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   2013| January-April  | Volume 10 | Issue 1  
    Online since January 10, 2013

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Association of autoimmune thyroiditis and Sjogrens syndrome: Case based review
Babul H Reddy, Mounika Guntaka, Sri V Nagesh, Jayanthy Ramesh
January-April 2013, 10(1):26-28
Sjogrens syndrome is a slowly progressing autoimmune disease, primarily affects exocrine glands, in addition non-exocrine glands affected as well. The coexistence of Sjogrens syndrome and autoimmune thyroiditis is frequent and suggests a common genetic or environmental factor predisposition with similar pathogenic mechanisms. We herein report three cases of this association, who presented to us with different manifestations of Sjogrens syndrome.
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An unusual case of precocious puberty and macroorchidism
Rajeev Philip, Sanjay Saran, Manish Gutch, Kumar K Gupta
January-April 2013, 10(1):29-31
The role of thyroid hormone in pubertal development is complex, with majority of the hypothyroid patients failing to attain puberty. However, isosexual precocious puberty with delayed bone age has been described in female hypothyroid patients, and is called Van Wyk Grumbach Syndrome (VWGS). The presentation of VWGS in boys is different, with the major presentation being isolated enlargement of the testes, with no signs of virilisation. The cross over action of Thyroid Stimulating Hormone (TSH) on Follicle Stimulating Hormone (FSH) receptor producing Sertoli cell hyperplasia produces testicular enlargement, and lack of action of TSH on Luteinizing hormone (LH) with no Leydig cell hyperplasia explaining lack of virilisation. Delayed bone age and typical features of hypothyroidism help to differentiate this condition from other causes of precocious puberty.
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Hyperthyroidism due to bilateral benign cystic struma ovarii: A rare case report
Bharathi Kannusamy, Anuradha Subramanyam
January-April 2013, 10(1):23-25
Struma ovarii is a rare specialized monodermal teratoma of ovary composed predominantly of thyroid tissue (> 50%). Most of the cases are asymptomatic. Hyperthyroidism due to functional struma ovarii is seen only in 5 to 10% of cases. We report here a case of bilateral benign cystic struma ovarii in a 50-year-old lady presenting with signs and symptoms of hyperthyroidism. Her thyroid profile showed elevated levels of total and free thyroxine levels. Pelvic ultrasonogram showed bilateral cystic ovarian tumor along with minimal ascites. 131-I whole body scan revealed bilateral focus of high radioactive iodine uptake in the pelvis. A provisional diagnosis of cystic struma ovarii was made. Abdominal exploration showed cystic mass lesion in both ovaries. She underwent total abdominal hysterectomy with bilateral salphingo-oophorectomy. Histopathological examination confirmed the mass as benign cystic struma ovarii. Signs and symptoms rapidly disappeared after surgical removal of tumor. This rare case is reported here for its unusual clinical presentation.
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Usage of non-iodized salt in North West India
Sanjay Kalra, Bharti Kalra, Kanishka Sawhney
January-April 2013, 10(1):12-14
Background: Though the sale of non-iodized salt is banned by law, it is still available in, and used in, North West India. Aims: This study aimed to assess the patterns of sale and consumptions of non-iodized salt, and explore the reasons behind its continued use. Materials and Methods: A cross-sectional survey was conducted using a semi-structured questionnaire, administered to 16 wholesalers, and 32 retailers, spread over eight districts of three states, and to 100 hypothyroid patients, attending an endocrine clinic. Results: Non-iodized salt was available at all 16 wholesale shops, and 30 out of 32 retail shops. The self-reported sale of non-iodized salt, as a percentage of total salt sold, was 10-20% at wholesale and 0-5% at retail counters. All (100%) of the patients consumed non-iodized salt, reporting this as 2-10% of their total consumption. Common reasons for use were religious necessity, better flavor, and perceived medicinal property (88%, 77%, 62% respectively). Conclusion: Use of non-iodized salt is still prevalent in North West India. Concerted and sustained public awareness campaigns are needed to ensure optimal consumption of iodized salt.
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Hyperthyroidism - A reversible cause of pulmonary hypertension: A prospective echo cardiographic study
Babul H Reddy, Sharath A Reddy, Jayanthy Ramesh, Rakesh K Sahay
January-April 2013, 10(1):8-11
Aim: To determine the prevalence of pulmonary hypertension (PHT) related to hyperthyroidism and its outcome with treatment. Materials and Methods and Results: We performed serial echocardiographic examinations in 25 consecutive patients with hyperthyroidism (20 females, five males) to estimate pulmonary artery hypertension at baseline and were repeated once an euthyroid state was achieved (mean 6 months after initiation of anti-thyroid treatment). Results were compared with 15 age- and sex-matched healthy controls. All hyperthyroid patients had normal Left Ventricular systolic function and 14 patients (56%) had PHT with Pulmonary arterial systolic pressure of at least 35 mmHg. There were no significant differences in the clinical characteristics of hyperthyroid patients with or without PHT. Nonetheless, those with PHT had significantly higher Cardiac Output PASP, peak trans-mitral early diastolic flow velocity (E), and ratio of E to early diastolic mitral annular velocity (E1). Among the 14 hyperthyroid patients with PHT, 10 (40%) had pulmonary arterial hypertension (PAH) with normal E/E1, and 10 (16%) had pulmonary venous hypertension (PVH) with elevated E/E1. These hemodynamic abnormalities and PHT were reversible in patients with PAH or PVH after restoration to a euthyroid state. Conclusion: In patients with hyperthyroidism and normal LV systolic function, up to 56% had PHT due to either PAH with increased CO (40%) or PVH with elevated LV filling pressure (16%). More importantly, hyperthyroidism-related PHT was largely asymptomatic and reversible after restoration to a euthyroid state.
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Papillary carcinoma in a thyroglossalduct cyst with neck nodal metastases
Arsheed H Hakeem, Imtiyaz H Hakeem, Rauf Ahmed, Omer S Kirmani
January-April 2013, 10(1):20-22
Although thyroglossal duct cysts are the most common form of congenital anomalies in the neck, diagnosis of cancer in such cysts is rare with a reported incidence of 1.3% of all thyroglossal cysts. Presence of the metastatic neck nodes is still more uncommon. Papillary thyroid carcinoma is the most frequently encountered carcinoma in thyroglossal duct cyst. We present a case of young female with papillary carcinoma in the thyroglossal duct cyst with metastatic lymph nodes in level IB.
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Euthyroid ophthalmopathy
Subodh Banzal, Abhishek Singhai, Pragya Jain
January-April 2013, 10(1):32-34
Thyroid-associated ophthalmopathy usually occurs in a close temporal relationship with hyperthyroidism. It is rare in patients with normal thyroid function (euthyroid ophthalmopathy) and in patients with hypothyroid forms of thyroid autoimmune disease (hypothyroid ophthalmopathy). Here we report wide spectrum of euthyroid ophthalmopathy ranging from mild proptosis, unilateral proptosis to severe keratopathy with blindness.
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Vitamin D and thyroid: Autoimmunity and cancer
Deep Dutta, Sujoy Ghosh
January-April 2013, 10(1):1-3
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Obesity and thyrotropinemia: Association in Indian adults
Sunil K Kota, Lalit K Meher, Sruti Jammula, Siva K Kota, Epari S Rao, Kirtikumar D Modi
January-April 2013, 10(1):4-7
Aim: Obesity affects pituitary thyroid axis resulting in elevated thyroid stimulating hormone (TSH) levels. The objective of our study was to investigate whether there is an association between body mass index (BMI) and TSH in euthyroid and subclinical hypothyroid obese persons and to compare serum TSH levels among obese and overweight subjects presenting to our obesity clinic. Materials and Methods: A total of 150 consecutive subjects aged between 18 and 60 years presenting to our obesity clinic were enrolled. Patients were divided in three groups, group 1: overweight (BMI: 23- 24.9 kg/m 2 , n = 65), group 2: class I obese (BMI: 25-29.9 kg/m 2 , n = 58), and group 3: class II obese (BMI: 30-34.9 kg/m 2 , n = 27). All subjects underwent thyroid profile along with other routine tests. Fisher's exact test, Mann-Whitney U test and Pearson's correlation were used for statistical analysis. P value <0.05 was considered significant. Results: Elevated TSH level (5-10 μIU/ml) with normal T 3 and T 4 was seen in 12/65 overweight, 19/58 class I obese (P = 0.614) and 12/27 of class II obese subjects (P = 0.529). Mean TSH levels were higher in subjects with higher BMI (group 1: 3.2 ± 3.1, group 2: 3.6 ± 2.2, group 3: 3.8 ± 2.8). Over all TSH showed no correlation with BMI (r = 0.0018, P = 0.872). Conclusion: Though higher BMI leads to higher TSH levels in our series, we could not find any significant relation between severity of obesity and TSH levels. Further large scale data from population is required to confirm or negate our finding.
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Metastatic iodophilic follicular carcinoma of thyroid to a hand bone
Arvind Krishnamurthy, Vijaylakshmi Ramshankar
January-April 2013, 10(1):36-37
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Chronoscopic reading in whole body reaction times can be a tool in detecting cognitive dysfunction in hypothyroidism: A case-control study
Vitthal Khode, Shambhulingaiah , Umesh Rajoor, Santosh Ramdurg, Komal Ruikar
January-April 2013, 10(1):15-19
Background: Hypothyroidism investigated as a risk factor for cognitive decline. It is known that difference between simple and choice reaction time (RT) implies time required for cognition. Though delayed RTs indicate involvement of cognition, they cannot quantify how much time is required for cognition. In whole body choice reaction time (WBCRT), RT is split into two chronoscopic readings, Chronoscope-1 (C1) and Chronoscope-2 (C2). C1 measures time required for central processing, which requires cognition and C2 measures total RT. C2-C1 measures time required for the peripheral motor response. We hypothesized that WBCRT C1will be delayed in hypothyroidism, and WBCRT C1 will have predictive value in detecting cognitive dysfunction. Settings and Design: Hospital based case control study. Materials and Methods: Study was conducted on 99 subjects using visual and whole body reaction timers having criteria of age (20-60years) and hypothyroidism, compared with an equal number of age and sex matched controls. Statistical analysis was done by Independent t-test and duration of hypothyroidism was correlated with cognition times (WBCRT C1) using Pearson's correlation. Predictive value of WBCRTC1 was calculated by using receiver operating characteristic curve. Results: Delayed visual simple reaction time (VSRT), Visual choice reaction time (VCRT), Whole body simple reaction time (WBSRT), and WBCRT observed among subjects of hypothyroidism when compared with controls. Choice RTs were more delayed compared to simple RTs. WBCRT C1 (578±110 ms) was more delayed than WBSRT C1 (396 ± 87.1 ms) among hypothyroid patients indicating cognitive dysfunction. There was no significant correlation between duration of hypothyroidism with cognition. The best cut-off value for WBCRTC1, when predicting cognitive dysfunction in hypothyroidism was 527 ms. (sensitivity 48% specificity 40.8%). Conclusions: WBCRT C1 can be used as a tool to detect cognitive dysfunction.
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Direct access testing in thyroidology: Perils aplenty
Sanjay Kalra, Bharti Kalra, Kanishka Sawhney
January-April 2013, 10(1):35-36
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