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  Citation statistics : Table of Contents
   2015| May-August  | Volume 12 | Issue 2  
    Online since May 8, 2015

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Thyroid dysfunction associated with excess fluoride intakes: Scope for primary prevention
Sandeep Sachdeva, Juned Ahmed, Balbir Singh
May-August 2015, 12(2):50-56
Background: Preventable thyroid dysfunction has remained a neglected entity worldwide. Excess fluoride consumption over years leads to irreversible thyroid dysfunction. Materials and Methods: Subjects (N = 275) with thyroid dysfunction were recruited from medicine and endocrinology OPDs/wards and were thoroughly examined. The source and type of water consumed by these subjects was asked and sampled for fluoride analysis. Results: A majority (75%) of the subjects were females. Hypothyroidism including subclinical hypothyroidism was the major underlying dysfunction. Majority of the afflicted (53%) consumed ground water as their predominant drinking water source. Fluoride content was well above acceptable limits of potability (1mg/L) in ground water and this correlated positively with elevated serum thyroid stimulating hormone (TSH) and negatively with free T3 levels in blood. The correlation was statistically significant (P < 0.05). Conclusion: Excess of fluoride in drinking water was the plausible cause of hypothyroidism in study individuals. Fluoridation of water for prevention of dental caries is a policy that can be amended for the sake of this larger picture. Thyroid diseases deserve recognition as non-communicable diseases (NCDs) of public health importance.
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Status of Thyroid disorders at Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, India
Archana J Dhok, Prashant S Adole, Priti V Puppalwar, Udit Agrawal
May-August 2015, 12(2):62-66
Background: Thyroid disorders are amongst the most common endocrine diseases in India. Numerous studies from various countries differ in their prevalence estimates for both hypothyroidism and hyperthyroidism. There is however a paucity of data from the rural areas. The present study was conducted to find out the prevalence of thyroid disorders among the people of Wardha district of Maharashtra. Materials and Methods: This is the observational, retrospective study conducted in Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha. In total, 1905 patients visiting to hospital and suspecting of thyroid disorders were screened for thyroid function. Thyrotrophin (TSH), free triiodothyronine (FT3), and free tetraiodothyronine (FT4) in human serum were quantitatively estimated by a microplate immunoenzymetric assay. Results: Of the 1905 total subjects in the age range 10-80 years, 35.7% had thyroid dysfunction and 64.3% had euthyroidism; 21.7% had hypothyroidism (6.9% clinical, 14.8% subclinical); 2.3% had hyperthyroidism (1.1% clinical and 1.2% subclinical), while 11.6% had mildly suppressed TSH with normal FT4. Conclusion: The prevalence of clinical (75%) and subclinical hypothyroidism (71%) and clinical (66%) and subclinical (70%) hyperthyroidism was high in the 21-50 year age group with decreasing trend towards end. Also, the prevalence of mildly suppressed TSH was high in the 21-50 year age groups, which is 65%. This means that major burden of thyroid disorders is on reproductive age groups. This problem must be addressed immediately to avoid deleterious effect of abnormal thyroid dysfunction on the patients as well as on their offspring.
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Savior turning into destroyer: An interesting case of destructive thyroiditis
Faiz M H Ahmad, Sandeep Kumar, K V S Hari Kumar
May-August 2015, 12(2):74-76
Rituximab is a monoclonal antibody directed specifically against the CD20 resulting in depletion of B lymphocytes. Rituximab is used in multiple autoimmune disorders across the medical specialties including multiple sclerosis, myesthenia grevis, rheumatoid arthritis and inflammatory bowel disease. In the field of endocrinology, rituximab is indicated specifically in resistant cases of Graves' opthalmopathy. We recently encountered a patient of multiple sclerosis, developing features of destructive thyroiditis after a course of rituximab and report the same here.
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Cytomorphology of Warthin-like variant of papillary thyroid carcinoma
Flora D Lobo, Murali Nirupama, Radha R Pai, Anand U Kini
May-August 2015, 12(2):80-82
Warthin-like variant of papillary thyroid carcinoma (PTC) is one of the several variants of papillary thyroid cancer. A 36-year-old female came with history of thyroid swelling. Ultra sound showed a solid nodule in the right lobe. Thyroid profile was within normal limits. Fine needle aspiration cytology (FNAC) revealed papillary carcinoma in a background of lymphocytic thyroiditis. Patient underwent thyroidectomy. Histopathology proved it to be Warthin-like variant of PTC with nodal metastasis. This uncommon variant behaves in an indolent fashion. However, our case is unique as it showed nodal metastasis. Cytodiagnosis is challenging with rare reports of cases diagnosed on FNAC. Herein we document cytomorphology of this uncommon variant reported at our institution.
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Thyroid cancer: Controversy about over-diagnosis versus the perils of underdiagnosis
Ambika Gopalakrishnan Unnikrishnan, Anjali Amit Bhatt
May-August 2015, 12(2):43-45
  1 3,413 414
Primary cavernous hemangioma of thyroid: A rare entity
Bhumika Gupta, Ashok K Gupta, Alok Rathi, Amanjit Bal
May-August 2015, 12(2):77-79
Primary hemangioma of thyroid gland is a rare entity. Preoperative diagnosis of primary thyroid hemangioma is difficult. High level of suspicion is required if the preliminary investigations are inconclusive. We here present a case of 62-year-old female who presented with a left-sided thyroid swelling with a preoperative diagnosis of colloid goiter and was diagnosed as hemangioma after surgery.
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Life threatening ANCA associated vasculitis on Carbimazole exposure
Vimal Upreti, Shrikant Somani, Narendra Kotwal, DS Bhakuni
May-August 2015, 12(2):71-73
ANCA-associated vasculitis is a rare side effect of commonly used thionamide group of anti-thyroid drugs. It is most commonly associated with use of propylthiouracil and p-ANCA positivity. However, rarely it has been reported with carbimazole exposure and c-ANCA positivity. Here we report a case of life-threatening episode of c-ANCA-associated vasculitis in a female patient of Graves' disease on exposure to carbimazole, who was managed successfully by discontinuation of carbimazole and immunosuppressive therapy. A high index of suspicion is required for diagnosing such cases, who if not diagnosed correctly, may have adverse outcome.
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Tattooing as a therapy for goiter
Deep Dutta, Satinath Mukhopadhyay
May-August 2015, 12(2):83-83
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Thyroid status of the pregnant women of Manipur: A comparison of American Thyroid Association guidelines and normal laboratory reference range
Felix K Jebasingh, Ranabir Salam, Trinity Laishram Meetei, Nabakishore Naorem Singh, Lallan Prasad
May-August 2015, 12(2):67-70
Gestation is the period when the thyroid function parameters undergo several changes. As the range of thyroid hormone levels differ in the gestational period due to the various physiological changes, the hormonal range, which is used for the normal population cannot be used for pregnant women. Our study was done to find the thyroid status of pregnant women by comparing the trimester specific range as published by American Thyroid Association (ATA) guidelines with the normal population/laboratory reference range. A total of 377 patients with a distribution of 110,149 and 118 among the trimesters were studied. One patient each in first and second trimester had overt hypothyroidism when trimester specific reference range as published by ATA was followed. The prevalence of subclinical hypothyroidism as per ATA guidelines were 34.4, 31.5 and 30.5%, in the respective trimesters. The prevalence of subclinical hypothyroidism on taking into account the normal laboratory reference range of 3.6, 2.6 and 6.8% in the respective trimesters. Overt hypothyroidism was seen, one each in the first and second trimester and 29.3% were misdiagnosed as normal patients in this study. It is inferred that large number of patients will be misdiagnosed as having normal thyroid function during pregnancy if the trimester specific reference range is not followed. Thus we conclude that the pregnancy reference range should be used to interpret the thyroid hormones in pregnancy to avoid the misdiagnosis, as thyroid hormones are necessary for the normal fetal brain development.
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Comparative Study of thyroidectomy wound closure using tissue glue versus subcuticular suture
Vinay V Rao, Caren D'Souza, Saurabh Kumar, Ashwin Kumar
May-August 2015, 12(2):46-49
Background: The purpose of this study is to compare closure of thyroidectomy incisions using octyl-cyanoacrylate (OCA) and traditional subcuticular suturing in terms of wound morbidity and patient satisfaction outcomes. Study Design: A prospective randomized study was performed on adult patients scheduled for thyroidectomy surgery in a tertiary referral center. Patients were randomized to have closure of thyroidectomy incisions using either OCA or subcuticular sutures. Patients were evaluated for scar appearance and pain at the operated site on 1 st and 3 rd postoperative week. Results: Seventy-four patients were enrolled in the study. They were randomly divided into two groups, group 1 (N-36): OCA was used and group 2 (N-38): Subcuticular sutures were used. Scar appearance was better and pain was relatively less in group 2 in early postoperative phase. Subjective sensation of pain at the operated site in the first postoperative week was more in patients in group 1, which was the only statistically significant finding (P value 0.010). Conclusion: OCA is as effective as conventional method of wound closure. Early postoperative changes of pain and appearance do not vary much. Cost is the major limiting factor in widespread usage.
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Study for optimal dose determination of levothyroxine in subclinical hypothyroidism in pregnancy
Semanti Chakraborty, Jayanta Chakraborty, Ankan Bandopadhay
May-August 2015, 12(2):57-61
Context: Subclinical thyroid dysfunction has been associated with pregnancy complications and affects both maternal and fetal outcomes such as impaired neuropsychological development in offspring and adverse obstetric outcomes-including miscarriage, premature birth, gestational hypertension, placental abruption, and fetal death. Endocrine Society guidelines recommend that all pregnant women with subclinical hypothyroidism be treated with Levothyroxine. The American Thyroid Association guidelines recommend that pregnant women with subclinical hypothyroidism and detectable thyroid-peroxidase antibodies receive Levothyroxine. But till date no authority has given any guideline about the initial dose of Levothyroxine. Aims: To formulate a dosage regime of levothyroxine which is optimal for urgent correction of hypothyroid state in pregnancy. Settings and Design: Prospective (longitudinal) study. Subjects and Methods: A total of 42 apparently normal pregnant women, with known last-menstrual period, with no known metabolic or hypertensive disorder who presented to the clinic had thyroid screening using a standardized method. Women with thyroid stimulating hormone (TSH) value in the range to be diagnosed as subclinical hypothyroidism were included in the study. All patients were followed-up till the time of delivery for the obstetric outcome. Levothyroxine was the mainstay of treatment. Levothyroxine dose were adjusted every trimester on the basis of thyroid function tests (TFTs) including free thyroxine (FT4) and TSH values. Anthropometric measurements included height and body weight at baseline. Statistical Analysis Used: Significance is assessed at 5% level of significance. Pearson and Spearmen correlation test used to find out correlation among normally and non-normally distributed data respectively. Analysis of variance (ANOVA) and Kruskal-wallis with distribution free multiple comparison test used to find the significance of study parameters between three or more groups of patients for normally distributed data and non-normally distributed data. Results: 81.25% of subjects achieved euthyroidism in third trimester. The mean levothyroxine dose used in the first trimester was 40.18 ± 13.78 μg. The mean levothyroxine dose used in the third trimester was 58.25 ± 18.57 μg. Significant increase in the mean dose of levothyroxine required in the third trimester (58.25 ± 18.57 μg) as compared to the first trimester (40.18 ± 13.78 μg, P = 0.0012). Conclusions: Significant improvement in the thyroid function as indicated by higher proportion of patients achieving normal TSH values with significant increase in the mean levothyroxine dose used during the course of treatment gives us guideline about the initial starting doses of levothyroxine.
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