Evaluation of Trace Elements in Thyroid Adenomas Using Energy Dispersive X-Ray Fluorescent Analysis

Thyroid adenomas (TA) are benign tumors, but there is a 20% possibility of malignant transformation. The distinguishing between the TA and thyroid cancer (TC) is tricky, therefore new TA biomarkers are needed. Furthermore, the role of trace elements (TE) in etiology and pathogenesis of TA is unclear. The aim of this exploratory study was to examine the content of bromine (Br), cooper (Cu), iron (Fe), rubidium (Rb), strontium (Sr), and zinc (Zn) in the normal and in adenomatous thyroid. Thyroid tissue levels of six TE were prospectively evaluated in 19 patients with TA and 105 healthy inhabitants. Measurements were performed using 109Cd radionuclide-induced energy-dispersive X-ray fluorescent analysis Tissue samples were divided into two portions. One was used for morphological study while the other was intended for TE analysis. It was found that contents of Br and Cu were significantly higher (25.8 and 4.16 times, respectively) and content of Sr were significantly lower (39%) in adenomatous thyroid in comparison with normal level. There are considerable changes in TE contents in the adenomatous thyroid.

Improved intraoperative verification of parathyroid glands by determining their autofluorescence in the infrared spectrum

Background. Detection of parathyroid glands by spectroscopy of their autofluorescence in the near-infrared spectrum (NIRAF) is considered a promising intraoperative tool in addition to their verification with visual identification. The study was aimed to evaluate the role of NIRAF by using two different imaging systems to confirm parathyroid glands during operations for benign and malignant thyroid and parathyroid tumors. Materials and methods. The study included 62 patients who underwent verification of NIRAF by using two different imaging systems equipped with a near-infrared (NIR) camera during surgery. Intravenous fluorophore of indocyanine green was applied to amplify the NIRAF signal. Results. Normal parathyroid glands were identified and mobilized after a visual inspection in 50 patients (80 %), which was subsequently confirmed by evaluation with NIRAF spectroscopy. Determination of NIRAF in the parathyroid glands and their differentiation from lymph nodes was achieved in 8 (13 %) patients with papillary thyroid carcinoma. In 3 (5 %) patients, the parathyroid gland was identified in the area of the postoperative scar, using NIRAF but not by the visual identification. In 2 (3 %) cases, the appearance of the signal was determined but with a decrease in the intensity of the NIRAF from the parathyroid glands during their unintentional removal. The strong NIRAF signal intensity was observed from the parathyroid gland after changing the position of the NIR camera when using the Fluobeam 800 device at an angle of approximately 45–65° to the area of the parathyroid gland location. The Fluobeam LX demonstrated a satisfactory NIRAF signal without any specific changes in camera position. NIRAF signal was determined in the tissue of toxic thyroid adenomas. NIRAF signal of the low intensity was detected in the invasion of thyroid carcinoma in a capsule of a thyroid gland. No NIRAF signal was observed from metastatic and normal lymph nodes. Conclusions. The use of NIRAF parathyroid spectroscopy technology allows impro-ving their imaging and verification as an additional method during surgery of the neck. The practical value of NIRAF spectroscopy of the parathyroid gland is increased in the case of reoperations due to the risk of accidental removal of the parathyroid gland as well as for differential diagnosis between the parathyroid gland and metastatic lymph nodes.

Evaluation of twenty chemical element contents in thyroid adenomas using neutron activation analysis and inductively coupled plasma atomic emission spectrometry

Thyroid adenomas (TA) are benign tumors, but there is a 20% possibility of malignant transformation. The distinguishing between the TA and thyroid cancer (TC) is tricky, therefore new TA biomarkers are needed. Furthermore, the role of chemical elements (ChE) in etiology and pathogenesis of TA is unclear. The aim of this exploratory study was to evaluate whether significant changes in the thyroid tissue levels of twenty chemical elements (ChE) Al, B, Ba, Br, Ca, Cl, Cu, Fe, I, K, Li, Mg, Mn, Na, P, S, Si, Sr, V, and Zn exist in the adenomatous transformed thyroid. Thyroid tissue levels of twenty ChE were prospectively evaluated in 19 patients with TA and 105 healthy inhabitants. Measurements were performed using a combination of non-destructive and destructive methods: instrumental neutron activation analysis and inductively coupled plasma atomic emission spectrometry, respectively. Tissue samples were divided into two portions. One was used for morphological study while the other was intended for ChE analysis. It was found that contents of of Al, B, Br, Cl, Cu, Na, and Zn are significantly higher whereas the levels of I some lower. in TA than in normal tissues. It was supposed that the changes in levels Al, B, Br, Cl, Cu, I, Na, and Zn in thyroid tissue can be used as TA markers.

Study of the risk factors for post-operative hypocalcemia after thyroid surgery

Background: Hypocalcemia is still a common post-operative consequence following total thyroidectomy, generating potentially serious symptoms and concern in patients and lengthening hospital stays. This study was conducted to evaluate the risk factors for post-operative hypocalcemia after thyroid surgery.Methods: In this study, 60 patients who underwent thyroidectomy were included. Patients with concomitant lymph node dissection and hypocalcemia were excluded from the study. Serial serum calcium measures were taken and information about the operation, such as the patient's age and gender, whether the inferior thyroid artery was ligated or not, and the pathological report.Results: In 60 patients, 17 patients were had post-operative hypocalcemia. 3 in 5 patients (60%) with Hashimoto thyroiditis had hypocalcemia, followed by toxic multinodular goiter (MNG) (37.5%), thyroid adenomas (33.33%) and Graves’ disease (33.33%) had hypocalcemia after thyroidectomy.Conclusions: To conclude, hypocalcemia is a common side effect of total thyroid surgery, and it is caused by the unintentional removal of parathyroid glands or injury or spasm of the blood arteries that supply them.

Sonographic Features Differentiating Follicular Thyroid Cancer from Follicular Adenoma–a Meta-Analysis

Certain ultrasound features are associated with an increased risk of thyroid malignancy. However, they were studied mainly in papillary thyroid cancers (PTCs); these results cannot be simply extrapolated for the differentiation of follicular thyroid adenomas and cancers (FTAs and FTCs). The aim of our study was to perform a meta-analysis to identify sonographic features suggesting malignancy in the case of follicular lesions, potentially differentiating FTA and FTC. We searched thirteen databases from January 2006 to December 2020 to find all relevant, full-text journal articles written in English. Analyses assessed the accuracy of malignancy detection in case of follicular lesions, potentially differentiating FTA and FTC included the odds ratio (OR), sensitivity, specificity, positive and negative predictive values. A random-effects model was used to summarize collected data. Twenty studies describing sonographic features of 10,215 nodules met the inclusion criteria. The highest overall ORs to increase the risk of malignancy were calculated for tumor protrusion (OR = 10.19; 95% confidence interval: 2.62–39.71), microcalcifications or mixed type of calcifications (coexisting micro and macrocalcifications): 6.09 (3.22–11.50), irregular margins: 5.11 (2.90–8.99), marked hypoechogenicity: 4.59 (3.23–6.54), and irregular shape: 3.6 (1.19–10.92). The most crucial feature associated with an increased risk of FTC is capsule protrusion, followed by the presence of calcifications, irrespectively of their type.

Raman Spectroscopy Discloses Altered Molecular Profile in Thyroid Adenomas

Follicular patterned nodules are sometimes complex to be classified due to ambiguous nuclear features and/or questionable capsular or vascular invasion. In this setting, there is a poor inter-observer concordance even among expert pathologists. Raman spectroscopy was recently used to separate benign and malignant thyroid nodules based on their molecular fingerprint; anyway, some histologically proved follicular adenomas were clustered as having a characteristic profile of malignant lesions. In this study, we analyzed five follicular thyroid adenomas with a malignant spectroscopic profile compared to five follicular adenomas with a benign Raman spectrum in order to assess possible molecular differences between the two groups. Morphological, immunohistochemical, and molecular analyses evidenced expression of malignancy-associated proteins in four out of five malignant clustered adenomas. The remaining malignant clustered adenoma showed a TSHR mutation previously associated with autonomously functioning follicular carcinomas. In conclusion, thyroid follicular adenomas are a group of morphologically benign neoplasms that may have altered the mutational or expression profile; cases of adenomas with altered immunophenotype are recognized as showing a profile associated with malignancy by Raman spectroscopy. This correlation warrants a more extensive evaluation and suggests a potential predictive value of spectroscopic assessment in recognizing characteristics associated with tumor progression in follicular thyroid neoplasms.

Prevalence of malignancy in thyroid nodule at People’s Medical College Hospital (PMCH) Nawabshah.

Objectives: The purpose of study is to ascertain the prevalence of malignancy in thyroid single/multiple nodules after ascertaining the features of nodules on different criteria. Study Design: Cross Sectional Study. Setting: Department of Surgical at PMCH Nawabshah. Period: April 2015 to April 2018. Material & Methods: All patients got admission from OPD and they were investigated for the disease. All biochemical examinations were done. Thyroid profile with thyroid scan was obtained. Fine Needle Aspiration Cytology (FNAC) was done to diagnose the type of cells either benign/ malignant. The decision of the surgical procedure was done according to the FNAC report of the thyroid nodule. Results: Total 80 patients were investigated. 55 (68.75%) females, 35 (43.75%) male and 60 (75%) showed the benign cells and 20 (25%) patient’s reports had malignant cells. Biopsies were sent for histopathology. 60 (75%) showed thyroid adenomas after biopsy. 10(12.5%) patients papillary carcinoma, 7 (8.75%) follicular, 2 (2.5%) medullary, 1 (1.25%) anaplastic, 0 for thyroid lymphoma, 0 thyroid carcinoma. 0 for squamous cell carcinoma. 40 (50%) were treated conservatively with thyroxine, 20 (25%) were operated for lobectomy. All malignant cases were undergone for total thyroidectomy. Conclusion: it is summed up that the prevalence of malignancy in thyroid nodules in our setup is only 25% that is the lower one as compared to other studies.

GABPA-dependent down-regulation of DICER1 in follicular thyroid tumours

Mutations in the miRNA enzyme gene DICER1 have been reported in several endocrine malignancies and is associated with the rare tumour-predisposing DICER1 syndrome. DICER1 mutations have been reported in subsets of follicular thyroid carcinoma (FTC), but the role of DICER1 in follicular thyroid tumorigenesis has not been extensively studied. In this study, we investigate the role of DICER1 in 168 follicular thyroid tumours and in an FTC cell line. We found rare DICER1 mutations in paediatric FTC cases and a general DICER1 down-regulation in FTCs visualized both on mRNA and protein level, especially pronounced in Hürthle cell carcinoma (HuCC). The down-regulation was also evident in follicular thyroid adenomas (FTAs), suggesting a potential early step in tumorigenesis. The expression of DICER1 was lower in FTCs of older patients in which TERT promoter mutations are more frequent. In FTCs, DICER1 down-regulation was not caused by gene copy number loss but significantly correlated to expression of the transcription factor GABPA in clinical cases. GABPA was found to bind to the DICER1 promoter and regulate DICER1 expression in vitro, as GABPA depletion in FTC cell lines reduced DICER1 expression. This in turn stimulated cell proliferation and affected the miRNA machinery, evident by altered miRNA expression. To conclude, we show that GABPA directly regulates DICER1 in FTC, acting as a tumour suppressor and displaying down-regulation in clinical samples. We also show reduced expression of DICER1 in benign and malignant follicular thyroid tumours, suggesting a potentially early tumorigenic role of this gene aberrancy.