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   2012| May-August  | Volume 9 | Issue 2  
    Online since May 12, 2012

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Fine-needle aspiration of the thyroid: A cytohistologic correlation with critical evaluation of discordant cases
Pinki Pandey, Alok Dixit, Nanak C Mahajan
May-August 2012, 9(2):32-39
Background: There is some "gray zone" of thyroid cytology, where the diagnostic efficacy declines sharply rendering it difficult to exactly categorize the lesion resulting in discrepancy. The aim of the study is to assess the accuracy of fine needle aspiration of the thyroid and critically evaluate the cytohistological discordant cases. Materials and Methods: A total of 447 patients with thyroid swelling were aspirated during a seven-year study period. Cases showing cytohistologic disparity were reevaluated for the detection of possible causes of failure. Results: In our study, cytohistologic concordance was achieved in 80.28% of the cases. Of the discordant cases, false positives accounted for 11.60% and false negatives for 9.8%. Suboptimal material and underdiagnosis of papillary carcinoma due to cystic degeneration were recognized as common pitfalls. Too much emphasis on cellularity and architectural pattern led to the erroneous false positive diagnoses. Conclusion: Strict adherence to adequacy criterion and meticulous examination of all the smears are of paramount importance in reducing discrepant cases.
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Goiter prevalence and current iodine deficiency status among school age children years after the universal salt iodization in Jamnagar district, India
Naresh R Makwana, Viral R Shah, Sumit Unadkat, Harsh D Shah, Sudha Yadav
May-August 2012, 9(2):40-44
Introduction: Iodine is an essential micronutrient with an RDA of 100-150 μg for normal human growth and mental development. Iodine deficiency disorder (IDD) refers to complex clinical and subclinical disorder caused mainly due to inadequate intake of food with sufficient iodine . Aims and Objectives: The objective was to find out the prevalence of goiter in primary school children; to determine median urinary iodine concentration; to assess the level of iodine in salt samples at household. Materials and Methods: A 30-cluster survey was done in Jamnagar district in primary school children (6-12 years). A total of 70 children from first to seventh standards (35 boys and 35 girls) and 20 children from the community in each cluster were included. Total 2792 children were taken for the total goiter examination by population proportion to size in each cluster with informed consent. A total of 360 children were tested for the median urinary concentration and 750 salt samples were tested on the spot with a test kit from the households of the study population. Results: The total goiter rate was 4.83% among primary school children aged 6-12 years with no significant difference between age and sex. As the age increased the goiter prevalence also increased but the difference was not statistically significant (P > 0.05). The median urinary iodine excretion level of the district was found 80 mcg/l. It was observed that 81.9% salt samples had more than 15 ppm (as recommended) iodine content. Conclusion: The goiter prevalence is less in the study district but low median urinary iodine excretion and use of insufficient iodized salt at households describe the inadequacy in efforts to eliminate IDDs in the district.
  9,883 850 4
The effects of Nigella sativa L. ethanolic extract on thyroid function in normal and alloxan-induced diabetic rats
Saleh Hassan Sharif, Barakat Mohammed Elmahdi, Ammar Mohammed Ali Mohammed, Alrasheed Hamid Mohammed
May-August 2012, 9(2):48-52
Context: Nigella sativa, (black cumin seeds) compounds display a remarkable array of biochemical, immunological, and pharmacological actions, including bronchodilatory, antibacterial, hypotensive, immunopotentiating, hypoglycemic, and antitumor activity. Aims : The aim of the present study was to evaluate effects of Nigella sativa L. ethanolic extract (NSE) on the thyroid function test in normal and alloxan-induced diabetic Wistar albino rats. Settings and Design: Experimental study. Materials and Methods: Alloxan monohydrate was injected intraperitoneally at single dose of 150 mg/kg body weight to induce diabetes. Twenty Wistar albino rats were divided into four groups: NSE-treated normal, diabetic, NSE-treated diabetic, and control. NSE was administered daily orally by gavage at a dose of 1 g/kg body weight for 14 days. Serum concentration of TSH, T 4 , T 3 were measured by radioimmunoassay on day 7 th and 14 th . Statistical Analysis Used: Data are expressed as the mean ± S.E.M. For statistical analysis, ANOVA was used. Results: NSE induced a significant increase in the T 3 serum concentration on both day 7 th and 14 th in the diabetic rats and increase T 4 serum concentration on day 14 th in the normal rats. Conclusions: The results revealed that daily oral administration of Nigella sativa L. ethanolic extract (1 g/kg Bwt.) for 14 days significantly increased the serum concentration of T 4 in the normal Wistar albino rats. On the other hand the results revealed that treatment returned the serum concentration of T 3 to the normal level in the Alloxan-induced diabetic rats. Further work is suggested for evaluating the effect of Nigella sativa L. on the serum concentration of thyroid hormones to elucidate the possible mode of action.
  9,602 702 5
Spindle cell variant of medullary carcinoma of thyroid with nodal metastasis: Cytodiagnosis and diagnostic dilemma
Santosh Kumar Mondal, Dipanwita Roy Nag, Ranjana Bandyopadhyay
May-August 2012, 9(2):60-63
A 45-year-old female presented with a thyroid nodule on right lobe since 2 years and an enlarged cervical lymph node for past 6 months. Fine needle aspirations were done from the thyroid nodule. Fine needle aspiration cytology from thyroid swelling revealed discretely arranged elongated spindle-shaped cells with scant cytoplasm. Clumps of glassy pink amyloid-like material were noted in the background on air-dried smears. A provisional cytodiagnosis of spindle cell variant of medullary carcinoma of thyroid (MCT) was made based on cytomorphology. But diagnostic dilemma appeared as spindle cell tumor might mimic fibroblasts from supporting stroma, melanoma, or even anaplastic carcinoma. Distinction of amyloid from hyaline collagen or basement membrane material was also difficult on cytologic smears. Subsequently, serum calcitonin measurement and histopathological examination confirmed the case to be spindle cell variant of MCT with nodal metastasis.
  7,620 450 -
Expect the unexpected: Nonrecurrent laryngeal nerve
Vinay Vaidyanathan, Caren D'Souza, Kishore Shetty
May-August 2012, 9(2):56-57
Injury to recurrent laryngeal nerve (RLN) in thyroid surgeries is the single most high morbid complication making thyroid surgery challenging. Presence of nonrecurrent laryngeal nerve (nRLN) increases the risk of injury many folds. Sound anatomical knowledge of this variant course can help the surgeon avert disaster.
  6,605 393 -
Kocher-Debre-Semelaigne syndrome
Satyam Rajvanshi, Rajeev Philip, Gopal K Rai, KK Gupta
May-August 2012, 9(2):53-55
Thyroid hormone deficiency is an unusual cause of acquired myopathy, although complaints of muscular weakness can be present in up to 40% of patients. Among the patients with myopathy, <10% of the patients develop pseudomuscular hypertrophy known as Kocher-Debre-Semelaigne syndrome (KDS) in children and Hoffmann syndrome in adults. We report a case of autoimmune hypothyroidism where weakness and growth failure were predominant complaints, and hypertrophied calf muscles were easily noticeable. Although rare, KDS remains an easy to diagnose and treatable cause of reversible myopathy and therefore, must be considered in differential diagnosis of hereditary myopathies.
  6,060 469 2
Spectrum of thyroid hormone resistance
Deep Dutta, Rajesh Jain, Ajitesh Roy, Sujoy Ghosh, Satinath Mukhopadhyay, Subhankar Chowdhury
May-August 2012, 9(2):64-67
Thyroid hormone resistance (THR) is a rare disorder with a prevalence of 1:40,000 and is commonly due to mutation in thyroid receptor β-isoform. Goiter is the most common presenting feature in patients of THR (66-95%) followed by behavioral abnormalities (60%). Severe mental retardation and short stature are uncommon. We present three patients of THR, all of whom presented with short stature and goiter. Patient-1 had attention deficit hyperkinetic disorder with severe mental retardation (IQ-52). Patient-2 presented with bleeding and non-palpable purpura and was diagnosed to have immune thrombocytopenic purpura (ITP). This is the first report of ITP in a patient of THR. Patient-3 in contrast had normal intelligence and presented with only short stature and goiter. Patients-1 and 2 had tachycardia which improved with propranolol. Propranolol can be a useful agent in the management of thyrotoxic symptoms in THR patients when thyroid hormone analogues are not available. Unlike previously reported case series of THR, short stature and goiter were the universal presenting features in our patients, probably reflecting the fact that such patients are more likely to seek medical care.
  5,417 475 1
Ectopic parathyroid adenoma
Caren Dsouza, KR Bhagavan, Gopalakrishnan , K Rakesh
May-August 2012, 9(2):68-70
Adenoma is the commonest cause of primary hyperparathyroidism; 10% of these adenomas can be ectopic, leading to one of the major causes for persistent and recurrent hyperparathyroidism. Proper preoperative evaluation is important in order to localize the position of the glands. We report a case of a 21-year-old male who presented with features of primary hyperparathyroidism. On evaluation with metaiodobenzylguanidine scan, he was found to have a parathyroid adenoma in the mediastinum, anterior to the arch of the aorta. The adenoma was excised via a sternotomy incision.
  5,261 426 1
Relationship between hypothyroidism and carotid artery intima media thickness, and prevalence of hypothyroidism in rheumatoid arthritis patient: An observational study
Jayanta Paul, Somnath Dasgupta, Mrinal Kanti Ghosh, Kishore Shaw, Arpan Kumar Dey, Tanmoy W Momin
May-August 2012, 9(2):45-47
Introduction: Rheumatoid arthritis (RA) and hypothyroidism both are associated with atherosclerosis. Prevalence of hypothyroidism is higher in RA than in general population. But there is still controversy regarding relationship between carotid artery intima media thickness (CAIMT) and hypothyroidism. Aims and Objectives: This study was done to find out prevalence of hypothyroidism in RA and relationship between hypothyroidism and CAIMT in RA patients. Materials and Methods: The study subjects included 52 RA patients. Among them, 8 RA patients were suffering from hypothyroidism. CAIMT was measured by B-mode ultrasound. Statistical analysis was performed by SPSS software (17 th edition for window). Result and Analysis: 15.4% of RA patients were suffering from hypothyroidism. There was also independent correlation between CAIMT and hypothyroidism in RA (P = 0.044). CAIMT of RA with hypothyroidism was significantly higher than RA without hypothyroidism (P = 0.023). Conclusion: Prevalence of hypothyroidism is higher in RA than in general population. Hypothyroidism is an independent risk factor of atherosclerosis in RA patients.
  4,817 394 1
Amyloid tumor of thyroid, amyloid goiter: A case report with a stress on importance of preoperative diagnosis
BJ Naveen Kumar, KV Santosh
May-August 2012, 9(2):58-59
Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, clinically significant enlargement of the thyroid owing to amyloid deposition is an extremely rare occurrence. Deposition of amyloid is commonly found in the kidneys, spleen, liver, lymph nodes, nerves, skin, heart, gastrointestinal tract, lungs, and blood vessels. We present a rare case of amyloid deposition in thyroid, leading to amyloid goiter which is still rarer.
  4,515 329 -
Follicular adenoma of thyroid with black pigmentation
Prerna Arora, Seema Rao, Nita Khurana, Anoop Raj
May-August 2012, 9(2):71-72
  4,351 337 -
Asymptomatic intrathyroid "Water Clear Cell" parathyroid adenoma: A rare entity
Harveen K Gulati, Mani Anand, Sanjay D Deshmukh
May-August 2012, 9(2):72-74
  3,783 308 1
The Nobel thyroid
Sanjay Kalra, Kanishka Sawhney
May-August 2012, 9(2):31-31
  3,054 415 -