Journal of thyroid disorders & therapy最新文献

{"title":"Ultrasound Imaging of Nodal Metastases in the Central Compartment in Thyroid Cancer: is it Possible to Increase Sensitivity","authors":"M. Hafez","doi":"10.4172/2167-7948.1000193","DOIUrl":"https://doi.org/10.4172/2167-7948.1000193","url":null,"abstract":"Background and Purpose: Ultrasound imaging criteria for cervical lymph nodes were set mainly to increase sensitivity. However, unlike the lateral neck compartment, the challenge in the central compartment is the low sensitivity of Ultrasonography. We performed this study to evaluate whether the sensitivity of Ultrasonography could be increased by considering any detected lymph node in the central compartment as malignant. \u0000 \u0000Methods: Forty one patients with differentiated thyroid cancer underwent dedicated pre-operative Ultrasonography by one radiologist for detection of metastatic lymph nodes in the central compartment. Any lymph node detected was considered positive regardless of Ultrasound morphologic criteria. All patients underwent thyroidectomy with central node dissection (CND), unilateral in 31 and bilateral in 10 cases, based on tumor size and laterality. Ultrasound imaging results were compared to histopathologic results. \u0000 \u0000Results: The number of true positive cases by Ultrasonography was 13, false negative cases 8, true negative 15 and false positive 5 cases. The sensitivity of US was 61.9%, the specificity 75%, the positive predictive value 72.2% and the negative predictive value 65.2%. \u0000 \u0000Conclusions: The sensitivity of Ultrasonography for detection of metastatic lymph nodes in the central compartment in patients with DTC may be increased, compared to previously published data, by considering every detected node as positive rather than using the routine criteria for lymph node metastases in other neck levels.","PeriodicalId":91565,"journal":{"name":"Journal of thyroid disorders & therapy","volume":"4 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2015-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70841118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synthetic or a Natural Thyroid Replacement: Should the Choice be Left to the Patient?","authors":"M. Gerdes, E. Yusupov","doi":"10.4172/2167-7948.1000E124","DOIUrl":"https://doi.org/10.4172/2167-7948.1000E124","url":null,"abstract":"Data from National Health and Nutrition Examination Survey (NHANES 1999-2002) reveals 3.7% prevalence of hypothyroidism in the general population [1]. 10.3 million People or 4.6% of those surveyed reported use of thyroid hormones (levothyroxine, liothyronine, or desiccated thyroid) [1]. Desiccated Thyroid Extract (DTE) of animal origin has been used to treat hypothyroidism since 1892 [2,3]. Several authors have previously raised questions about standardization of levothyroxine (T4) and L-triiodothyronine (T3) in thyroid extract [3]. The switch to a more expensive synthetic preparation, sodium L-thyroxine, had been advocated in the 1960’s [4].","PeriodicalId":91565,"journal":{"name":"Journal of thyroid disorders & therapy","volume":"4 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2015-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70842355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Diseases and Hepatitis C Chronic Infection","authors":"Aless, R. Antonelli","doi":"10.4172/2167-7948.1000E123","DOIUrl":"https://doi.org/10.4172/2167-7948.1000E123","url":null,"abstract":"More than 185 million subjects worldwide are infected by Hepatitis C virus (HCV), and about 20% of patients chronically infected with HCV progress to cirrhosis and 1-2% to hepatocarcinoma [1]. HCV chronic infection is also associated with extrahepatic manifestations in up to 74% of patients (mixed cryoglobulinemia, lymphomas, rheumatic disorders, type 2 diabetes, and thyroid disorders) [2]. For about two decades combination therapy with PEGylated-interferon-α [3] and ribavirin has been the standard of care for patients with HCV chronic infection; however, interferon had limited effectiveness and was associated with important adverse side effects. More recently, advances in understanding the molecular pathways associated with HCV life cycle, and the complex inflammatory network involving cytokines and chemokines associated with HCV chronic hepatitis, have led to important advancements in therapy [4]. In the last years, direct-acting antivirals (DAAs) (as protease inhibitors, polymerase inhibitors, or NS5A inhibitors) have been used to treat HCV chronic infection, resulting in shorter treatment duration, better efficacy and tolerance, and are able to eradicate HCV [5,6].","PeriodicalId":91565,"journal":{"name":"Journal of thyroid disorders & therapy","volume":"4 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2015-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2167-7948.1000E123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70842296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Hormone Replacement Therapy: More than Meets the Eye","authors":"A. Bhargava","doi":"10.4172/2167-7948.1000E122","DOIUrl":"https://doi.org/10.4172/2167-7948.1000E122","url":null,"abstract":"The treatment of hypothyroidism with thyroid hormone replacement therapy has been the standard of care for over a century. Levothyroxine (LT4) is and has been the cornerstone of this treatment paradigm [1]. It can be taken either orally or intravenously, with the latter route used only in select circumstances. The long serum half-life permits daily as well as weekly administration. Several brand names exist in the market, as well as other alternative forms of thyroid hormone replacement (i.e. thyroid hormone extracts and preparations of liothyronine [T3]) [2]. Faced with an increasing demand for alternative therapy and medication regimens that foster greater compliance, physicians are often confronted with the dilemma of sticking to conventional dosing or trying a different treatment modality/regimen. Therefore, it is imperative that we understand the data behind compounds like liothyronine, once a week levothyroxine or desiccated thyroid extracts, for that matter. This will aid in clinical decision-making and help determine the true place of these compounds in practice algorithms.","PeriodicalId":91565,"journal":{"name":"Journal of thyroid disorders & therapy","volume":"4 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2015-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70842231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Radiofrequency Ablation: Original Case Report","authors":"R. Cesareo","doi":"10.4172/2167-7948.1000191","DOIUrl":"https://doi.org/10.4172/2167-7948.1000191","url":null,"abstract":"Background: Radiofrequency ablation has been reported to be effective and safe in reducing benign thyroid volume nodules. Most studies carried out so far were performed on a limited number of large nodules and often a subset of them required more than one single treatment. Case report: We describe the case of 82-year-old woman with a very large volume thyroid nodule treated with a single session of thyroid radiofrequency ablation. After six months, the patient showed significant improvement of compression symptoms and significant volume reduction of 68% (from 152 mL to 48 mL). Methods: To our knowledge, this is the first case report so far that proves the effectiveness and safety of radiofrequency ablation in such a large thyroid nodule. Conclusions: Radiofrequency ablation is very effective technique for the percutaneous treatment of thyroid nodules. Further data are needed to define the effectiveness and the feasibility in treating large thyroid nodules.","PeriodicalId":91565,"journal":{"name":"Journal of thyroid disorders & therapy","volume":"4 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2015-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2167-7948.1000191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70841416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of T-Cell Prolymphocytic Leukemia/Lymphoma Suggested Thyroid Origin","authors":"N. Okuno","doi":"10.4172/2167-7948.1000190","DOIUrl":"https://doi.org/10.4172/2167-7948.1000190","url":null,"abstract":"Primary thyroid T-cell lymphoma is rare, with only 19 cases reported previously. T-cell prolymphocytic leukemia/ lymphoma (T-PLL) is a rare entity among T-cell lymphomas. T-PLL patients present with hepatosplenomegaly, lymphadenopathy, skin infiltration and a high leukocyte count, sometimes with anaemia and thrombocytopenia, but thyroid infiltration has been reported in only one other case. Here, we report an extremely rare case of T-PLL with foci seen in the thyroid gland and bone-marrow. Confirming the primary lesion was difficult, but the clinical and histopathological features suggest the thyroid gland as the primary lesion.","PeriodicalId":91565,"journal":{"name":"Journal of thyroid disorders & therapy","volume":"4 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2015-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2167-7948.1000190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70840712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Study of Sirolimus and Cyclophosphamide in Patients with Advanced Differentiated Thyroid Cancers.","authors":"Poorni M Manohar,&nbsp;Lauren J Beesley,&nbsp;Jeremy Mg Taylor,&nbsp;Elizabeth Hesseltine,&nbsp;Megan R Haymart,&nbsp;Nazanene H Esfandiari,&nbsp;David A Hanauer,&nbsp;Francis P Worden","doi":"10.4172/2167-7948.1000188","DOIUrl":"https://doi.org/10.4172/2167-7948.1000188","url":null,"abstract":"<p><strong>Background: </strong>We hypothesize that the combination of an mTOR inhibitor, sirolimus, with a well-known cytotoxic agent, cyclophosphamide, provides a well-tolerated and promising alternative treatment for advanced, differentiated thyroid cancers (DTC).</p><p><strong>Methods: </strong>This retrospective review extracted data from patients treated for advanced DTC at the University of Michigan Comprehensive Cancer Center from 1995 through 2013. Fifteen patients treated with combination sirolimus and cyclophosphamide were identified as the sirolimus+cyp group. Seventeen patients treated with standard of care and enrolled in clinical trials were identified as the comparison group.</p><p><strong>Results: </strong>The one-year progression free survival rate (PFS) was 0.45, 95% CI [0.26, 0.80] in the sirolimus+cyp population and 0.30, 95% CI [0.13, 0.67] in the comparison population. The hazard ratio for PFS from initiation of treatment was 1.47, 95% CI [0.57, and 3.78]. In patients treated as first line, one-year PFS rate was 0.57, 95% CI [0.30, 1.00] in the sirolimus+cyp group and relatively unchanged at 0.29, 95% CI [0.11, 0.74] in the comparison group. The hazard ratio for PFS for first line patients was 1.10, 95% CI[ 0.4, and 3.5]. In patients with 3 or fewer sites of metastases, the one year PFS was 0.58, 95% CI [0.33, 1.00] in the sirolimus+cyp group, and 0.37, 95% CI [0.17, 0.80] in the comparison group. The average number of toxicities was 0.87 in the sirolimus+cyp patients and 1.71 in the comparison group.</p><p><strong>Conclusions: </strong>The combination of sirolimus and cyclophosphamide was generally well tolerated with similar progression free survival, highlighting its applicability in patients with limited options.</p>","PeriodicalId":91565,"journal":{"name":"Journal of thyroid disorders & therapy","volume":"4 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2167-7948.1000188","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34312238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot testing of an Assessment tool of Otolaryngology Residents PerformingThyroid Surgery by Using the Global Rating of Thyroid Surgical Skills","authors":"K. Al-Qahtani","doi":"10.4172/2167-7948.1000189","DOIUrl":"https://doi.org/10.4172/2167-7948.1000189","url":null,"abstract":"Background: There is a pressing need to evaluate the performance of surgical resident in the operation theater objectively by using a structured assessment tool. This will eliminate the possibility of bias which might be a concern when the assessment is subjective. An Objective Structured Assessment of Technical Skills (OSTAT) based tool was tested using Global Rating of Thyroid Surgical Skills (GRTSS) in terms of feasibility, reliability and construct validly in evaluating otolaryngology head and neck surgery residents at various postgraduate years. Objectives: A prospective observational study using a global rating evaluation form developed in conjunction with the OSATS to assess the thyroid surgical skills of residents. The study was conducted in King Abdul Aziz University hospital, Riyadh, KSA. A total of 23 thyroid surgeries performed by 7 residents at three different levels were assessed. The participants’ scores were calculated as percentages and were entered using SPSS (Statistical Package for the Social Sciences, version 17.0) for reliability and construct validity measures. Methods: Construct validity was established by comparing senior and junior years (P<0.001, mean difference: 11.375, 95% confidence interval 6.25-16.49) and by comparing same residents in two different levels (P<0.005, mean difference: 18.8, 95% confidence interval 7.45-30.14). Proved reliability with a value of Cronbach alpha of 0.707. Conclusions: This pilot study has shown this tool to be a valid, feasible, and reliable instrument to assess the thyroidectomy surgical skills. Potential applications","PeriodicalId":91565,"journal":{"name":"Journal of thyroid disorders & therapy","volume":"4 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2015-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2167-7948.1000189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70840662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained Lower Incidence of Thyroid Cancer in West Cumbria, UK","authors":"L. Jonker","doi":"10.4172/2167-7948.1000187","DOIUrl":"https://doi.org/10.4172/2167-7948.1000187","url":null,"abstract":"Background: In recent years, incidences of thyroid cancer have increased in developed countries; one of the known risk factors for thyroid cancer is exposure to radioiodine. Previous research by Bowlt and Tiplady [5] has shown an inverse link between radioactive iodine levels contained in thyroid tissue of deceased inhabitants and the distance they lived from the Sellafield nuclear facility in Cumbria, UK. Objectives: The present study aimed to determine what thyroid cancer incidences were in the regional localities in Cumbria for the last decade. Methods: An ethics-approved retrospective cohort study in which age-standardised incidence of thyroid cancer per 100,000 population was compared between localities within Cumbria and with UK average figures. Conclusions: The present study shows that the apparent lower incidence of thyroid cancer in West Cumbria has persisted, although due to the limited number of thyroid cancers diagnosed, a statistically significant difference was not observed. Further research – potentially involving populations living near sources of radioiodine emission - is indicated to investigate if there are any mechanisms that underlie this apparent trend.","PeriodicalId":91565,"journal":{"name":"Journal of thyroid disorders & therapy","volume":"4 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2015-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70840593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Patient with Neuropsychiatric Manifestations and Thyrotoxicosis in a background of Lithium Toxicity","authors":"Arambewela Mh","doi":"10.4172/2167-7948.1000186","DOIUrl":"https://doi.org/10.4172/2167-7948.1000186","url":null,"abstract":"Neuropsychiatric manifestations are well known to occur in thyrotoxicosis. In many cases, these manifestations occur in conjunction with the systemic features of the disease, but may be the presenting symptom in some patients. We report on an elderly gentleman with, neuropsychiatric manifestations and thyrotoxicosis in the background of lithium toxicity who presented as a diagnostic dilemma. Case report: A-70 year old man awaiting coronary artery bypass graft was detected to have thyrotoxicosis with FT4 of 2.7 ng/l(0.7-1.8) and TSH levels of 0.03 μIU/mL (0.4-4.3). A Tc 99 thyroid scan showed <1% iodine uptake suggestive of thyroiditis. He had no prior history of thyroid disorders, but has had a recent coronary angiogram. He was commenced on thioamides, lithium and small doses of prednisolone. One week after initiation of medication he presented with ataxia, dysarthria, choreiform movements and altered level of consciousness following a bout of diarrhea and vomiting and was found to have elevated levels of lithium 2.57 mmol/l(0.6-1.2) with serum creatinine of 219 µmol/l(80-120). In spite of adequate hydration, hemodialysis and normalization of lithium levels he did not show any clinical improvement. Blood and cerebrospinal fluid analysis for a possible infectious etiology were negative. This prompted an alternative diagnosis of Hashimoto’s encephalopathy (HE). Treatment with high doses of steroids led to a remarkable clinical resolution. HE also known as steroid responsive encephalopathy associated with autoimmune thyroiditis is an autoimmune thyroid disease with neuropsychiatric manifestations. Although almost all cases of HE have positive thyroid antibodies, these were repeatedly negative in our patient. This case posed a diagnostic challenge in differentiating between acute lithium toxicity and thyroiditis with encephalopathy. The dramatic response to high dose steroids in the presence of negative thyroid antibody highlights the possible rare existence of an antibody negative steroid responsive encephalopathy associated with thyroiditis.","PeriodicalId":91565,"journal":{"name":"Journal of thyroid disorders & therapy","volume":"4 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2015-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2167-7948.1000186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70840905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}