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  Citation statistics : Table of Contents
   2016| May-August  | Volume 13 | Issue 2  
    Online since June 1, 2016

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Central sleep apnea in untreated hypothyroidism: A rare association
Sapna Erat Sreedharan, Pragati Agrawal, Ashalatha Radhakrishnan
May-August 2016, 13(2):83-85
Obstructive sleep apnea (OSA) has been reported with untreated hypothyroidism. Here, we report a young patient referred to us due to prolonged apneas detected during recovery from minor surgery done under a short-acting general anesthetic drug. Polysomnography (PSG) was suggestive of severe OSA with high central index. He was later found to have severe hypothyroidism. Thyroxine replacement for 3 months followed by a repeat PSG showed persisting severe OSA but with no central events. This case highlights the rare association of central sleep apnea in untreated hypothyroidism which can be easily overlooked.
  2 6,424 309
Thyroid ectopia is distinctly uncommon in Indian children with permanent congenital hypothyroidism due to dysgenetic glands
Devi Dayal
May-August 2016, 13(2):94-95
  2 2,013 195
Prevalence of hypothyroidism in common bile duct stone patients
Srinivas Sidduri, Babulreddy Hanmayyagari, Vivekanand Bongi, Mythili Ayyagari, Subramanyam Venkata
May-August 2016, 13(2):57-62
Background: Hypothyroidism affects bile content, bile flow, and functions of the sphincter of Oddi, thereby increases the formation of common bile duct (CBD) stones. The exact prevalence of hypothyroidism in CBD stone patients is not known. Objectives: The aims are: (1) To investigate the prevalence of undiagnosed thyroid dysfunction in CBD stone patients compared with controls, (2) Comparison of lipid parameters in CBD stone patients and healthy controls, (3) Comparison of lipid parameters in CBD stone patients with and without thyroid dysfunction. Materials and Methods: This study recruited 44 CBD stone patients diagnosed with endoscopic retrograde cholangiopancreatography (ERCP) (cases). The control group includes 33 age, sex, and body mass index (BMI) matched healthy people. The control group underwent ultrasonography to exclude any asymptomatic cholelithiasis. Fasting blood samples were taken from all participants for measurements of serum total thyroxine (T4), serum thyroid stimulating hormone (TSH), triglycerides (TG), total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Results: The mean values of TSH in cases and controls were 3.57 ± 1.7 and 2.58 ± 0.67, respectively (P value 0.0029). Subclinical hypothyroidism (SCH) found in 30% of cases compared with 9.09% of controls (P value < 0.05). In the CBD stone group, the prevalence of SCH was 36% in the patients older than 50 year compared to 22% in the less than 50 year age-group (P > 0.05). The prevalence of SCH was more in females (23%) compared with males (11%) (P > 0.05). There is a trend toward increase in the mean values of TC, LDL, and TG levels in cases compared to controls. There is a non-significant increase in mean HDL values in cases. On subanalysis of lipid parameters in CBD stone patients with and without thyroid dysfunction, there is a trend toward an increase in the mean TC and LDL-C in cases with SCH compared to those without SCH (P > 0.05). Conclusions: SCH was more common in the CBD stone patients compared with controls. SCH was more prevalent in CBD patients older than 50 years of age. Prevalence of SCH in CBD stone patients was more common in females compared to males. Dyslipidemia may be one of the contributing factors for increased CBD stone formation in SCH.
  2 4,333 350
Hearing impairment in children with permanent congenital hypothyroidism: Data from Northwest India
Devi Dayal, Nirmal Hansdak, Dharam Vir, Atul Gupta, Jaimanti Bakshi
May-August 2016, 13(2):67-70
Background: There is an increased risk of hearing impairment in permanent congenital hypothyroidism (CH). Only a few studies have explored the prevalence of hearing impairment in CH and their results vary widely. There is no data on hearing impairment in Indian children with CH. Setting and Design: Pediatric Endocrinology Clinic of a large tertiary care hospital located in Northwest India. Cross sectional study. Materials and Methods: Hearing evaluation of 77 children diagnosed with permanent CH was performed with a battery of tools that included Middle ear analysis, Pure Tone Audiometry (PTA), Behavioral Observation Audiometry (BOA) and Oto Acoustic Emissions (OAE). The choice of assessment tool was based on patient's age. Results: The mean age at diagnosis and at inclusion into the study was 3.0±2.7 years and 5.2±3.3 years respectively. The majority (63, 82%) of patients had symptoms suggestive of hypothyroidism; none complained of hearing loss. The etiological diagnosis was thyroid agenesis in 55 (71.4%), ectopia in 5 (6.5%), dyshormonogenesis in 9 (11.7%) and hypothyroidism with eutopic gland in 8 (10.3%) patients. Middle ear analysis, PTA, BOA and OAE was done in 48, 44, 43 and 53 patients respectively. Sensorineural hearing loss was detected in 1 out of 77 (1.2%) patients while conductive hearing loss was found in 5 (6.5%) patients. Conclusion: Hearing loss was present in a small proportion of patients with permanent CH. Further larger studies are required to determine the exact prevalence of hearing impairment in Indian children with permanent CH.
  2 3,917 326
Carcinoma showing thymus like differentiation (CASTLE) - A rare thyroid neoplasm
Vinod Raosaheb Patil, Keyuri Patel, Girish Muzumdar
May-August 2016, 13(2):71-73
Carcinoma showing thymus like differentiation (CASTLE) is a rare tumor involving soft tissues of the neck and the thyroid gland. It arises from ectopic thymus or remnants of branchial pouches in the neck. It may present as an asymptomatic neck or thyroid mass, which may or may not be invasive. Most cases follow an indolent course and have good prognosis. We report a case of 34-year-old female who presented with hoarseness of voice and mass in the neck. Surgical excision was done. Histopathology and immunohistochemistry (CD5 positivity) revealed carcinoma showing thymus like differentiation (CASTLE). No recurrence was noted after one year of follow-up.
  1 3,065 252
Iodized salt in India: Insights from National Family Health Survey-4
Arun Kumar, Sanjay Kalra, AG Unnikrishnan
May-August 2016, 13(2):49-51
  1 4,598 448
Serum thyroid stimulating hormone levels and suicidal tendency in patients with first-episode schizophrenia: An exploratory study
Amresh Shrivastava, Vidya Jadhav, Sagar Karia, Nilesh Shah, Avinash De Sousa
May-August 2016, 13(2):63-66
Background: Neuroendocrine hormones play an important role in emotional regulation in normal individuals and those suffering from mental disorders. The objective of the study was to examine levels of thyroid stimulating hormone (TSH) and the severity of psychopathology and suicidality in patients suffering from first episode schizophrenia (FES). Materials and Methods: In 60 patients of FES, the level of TSH was measured. The level of psychopathology was assessed using the positive and negative symptoms scale for schizophrenia (PANSS) while suicidal tendency was measured using The Scale for Impact of Suicidality-Management, Assessment, and Planning of Care (SIS-MAP). Results: We found that 21% patients were hospitalized with a suicide attempt within preceding 5 days. Mean TSH level was 5.7 mIU/L, which was slightly higher than cut-off point. There was no significant difference in TSH levels between those who had attempted suicide before the admission into the hospital and those who did not. Further, the level of TSH was not found to correlate with total PANSS score, positive symptoms or negative symptoms score but with global psychopathology scale. There was a positive correlation with TSH score and SIS-MAP score. Conclusions: The present study shows the presence of higher level of TSH in FES and an inverse correlation with suicide potential in patients suffering from schizophrenia. Further, it shows the presence of high suicide risk and possibility of hypothyroid state. The study argues more careful screening for suicide in patients with FES among patients who are admitted without and the attempt of suicide.
  1 3,620 298
Core needle biopsy: An additional diagnostic armamentarium
Shrikant Somani, Narendra Kotwal
May-August 2016, 13(2):52-56
Fine needle aspiration cytology (FNAC) is considered to be most effective and accurate diagnostic test to differentiate benign from malignant thyroid nodules and most guidelines recommend FNAC as the initial test. However, significant percentage of FNAC results are inconclusive owing to nodule characteristic, operator limitations, or limitations of the procedure itself. Core needle biopsy (CNB) in the evaluation of thyroid nodules have been performed since many decades; however, due to large bore needle, complication rates, and previous reports of inaccuracies, presently CNB has not been included by most guidelines in the diagnostic algorithm of thyroid nodules. Multiple recent studies have shown much higher rates of sensitivity, specificity, and accuracy using CNB in differentiating benign from malignant lesions, particularly when initial FNA is indeterminate, nondiagnostic or if there are discordant results between radiologic and cytologic tests or in nodules with macrocalcifications or fibrosis.
  1 3,819 311
Right lobar hemiagenesis with ectopic thyroid: A case report of a very rare entity
Anil Taneja, Sonal Sethi, Bindu Kulshreshtha, Imroz Sachdev
May-August 2016, 13(2):74-76
Developmental morphological abnormalities of the thyroid gland are very rare. Thyroid lobe hemiagenesis is a very rare abnormality, in which one thyroid lobe fails to develop. Ectopic thyroid is one of the common developmental anomalies of thyroid characterized by the presence of thyroid tissue in a site other than its usual. Of all, lingual thyroid is the most common manifestation of benign ectopic thyroid tissue, but it is still a rare clinical entity. Both of them seen together is even rarer. These developmental defects may or may not be associated with thyroid dysfunction. Ultrasonography (USG) is the initial modality of choice for thyroid hemiagenesis but further evaluation by computed tomography (CT) scan or nuclear scan should be done to look for other thyroid ectopic tissue rest. We report a case of right thyroid hemiagenesis with ectopic lingual thyroid in a 13-year-old female. To the best of our knowledge, only two similar cases in the world literature have been reported till date.
  - 3,114 227
Conservatively managed thyroglossal duct cyst carcinoma with lymph node metastasis: Long-term result
Ilker Burak Arslan, Ahmet Tugrul Eruyar, Murat Gumussoy, Selahattin Genc
May-August 2016, 13(2):77-79
Thyroid papillary carcinomas of thyroglossal duct cysts (TGDCs) are quite uncommon. Despite the identification of risk factors, the treatment course is controversial. A 34-year-old woman suffering sudden growth of a mass in the neck was clinically diagnosed TGDC. Ultrasonography and computed tomography (CT) showed irregular heterogeneous mass, with a large cystic component consisting of calcification and 7 × 6 mm solid smoothly contoured mass close to the left isthmus. Thyroid scintigraphy exposed normal thyroid gland uptake and a small cold nodule near the isthmus. Fine-needle aspiration cytology revealed signs of well-differentiated papillary TGDCs carcinoma. Sistrunk's procedure with an anterior neck dissection was performed. Postoperative histopathological examination revealed well-differentiated papillary carcinoma arising from thyroglossal cyst and lymph node metastasis. No further treatment was carried out and she was followed-up without recurrence for 44 months. A conservative procedure should be performed in well-differentiated papillary carcinoma of the TGDC.
  - 3,286 188
Scalp metastasis from follicular thyroid carcinoma diagnosed by fine needle aspiration cytology: A case series
Madhu Kumar, Aakanksha Singh, Sanjeev Mishra
May-August 2016, 13(2):80-82
The scalp metastasis of follicular thyroid carcinoma is a rare condition and the lesion should be differentiated from primary skin tumors. It account for 10–20% of all thyroid malignancies and is most commonly seen in female of 40–50 years of age. We present a case series of four cases showing cutaneous metastases from follicular thyroid carcinoma in patients presenting with a nodular thyroid mass and scalp swelling. Fine needle aspiration cytology (FNAC) of thyroid gland and scalp nodule, both shows repetitive microfollicles and clusters of follicular epithelial cells. The cases were diagnosed as scalp metastasis from follicular thyroid carcinoma on FNAC.
  - 5,316 250
Microfilaria in fine needle aspirate of thyroid nodule
Richa Bhartiya, Mahasweta Mallik, Nawanita Kumari, Manish Kumar
May-August 2016, 13(2):86-88
Filariasis is a major public health problem in tropical countries including India. About 90% of cases of lymphatic filariasis are caused by infection with Wuchereria bancrofti and rest by Brugia malayi in Southeast Asia. Filariasis is transmitted by the bite of Culex mosquitoes. The diagnosis of it is conventionally made by demonstrating microfilaria in the peripheral blood smear. Microfilaria have been incidentally detected in fine needle aspiration cytology smears from various sites. However, the presence of filarial worm in thyroid aspirate is unusual. We report a case in which aspiration cytology revealed presence of microfilaria in thyroid nodule.
  - 2,922 181
Diffuse coronary vasospasm in a patient with hypothyroidism
Altug Osken, Selcuk Yaylaci, Ercan Aydin, Tugba Kemaloglu Oz, Gokturk Ipek, Isil Atasoy, Regayip Zehir, Sennur Unal Dayi
May-August 2016, 13(2):89-91
Coronary vasospasm is an important etiology of ischemic heart disease. Sometimes thyroid disorders may be associated with cardiovascular disease. The major cardiovascular changes that occur in hypothyroidism include a decrease in cardiac output and cardiac contractility, a reduction in heart rate, and an increase in peripheral vascular resistance. There are also significant changes in modifiable atherosclerotic risk factors, including hypercholesterolemia, diastolic hypertension, carotid intimal media thickness, and endothelial derived relaxation factor (nitric oxide), which accompany overt hypothyroidism. Here, we present a case of diffuse coronary arterial vasospasm in a patient with hypothyroidism.
  - 4,080 236
Rare renal metastasis from a follicular carcinoma thyroid and its evaluation
Arvind Krishnamurthy
May-August 2016, 13(2):92-94
  - 2,097 177
Papillary carcinoma thyroid associated with Hashimoto's along with lymph node involvement
S Srikanth
May-August 2016, 13(2):95-97
  - 2,061 181
The butterfly in the neck
Tiny Nair
May-August 2016, 13(2):98-98
  - 1,946 197