abscess arising due to it is even rarer. Sometimes, surgical drainage is required to control ongoing infection and sepsis. We report a case of a 4-year-old girl who had acute suppurative thyroiditis. The swelling was not resolving after 9 days of administering intravenous antibiotics and eventually compressing the esophagus and trachea which was relieved leading to a speedy recovery on emergency surgical drainage.
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Cytodiagnosis of anaplastic thyroid carcinoma with osteoclast-like giant cells − A case report with a review of the literature p. 40
Padmanaban Krishnan Govindaraman, Selvaraj Balakumar, Anthuvan Jeyarani Lawrence
DOI:10.4103/trp.trp_8_21  
Anaplastic thyroid carcinoma (ATC) accounts for 5%–10% of primary thyroid malignancies. Cytodiagnosis of osteoclast-like giant cells (OLGCs) variant of ATC is very rare with only few cases reported in literature. We report a case of ATC with OLGC variant in an 85-year-old female who presented with swelling in the right lobe of thyroid and scalp nodule, which on radiological evaluation and subsequent fine-needle aspiration biopsy (FNAB) was diagnosed as ATC having numerous OLGC with metastases in skull bones. Cytologically, thyroid aspirate revealed sheets of epithelioid neoplastic cells admixed with many OLGC. Aspirate from the scalp nodule showed neoplastic cells with follicular differentiation. She also had radiological evidence of lung metastasis. Such a presentation of this rare variant being diagnosed by FNAB is rarely reported in literature and highlights the importance of this simple procedure in diagnosing and planning management of this rare condition.
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