Background: Hypothyroidism is the most common endocrinological problem affecting women who present with ovulatory dysfunction thereby leading to infertility. It's milder form, subclinical hypothyroidism (characterized by supranormal TSH levels and normal freeT4 levels), may also contribute to disturbed reproductive function. Since it is known, based on historical data, that thyroid hormones have a beneficial effect on pregnancy outcomes, we proposed that institution of thyroxine replacement therapy in infertile women with SCHT leads to favorable fertility outcomes. Methods: In a cohort of 14 infertile women with SCHT, we conducted and assessed: l)an in depth thyroid hormonal profile prior to LT4 therapy, 2)institution of LT4 replacement therapy in women with SCHT and 3) monitoring response to therapy by assessing pregnancy rate and adjusting the dosage based on TSH levels. Results: Following institution of thyroxine replacement therapy, the average time period to conception was 5 months. A conception rate of 78.5% was achieved, among whom 27.2% had a full term delivery and the rest are being followed up. Three 1st trimester miscarriages (21.5%) occurred. Conclusions: Based on the presented protocol, a higher fertility rate was observed which was associated with normal TSH levels regularized with LT4 therapy. Abortions were accounted for by inadequate LT4 and prior discontinuation of LT4 therapy

Objective - To determine the prevalence of thyroid autoimmunity in patients with type 1 diabetes mellitus.n Methods - Data were analyzed from 22 patients (7 males, 15 females) with type 1 diabetes aged 7 to 29 years who were under follow up at SVIMS, Tirupati. Antibodies to thyroid peroxidase (anti-TPO) were measured in all patients. The mean age was 14.2 years (min - max 7-29 years), and mean duration of diabetes was 5.3 years (min - max 0.1-22 years). Results - Nine (41 %) patients, had elevated (>18A U/ml) anti-TPO levels. While 8 of 15 girls (53%) were positive for anti TPO antibodies only 1 out of 7 boys (14.2%) were likewise positive. Eight of the nine (88.9%) patients who were positive for TPO antibodies also had a goiter while only 2 of the 13 (15.4%) patients lacking TPO antibodies had a goiter (p<0.001). Using TPO as the serological gold standard for the diagnosis of thyroid autoimmunity, the sensitivity and specificity of clinical goiter presence in identifying underlying thyroid autoimmunity was 88.9% and 84.6% respectively. Of the 9 patients who were positive for anti TPO antibodies, 7 (78%) had biochemical evidence of hypothyroidism. All of them were girls. However only two had frank hypothyroidism (both had TSH > 50 IU/ml). Conclusions - Thyroid autoimmunity and consequent hypothyroidism is common in type 1 diabetes thus emphasizing the importance of screening.

This original work studies vitamin D status in well controlled hypothyroid adult patients in Karnal, Haryana, north India. A high prevalence of vitamin D deficiency/insufficiency (96.15 %) was observed amongst patient with hypothyroidism, in spite of achieving euthyroid status. The condition was equally common amongst women and men.

Aim: The aim is to describe a very rare case of invasive giant benign pituitary adenoma that was noted incidentally during workup for large benign multinodular goiter. Results: The patient presented with an enlarged mass in the neck that was cosmetically disfiguring. There was no evidence of any compressive symptoms. The mass was felt to arise from the thyroid gland, nodular, firm without obvious lymph-adenoapthy Imaging studies revealed diffusely enlarged thyroid mass with large well marginated calcific mass involving left lobe displacing carotid sheath and extending superiorly causing compression of trachea. There was also small lcm sized non-necrotic lymph node at level 1 at right side of neck Histopathology revealed follicular adenoma on background of multinodular goiter .Coincidentally imaging studies revealed a large heterogeneous enhancing mass involving sella and suprasellar region with destruction of walls of sella extending into right cavernous sinus, pre-pontine cistern, sphenoid sinus and anteriorly into posterior ethmoid air cells bilaterally. Baseline pituitary functions were well preserved. Bitemoral hemianopia was seen on perimetry. Histopathology confirmed a benign non-functioning pituitary adenoma. The thyroid mass was surgically excised first followed by removal of pituitary mass. An initial unsuccessful transphenoidal approach to remove the pituitary mass was followed by transcranial approach. Post-operatively course was complicated by 3rd nerve palsy without any diabetes insipidus or hypopituitarism. Conclusion: Asymptomatic clinical presentation of the giant invasive pituitary adenoma is rare. The combination of two benign endocrine gland lesions is very rare.