Determination of thyroid volume in infants with suspected congenital hypothyroidism—the limitations of both subjective and objective evaluation

Objective: To compare two methods of assessing gland size on thyroid ultrasound in newborn infants with suspected congenital hypothyroidism (CH). Methods: Images from infants with eutopic glands referred between 2007 and 2013 were evaluated blind by two sets of observers. Subjective gland size was categorised as small, borderline-small, normal, borderline-large and large. Objective gland volume, calculated as the sum of each lobe using the prolate ellipsoid formula (length x width x depth x π/6), was put into corresponding categories: <0.8, 0.81–1.0, 1.1– <2.2, 2.2–2.4 and >2.4 ml, derived from normative Scottish data. Results: Of 36 infants, permanent CH was present in 17, transient CH in 17, status uncertain in 2. Mean (SD) intraobserver error for thyroid volume measurement was 0.11 (0.23) ml [8.3%]. Subjective assessment by two observers was discordant in only four (10.8%) infants. However, subjective vs objective evaluation was discordant in 14 (39%). Eight (three permanent, five transient CH) had large glands subjectively but normal glands objectively; and six (four transient CH) had normal glands subjectively but small glands objectively. The former infants all showed a single flattened curve to the anterior thyroid margin, giving an impression of bulkiness. Gland shape was normal in the latter infants. Conclusion: Neither subjective nor objective evaluation predicts permanent vs transient CH. Altered gland shape may confound both methods, and undermine use of the conventional formula for measuring lobe volume. Advances in knowledge: Until more refined methods are available for assessing thyroid size, both subjective and objective evaluation are recommended in CH.

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Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency

Acta Endocrinologica ◽

10.1530/eje.0.1430727 ◽

2000 ◽

pp. 727-731 ◽

Cited By ~ 62

Author(s):

M Zimmermann ◽

A Saad ◽

S Hess ◽

T Torresani ◽

N Chaouki

Keyword(s):

Iodine Deficiency ◽

Urinary Iodine ◽

Thyroid Volume ◽

Classification Systems ◽

World Health ◽

Urinary Iodine Concentration ◽

Thyroid Ultrasound ◽

Iodine Deficiency Disorders ◽

Goiter Prevalence

OBJECTIVES: In 1994, WHO/International Council for the Control of Iodine Deficiency Disorders recommended replacing the WHO 1960 four-grade goiter classification with a simplified two-grade system. The effect of this change in criteria on the estimation of goiter prevalence in field studies is unclear. In areas of mild iodine deficiency disorders (IDD) where goiters are small, ultrasound is preferable to palpation to estimate goiter prevalence. However, in areas of moderate to severe IDD, goiter screening by palpation may be an acceptable alternative to thyroid ultrasound. To address these two issues, we compared WHO 1960 and 1994 criteria with thyroid ultrasound for determination of goiter prevalence in areas of mild and severe IDD in Morocco. DESIGN: A cross-sectional study of 400 six- to 13-year-old children from two mountain villages (Ait M'hamed and Brikcha) in rural Morocco was carried out. METHODS: Urinary iodine concentration (UI), whole blood TSH and serum thyroxine were measured. Thyroid size was graded by inspection and palpation by two examiners using both WHO 1960 and 1994 criteria. Thyroid volume was determined by ultrasound. Variation between examiners and examination methods was assessed. Sensitivity and specificity of the two classification systems compared with ultrasound were calculated. RESULTS: Median UIs in Ait M'hamed and Brikcha were 183 and 24 microg/l respectively. In Ait M'hamed, using 1960 and 1994 criteria, goiter prevalence was 21 and 26% respectively, compared with 13% by ultrasound. In Brikcha, with 1960 and 1994 criteria, goiter prevalence was 64 and 67% respectively, compared with 64% by ultrasound. Agreement between observers was better with the 1994 criteria than with the 1960 criteria in Ait M'hamed (kappa=0.53 and 0.47 respectively), while in Brikcha observer agreement was similar with the two systems (kappa=0.67). Using either the 1994 or 1960 criteria, agreement with ultrasound was only moderate in Ait M'hamed (kappa=0.41-0.44), but good in Brikcha (kappa=0.55-0.64). Overall, compared with ultrasound, sensitivity increased 3-4% using 1994 criteria, while specificity decreased 4-5%. CONCLUSIONS: The WHO 1994 criteria are simpler to use than the 1960 criteria and provide increased sensitivity with only a small reduction in specificity. Agreement between observers is better with the 1994 criteria than with the 1960 criteria, particularly in areas of mild IDD. Like the 1960 criteria, the 1994 criteria overestimate goiter prevalence in areas of mild IDD, compared with ultrasound. However, the 1994 palpation criteria provide an accurate estimate of goiter prevalence in areas of severe IDD, and may be an acceptable and affordable alternative to thyroid ultrasound in these areas.

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Determination of thyroid volume by ultrasound: a valuable tool for the investigation of congenital hypothyroidism

Radiologia Brasileira ◽

10.1590/0100-3984.2021.54.3e2 ◽

2021 ◽

Vol 54 (3) ◽

pp. VII-VII

Author(s):

Maria Cristina Chammas

Keyword(s):

Congenital Hypothyroidism ◽

Thyroid Volume

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Objective and parametric methods used in functional classification disabled swimmers

Physiotherapy ◽

10.2478/physio-2013-0022 ◽

2013 ◽

Vol 21 (3) ◽

Cited By ~ 1

Author(s):

Natalia Uścinowicz ◽

Wojciech Seidel ◽

Paweł Zostawa ◽

Sebastian Klich

Keyword(s):

Medical Diagnosis ◽

Olympic Games ◽

Objective Evaluation ◽

Subjective Assessment ◽

Fair Play ◽

Functional Classification ◽

Kinematic Parameters ◽

Athletes With Disabilities ◽

Rule Out

AbstractThe recent Olympic Games in London incited much interest in the competition of disabled athletes. Various people connected with swimming, including coaches and athletes, have speculated about the fairness of competitions of disabled athletes. A constant problem are the subjective methods of classification in disabled sport. Originally, athletes with disabilities were classified according to medical diagnosis. Due to the injustice which still affects the competitors, functional classification was created shortly after. In the present review, the authors show the anomalies in the structure of the classification. The presented discovery led to the suggestion to introduce objective methods, thanks to which it would be no longer necessary to rely on the subjective assessment of the classifier. According to the authors, while using objective methods does not completely rule out the possibility of fraud by disabled athletes in the classification process, it would certainly reduce their incidence. Some of the objective methods useful for the classification of disabled athletes are: posturography, evaluation of the muscle parameters, electrogoniometric assessment, surface electromyography, and analysis of kinematic parameters. These methods have provide objective evaluation in the diagnostic sense but only if they are used in tandem. The authors demonstrate the undeniable benefits of using objective methods. Unfortunately, there are not only advantages of such solution, there also several drawbacks to be found. The conclusion of the article is the statement by the authors that it is right to use objective methods which allow to further the most important rule in sport: fair-play.

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Infants Diagnosed with Athyreosis on Scintigraphy May Have a Gland Present on Ultrasound and Have Transient Congenital Hypothyroidism

Hormone Research in Paediatrics ◽

10.1159/000514989 ◽

2021 ◽

pp. 1-8

Author(s):

Niamh McGrath ◽

Colin Patrick Hawkes ◽

Stephanie Ryan ◽

Philip Mayne ◽

Nuala Murphy

Keyword(s):

Thyroid Gland ◽

Congenital Hypothyroidism ◽

Thyroid Tissue ◽

Thyroid Stimulating Hormone ◽

Thyroid Ultrasound ◽

Free T4 ◽

Median Serum ◽

Thyroid Glands ◽

Rule Out

Scintigraphy using technetium-99m (99mTc) is the gold standard for imaging the thyroid gland in infants with congenital hypothyroidism (CHT) and is the most reliable method of diagnosing an ectopic thyroid gland. One of the limitations of scintigraphy is the possibility that no uptake is detected despite the presence of thyroid tissue, leading to the spurious diagnosis of athyreosis. Thyroid ultrasound is a useful adjunct to detect thyroid tissue in the absence of 99mTc uptake. Aims: We aimed to describe the incidence of sonographically detectable in situ thyroid glands in infants scintigraphically diagnosed with athyreosis using 99mTc and to describe the clinical characteristics and natural history in these infants. Methods: The newborn screening records of all infants diagnosed with CHT between 2007 and 2016 were reviewed. Those diagnosed with CHT and athyreosis confirmed on scintigraphy were invited to attend a thyroid ultrasound. Results: Of the 488 infants diagnosed with CHT during the study period, 18/73 (24.6%) infants with absent uptake on scintigraphy had thyroid tissue visualised on ultrasound (3 hypoplastic thyroid glands and 15 eutopic glands). The median serum thyroid-stimulating hormone (TSH) concentration at diagnosis was significantly lower than that in infants with confirmed athyreosis (no gland on ultrasound and no uptake on scintigraphy) (74 vs. 270 mU/L), and median free T4 concentration at diagnosis was higher (11.9 vs. 3.9 pmol/L). Six of 10 (60%) infants with no uptake on scintigraphy but a eutopic gland on ultrasound had transient CHT. Conclusion: Absent uptake on scintigraphy in infants with CHT does not rule out a eutopic gland, especially in infants with less elevated TSH concentrations. Clinically, adding thyroid ultrasound to the diagnostic evaluation of infants who have athyreosis on scintigraphy may avoid committing some infants with presumed athyreosis to lifelong levothyroxine treatment.

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Video Objective Quality Evaluation System Based on the Visual Saliency Map

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.411-414.1362 ◽

2013 ◽

Vol 411-414 ◽

pp. 1362-1367 ◽

Cited By ~ 1

Author(s):

Qing Lan Wei ◽

Yuan Zhang

Keyword(s):

Evaluation System ◽

Quality Evaluation ◽

Objective Assessment ◽

Visual Saliency ◽

Objective Evaluation ◽

Subjective Assessment ◽

Saliency Map ◽

Assessment Scores ◽

Objective Quality ◽

Quality Evaluation System

This paper presents the thoughts about application of saliency map to the video objective quality evaluation system. It computes the SMSE and SPSNR values as the objective assessment scores according to the saliency map, and compares with conditional objective evaluation methods as PSNR and MSE. Experimental results demonstrate that this method can well fit the subjective assessment results.

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Determination of Blood Sugar in Newborn Infants

PEDIATRICS ◽

10.1542/peds.28.5.850 ◽

1961 ◽

Vol 28 (5) ◽

pp. 850-851

Author(s):

GLORIA S. BAENS ◽

WILLIAM OH ◽

EVELYN LUNDEEN ◽

MARVIN CORNBLATH

Keyword(s):

Blood Sugar ◽

Newborn Infants ◽

Newborn Period ◽

Claude Bernard

To the Editor: Recently, there has been a renewed interest in the level of blood sugar in the newborn period, with very low or zero blood sugars being reported1, 2 In some of these reports there is no mention of how the blood was collected, how long it was permitted to stand, how it was precipitated, or analyzed. As reviewed by Peters and Van Slyke,3 the disappearance of sugar from blood in vitro has been well documented since the time of Claude Bernard.

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ACTIVITY OF GLUTAMIC-OXALOACETIC TRANSAMINASE IN THE SERUM IN THE NEONATAL PERIOD

PEDIATRICS ◽

10.1542/peds.20.4.584 ◽

1957 ◽

Vol 20 (4) ◽

pp. 584-589

Author(s):

Simon Kove ◽

Stanley Goldstein ◽

Felix Wróblewski

Keyword(s):

Neonatal Period ◽

Newborn Infants ◽

Normal Range ◽

Glutamic Oxaloacetic Transaminase ◽

Newborn Period ◽

Method Of Determination ◽

Normal Term ◽

Pathologic State ◽

Normal Adults

The activity of glutamic oxaloacetic transaminase (GOT) in the serum was determined by the spectrophotometric method in 63 normal term newborn infants, varying from birth to 11 days of age. The normal range of activity in the newborn period varied from 13 to 105 units (with the exception of one infant in whom the level was 160 units). This is a considerably wider range than that of 5 to 45 units found in normal adults. Allowing for an error of about ±10% inherent in the method of determination of GOT, activity as great as approximately 120 units, which in adults would be indicative of some pathologic state, must be considered physiologic in the newborn infant. The activity of GOT was not related to the age of the infant within the neonatal period studied, and varied widely in different infants for each day of age, without any distinctive pattern. Variations of the activity of GOT in specimens of cord blood studied ranged below 59 units, which was lower than for any other day of the neonatal period adequately investigated. No infants were studied repeatedly. No relation was found between the concentration of bilirubin and the activity of GOT in the serum.

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A method for measurement of oxygen uptake in neonates

Journal of Applied Physiology ◽

10.1152/jappl.1979.46.6.1200 ◽

1979 ◽

Vol 46 (6) ◽

pp. 1200-1204 ◽

Cited By ~ 8

Author(s):

D. B. Raemer ◽

D. R. Westenskow ◽

D. K. Gehmlich ◽

C. P. Richardson ◽

W. S. Jordan

Keyword(s):

Intensive Care ◽

Oxygen Uptake ◽

Positive Airway Pressure ◽

Animal Experiments ◽

Newborn Infants ◽

Positive End Expiratory Pressure ◽

Newborn Intensive Care Unit ◽

Frequent Use ◽

Newborn Intensive Care

The frequent use of continuous positive airway pressure and positive end-expiratory pressure in newborn infants with pulmonary disease has prevented the use of conventional methods for measuring oxygen uptake (VO2) in intensive-care units. A feed-back replenishment technique for the determination of the oxygen uptake of these newborn infants has been developed. An instrument utilizing this method has been designed and built permitting continuous VO2 monitoring without interfering in the routine ventilatory therapy of the critically ill infant. Theoretical, bench, and animal experiments using room air as an inspired gas indicate instrument accuracies as a percentage of full scale of 2.4, 2.8, and 7.3, respectively. Preliminary trials on infants demonstrate that the instrument functions satisfactorily in the newborn intensive-care unit.

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