Spectrum and Prevalence of Thyroid Diseases at a Tertiary Referral Hospital in Mogadishu, Somalia: A Retrospective Study of 976 Cases

Background. Thyroid disorder is one of the most common noncommunicable diseases worldwide and neglected public health issues in Somalia. The aim of the study thus was to investigate the thyroid disorders in patients attending to the largest tertiary referral hospital in Somalia. Methods. This retrospective study was conducted on patients admitted to the internal department of Somalia Mogadishu-Turkey Education and Research Hospital, Somali, between January 2017 and December 2019. Patients who were tested for thyroid function tests and had complete data were included. Patients with incomplete data and currently treated for any thyroid disorder were excluded from the study. Abstracted data including patients’ sociodemographic characteristics, thyroid function tests, and histopathological findings were retrieved from the hospital database system. Results. A total of 976 patients with thyroid disorders were enrolled, of whom 66.6% (n = 650) were female and 33.4% (n = 326) were male. The mean age of the patients was 47 ± 18.5 years. The majority of the patients were reported in the 31–50 (35.9%) age range. The most reported thyroid function disorders were 58.8% euthyroid sick syndrome followed by 15.4% hypothyroidism, 12.5% subclinical hypothyroidism, 7.6% hyperthyroidism, and 5.7% subclinical hyperthyroidism. The distribution of comorbidity indicated that 13.4% had diabetes mellitus, 10.4% had HIV, 4.9% had malaria, and 4.5% had HIV and malaria coinfection. Thyroid malignancies were detached in 22 (2.2%) patients including eleven papillary thyroid cancer, nine patients had follicular thyroid cancer, and two patients had differentiated thyroid cancer. Conclusions. Euthyroid sick syndrome was the most common type of thyroid disease in our setup. Hypothyroidism is the second most common, followed by subclinical hypothyroidism. Papillary thyroid cancer was the predominant histology among thyroid malignancies, followed by follicular thyroid cancer. This study revealed that thyroid diseases emerge as an important endocrine disorder encountered in Somali, necessitating a major public health response.

Download Full-text

Expression of Caveolin-1 Is Associated With Thyroid Function in Patients With Human Papillary Thyroid Carcinoma

Dose-Response ◽

10.1177/1559325820919330 ◽

2020 ◽

Vol 18 (2) ◽

pp. 155932582091933

Author(s):

Jingyi Zhang ◽

Dongxia Yan ◽

Lianping He ◽

Qing Zhang ◽

Shuang Wen ◽

...

Keyword(s):

Thyroid Cancer ◽

Epithelial Cells ◽

Thyroid Nodule ◽

Papillary Thyroid Cancer ◽

Thyroid Function ◽

Follicular Adenoma ◽

Papillary Thyroid ◽

Follicular Thyroid Cancer ◽

Caveolin 1 ◽

Potential Biomarker

Objective: The aim of this study was to evaluate the levels of caveolin-1 in thyroid follicular epithelial cells of papillary thyroid cancer, follicular thyroid cancer, and nonmalignant thyroid nodule benign follicular adenoma, as well as to explore the relationship between the levels of caveolin-1 and thyroid function. Methods: Thirty cases of papillary thyroid cancer, 10 cases of follicular thyroid cancer, 32 cases of nonmalignant thyroid nodule benign follicular adenoma, and 30 controls were enrolled in this study. Caveolin-1 expression in tissue specimens obtained from these cases was evaluated by immunohistochemistry and Western blotting. Results: Caveolin-1 expression in thyroid epithelial cells of patients with papillary thyroid cancer, particularly female patients, was significantly higher than that in patients with follicular thyroid cancer and nonmalignant thyroid nodule benign follicular adenoma ( P < .005). Serum thyroid-stimulating hormone (TSH) levels in the caveolin-1-positive expression group were lower than that in the caveolin-1-negative expression group, and the lowest expression of caveolin-1 was detected in tissues of patients with Graves’ disease. The serum TSH level was associated with caveolin-1 expression in thyroid epithelial cells. Conclusion: Caveolin-1 may participate in regulating thyroid function and is a potential biomarker of follicular thyroid cancer.

Download Full-text

DOES T STAGE AFFECT PROGNOSIS IN PATIENTS WITH STAGE IV B DIFFERENTIATED THYROID CANCER?

Endocrine Practice ◽

10.4158/ep-2019-0051 ◽

2019 ◽

Vol 25 (9) ◽

pp. 877-886 ◽

Cited By ~ 3

Author(s):

Mu Li ◽

Nitin Trivedi ◽

Chenyang Dai ◽

Rui Mao ◽

Yuning Wang ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Univariate Analysis ◽

Stage Iv ◽

Papillary Thyroid ◽

Follicular Thyroid Cancer ◽

Cancer Specific Survival ◽

T Stage

Objective: Differentiated thyroid cancer (DTC), the most common subtype of thyroid cancer, has a relatively good prognosis. The 8th edition of the American Joint Committee on Cancer (AJCC) pathologic tumor-node-metastasis (T [primary tumor size], N [regional lymph nodes], M [distant metastasis]) staging system did not take the T stage into consideration in stage IV B DTC patients. We evaluated the prognostic value of the T stage for advanced DTC survival. Methods: DTC cases that were considered stage IV B in the AJCC 8th edition were extracted from the Surveillance, Epidemiology, and End Results database. T stage (AJCC 6th standard) was categorized into T0–2, T3 and T4. We analyzed overall survival (OS) and cancer specific survival (CSS) in the overall group as well as in pathologic subgroups. We used the Kaplan-Meier method and log-rank test for univariate analysis and the Cox regression model for multivariate analysis. Results: A total of 519 cases were extracted. Patients with earlier T stages showed significantly better OS and CSS in univariate analysis. T stage was an independent prognostic factor for both OS and CSS in multivariate analysis. Subgroup analysis in papillary and follicular thyroid cancer showed that T4 was an independent prognostic factor for both OS and CSS. Conclusion: AJCC 8 stage IV B DTC patients could be further stratified by T stage. Further studies with larger samples and AJCC 8 T stage information are necessary. Abbreviations: AJCC = American Joint Committee on Cancer; CI = confidence interval; CSS = cancer specific survival; DTC = differentiated thyroid cancer; FTC = follicular thyroid cancer; FVPTC = follicular variant of papillary thyroid carcinoma; HR = hazard ratio; OS = overall survival; PTC = papillary thyroid cancer; SEER = surveillance, epidemiology, and end results database

Download Full-text

Thyroid Cancer - Changing Patterns of Diagnosis and Treatment

US Endocrinology ◽

10.17925/use.2005.00.01.62 ◽

2005 ◽

Vol 00 (01) ◽

pp. 62

Author(s):

Ernest L Mazzaferri

Keyword(s):

Thyroid Cancer ◽

Thyroid Hormone ◽

Differentiated Thyroid Cancer ◽

Mortality Rates ◽

Papillary Thyroid ◽

Follicular Thyroid Cancer ◽

Thyroid Follicular Cell ◽

Changing Patterns ◽

Hürthle Cell Thyroid Cancer ◽

Tumor Types

Thyroid cancer is the most common endocrine malignancy. It comprises several distinct tumor types; including papillary thyroid cancer (PTC); follicular thyroid cancer (FTC); and Hürthle cell thyroid cancer (HTC), which are tumors of the thyroid follicular cell derived from the embryonic foregut. They ordinarily concentrate iodine and sometimes synthesize and secrete thyroid hormone, and for this reason are collectively referred to as differentiated thyroid cancer (DTC). The three tumor types represent 80%, 11%, and 3% of all thyroid cancers, respectively, and have 10-year mortality rates of approximately 7%, 15%, and 25%, respectively.1

Download Full-text

Incidental Diffuse Sclerosing Variant Papillary Thyroid Cancer in Grave’s Disease

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1820 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A891-A892

Author(s):

Nicolle Canales ◽

Yadiel Rivera Nieves ◽

Nydia Ivette Burgos Ortega ◽

Janet Marie Colon Castellano ◽

Nicole Hernández Cordero ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Total Thyroidectomy ◽

Papillary Thyroid Cancer ◽

Outpatient Basis ◽

Thyroid Function Tests ◽

Papillary Thyroid ◽

Diffuse Sclerosing Variant

Abstract The diffuse sclerosing variant papillary thyroid carcinoma (DSPTC) is an uncommon form of this neoplasm. Some studies describe its high propensity for tumor invasion, metastasis, and mortality compared with classic papillary thyroid carcinoma. Histologic features of DSPTC may resemble diffuse inflammation as seen with Grave’s or Hashimoto’s thyroiditis, which makes initial diagnosis challenging. A 27-year-old female with Noonan’s Syndrome was evaluated on an outpatient basis after developing atrial fibrillation de novo. Thyroid function tests were consistent with hyperthyroidism with TSH: <0.005 (n: 0.300-3.000 uIU/mL), FT4: 3.59 (0.71-1.85 ng/mL) and FT3: 16.77 (n: 2.0-7.0 pmol/L). Diffuse goiter was noted on physical exam, but no ophthalmopathy or dermopathy was present. TRAB and TSI were elevated at 38.4 (n: <16%) and 423% (n: <140%) respectively. A twenty-four-hour radioiodine uptake was 48% (n:10-35%) and described as essentially homogenous with two foci of decreased radiotracer concentration suggestive of cold nodules. Thyroid ultrasound showed diffuse nodularity bilaterally with associated clusters of calcifications and no discrete nodules. No abnormal appearing lymph nodes were identified. Fine-needle aspiration of both nodular areas was positive for DSPTC. Total thyroidectomy with central neck dissection was performed. Gross and microscopic post-surgical pathology confirmed the presence of diffuse sclerosing papillary thyroid cancer, along with local metastasis to one central lymph node. Patient was scheduled for radioactive iodine therapy. Diffuse sclerosing variant is considered an aggressive histotype of papillary thyroid cancer. Ultrasound features include diffuse scattered microcalcifications with or without discrete nodules that may be confused with chronic inflammatory changes. Despite the limited number of cases, DSPTC is recognized to have specific characteristics, a high female to male ratio, and a young patient age. DSPTC has a high potential for aggressive biologic behavior if not treated promptly at the time of diagnosis. When suspected, total thyroidectomy with lymph node excision followed by radioiodine therapy has been proposed as the correct management to decrease the risk of persistent or recurrent disease.

Download Full-text

Determinants of deranged thyroid function parameters in children admitted for management of diabetic ketoacidosis/diabetic ketosis

10.21203/rs.3.rs-21868/v2 ◽

2020 ◽

Author(s):

Peng Shao ◽

Shujuan Guo ◽

Guimei Li ◽

Daogang Qin ◽

Sen Li ◽

...

Keyword(s):

Diabetic Ketoacidosis ◽

Thyroid Function ◽

Glycosylated Hemoglobin ◽

Overt Hypothyroidism ◽

Thyroid Function Tests ◽

Hydroxybutyric Acid ◽

Free T4 ◽

Free Thyroid Hormones ◽

Euthyroid Sick Syndrome ◽

Diabetic Ketosis

Abstract Background: Sick euthyroid syndrome is frequent in children admitted with diabetic ketoacidosis/diabetic ketosis (DKA/DK). This study evaluates the interplay of various metabolic factors with occurrence of deranged thyroid function tests in children admitted for management of DKA/DK.Methods: 98 DKA and 96 DK children patients were selected from hospital records, among which individuals on thyroxine replacement, with overt hypothyroidism or positive anti-thyroperoxidase (TPO) antibody were excluded. Tests for liver function, renal function, lipid profile, serum osmolarity, thyroid function, c-peptide levels, and glycosylated hemoglobin were done for all. Children were divided into euthyroid (n=88) and euthyroid sick syndrome（ESS）groups (n=106).Results: The ESS group had a higher level of white blood cell count (WBC), plasma glucose (PG), beta-hydroxybutyric acid (β-HB), triglyceride (TG), anion gap (AG), glycosylated hemoglobin (HbA1c) and a lower level of HCO3-, prealbumin (PA), and albumin (ALB) compared with the euthyroid group (P<0.05). Free T3 (FT3) levels were significantly correlated to β-HB, HCO3-, AG, PA, and HbA1c (r=-0.642, 0.681, -0.377, 0.581, -0.309, respectively; P<0.01). Free T4 （FT4） levels were significantly correlated to β-HB, HCO3-, and ALB levels (r=-0.489, 0.338, 0.529, respectively; P<0.01). TSH levels were significantly affected by HCO3– only (r=-0.28; P<0.01). HCO3– level was the most important factor deciding euthyroid or ESS on logistic regression analysis (OR=0.844, P=0.004, 95%CI=0.751-0.948).Conclusions: Lower levels of free thyroid hormones and occurrence of ESS were associated with a higher degree of acidosis in children with DKA/DK.

Download Full-text

The Independent Association of TSH and Free Triiodothyronine Levels With Lymphocyte Counts Among COVID-19 Patients

Frontiers in Endocrinology ◽

10.3389/fendo.2021.774346 ◽

2022 ◽

Vol 12 ◽

Author(s):

David Tak Wai Lui ◽

Chi Ho Lee ◽

Wing Sun Chow ◽

Alan Chun Hong Lee ◽

Anthony Raymond Tam ◽

...

Keyword(s):

Thyroid Function ◽

Linear Regression Analysis ◽

Thyroid Stimulating Hormone ◽

Thyroid Function Tests ◽

Thyroid Disorder ◽

Free Triiodothyronine ◽

Protein Levels ◽

Pituitary Thyroid Axis ◽

Independent Association ◽

Positive Correlations

BackgroundBoth lymphopenia and thyroid dysfunction are commonly observed among COVID-19 patients. Whether thyroid function independently correlates with lymphocyte counts (LYM) remains to be elucidated.MethodsWe included consecutive adults without known thyroid disorder admitted to Queen Mary Hospital for COVID-19 from July 2020 to April 2021 who had thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3) and LYM measured on admission.ResultsA total of 541 patients were included. Median LYM was 1.22 x 109/L, with 36.0% of the cohort lymphopenic. 83 patients (15.4%) had abnormal thyroid function tests (TFTs), mostly non-thyroidal illness syndrome (NTIS). Patients with lymphopenia had lower TSH, fT4 and fT3 levels than those without. Multivariable stepwise linear regression analysis revealed that both TSH (standardized beta 0.160, p<0.001) and fT3 (standardized beta 0.094, p=0.023), but not fT4, remained independently correlated with LYM, in addition to age, SARS-CoV-2 viral load, C-reactive protein levels, coagulation profile, sodium levels and more severe clinical presentations. Among the 40 patients who had reassessment of TFTs and LYM after discharge, at a median of 9 days from admission, there were significant increases in TSH (p=0.031), fT3 (p<0.001) and LYM (p<0.001). Furthermore, patients who had both lymphopenia and NTIS were more likely to deteriorate compared to those who only had either one alone, and those without lymphopenia or NTIS (p for trend <0.001).ConclusionTSH and fT3 levels showed independent positive correlations with LYM among COVID-19 patients, supporting the interaction between the hypothalamic-pituitary-thyroid axis and immune system in COVID-19.

Download Full-text

Follicular thyroid carcinoma

Acta chirurgica iugoslavica ◽

10.2298/aci0303107k ◽

2003 ◽

Vol 50 (3) ◽

pp. 107-111

Author(s):

Ksenija Krgovic ◽

Ivan Paunovic ◽

Aleksandar Diklic ◽

Vladan Zivaljevic ◽

Svetislav Tatic ◽

...

Keyword(s):

Thyroid Cancer ◽

Surgical Treatment ◽

Adjuvant Therapy ◽

Follicular Thyroid Carcinoma ◽

Cytological Diagnosis ◽

Papillary Thyroid ◽

Thyroid Malignancy ◽

Follicular Thyroid Cancer ◽

Advanced Phase ◽

Risk Of Relapse

Follicular thyroid cancer is the second most common thyroid malignancy. This tumor has a predisposition for hematogenous dissemination an extrathyroid spread. Accurate cytological diagnosis of follicular thyroid cancer is not possible and this fact highlights the necessity for surgical treatment of any suspicious thyroid nodule. Aggressiveness of this tumor is greater than in the case of papillary thyroid cancer and it is the reason for radical surgical treatment of follicular thyroid cancer. Total thyroidectomy facilitates later adjuvant therapy with thyroid hormones and radioiodine. This procedure improves the outcome and the risk of relapse. Results of our study clearly demonstrate that diagnosis of follicular thyroid cancer in us is established in the early phase of the disease (78.57%), but the significant number of the patients (21.43%) is still in the advanced phase of the disease.

Download Full-text

MON-501 Physician-Reported Misuse of Thyroid Ultrasound

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.460 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Debbie W Chen ◽

David Reyes-Gastelum ◽

Archana Radhakrishnan ◽

Ann S Hamilton ◽

Kevin C Ward ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Function ◽

Categorical Variables ◽

Thyroid Function Tests ◽

Thyroid Antibodies ◽

Thyroid Ultrasound ◽

Patient Request ◽

The Past ◽

Function Tests ◽

General Surgeons

Abstract BACKGROUND: Over the past four decades, there has been a substantial increase in the incidence of thyroid cancer with studies suggesting that greater use of thyroid ultrasound contributes to the rise in incidence. However, little is known about physician reported practice patterns on ultrasound use. Methods: Patients diagnosed with differentiated thyroid cancer in 2014–15 from the Surveillance, Epidemiology and End Results registries of Georgia and Los Angeles were surveyed and asked to identify the surgeon who performed their thyroid surgery, and the endocrinologist and other doctors most involved in their thyroid cancer treatment decision making. We surveyed all physicians identified by more than one patient, and a random sample of physicians identified by one surveyed patient (N=610; 65% response rate). Surveyed physicians were asked to identify the clinical scenarios in which they would schedule a thyroid or neck ultrasound. We generated descriptive statistics for all categorical variables and used multivariable logistic regression to identify factors associated with thyroid ultrasound misuse. Results: The cohort consisted of primary care physicians (PCPs; N=162), endocrinologists (N=176), otolaryngologists (N=130), and general surgeons (N=134). In addition to physicians reporting ultrasound use for accepted reasons such as palpable nodule on exam (98%), large goiter (92%), and nodule seen on other imaging test (88%), a substantial number of physicians endorsed ultrasound use for clinically unsupported reasons: patient request (33%); abnormal thyroid function tests (28%); and positive thyroid antibodies (22%). In multivariable analysis, compared to PCPs, endocrinologists, otolaryngologists, and general surgeons were significantly more likely to schedule an ultrasound in response to patient request (odds ratio (OR) 2.52, 95% confidence interval (CI) 1.27–5.11; OR 2.98, 95% CI 1.57–5.79; OR 2.14, 95% CI 1.17–3.97, respectively). Physicians in private practice were more likely to schedule an ultrasound for abnormal thyroid function tests (OR 2.44, 95% CI 1.33–4.73) and positive thyroid antibodies (OR 2.47, 95% CI 1.27–5.21) compared to those in academic medical centers. Physicians who managed ten patients or less, compared to more than 50 patients, with thyroid nodules in the past 12 months were less likely to schedule an ultrasound for positive thyroid antibodies (OR 0.43, 95% CI 0.19–0.95). Conclusion: Physicians report scheduling thyroid ultrasound for reasons not supported by clinical guidelines and in conflict with the Choosing Wisely recommendations. Understanding why physicians use thyroid ultrasound and factors that correlate with clinically unsupported reasons is essential to creating targeted educational interventions to improve physician adherence to guidelines, reduce unnecessary imaging, and curb the overdiagnosis of low-risk thyroid cancer.

Download Full-text

VAIKŲ SKYDLIAUKĖS VĖŽYS PO PERSIRGTOS ONKOLOGINĖS LIGOS

Medicinos teorija ir praktika ◽

10.15591/mtp.2015.016 ◽

2015 ◽

Vol 21 (2.1) ◽

pp. 110-116

Author(s):

Ingrida Albužytė ◽

Gražina Lingė ◽

Gražina Mickunaitienė ◽

Gražina Kleinotienė ◽

Jelena Rascon

Keyword(s):

Thyroid Cancer ◽

Thyroid Gland ◽

Old Age ◽

Age Group ◽

Papillary Thyroid ◽

Thyroid Malignancy ◽

Follicular Thyroid Cancer ◽

Carcinogenic Effect ◽

Pediatric Malignancy

Thyroid cancer is a rare disease in children. Approximately 5 to 6 children in Lithuania are diagnosed thyroid malignancy each year. According to Thyroid Cancer Survivors‘ Association papillary and follicular thyroid cancer accounts approximately for only 1 percent of all paediatric cancers in the 5–9 year old age group and up to 7 percent of cancers in 15–19 year old age group. Thyroid gland in children is more sensitive to the carcinogenic effect of ionizing radiation than in adults. Damage to the thyroid gland after the first paediatric malignancy is usually the result of radiation to the head or neck area. Regular follow-up after the first oncological disease is essential to identify thyroid lesions early so that the proper treatment can be initiated. Fortunately, the prognosis is excellent for the most cases of paediatric thyroid cancer, even if there is metastatic disease at diagnosis. In this article we aimed to review pathogenesis, risk factors and prognosis of the second thyroid cancer following cure for the first pediatric malignancy. We report also a clinical case of papillary thyroid carcinoma diagnosed in a young patient following 13 years after being treated for nephroblastoma.

Download Full-text

Euthyroid sick syndrome in older people

Reviews in Clinical Gerontology ◽

10.1017/s095925980101111x ◽

2001 ◽

Vol 11 (1) ◽

pp. 1-4

Author(s):

Nadya Kagansky ◽

Sari Tal ◽

Shmuel Levy

Keyword(s):

Thyroid Hormone ◽

Older People ◽

Thyroid Function ◽

Clinical Evidence ◽

Thyroid Function Tests ◽

Hormone Metabolism ◽

Euthyroid Sick Syndrome ◽

Thyroid Hormone Metabolism ◽

Function Tests ◽

Altered Thyroid

The term euthyroid sick syndrome (ESS) is used to describe abnormalities in thyroid function tests that are observed in patients with systemic non-thyroid illness. Despite these abnormalities, there is usually little clinical evidence of hypothyroidism. Patients with ESS are generally considered to have altered thyroid hormone metabolism and to be euthyroid.

Download Full-text