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   2017| September-December  | Volume 14 | Issue 3  
    Online since October 9, 2017

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Recurrent hypoglycemia: An unusual finding of hypothyroidism
Tek Chand Yadav, Jaikrit Bhutani, Manisha Upadhyay, SK Raghunandan
September-December 2017, 14(3):127-129
Hypothyroidism is one of the most prevalent endocrine disorders in the world, with a sharp rising incidence. The evaluation of recurrent hypoglycemia in the light of hypothyroidism still remains a major diagnostic challenge for most clinicians. We report a rare case of hypothyroidism presenting as recurrent hypoglycemia with relative adrenal insufficiency. Blunting of hypophyseal–pituitary–adrenal axis, pituitary dysfunction, delayed gastric emptying, decreased production and effect of glucagon on hepatocytes, reduced insulin clearance, gluconeogenesis, and glycogenolysis in patients with hypothyroidism may be the plausible mechanisms of hypoglycemia in such individuals. This will enable clinicians to consider thyroid dysfunction while evaluating causes of hypoglycemia in individuals without diabetes mellitus or treating unexplained hypoglycemic episodes in individuals with diabetes.
  21,751 458 1
Congenital hypothyroidism - An Indian perspective
Ambika G Unnikrishnan, Upal Vyas
September-December 2017, 14(3):99-105
Congenital hypothyroidism (CH) is a preventable cause of mental retardation in neonates. In India, CH is compounded by a lack of efficient newborn screening (NBS) programs, nonavailability of infrastructure, and the rising cost of health care. This review focuses on NBS techniques for early detection of CH, along with management strategies in the Indian scenario. Guidelines recommend measuring thyroid-stimulating hormone (TSH) or thyroxine (T4) levels or combined TSH and T4 as an ideal approach for screening CH within 2–4 days after birth. In preterm and low birth weight neonates, additionally, after 2–4 weeks, a follow-up screening has been suggested. If laboratory test is positive, a noninvasive scintigraphy and/or ultrasound has also been suggested as additional test to identify underlying etiology. Levo-T4 (L-T4) has been recommended as the first-line treatment with an initial standard dose of 10–15 μg/kg/day, based on the disease severity; with regular follow-up, up to 3 years of age. Although L-T4 tablet form is the standard of care in many developing countries like India, liquid formulations of L-T4 have been found to possess some additional beneficial effects. In summary, the government or policymakers should encourage mandatory cost-effective NBS for the early detection and treatment of CH.
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Brig. Santosh Kumar Mazumdar Father of nuclear medicine in India
Rashmi Aggarwal, Pradeep Chugh, Sanjay Kalra
September-December 2017, 14(3):95-96
Brig. Santosh Kumar Mazumdar is rightly called the Father of nuclear medicine in India as he pioneered the use radioactive iodine for the management of hyperthyroidism back in 1959 when he treated ten hyperthyroid patients with I 131 at Safdarjung Hospital that was before the inception of Institute of Nuclear Medicine and Allied Sciences (INMAS). Today, INMAS is a famous tertiary care center for the management of thyroid disease and all credit goes to Brig. Santosh Kumar Mazumdar.
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Patients' instuction list for radioactive iodine I-131 treatment (for hyperthyroidism management)
Rashmi Aggarwal, Sanjay Kalra
September-December 2017, 14(3):122-123
This patient information guide sets out instructions for patients who plan to undergo radioactive iodine ablation for the management of uncontrolled hyperthyroidism. This information, shared in a reader-friendly format, will benefit both patients and health-care providers.
  4,480 354 1
Evaluating thyroid function in the clinical laboratory
Marlene A Tapper, Chanice A Francis, Lowell L Dilworth, Donovan A McGrowder
September-December 2017, 14(3):118-121
Background: Thyroid disorders are common in clinical medicine and laboratory confirmation is essential, especially in cases where overt signs and symptoms are absent. The measurement of thyroid-stimulating hormone (TSH) is recommended as the best indicator of thyroid function and is utilized along with thyroxine (T4) and in some circumstances triiodothyronine (T3). Aim: The aim is to evaluate the relationship between TSH and free T4 (FT4), and TSH and FT3. Methods: Thyroid function tests (TFTs) – TSH, FT4, and FT3 – performed in the Chemical pathology laboratory from February to December 2015 were retrieved from the laboratory information management system. Results were classified based on TSH results into suppressed, mildly suppressed, normal, mildly elevated and elevated, and correlated with FT3 and FT4 results. Results were also categorized as overt hyperthyroidism, subclinical hyperthyroidism, normal, subclinical hypothyroidism, overt hypothyroidism, and “others” and compared based on age and gender. Results: FT4 and FT3 correlate best with TSH at suppressed and elevated levels. Mean TSH was significantly higher in males than in females only in those with normal FT4 and TSH. TSH was significantly higher in the 41–60 age group, with females in this group having significantly higher levels as compared to males. Conclusions: There is an inverse correlation between FT4 and TSH, and FT3 and TSH, especially significant at suppressed and elevated levels of TSH. Highest TSH levels were observed in women in the 41–60 age cohort.
  4,161 272 -
The dead indeed tell tales
Krishna G Seshadri
September-December 2017, 14(3):93-94
  2,718 1,369 -
Cystic parathyroid adenoma mimicking thyroid adenoma: A rare case with review of literature
Arockia Silviya Irene, Krishna Biswas, Shivani Paruthi, Ashish K Mandal
September-December 2017, 14(3):124-126
Parathyroid cyst is one of the rare differential diagnosis of cystic neck mass. It is often mistaken as a thyroid swelling. Functional parathyroid cyst secretes parathyroid hormone producing hypercalcemia. Here, we report a case of cystic parathyroid adenoma, which was mistaken as thyroid adenoma and operated upon. Reevaluation of the pathology specimen has given clue to the presence of parathyroid tissue. Ultrasonographic evaluation of cystic neck lesion by experienced radiologist and technetium 99m sestamibi scan helps in the diagnosis. Biochemical evaluation for hyperparathyroidism should be done in all such suspected cystic neck lesion as they may be asymptomatic for hypercalcemia.
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Thyroid cancer and nodular goiter of thyroid: An analysis of patients in rural South Tamil Nadu
Johnsy Merla, Shantaraman Kalyanaraman
September-December 2017, 14(3):106-111
Background: The aim of the study was to analyze the profile of nodular goiters of thyroid presenting with thyroid cancers in a tertiary hospital in rural South India. Materials and Methods: This study was conducted for 2 years since 2010 in patients with thyroid enlargements. Patients with multinodular or solitary thyroid enlargements with ultrasonogram suspicious of malignancy, fine-needle aspirate suspicious of malignancy, or persons with clinical suspicious thyroid enlargements with equivocal ultrasonogram or cytology with or without symptoms of mass effect were selected for the study. The clinical, operative, cytological, and histological data were tabulated and statistically analyzed. Results: Of 522 patients analyzed, 91.57% were females and 67.62% were between 21 and 40 years. Nearly 17.04% presented with hypothyroidism, 15.13% with hyperthyroidism, and 67.82% patients were euthyroid. Of the 522 patients, 425 (81.42%) had nodular thyroid enlargements, of whom 224 (42.91%) had multinodular goiters (MNGs), 201 (38.51%) had solitary thyroid nodules (SNT), and 97 (18.58%) had diffuse thyroid enlargements. The malignant tumors were present in 105 patients with papillary carcinoma, 20 patients with follicular carcinoma, and 6 with medullary carcinoma, of whom 76 (33.93%) had MNG and 54 (26.87%) had SNT. Conclusion: Thyroid cancers are best diagnosed through concerted clinical, radiological, cytological, and histological analyses. All nodules of thyroid, whether solitary or multinodular, should be sampled in fine-needle aspiration under radiological assistance and similarly all nodules need to be studied for malignancy in histopathology. In this study, we observed that the incidence rates of malignancy were higher than that of the existing Indian data and these patients were from the coastal regions of Tirunelveli and Thoothukudi districts. We also observed that multinodular goiters had microscopic malignant foci.
  3,503 263 1
A histopathological study of autopsied thyroid
Murari Mohan Das, Bhawna Bhutoria Jain, Biswajit Sukul, Sarbani Chattopadhyay
September-December 2017, 14(3):112-117
Introduction: To find the prevalence and frequency of different thyroid lesions, especially papillary carcinoma in our population, we conducted a histopathological study of thyroid glands obtained from medicolegal autopsy in cases with no obvious history of thyroid disease in our region. Methods: The study population comprised deceased undergoing medicolegal autopsy in police morgue under the Forensic Medicine Department of our institution over a period of 18 months. Thyroid gland was dissected out at the time of autopsy. Gross and histopathological findings of each specimen were documented in details. The data were collected, compiled, and tabulated, and statistical analysis was done using IBM SPSS version 20 software and Microsoft Office Excel 2007. Results: The total number of samples was 240. The mean age of the study participants was 42.35 years. About 60.4% were male, and 39.6% were female. Mean weight of thyroid was 34.08 g. In 56 cases (23.3%), single or multiple nodules were observed on cut section of thyroid. Minimum and maximum size of the nodules was 0.40 and 1.30 cm, respectively, with mean size of 0.74 cm in diameter. On microscopic examination, 54.6% of the cases were seen to be normal in histological examination while 45.4% had one or other histopathological changes. Among the nonneoplastic lesions, the most common lesions seen were nodular colloid goiter (20%) and lymphocytic thyroiditis (7.5%). Papillary thyroid carcinoma was seen in 5 (2.1%) cases. Among the five cases of papillary carcinoma, three cases had papillary microcarcinoma (<1 cm). All cases of papillary carcinoma showed strong diffuse reactivity with cytokeratin-19 immunostain.
  2,995 267 -
Preconception advice to hyperthyroid women
Rashmi Aggarwal, Sanjay Kalra
September-December 2017, 14(3):97-98
Uncontrolled or untreated hyperthyroidism in pregnancy may have adverse outcomes both in mother as well as her fetus. The mother is at increased risk of miscarriage, abruptio placentae, heart failure, and thyroid storm. The neonate is at increased risk of still birth or developing fetal and neonatal hyperthyroidism. Women with Graves' disease or those suffering from any other causes of hyperthyroid should be given reassurance and preconception advice before their becoming pregnant. Antithyroid drugs are the main therapy for maternal hyperthyroidism. This article shall focus on the choice of antithyroid medication that can be used in different trimesters of pregnancy. The patient should also be reminded to undergo thyroid function test in the postpartum period as well.
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A challenging case of neonatal hyperparathyroidism
Vivek Aggarwal, Manish Sahni, Neeraj Gupta, Deepak Khandelwal
September-December 2017, 14(3):130-132
Neonatal severe primary hyperparathyroidism (NSPHT) is rare disease in neonates, characterized by hypercalcemia, failure to thrive, skeletal demineralization and often multiple fractures. NSPHT induced hypercalcemia is often refractory to conventional medical therapy and may demand technically challenging surgery. We herein report a case of a neonate with NSPHT, due to novel mutation, who failed medical therapy including calcimimetics and underwent total parathyroidectomy with tracheostomy in our setup.
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Encephalopathy associated with autoimmune thyroid disease in an 11-year-old girl, a rare clinical presentation
Mahmood Dhahir Al-Mendalawi
September-December 2017, 14(3):133-133
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