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   2013| September-December  | Volume 10 | Issue 3  
    Online since August 6, 2013

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Fine needle aspiration cytology of thyroglossal duct cyst: Diagnostic pitfalls and a study of 14 cases
Shirish S Chandanwale, Archana C Buch, Kaur R Chawla, Pratik U Mittal
September-December 2013, 10(3):104-107
Objectives: To review the cytohistological features of 14 cases of thyroglossal duct cyst (TDC), to ascertain the role of fine needle aspiration cytology (FNAC) in the diagnosis and treatment, and to discuss the diagnostic pitfalls. Materials and Methods: FNAC of 14 patients of TDC diagnosed clinically and by ultrasound examination of neck was studied. Cytology features were correlated with histopathologic features. Results: Cytology smears showed most commonly few macrophages (n = 7), followed by polymorphonuclear leukocytes (n = 4). One case showed few small sheets and many dispersed follicular cells showing features suspicious of papillary thyroid carcinoma (PTC). Histopathology showed pseudostratified columnar and cuboidal epithelium (n = 6) in maximum cases and confirmed PTC in one case. Conclusion: Imaging techniques or FNAC alone is not adequate for pre-treatment assessment of all TDC cases. All TDC patients must be subjected to image-guided FNAC for early and accurate diagnosis of TDC carcinoma for timely clinical intervention.
  31,207 883 2
Radioactive iodine therapy for hyperthyroidism: Our experience
Subodh Banzal, Abhishek Singhai, Jamal Asaraf, DC Tiwary, Padmnabh Sharma, Pragya Jain
September-December 2013, 10(3):96-99
Context: Radioactive iodine (RAI) therapy for hyperthyroidism is safe and definitive, although, post-treatment hypothyroidism and the need for life-long thyroxine are to be expected. The optimal dose of I-131 for hyperthyroidism is still debated. Aims: The aim of this study is to evaluate the response rate of hyperthyroidism to RAI treatment, optimum effective dose, effect of pre-treatment with anti-thyroid medications, ophthalmopathy, and hypothyroidism incidence post RAI therapy. Subjects and Methods: A prospective study was conducted in a tertiary care center to look at the therapeutic practice of use of RAI in the treatment of hyperthyroidism, to determine whether the expected or desired therapeutic outcome is achieved. Seventy consecutive subjects of hyperthyroidism, treated with RAI were followed-up. Results: Grave's disease was the most common cause of hyperthyroidism. The dose of RAI ranged from 4 mCi to 17.5 mCi. Over 95% cure rate achieved with RAI dose 4-7 mCi. Hypothyroidism occurred in 52.17% cases with this dose. Goiter size significantly decreased with RAI therapy. No deterioration of eye signs observed with RAI therapy. Pre-treatment with anti-thyroid drugs had no influence on outcome. Conclusions: RAI treatment is an effective modality for definitive treatment of hyperthyroidism with long-term cure approaching 95%. Its efficacy, safety and low cost made it the preferred definitive treatment for most patients with hyperthyroidism.
  11,695 614 1
The global burden of thyroid disease
Sanjay Kalra, Ambika Gopalakrishnan Unnikrishnan, Rakesh Sahay
September-December 2013, 10(3):89-90
  7,409 1,050 5
Evaluation of upper reference limit of TSH in adults: Review of biological upper reference limit for TSH on a "chemiluminescence based" analysis technique
Sultana Furruqh, Geraldine Menezes, Bantwal Ganapathy, Vagheesh Ayyar, Shilpa Hiriyur Dhruvakumar, Mohammed Vaseem, Sundarrajan Seshan
September-December 2013, 10(3):100-103
Background: There was an identified need to review the use of the manufacturer provided upper reference limit (URL) of the thyroid stimulating hormone (TSH) assay for the Indian population. URL's provided by manufacturers are usually based on western populations. This study triggered from our clinical feedback, identified that there is indeed difference for the URL for the Indian population compared to what the manufacturer has provided for the TSH assay. Materials and Method: Prospective study with volunteers from St. John's Medial College Hospital general health check who were pre-screened and selected based on inclusion/exclusion criteria decided for the purpose. We utilised the Access ® range of Chemiluminescence based Immuno assay system from Beckman Coulter Inc., Brea. CA, USA for this study. As indicated in the "background", we investigated URL of the TSH assay. Results and Conclusion: Results strongly favored the reduction of the URL to be more suitable for the population covered in this study.
  5,973 457 -
Thyroid status in Egyptian primary school children with iron deficiency anemia: Relationship to intellectual function
Kotb Abbass Metwalley, Hekma Saad Farghaly, Asmaa Farghaly Hassan
September-December 2013, 10(3):91-95
Background: Only few studies concerning thyroid status and intellectual evaluation in iron deficiency anemia, which is frequently seen in primary school children in Egypt. Aim: The present study was planned to investigate the effect of iron deficiency anemia on the thyroid functions and intellectual activity of young children in a primary school. Settings and Design: Cross-sectional controlled study. Patients and Methods: This study was carried out on 60 primary school children aged 6-12 year with iron deficiency anemia (Group 1) and 20 children as control (Group 2). Complete blood count, iron, total iron binding capacityferritin, thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroid hormones (FT4 and FT3), and intelligence quotient (IQ) were determined in all the children included in the study. Results: TT3 and TT4 values were statistically lower while TSH is significantly higher in the study group as compared to control (P < 0.001 for each). Patients with hemoglobin (HB) level < 10 > 7 g/dl had significantly lower levels of serum FT3 and FT4 (P < 0.01 for both) and significantly higher levels of serum TSH (P < 0.05) as compared to patients with HB level <7 g/dl. Serum ferritin was correlated negatively with TSH levels (r = −0.76, P < 0.001) while positively with TT4 (r = 0.69, P < 0.001) and TT3 (r = 0.84, P < 0.001) levels. A significant positive correlation was found between serum level of TT3 and transferrin saturation% (r = 0.78, P < 0.001). Total, as well as performance IQ were significantly lower in patients than controls with P <0.05 for each. Significant positive correlations were observed between both total and performance IQ and thyroid hormone levels and iron status parameters. Conclusion: Egyptian primary school children with iron deficiency anemia especially severe type are liable to develop subclinical hypothyroidism and intellectual dysfunction. A randomized, double-blind, controlled study is needed to address the question of whether subclinical hypothyroidism associated with iron deficiency anemia should be treated with oral iron only or iron and levothyroxine combination aiming to prevent the combined effects of both conditions on cognitive function of the brain. Moreover, more comprehensive studies are needed to elucidate if the effect of iron deficiency anemia on thyroid status is reversible or not.
  5,575 616 8
A case of hypothyroidism with excessive aberrant mongolian spots
V. S. S. Yerramilli Murty, Manisha R Patel, V. R. V. K. Kishore, K Dinedra Ram
September-December 2013, 10(3):108-110
Association of hypothyroidism with excessive ectopic/aberrant mongloian spots is not reported in the literature till date. We herewith report, a 1-year-old male child who presented with clinical features of hypothyroidism with excessive ectopic/aberrant monglolian spots. Child is evaluated for hypothyroidism and found to have abnormal thyroid profile. Bone-age was less than chronological age. Cardiac evaluation revealed mild pericardial effusion. Child was started on thyroid hormone replacement therapy and advised follow-up.
  5,533 325 -
Thyrotoxicosis presenting first time as hypokalemic paralysis
ZD Sharma, VS Gokhale, N Chaudhari, AL Kakrani
September-December 2013, 10(3):114-115
Thyrotoxicosis has varied manifestations, from its usual to rare presentations. Thyrotoxicosis presenting as acute quadriplegia is a very rare phenomenon and is attributed to hypokalemia. Thyrotoxic hypokalemic periodic paralysis is known but rare manifestation and as a first presentation is relatively unknown. Here, we present a case of young male in whom thyrotoxicosis presented for the first time as hypokalemic paralysis.
  4,494 378 2
Metastatic lesions to thyroid associated with dual primaries: A report of two cases
Binit Kumar Khandelia, Shrijeet Chakraborti, Santosh Rai, Hema Kini
September-December 2013, 10(3):111-113
The presence of metastatic malignancy entails a search for the primary tumor. In this study, two unusual cases of metastatic tumors, one a diffuse B-cell Non-Hodgkin lymphoma (NHL) and the other squamous cell carcinoma (SqCC), to the thyroid gland, revealed two primary sites on further work-up. In view of diffuse B-cell NHL involving the nasopharynx, parapharyngeal and cervical lymph nodes, it was presumed that the involvement of thyroid was secondary. Similarly, because of uncommon occurrence of SqCC of thyroid and proven synchronous SqCC in lung and larynx, the tumor in the thyroid was diagnosed as a metastatic SqCC.
  3,996 320 1
Qualitative research in thyroidology
Sanjay Kalra, Bharti Kalra, Vibha Pathak
September-December 2013, 10(3):116-117
  3,177 277 -