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   2014| September-December  | Volume 11 | Issue 3  
    Online since August 13, 2014

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Thyrotoxic neuropathy; an under recognized condition: A clinical vignette
Partha Pal, Sayantan Ray, Kaushik Biswas, Animesh Maiti, Deep Mukhopadhyay, Rintu George, Debabrata Mukherjee
September-December 2014, 11(3):118-120
Neurological sequelae such as neuromuscular or primary muscle disorders are well recognized complications of hyperthyroidism. However, the association of neuropathy with thyrotoxicosis is uncommon. Thyrotoxic neuropathy or Basedow's paraplegia is a rarely reported entity, which was first described by Charcot in 1889. We are reporting the case of a middle-aged man with subacute distal neuropathy as the presenting manifestation of thyrotoxicosis which improved on antithyroid treatment. Peripheral neuropathy in hyperthyroidism is underdiagnosed and may be found even in patients with mild thyrotoxicosis. Thyroid function tests can be helpful in the diagnosis of this treatable neuropathy in such cases and hence should be included in the routine workup in patients with peripheral neuropathy.
  23,814 562 -
Oral calcium and vitamin D supplementation after total thyroidectomy
Mohamed El-Shinawi, Aly El-Anwar, Mohamed Nada, Tarek Youssef, Essam Fakhry, Salah Raslan, Hatem El-Gohry
September-December 2014, 11(3):98-102
Introduction: Hypocalcemia is an important and common complication following thyroid surgery with reports varying from 0.5% to 75%. Despite being self-limiting in most patients, symptomatic hypocalcemia is of particular concern because of a delay in its manifestation and the consequent need for prolonged patient hospitalization or re-admission. Aim of the Work: The aim of this study is to evaluate the clinical usefulness of oral calcium and vitamin D administration after total thyroidectomy in the prevention of post-operative hypocalcemia. Materials and Methods: Fifty patients who underwent total thyroidectomy for non-toxic goiters were randomly assigned to routinely receive or not receive oral calcium (1.5 g/d) and vitamin D (0.5 μg/d) for 4 weeks. Hypocalcemic symptoms and signs and total serum calcium levels were monitored and compared between the 2 groups. Results: The incidence of symptomatic and laboratory hypocalcemia was lower in the treatment group receiving the supplement than in the control group not receiving the supplement: 6 of 25 patients (24%) versus 11of 25 (44%). The hypocalcemic symptoms were minimal in the treatment group but more severe in the control group not receiving the supplement. Serum calcium levels decreased in both groups after surgery but were less in the treatment group. Conclusion: Routine administration of a supplement containing oral calcium and vitamin D may be effective in reducing the incidence and severity of hypocalcemia after total thyroidectomy.
  12,210 679 4
NAFLD, Prediabetes and Hypothyroidism: Fixing the Links
AG Unnikrishnan, Shalbha Tiwari, Vedavati Purandare, Rita Basu, Ananda Basu
September-December 2014, 11(3):87-88
  2,944 3,687 -
Primary empty sella syndrome presenting as isolated central hypothyroidism
Sourya Acharya, Samarth Shukla, Shivali Kashikar, Sameer Dasarwar, Satish N Mahajan
September-December 2014, 11(3):137-138
  6,030 216 -
Non-invasive and percutaneous ablation of nontoxic solid nodules
Narendra Kotwal, Aditi Pandit
September-December 2014, 11(3):89-93
Thyroid nodules (TNs) are commonly seen in the general population with a prevalence of about 4% by palpation and about 10-41% by ultrasound. Most of the TNs are benign. Surgery and radioiodine therapy have been the mainstay of therapy in compressive TNs. Surgery has its own complications and hence, the quest for a non-invasive modality of treatment remains. Radiofrequency ablation, ethanol ablation and laser ablation are the non-invasive methods of treating a benign TN. Also, microwave ablation and high intensity focused ultrasound have recently been tried in the treatment of TNs. In this review, we will be discussing the above newer and emerging modalities in the non-invasive ablation of non-toxic nodules.
  3,493 2,135 2
A curious case of gynaecomastia!
Subramanian Kannan, Shreya Kunder, Anthony Pais
September-December 2014, 11(3):116-117
Gynecomastia is a benign proliferation of the glandular tissue of the male breast and is caused by a relative increase in the ratio of estrogen to androgen activity. Gynaecomastia has been reported in patients with Graves's disease; however, it is unusual in transient thyroid disorders like thyroiditis and thyroid hormone over-replacement. We report a case of a young healthy male who presented with gynaecomastia, elevated levels of testosterone, and elevated-free thyroid hormones. Tc 99m uptake was suppressed. Patient was started on corticosteroids and in a period of 6-8 weeks, gynaecomastia resolved, and his thyroid hormone and testosterone levels normalized.
  4,413 254 -
'Two are not always better than one' - Dual Ectopic Thyroid: A rare anomaly
Ashutosh Kansal, Shruti Aggarwal
September-December 2014, 11(3):113-115
Congenital abnormalities are the least common of the thyroid disorders. It is very unusual for dual ectopic foci of thyroid tissue to be present simultaneously. We are reporting a case of dual ectopic thyroid in the lingual and sub-hyoid areas in a 15-year-old boy with no thyroid gland in its normal anatomical location. However, physical examination showed monoectopic thyroid presented as a 3 × 3.5 cm anterior midline neck swelling just below the hyoid bone, though the neck ultrasonography and thyroid scan with technetium-99m sodium pertechnate confirmed lingual and sub-hyoid dual ectopic thyroid with no thyroid tissue at the normal anatomical location of the thyroid gland.
  4,138 258 1
Thyroid functions in Egyptian children with steroid responsive nephrotic syndrome: Relation to oxidative stress
Hekma Saad Farghaly, Tahra Sherif
September-December 2014, 11(3):94-97
Background : The interactions between kidney and thyroid functions have been known for many years; oxidative damage has been proposed as one of the possible mechanism involved in the nephrotic syndrome (NS). This study was done to find out the thyroid function of nephrotic children during nephrosis and to compare any significant changes of thyroid function status during nephrosis and remission in relation to oxidative stress markers. Patients and Methods: The study included 60 patients with steroid responsive NS (SRNS) and 30 children with matched age and sex as control. Cases were divided into three groups as follow, Group A: Include 35 patients with SRNS in relapse. Group B: Include 25 patients with SRNS in remission for periods ranging from 3 to 9 months, and not receiving steroid therapy. Group C: Include 30 children with matched age and sex as control. Methods: A thorough history and examinations, total serum thyroxine and triiodothyronine (TT4 and TT3) as well as serum free T4 (FT4), thyroid-stimulating hormone (TSH), and assessment of malondialdehyde (MDA) and total antioxidant capacity (TAC) levels as an oxidative stress markers were measured in all studied groups. Results: Serum TSH was significantly higher in patients with SRNS in relapse in comparison with patients with SRNS in remission and with control group (P < 0.001 in both), we found a significant decrease in TT4 and FT4 and TT3 and FT3 (FT3) concentrations in patients with SRNS in relapse in comparison with both cases with SRNS in remission and control group (P < 0.001 in both). MDA levels were significantly elevated, while TAC level was significantly decreased in patients with SRNS in relapse in comparison with patients with SRNS in remission and with control group (P < 0.001 in both). There was a positive correlation between serum TSH and plasma MDA and a negative correlation with FT4. Conclusions: The development of hypothyroidism in children with SRNS is associated with alteration in oxidant and antioxidant status. The biochemical hypothyroid state in relapse phase is temporary and improves with remission.
  3,153 473 1
Steroid responsive myoclonus as a presentation of Hashimoto's encephalopathy
Rajeev Philip, Sanjay Saran, Manish Gutch, Arya Tungveersingh
September-December 2014, 11(3):133-135
Hashimoto's Encephalopathy (HE) can have highly variable neuropsychiatric manifestations, making it difficult to diagnose, and may go unrecognized for a long time. HE is a diagnosis of exclusion and should be kept in mind when evaluating a patient with cognitive dysfunction and high titres of antithyroid antibodies as it responds dramatically to steroids. Steroid responsive myoclonus can be a presentation of HE.
  3,298 258 2
Thyroid abscess: A rare entity?
DS Nirhale, VS Athavale, Gaurav Goenka, Mohit Bhatia
September-December 2014, 11(3):131-132
A thyroid abscess is an infrequently encountered condition with a rarity that is attributable to anatomic and physiologic characteristics of the gland that impart a unique quality of infection resistance. The differential diagnosis for a painful thyroid is limited, with sub-acute and chronic thyroiditis being the most often-encountered processes. Acute suppurative thyroiditis with abscess formation, although rare, is a formidable clinical scenario with morbid complications. The common causative organisms responsible for thyroid abscess are Staphylococci and Streptococci species. We describe a case of thyroid abscess due to methicillin resistant Staphylococcus aureus in young female. The patient was successfully treated with open surgical drainage and appropriate antimicrobial agents.
  3,246 249 2
ANCA positive vasculitis in a patient with nodular Graves' disease caused by carbimazole
Viral N Shah
September-December 2014, 11(3):121-123
Anti-neutrophil cytoplasmic antibody (ANCA) positive vasculitis is an uncommon and infrequently recognized adverse event with thionamide drugs. It is most commonly reported with propylthiouracil (PTU) and rarely with carbimazole (CBZ). We report a male patient who presented with arthralgias, fever, and other symptoms of hyperthyroidism who was on CBZ treatment on and off for the past 14 years. His laboratory evaluation revealed a diagnosis of ANCA positive vasculitis. CBZ was stopped and prednisolone was started in tapering doses while he underwent radioiodine ablation for control of hyperthyroidism. This treatment leads to clinical improvement in the patient. This is the second case report from India.
  3,139 237 -
A rare case of extra - Adrenal pheochromocytoma with coexisting thyrotoxicosis
Lingudu Brahmanandam, Bongi Vivekanand, Ayyagari Mythili, Kandregula Subrahmanyam
September-December 2014, 11(3):127-130
We report a rare case of extra-adrenal pheochromocytoma with coexisting thyrotoxicosis. A 52 year old female presented with hypertension, diabetes, hyperadrenergic symptoms, paroxysmal spells and computed tomography abdomen revealing a left extra adrenal mass. Evaluation showed normal 24 hour urinary epinephrine and metanephrines with an elevation of urinary norepinephrine. Thyroid function tests revealed thyrotoxicosis. The diagnosis of pheochromocytoma is delayed and the case illustrates the similarity of both the disorders. Despite existence of two similar disorders the patient recovered with treatment of both pheochromocytoma and thyrotoxicosis.
  3,078 209 -
Thyroid functions and autoimmunity in Egyptian children with chronic hepatitis C virus infection before interferon treatment
Kotb Abbass Metwalley, Tahra Sherif
September-December 2014, 11(3):103-107
Background: The association of thyroid dysfunction with hepatitis C virus (HCV) infected children who are on interferon therapy is well established. But thyroid functions in untreated chronic HCV children is an aspect which the present study intended to explore. Settings and Design: Cross-sectional controlled study. Materials and Methods: The study included 30 children with chronic hepatitis C (Group 1; mean age 9.86 ± 2.22 years). Thirty healthy children age- and sex-matched were included as control group (Group 2; mean age 8.54 ± 2.31 years). Measurement of thyroid stimulating hormone (TSH), free thyroxine (FT 4 ), and free triiodothyronine (FT 3 ), as well as anti-thyroid peroxidase antibodies (TPO Ab) and anti-thyroglobulin (Tg Ab) were done. Results: Mean TSH levels were significantly higher in the group 1 as compared to control (P < 0.001). Subclinical hypothyroidism was detected in 13.3% in the study group vs 3.3% in the control group (P < 0.001). Positive levels of TPO Ab and Tg Ab were found to be 23.3% and 13.3% in Group 1 compared with 6.6% and 3.3% in controls, respectively. We also observed a significant positive correlation between TSH levels and age, HCV duration, viral load, anti-TPO Abs, antiTg Abs, and negative correlation with FT4. Conclusions: Both subclinical hypothyroidism and thyroid autoimmunity are common in Egyptian children with chronic hepatitis C before interferon treatment.
  2,685 228 1
Infarcted papillary carcinoma of thyroid following fine needle aspiration
Muniyappa Usha, Krishnappa Rashmi, Muniyappa Sridhar, Rau Rangan Aarathi
September-December 2014, 11(3):124-126
Fine needle aspiration (FNA) is a well-established and safe method for the rapid diagnosis of palpable thyroid lesions. Serious complications after FNA are rare, but there is also an underestimation of complications because of record, selection, and publication bias. Most common post FNA related complications are in the form of hemorrhage and pain. Very little attention has been focused on tissue related changes resulting from FNA. FNA related tissue changes will alter the reporting in successful aspirations or during histopathological examination which may create confusion in reporting and successive treatment of the patient. Increased awareness regarding these secondary changes is required for the benefit of clinician, pathologist, and most important for successful management of the patient. We report a case of papillary carcinoma of thyroid diagnosed on FNA. Subsequent histopathological examination of the resected specimen revealed a completely infarcted tumor. However, correlating the FNA history and presence of ghost outlines of papillae a final diagnosis of papillary carcinoma was given.
  2,520 207 -
Pattern of thyroid carcinoma in Gizan region of Saudi Arabia
Subodh Banzal, Abhishek Singhai, Bhimsingh Shekhawat, PG Raman
September-December 2014, 11(3):108-110
Objective: To study the frequency, clinical features, and histopathological types of thyroid carcinoma in Gizan region of Saudi Arabia. Research Design and Methods: We analyzed the clinical features, laboratory data, histopathological reports, and outcome of 32 patients diagnosed with thyroid carcinoma out of 231 patients who underwent thyroidectomy at King Fahd Central Hospital (KFCH), Gizan and peripheral hospitals over a period of 6 years. Results: The papillary thyroid carcinoma (PTC) was present in 25 patients and follicular thyroid carcinoma (FTC) in 5 cases. Anaplastic cell variety was found in two cases. The mean (±SD) were significantly different (P = 0.015) when the groups with PTC and FTC were compared (43.1 ± 12.7 vs. 61.3 ± 15.4). Fine needle aspiration cytology (FNAC) was done in all 32 cases; it was negative in 11 cases. Conclusions: In Gizan, incidence of thyroid carcinoma is about 14% among total patients undergoing thyroidectomy. Painless thyroid nodule is the most common clinical feature. PTC is the most common variant. FNAC is a useful tool for diagnosis but it can be false negative also.
  2,349 264 1
Image findings of a false positive radioactive I-131 uptake mimicking metastasis in pulmonary aspergillosis identified on Single photon emission computed tomography-computed tomography
Koramadai Karuppusamy Kamaleshwaran, Joppy Antony, Edathuruthy Kalarickal Radhakrishnan, Ajit Sugunan Shinto
September-December 2014, 11(3):111-112
High doses of iodine-131 (I-131) are commonly used in patients with differentiated thyroid cancer (DTC) after total or subtotal thyroidectomy, in order to ablate the remaining cancer or normal thyroid tissue. Multiple different false-positive scans can occur in the absence of residual thyroid tissue or metastases. The authors present a case of abnormal uptake of radioactive iodine in the Aspergilloma, potentially masquerading as pulmonary metastases.
  2,378 218 -
A primary retrosternal goiter successfully managed via a cervical approach
Arvind Krishnamurthy
September-December 2014, 11(3):136-137
  1,875 170 1