Background:  Thyroid nodules are commonly encountered in clinical practice, with up to 8% of the adult population having palpable nodules. The concern with thyroid nodules is the differentiation between benign and malignant nodules. The aim of this study was to evaluate the demographic, ultrasonographic, fine needle aspiration cytology, histology and scintigraphic findings in differentiating benign from malignant thyroid lesions in patients presenting with thyroid nodules. Methods:  A total of 1264 patients with thyroid disorders were screened in the OPD for fulfillment of the inclusion criteria. All patients presenting with a clinically palpable nodule were included in the study. A total of 218 patients were finally enrolled after informed consent. The various investigations that were carried out include Thyroid Function Tests (TFT), Fine Needle Aspiration Cytology (FNAC), ultrasonography (USG) and radionuclide scanning. Results:  One hundred and thirty eight out of the 218 cases were operated upon and 78 patients were managed conservatively. A total of 94 patients presented with non neoplastic thyroid nodules. Approximately 89% were females while 11% were males. Approximately 80% of the patients with benign nodules were euthyroid, while all the patients with malignancies had no thyroid abnormality. FNAC was not of much utility in differentiating between benign and malignant thyroid neoplasms. Conclusions:  A battery of investigative procedures, instead of a solitary test can differentiate between benign and malignant thyroid nodules.

Aims:  The aim of our study was to determine the prevalence of anti-thyroid peroxidase (anti-TPO) and tyrosine phosphatase (IA2) antibodies positivity in glutamic acid decarboxylase (GAD65) antibody positive type 1 diabetics. Methods:  Seventy five type 1 diabetic patients with GAD65+ve were included in this hospital based study. IA -2 and Anti TPO antibodies were measured in this cohort Results:  In GAD65 +ve Type 1 diabetics the TPO antibody positivity was found in 58.7%(44/75) patients, Females had higher prevalence of TPO antibodies positive than the males(73% vs. 44.7%, P = 0.019). Positive IA-2A is present in 68.2 % males and 55.5 % females in Type 1 diabetic patients who were Gad 65 positivity. Conclusions:  There is a high prevalence of Anti TPO positivity in our Type 1 diabetic patients who are Gad 65 positive. So thyroid autoimmunity should be screened at diagnosis in all our Type 1 diabetic patients.

Graves' disease and thyroiditis are two common causes of hyperthyroidism in our clinical practice. Isotope scan is the test for differentiating Graves' disease from thyroiditis with thyrotoxicosis but not available widely in India [Figure 1]. In our cohort of consecutive 228 cases of Graves' disease and thyroiditis, we tried to compare the clinical and biochemical features at diagnosis. Our data favours a diagnosis of Graves' disease with positive family history, high Crooks Wayne's index, high free T4 and low ESR at the time of diagnosis. But these alone may not be sufficient as differentiating pointer between Graves' disease and thyroiditis with thyrotoxicosis.

Thyroid physiology is linked to skeletal health. T3 and TSH independently affect bone growth and development, mineralization, and remodeling. Previously treated hyperthyroidism is likely a long-term risk factor for fractures. Thyroidectomy and methimazole may decrease the risk of fractures in these patients compared with treatment with radioactive iodine. Hypothyroidism may also be a risk factor for fractures, although the mechanism is not understood .Fracture risk does not seem to be related to levothyroxine replacement in hypothyroid patients. Treatment of hyperthyroidism improves BMD but not necessarily to normal levels. The effects of subclinical hyperthyroidism on the bone are controversial. TSH-suppressing doses of levothyroxine may cause reduced bone density, especially in postmenopausal women. Replacement therapy with levothyroxine has not been shown to cause osteoporosis, although it may temporarily reduce bone density after the initiation of treatment. Supplementation of calcium and vitamin D in hyperthyroid patients should be considered.