scholarly journals Prevalence of Malignancy in MNG: Final Histopathology Perspective

2021 ◽  
pp. 183-187
Author(s):  
Abdul Waheed ◽  
Ghulam Shabir Mehar ◽  
Muhammad Razzaq Dogar ◽  
Junaid Hussain ◽  
Amrat Kumar ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Total Thyroidectomy ◽  
Thyroid Function ◽  
Multinodular Goiter ◽  
Follicular Cell ◽  
Base Line ◽  
Thyroid Function Tests ◽  
College Hospital ◽  
Function Tests ◽  
Follicular Cell Carcinoma

Objective: To determine the malignancy in multinodular goiter by doing final histopathology of specimen.            Study Design: This is an observational study. Setting: Study carried out in the department of ENT, Head & Neck Surgery of Khairpur Medical College Hospital Khairpur, from August 2016 to July 2019. Materials and Methods:  All those patients with MNG with or without thyrotoxicosis were selected and advised for Thyroid function tests, ultrasound thyroid and serum calcium level. FNAC was performed only in cases with suspicious nodule. All the patients under went total/near total thyroidectomy after all base line routine investigations along with thyroid function tests. Histopathological evaluation was also conducted. Results:  Out of total 70 patients with MNG, 17 (24.3%) cases were suspected of malignancy. Out of 17 suspicious cases, FNAc showed colloid goiter in 8 (47%), follicular in 7 (41%) cases and papillary in 2 (12%) cases. Final histopathology showed total 5 (29%) cases as malignant and remaining 12 (71%) cases were benign. Out of 5 malignant cases, 4 (80%) cases were papillary and 1 (20%) cases were Follicular cell carcinoma. While other 53 (75.7%) cases under went for near total thyroidectomy and specimens sent for histopathology, among these only 1 (2%) case found as Papillary cell Carcinoma. Total 6 cases were malignant out of which in which 5 cases were Papillary cell Carcinoma and one was Follicular cell Carcinoma.  Conclusion: We conclude that multinodular goiter is the most prevalent thyroid disease found in female. Follicular thyroid carcinoma is the most frequent cancer seen in this study.

scholarly journals SUN-LB87 De-Novo Graves Ophthalmopathy After Total Thyroidectomy With Exacerbation Following Rifampicin Therapy for Latent Tuberculosis: A Call for Attention to Disease Modifying Interventions

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sigal Shaklai ◽  
Yonit Marcus-Perlman ◽  
Ainat Klein ◽  
Naftali Stern ◽  
Yona Greenman
Keyword(s):  
Total Thyroidectomy ◽  
Thyroid Function ◽  
De Novo ◽  
Latent Tuberculosis ◽  
Interferon Gamma Release Assay ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Graves Ophthalmopathy ◽  
Minor Improvement

Abstract Introduction Factors influencing development and course of ophthalmopathy, the most common extrathyroidal manifestation of Graves’ disease, remain poorly defined. Clinical Case A 46 year old healthy, non-smoking, medical secretary, presented with Graves’ disease. Laboratory investigation showed thyrotoxicosis with high thyroid stimulation immunoglobulin (TSI) levels (1608 %, normal <140%). At presentation there was no evidence of thyroid eye disease on clinical exam and orbital MRI. Treatment with Methimazol and PTU induced severe pruritus and she underwent total thyroidectomy. One month after surgery she presented with retroorbital pain, eyelid edema and chemosis, as well as bilateral limitation in abduction; a clinical activity score (CAS) of 3/7. She received IV pulse methylprednisolone 4.5 gr with minor improvement. MRI showed bilateral thickening of all rectus muscles with orbital fat infiltration. TSI increased concomitantly to 3600%. Three months later, she underwent standard retrobulbar radiotherapy (20 Gy), again with only minor improvement. She continued treatment with oral prednisone 20mg with small fluctuations in disease activity in the following months during which TSI remained high (3145%) and latent tuberculosis was detected (elevated interferon-gamma release assay). Therefore, rifampicin 600mg/d was started. A month later the ophthalmopathy worsened (a CAS score of 5/7 without optic neuropathy). Laboratory tests showed new perturbation in thyroid function tests (TSH increased from 5 to 15 mIU/l, normal: 0.5-5; FT4 decreased from 16 to 11 pmol/l, normal: 10-20) and TSI increased to 3879%. Euthyrox dose was increased by 50% from 800 to 1200 microgram/week. It was postulated that prednisone was also being rapidly metabolized by rifampicin mediated induction of the CYP450, and therefore the dose was increased from 20 to 40 mg/d. Six weeks later, normalization of thyroid function tests was followed by improvement in the ophthalmopathy (CAS-3). Conclusion (Clinical lesson) A) De-novo severe Graves’ ophthalmopathy after thyroidectomy requiring multiple forms of treatment is rare but close surveillance is advisable, perhaps particularly in the presence of high TSI. A plausible mechanism may be transient increase in antigenic exposure/dissemination during surgery. B) Rifampicin, through induction of cytochrome P450-mediated metabolism of levothyroxine, steroids and mycophenolate (the latter not used in our patient) can lead to disease flare-up. Tight clinical and laboratory monitoring of thyroid function tests with individualized dose escalation might be needed. In the future, pharmacogenomics may serve to personalize treatment protocols.

In a bind: abnormal thyroid function tests

2019 ◽  
Author(s):  
Catriona Hilton ◽  
Farhan Ahmed ◽  
Asif Ali
Keyword(s):  
Thyroid Function ◽  
Thyroid Function Tests ◽  
Function Tests

scholarly journals Falsely diagnosed thyrotoxicosis caused by anti-streptavidin antibodies and pre-wash procedures

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Takuya Ishikawa ◽  
Hiroyuki Sakai ◽  
Tokutaro Itaya ◽  
Suwanai Hirotsugu ◽  
Jumpei Shikuma ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Magnetic Particle ◽  
Thyroid Function Tests ◽  
Case Presentation ◽  
Analytical Interference ◽  
Function Tests ◽  
Inappropriate Treatment ◽  
Published Report ◽  
Old Japanese ◽  
Polyethylene Glycol Precipitation

Abstract Background Anti-streptavidin antibodies are causal determinants of analytical interference during Thyroid function tests, and numerous reports have detailed such interference, with anti-streptavidin antibodies attracting attention. Case presentation We conducted a straightforward investigation of interference due to anti-streptavidin antibodies, with a case of a 60-year-old Japanese man who consulted our department for inconsistencies between his clinical course and Thyroid function tests. Experiments were conducted using Cobas8000 e602, which employs assay procedures with pre-wash to evaluate FT4 and FT3 levels. Conclusions To our knowledge, this is the first published report to clearly investigate such interferences using a combination of polyethylene glycol precipitation, heterophilic blocking tube precipitation, streptavidin-coated magnetic particle precipitation, and different instruments with or without pre-wash. Clinicians should consider that interferences caused by anti-streptavidin antibodies could lead to a misdiagnosis of thyrotoxicosis. Moreover, discussions between laboratory specialists, clinicians, and manufacturers are required to identify interferences and avoid unnecessary examinations and inappropriate treatment.

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