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   Table of Contents - Current issue
Coverpage
May-August 2021
Volume 18 | Issue 2
Page Nos. 45-88

Online since Friday, August 12, 2022

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REVIEW ARTICLES  

Recurrent thyroiditis: Rare but resistant p. 45
Pramila Kalra, KM Prasanna Kumar
DOI:10.4103/trp.trp_9_21  
Recurrent thyroiditis is defined as a repeat attack of subacute thyroiditis. The recurrence rates may vary from 1.4% to 20%. The recurrence may happen at any time ranging from weeks to years after the first episode. The patients with recurrent thyroiditis not responding to nonsteroidal anti-inflammatory drugs may require steroids. The recovery to euthyroidism is mostly complete but a small percent may develop transient and less commonly permanent hypothyroidism. The mainstay of treatment is medical therapy but surgery may be needed in resistant cases.
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Doctor-patient communication in thyroid conditions: Impact on outcomes p. 50
Tejal Lathia, Chitra Selvan, Shraddha Namjoshi, Satyendra Badhe
DOI:10.4103/trp.trp_6_22  
Thyroid disorders are common conditions in the population that have repercussions on health, fertility, quality of life (QoL), and overall well-being. A literature search was conducted using PubMed database, using the key search words “thyroid disorders,” “QoL,” and “doctor‒patient communication.” The impact of thyroid disorders on patients' QoL, overall well-being, and the patients' outlook toward their prognosis necessitates better and more detailed communication between patient and provider. Thyroid disorders can have lasting psychological impacts and patient coping depends on effective management of these. An empathetic clinician can play a major role in boosting patient confidence and improving patient satisfaction, well-being, and adherence to treatment, resulting in improved outcomes. Physicians must identify the unmet needs of their patients and potential areas where their patients may need greater support and bridge the gap between the information that they are providing and patient-expected information.
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ORIGINAL ARTICLES Top

Prevalence of hypothyroidism in Kannur; a coastal district in Kerala p. 55
TV Devaraj, S Salina
DOI:10.4103/trp.trp_1_22  
Background: Hypothyroidism is an emerging health issue in India and worldwide. However, detail data related to the magnitude of the problem is lacking currently. Materials and Methods: A cross-sectional, multicentric study was conducted at four villages in Kannur district of Kerala, to study the prevalence of hypothyroidism among the adult population. Thyroid abnormalities were diagnosed based on laboratory results (free thyroxin [FT4] and thyroid-stimulating hormone [TSH]). Participants with history of hypothyroidism and receiving levothyroxine therapy or those with serum FT4 ≤ 0.78 ng/dL and/or TSH ≥ 4.68 μIU/mL were categorized as hypothyroid. The prevalence of self-reported and undetected hypothyroidism was assessed. Results: A total of 1084 adult male or nonpregnant female participants ≥ 18 years of age were enrolled, of which 508 were evaluated. The overall prevalence of hypothyroidism was 9.6%. 2.1% were already on levothyroxine therapy and is self-reported, whereas 7.48% were previously undetected. Higher proportion of female versus male (8.07 vs. 7.87) was diagnosed with hypothyroidism. Conclusion: The prevalence of hypothyroidism was high, affecting approximately 9.6% of adult in the study population. Female gender (odds ratio = 1.791) were found to have significant association with hypothyroidism.
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Fasting versus postprandial state: Impact on thyroid function testing p. 61
Dheeman Futela, K Maheswari, Tejasvini Khanna
DOI:10.4103/trp.trp_11_21  
Context: Thyroid dysfunctions are common health problems worldwide. Thyroid function tests (TFTs) are the mainstay of diagnosis. A common question by labs and clinicians is whether food intake makes a clinically significant difference for TFTs. Aims: We aimed to assess the effect of fasting and postprandial state on thyroid-stimulating hormone (TSH), free T3, and free T4. Settings and Design: A cross-sectional study was conducted. Sixty patients were prospectively selected. Subjects and Methods: Patients were divided into two groups: Group A (known case of thyroid disorder and on medication) and Group B (no prior history of thyroid dysfunction). Two blood samples were collected from each patient, before and after breakfast, with a gap of 2 h. Serum samples were analyzed for TSH, free T3, and free T4. Results: Mean (± standard deviation) TSH values (mIU/L) in fasting state were 2.38 ± 1.88 and in postprandial state were 2.08 ± 1.65. A statistically significant postprandial decline was observed in TSH values (mean difference: -0.30 mIU/L) and free T3 (mean difference: –0.21 pmol/L), in both groups. Conclusions: TFT results were altered in a statistically significant manner after food intake. Multiple studies have reported a similar postprandial decline in serum TSH. This may impact the diagnosis and management of thyroid patients, especially where minor changes in TSH levels are clinically relevant.
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Pattern of short-term adverse effects in patients undergoing low-dose radioactive iodine therapy p. 67
Ancy George, Y Annapurna, P Harilal, Anila Kumari Vatakke Purayil
DOI:10.4103/trp.trp_4_22  
Introduction: The disorders of the thyroid gland are on the rise. It involves the dysregulation of hormone synthesis and release and carcinoma of the thyroid gland among others. Radioactive iodine (RAI – I-131) is now used for the treatment of hyperthyroidism and thyroid carcinoma. This helps in the destruction of the follicular cells, and the radiation helps in annulling the cancer cells. RAI has many adverse effects including short term and long term; the short-term effects include gastrointestinal disorder, salivary dysfunction, and thyroiditis, while the long-term adverse effects include secondary carcinomas. The facilities for giving RAI therapy (RAIT) are fewer in the state of Kerala and even less in the government sector; further, the adverse effects of RAIT are less studied in our population. Thus, this study aims at finding the pattern of short-term adverse effects of low doses of RAI. Objectives: To evaluate the pattern of short-term adverse effects following low doses of RAIT in patients with hyperthyroidism and thyroid cancer. Materials and Methods: This study was designed as a prospective, observational study conducted in patients attending the department of nuclear medicine for low-dose radioiodine therapy in a tertiary care center. Patients were followed up for any occurrences of adverse effects at 1, 3, and 6 months. Data were analyzed using SPSS software version 18, and Chi-square test was done to find the association between dose and adverse drug reactions. Results: The study comprised 53 participants, of which 38 (72%) were female. The adverse reactions were reported by 39 participants (74%). Loss of taste and smell in 19 participants (39%), xerostomia in 17 patients (32%), and hair loss in 14 patients (26%) were reported. After 1 month of RAIT, these subsided. The association between gender, age, dose, and adverse effects due to RAIT was tested but was found to have no association (P = 0.979, 0.504, and 0.494, respectively). The complaint of hair loss was higher in female participants, showing a statistically significant association with a P = 0.04. The complete blood counts done pre- and post-RAIT showed a statistically significant decrease in platelet count (P = 0.00) and lymphocytes (P = 0.003), with no clinically significant symptoms or signs. Conclusion: RAI produces short-term adverse effects such as loss of taste and smell, xerostomia, and hair loss which are self-limiting. However, there is a need to identify and manage it for better treatment and patient compliance.
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Development of a symptoms-based thyroid risk questionnaire to screen for hypothyroidism in India p. 74
KM Prasanna Kumar, Bipin Kumar Sethi, Sanjay P Khare, Mahesh Padsalge, Anadya Prakash Tripathi, Milind Bhole, Dyotona Sen Roy
DOI:10.4103/trp.trp_5_22  
Context: In India, many cases of hypothyroidism go undetected due to lack of timely screening. Aims: The aim of the study is to develop a symptom-based thyroid risk index (STRI) questionnaire. Subjects and Methods: Questionnaire development involved the following steps: (1) hypothyroidism symptom selection and questionnaire construction based on the literature survey, (2) expert (2 endocrinologists and 2 consultant physicians) review, (3) face validation (Phase 1, cross-sectional survey followed by review by a psychometrician, an endocrinologist, and a layperson), and (4) pilot survey (Phase 2). The face validation was conducted in subjects from general population naïve to their thyroid status (Arm 1 [at 2 nonclinical settings], n = 16) and in subjects with hypothyroidism who were treatment-naïve (Arm 2 [at 2 clinical centers], n = 19). Results were summarized descriptively. Results: Hypothyroid symptoms were incorporated into the questionnaire in the form of 18 questions under four sections and were assigned a score from 1 to 4 based on the strength of literature evidence. The questionnaire underwent face validation followed by incorporation of expert review and recommendations. In Arm 1, 12 subjects (75%) had thyroid-stimulating hormone levels >4.5 mIU/L indicating hypothyroidism. The total mean (standard deviation) STRI score was 25.4 (10.7) in the Arm 1 (29.8 [8.2] in the 12 hypothyroid-positive subjects) and was 18.6 (10.8) in the Arm 2. Conclusions: The STRI questionnaire was successfully face validated for its applicability in clinical and nonclinical settings. The questionnaire, finalized after expert committee review and recommendations, will be validated for its sensitivity and specificity to detect symptoms of hypothyroidism in a pan-India pilot study.
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CASE REPORTS Top

Cartilaginous metaplasia: A unique microscopic finding in multinodular goiter p. 82
Seetu Palo
DOI:10.4103/trp.trp_12_21  
Cartilaginous metaplasia in multinodular goiter is an extremely rare finding and this study is only the second case report describing the same. A 54-year-old female presented with thyroid swelling of 3 years' duration and underwent total thyroidectomy. Microscopy revealed the features of multinodular goiter with areas of cystic change, hemorrhage, Hurthle cell metaplasia, lymphoid aggregates, and sclerosis along with tiny islands of mature cartilage formation.
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Subacute thyroiditis after COVID-19 vaccination p. 84
Bashir Ahmad Laway, Atul Sharma
DOI:10.4103/trp.trp_14_21  
Thyroid dysfunction during COVID-19 infection has been described. Few cases of thyroiditis following COVID-19 vaccination have also been described. We describe the clinical details of a woman who developed subacute thyroiditis after the COVID-19 vaccination.
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LETTERS TO THE EDITOR Top

Is screening for thyroid dysfunction a requisite for all with alopecia areata? p. 86
Rahman Nadiya, Priya Prathap, Neelakhandan Asokan
DOI:10.4103/trp.trp_2_22  
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