A case report of rhabdomyolysis and osteofascial compartment syndrome in a patient with hypothyroidism and diabetes

Background Hypothyroidism is frequent and has various forms of muscle involvement. We report the diagnosis and treatment of a case of rhabdomyolysis, bilateral osteofascial compartment syndrome (OCS) of the lower extremities, and peroneal nerve injury causing bilateral foot drop in a diabetic patient with hypothyroidism. Case presentation A 66-year-old man with diabetes for 22 years was admitted because of drowsiness, tiredness, facial swelling, and limb twitching for 2 months, and red and swollen lower limb skin for 3 days. Serum creatinine kinase (CK), CK-MB, myoglobin (Mb), blood glucose, and HbA1c were elevated. TSH, thyroid peroxidase antibodies, and antithyroglobulin antibodies were elevated. FT3 and FT4 were low. Urine was dark brown. He was diagnosed with hypothyroidism, rhabdomyolysis, and OCS. CK, CK-MB, and Mb returned to normal after treatment with thyroid hormone, insulin, albumin infusion, ceftriaxone, ulinastatin, and hemofiltration, and the redness and swelling of the lower limbs were relieved, but the patient developed dropping feet. The patient recovered well but had to undergo rehabilitation. Conclusion Hypothyroidism may induce rhabdomyolysis, OCS, and other complications. This case reminds us of the importance of screening for hypothyroidism and strengthens the clinicians’ understanding of the disease.

“Vitamin D Deficiency Is More Common in Women with Autoimmune Thyroiditis: A Retrospective Study”

Background. Vitamin D is a hormone that is mainly produced in the skin upon ultraviolet B radiation exposure and has important influence on various organs. In recent years, data have been collected that vitamin D deficiency plays an important role in the development of various nonskeletal diseases, including autoimmune diseases. Chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) is one of the most common organ-specific autoimmune endocrine diseases. It is characterized by increased level of antithyroid peroxidase and/or antithyroglobulin antibodies in blood, which often leads to thyroid dysfunction and structural changes of the gland. There is an opinion that vitamin D deficiency may be considered as an important risk factor for development of chronic autoimmune thyroiditis, but data of various small studies are controversial. Despite the fact that Georgia is a sunny country, vitamin D deficiency is a widespread problem here. Thyroid diseases, including the chronic autoimmune thyroiditis, are also very common in Georgia. The aim of our research was to compare the level of vitamin D between the patients with chronic autoimmune thyroiditis and the healthy subjects. Methods. This retrospective study enrolled subjects, who were 18–70 years old and visited the clinics “Cortex” and “National Institute of Endocrinology” in 2018 or in 2019 from mid-spring to mid-summer. Data of thyroid-stimulating hormone, free thyroxine, antithyroid peroxidase antibodies, antithyroglobulin antibodies, thyroid ultrasonography, and 25(OH) vitamin D were retrospectively analysed based on medical history. In total, data of 1295 patients were collected. The statistical processing of data was performed through the SPSS 20 program. Results. The negative association between thyroid-stimulating hormone, antithyroid peroxidase antibodies, antithyroglobulin antibodies, heterogeneous parenchyma of thyroid gland, and vitamin D was found in women. Statistically significant association was not detected in men. Conclusions. Serum vitamin D is lower in women with autoimmune thyroiditis and primary hypothyroidism. Further studies are needed to evaluate the influence of vitamin D supplementation on thyroid autoantibody positivity or primary hypothyroidism.

To study cytomorphological details in case of autoimmune thyroiditis

Various smears were readied, air-dried and fixed in ethanol for staining by May-Grunwald-Giemsa stain and Papanicolaou staining strategy. A nitty gritty assessment of the cytologic smears was done and includes like cellularity, sum and nature of colloid, Hurthle cell change, anisonucleosis of follicular cells, range of receptive lymphoid cells and other incendiary cells like eosinophils, macrophages, goliath cells and epithelioid cells were noted. Thyroid capacity tests were finished utilizing COBAS E analyser.In our study we found, 82% Females whereas 18% Males. Lymphocytic Thyroiditis 42%, Granulomatous Thyroiditis 31 & Hashimoto’s Thyroiditis 27%. Types of swelling and diagnosis with painless 71 % and painful 29 %. Cross-sectional Observational Study. A total of 200 thyroiditis cases studied with detailed history, thorough clinical examination and relevant blood investigations like Thyroid Profile were being done. The various studies on the correlation of cytomorphological spectrum and antithyroglobulin antibodies in autoimmune thyroiditis cases all acreoss the globe have great variations in their findings.

To correlate cytological finding with clinical presentation and antithyroglobulin antibodies

All cases undergoing FNAC for thyroid swelling during study period were included in the study. The data was collected as per the pre-designed proforma including the general profile, clinical examination, laboratory investigations, USG findings and FNAC observations.In our study we found, correlation between antithyroglobulin antibody levels, 100-500 IU/ml (53), 501-1000 IU/ml (87) & >1000 IU/ml (10). Chi square = 8.2068; p-value= 0.7120 (insignificant). Correlation between T3 levels, Normal (18), Low (24) and High (108). Chi square = 12.3129; p-value= 0.3580 (insignificant). Correlation between T4 levels, Normal (00), Low (24) and High (108). Chi square = 19.9758; p-value= 0.00012 (significant). Correlation between T4 levels, Normal (00), Low (24) and High (108). Chi square = 79.0167; p-value<0.00001 (significant). Prospective Observational Study. Antithyroglobulin antibodies may be insignificant statistically, yet they should always be tested for, in order to establish a better understanding of the cases. The ATG levels should be kept in mind before prescribing a treatment regime for such cases. This not only leads the pathologists to continuously seek for better than the present investigations but also leads clinicians to decide a dynamic management regime. Though there is a defined protocol for thyroid work up of clinically diagnosed patients, newer and more sensitive test need to be devised.

Follow-up of patients with thyroid cancer and antithyroglobulin antibodies: a review for clinicians

Antithyroglobulin antibodies (TgAb) are present in up to 25% of patients with differentiated thyroid carcinoma on initial postoperative assessment. Detectable concentrations of TgAb even below the manufacturer’s cut-off can interfere with serum thyroglobulin (Tg) determination. When Tg is quantified using an immunometric assay (IMA) (hereafter referred to as Tg-IMA), this interference results in underestimated values of Tg. Although promising, more clinical trials evaluating the capacity of liquid chromatography/tandem mass spectrometry and of new assays to detect elevated Tg in patients with TgAb and structural disease are necessary, particularly when Tg is undetectable by a second-generation IMA (Tg-2GIMA). Neck ultrasonography (US) should be performed in patients submitted to total thyroidectomy and with negative Tg-IMA but with detectable TgAb more than 6 months after initial therapy. In patients treated with 131I, comparison of TgAb concentrations obtained before this treatment is useful to estimate the risk of disease and to guide the investigation. If initial assessment does not reveal any persistent tumor, repetition of US is recommended while TgAb persist. Significant elevation of TgAb requires extended investigation. On the other hand, patients with negative Tg-IMA and US without abnormalities who exhibit a reduction > 50% in TgAb generally do not require investigation. Although TgAb can interfere with Tg, the management and follow-up of patients submitted to total thyroidectomy with borderline TgAb can probably be the same as those recommended for patients without TgAb if Tg-2GIMA and US indicate an excellent response to therapy. Currently, the presence/absence or the trend of TgAb levels cannot be considered in the follow-up of patients submitted to lobectomy.

TO STUDY LEVEL OF ANTITHYROGLOBULIN ANTIBODIES IN CASE OF AUTOIMMUNE THYROIDITIS

Background & Method: The present study titled “To study level of Antithyroglobulin Antibodies in case of Autoimmune Thyroiditis” was conducted among the patients at Amaltas Institute of Medical Sciences. Dewas Patients coming to any clinical department with thyroid swelling during the study period were randomly selected for the study. After complete history and thorough clinical examination, FNAC was being performed with a 22 gauge needle in 10 ml syringe with or without USG guidance as per requirement. Result: In the present study, all the cases presented with a neck swelling. 71 (71%) out of the 100 cases had painful swelling while 29 (29%) presented with painless swelling. The levels of antithyroglobulin antibodies were found to be above 100 IU/ml in all the cases studied. 35 cases had levels between 100-500, 58 between 501-1000 and 7 above 1000 IU/ml. Conclusion: The cytomorphological details in cases of autoimmune thyroiditis, to study the level of antithyroglobulin antibodies and to correlate the cytological findings with clinical presentation and antithyroglobulin antibodies. The present study could not prove any statistical significance of the association of antithyroglobulin antibodies, yet the levels of these antibodies are essential as a part of thyroid work up of clinically diagnosed patients. Keywords: Antithyroglobulin, Antibodies & Thyroiditis. Study Designed: Observational Study

Prognostic value and dynamics of antithyroglobulin antibodies for differentiated thyroid carcinoma

Background: The clinical value of antithyroglobulin antibodies (TgAb) as a tumor marker for differentiated thyroid cancer (DTC) is still controversial. Materials & methods: We studied 110 TgAb positive DTC patients who underwent total thyroidectomy and 131I therapies. Multivariate logistic regression was conducted to analyze the association between prognostic factors and disease outcomes. Results & conclusion: Pre-ablation TgAb levels and the changes of TgAb in 6–12 months after the first 131I therapy were risk factors for disease outcome in patients younger than 55, while extrathyroid extension was a risk factor in patients older than 55. The median TgAb half-life was 7.7 months and the median time for TgAb positivity to become negative was 15.8 months. The dynamics of TgAb within the first year after remnant ablation could predict disease outcome for DTC patients.

Antithyroid Peroxidase Antibodies and Histopathological Outcomes in Egyptian Patients Subjected to Total Thyroidectomy for Nonmalignant Nodular Goiter

Objective: The study aimed to assess antithyroid antibodies in patients with benign thyroid masses and the effect of total thyroidectomy on the antibodies titers.Patients and Methods: This is a retrospective work of 112 cases managed with total thyroidectomy who have positive antithyroid peroxidase antibodies (TPO-Ab), antithyroglobulin antibodies (Tg-Ab), or both. All patients were euthyroid before surgery. Thyroid function tests and thyroid antibodies levels were measured before and 6 and 12 months after surgery.Results: Histopathological evaluation revealed Hashimoto thyroiditis (47.3%), colloid nodules (22.3%), and lymphocytic thyroiditis (30.4%). All patients were TPO-Ab positive, while 96 patients (85.7%) were Tg-Ab positive before surgery. There was no considerable change in TPO-Ab and Tg-Ab after surgery (p = 0.817, and p=0.560, respectively). Also, there was no significant difference between the three histopathological diagnoses in the levels of TPO-Ab (p = 0.086) or Tg-Ab (p = 0.673). Conclusion: Antithyroid antibodies are not valuable markers for diagnosis or prognosis of benign thyroid diseases subjected to total thyroidectomy. We do not recommend their use beyond being a supportive evidence of the possibility of autoimmune nature of the disease if other criteria are confirmed.