thyroid

Aim: Secondary hyperparathyroidism (SHPT) is an often underestimated cause of anemia in hemodialysis (HD) patients. The aim of this study was to assess the effect of pharmacological correction of SHPT on anemia and erythropoiesis-stimulating agents (ESAs) need. Methods: For the purpose of this retrospective pre-post observational study, we selected 55 HD patients, receiving HD at one single center, in the period from January 2005 to December 2020. The follow-up (F-U) lasted 12 months. The selection criteria were parathormone (PTH) levels > 300 pg/ mL, and hemoglobin (Hb) levels < 11 g/dL, despite treatment with ESAs. Parametric and non-parametric tests were used when appropriate. In the light of exploratory nature of the study, the limited sample size and in consideration of the pre-post-design, no further adjustment for potential confounders is performed. Results: The hemoglobin levels throughout the study were correlated to serum PTH (r = -.257, p < 0.01). At the end of the F-U, in the 40 patients whose PTH levels decreased ≥ 30% (responders group) Hb levels increased from 10.3 ± 0.5 g/dL to 12.2 ± 1.1 g/dL (p < 0.001), and ESAs doses decreased from 141 ± 101 IU/kg/b.w./week to 94 ± 76 IU/kg/b.w./week (p < 0.05). On the contrary, in the non-responders group Hb levels did not change 10.3 ± 0.5 gr/dL at baseline and 10.1 ± 1.1 gr/dL at F-U (P = NS), and the mean doses of ESAs increased from 144 ± 75 IU/kg/b.w./week to 218 ± 145 IU/kg/b.w./week (P = NS). Conclusion: Adequate control of SHPT is associated with concomitant improvement of anemia and decrease in ESAs need. Future endeavors are required to confirm these preliminary results. 

In vitro fertilization is one of the most common and effective procedure for thousands of couples worldwide who want to have a child and are unable to do so for various reasons. Diverse studies show that couples who conceive naturally after one year of trying had newborns with an increased risk of prematurity and low birth weight, compared with couples who conceived before completing one year of trying. Children from assisted reproduction (AR), have a 30% increased risk of prematurity and low birth weight, compared with children from infertile fathers. Regarding the conflicting results the present study aimed to record the frequency of genetic, congenital anomalies in children and adolescents who had examined in the last decade to the Clinical Genetics Clinic of the National and Kapodistrian University of Athens whose mothers had undergone assisted reproduction. The research process was conducted at the "Aghia Sofia" Children's Hospital based in Athens. However, the cases that were studied came from all over Greece. Initially, the researcher recorded the cases that came to the clinic of Clinical Genetics and whose conception occurred after technical assisted reproduction. After telephone communication and the consent of the parents, a live appointment was scheduled. In this meeting-interview all the provisions of the investigation and the protocol were asked and some elements of the medical history of the cases were confirmed. The total sample included 230 children and adolescents. The resulting data were recorded on a printed form/questionnaire. Then, they were registered electronically in the program SPSS 25.0 (Statistical Package for Social Sciences) with a specific unit code for each case/patient, followed by the processing and statistical analysis of the data as well as the recording of the results. The gender of the participants was male for 118 participants (51.3%) and 112 females (48.7%). Mean and standard deviation (SD) of maternal, paternal (at the time of delivery) age was equal to 36.38 (5.94) and 39.94 (6.58) respectively. The observed abdormalities were 35.53% psychomotor retardation, 23.68% facial abnormalities, 23.68% spinal cord abnormalities, 21.05% morphological abnormalities, 20.61% short stature, 19.74% developmental disorders, 19.30% heart disease, 16.67% neurological diseases, 14.47% genetic syndromes, 11.40% genital abnormalities, 8.33% limb abnormalities, 7.46% dermatological abnormalities, 6.14% eye abnormalities, 6.14% hypothyroidism, 5.70% endocrine disorders, 5.26%otolaryngology abnormalities, 2.63% disease of kidney, intestine, 2.19% vascular malformations. Regarding the karyotype chromosome analysis by G-banding technique, from the 230 children in: 24 (10.43%) a pathological result was found, in 158 children (68.70%) it was found normal (46, XX or 46, XY by case) without other findings, while in 48 children (20.87%) the test was not performed for various reasons. Regarding the results of molecular analysis (DNA) from the 230 children, in 50 (21.74%) a pathological finding was found, in 56 children (24.35%) no abnormalities were found and in 124 children (53.91%) no molecular analysis was performed for various reasons. In conclusion, the sample of this descriptive study is characterized as uniform in terms of the method of assisted reproduction since 96.24% had followed the classic IVF. Full-term pregnancy was associated with the appearance of malignancy and head morphological abnormalities (64.6%), normal pregnancy was associated with genetic syndromes (18.2%) and facial abnormalities (11.1%). It is recommended the screening oocyte and sperm donors in order to help protect the safety and health of donors, recipients, and future offspring. The present study confirms the association of the presence of congenital anomalies after in vitro fertilization (IVF). However, the absolute risk of developing severe dysplasias after an IVF procedure is limited.

The SARS-Cov-2 virus was firstly identified in Wuhan, China and caused catastrophic destruction all over the world. COVID-19 virus primarily effects lungs of its hosts and impairs it in number of ways. It can also damage multiple organs like Heart, kidney, endocrine glands, skin, brain and several others. Kidneys are also damaged to a great extent. In Heart it can cause acute coronary syndrome, Heart failure, Myocardial infarction. SARS-CoV-2 effect brain especially psychologically. It also causes serious lymphocyte apoptosis. It also neutralizes human spleen and lymph nodes. SARS-CoC-2 can be harmful for those having already liver diseases. Similarly, SARS-CoV-2 has a direct impact on endocrine glands. It is responsible for the various injurious changes in hormones, causes various diseases like acute pancreatitis, decrease in GH, hypoparathyroidism etc. and lead to cause tissues damage in glands. It also some minor effects on nose, and respiratory pathways. It also has some minor effects on eyes and ears whereas it causes several devastations in GIT.

Malignant pericardial effusion is a usual and crucial exacerbation in malignancies. In some cases, pericardial effusion may be the first manifestation of the disease. Neoplastic pericarditis is extremely rare in thyroid cancer. Hereby, we describe the case of a 54-year-old man submitted to the hospital for chest pain and dyspnea. Clinical and radiological examinations were suggestive of pericardial effusion and mediastinal lymphadenopathy. The patient underwent pericardial drainage and surgical biopsy of a paratracheal lymph node. Pericardial biopsies were also taken. Histology study was compatible with metastatic papillary thyroid carcinoma with “signet-ring” cell morphology. Extended study of thyroid gland and function was performed and he was referred to oncologists for further treatment. Clinical presentation and histology are discussed emphasizing the rare correlation between pericardial pathology and metastatic thyroid carcinomas as the first diagnosis. Histopathologic findings of “signet-ring” cell morphology are very challenging for a differential diagnosis between thyroid carcinoma and other metastatic adenocarcinomas.

Hoarseness of voice can occur due to anatomical or functional abnormality of the larynx, vocal cord, or recurrent laryngeal nerves. Common cause includes infections, blunt trauma, iatrogenic affection of recurrent laryngeal nerve, malignancies of thyroid, esophagus, and lung and cardio-vascular conditions such as mitral stenosis. Vocal cord paralysis due to respiratory cause is known as a pulmonary vocal syndrome. 

Over the last few years, the prevalence of thyroid nodules has increased. There are multiple reasons: true increase in incidence and increase in investigations with better technology. Finding a nodule in the thyroid does lead to a flurry of investigations. 

Calcinosis cutis (CC) [1] is an unusual disorder characterized by calcium-phosphate deposition into cutaneous and subcutaneous tissues. There are five subtypes: dystrophic, metastatic, idiopathic, iatrogenic and calciphylaxis.Calciphylaxis or calcifying panniculitis is defined as small vessel calcification mainly affecting blood vessels of the dermis and subcutaneous fat. Despite the predominance of cases in patients with ESRD, calciphylaxis can also be found in patients with normal renal function and normal levels of calcium and phosphate. These cases are often referred to as nonuremic calciphylaxis (NUC), a heterogeneous category with several associations. Literature reveals an association with hyperparathyroidism (28%), malignancy (22%), alcoholic liver disease (17%) and connective tissue diseases (11%) while obesity, liver disease, high-serum calcium (Ca) × phosphorus (P) levels, combined therapies of calcium salts with vitamin D, warfarin and corticosteroids have been observed to increase the likelihood of this disease [2]. The lesions in both nonuremic and uremic calciphylaxis tend to be indistinguishable from each other, initially presenting as tender subcutaneous plaques that progress into nonhealing ulcers with overlying black eschar. Skin changes often begin with a livedo reticularis pattern that can progress to livedo racemes and ultimately retiform purpura.In our clinical case, we describe a patient with multiple risk factors for calciphylaxis, intense widespread calcification (vessels, tendons, joints) and cutaneous calcific stone of calcium and phosphate oxalate not elsewhere described before.

The impact of vitamin D on the musculoskeletal system is well known. The diverse role of vitamin D is well supported by the functionality of vitamin D receptors and vitamin D activating enzymes (hydroxylase) present in tissues and cells. Hypovitaminosis D causes rickets, osteomalacia, hyperparathyroidism, and an increased risk of bone fracture. Vitamin D has immune-stimulatory effects on both the innate and adaptive immune systems. Vitamin D induces antimicrobial peptide cathelicidin and defensin that can inhibit viral replication of pro-inflammatory cytokines that regulate inflammatory encasement. Moreover, several studies on vitamin D have shown its interdictory role in the immune and respiratory systems. This global crisis, the COVID-19 pandemic condition has increased the risk of acute respiratory tract infection by immune dysregulation along with cytokine storm, which further progress into acute respiratory distress syndrome. Vitamin D has immunomodulatory and anti-inflammatory properties which are effective against respiratory viral infections. Vitamin D supplementation has shown a compatible effect on viral infection. This review article discusses the role of vitamin D in reducing the risk of respiratory infections including the severity of COVID-19 infections. This review focuses on the therapeutic role of vitamin D to improve clinical outcome during COVID-19 infection and suggest its possible role in the prevention and treatment of respiratory infections.

Neck exploration for primary HPT is the standard operation in which 4 parathyroid glands are identified and one abnormal parathyroid gland is removed. This is recommended for all patients with primary HPT. We hypothesized that most patients with primary HPT have a single abnormal parathyroid gland (adenoma) and parathyroid imaging studies will identify it and support a focused minimally invasive parathyroidectomy (MIP). This can be combined with ioPTH monitoring making bilateral exploration unnecessary. This paper reports a 93.4% success rate in 249 consecutive prospective patients with primary HPT over a 15-year period with a short operating time and few complications. The findings suggest that this alternate surgical MIP approach should be the procedure of choice for HPT patients.

Background: 800 women die and 2.6 million stillbirths occur worldwide related to pregnancy complications. Racial/ethnic disparities in pregnancy-related mortality have continued to be significantly higher among black than whites due to various factors. We sought to investigate complications among pregnant women of different race/ethnicity.Methods: Cross-sectional observational study of 2030 obstetric cases randomly selected for the period January 1 to December 31, 2021. Data was collected from the hard copy and electronic inpatients’ records. Analysis was performed using SPSS version 23. Descriptive statistics analyzed the pregnancy complication frequencies, standard deviations, range, minimum and maximum values. Maternal characteristics were analyzed using an independent samples t-test. Maternal characteristics were evaluated using the two samples t-test. The odds ratios and confidence intervals were calculated as measures of association between ethnicity/race and pregnancy complications using a binary logistic regression model. Confidence interval was set at 95% and p < 0.05 (2-tailed) was considered statistically significant.Results: 76.25% of Chinese and 67.86% of Zambians were affected by one or more complications. The mean ± standard deviation for MGH [age (26.69 ± 7.33), gravidity (3.35 ± 2.08), and parity (2.07 ± 1.68)] and for 2nd affiliated hospital was [age (30.04 ± 4.29), gravidity (2.19 ± 1.38) and parity (0.45 ± 0.55)]. Prevalence of top five pregnancy complications in the Chinese group was gestational diabetes mellitus at 18.41%, hypothyroidism at 15.91%, oligohydramnios at 14.39%, premature rupture of membranes at 12.17%, and anemia at 5.73%. The prevalence of the top five pregnancy complications in the Zambian group was preeclampsia at 13.80%, PIH at 12.74%, PROM at 12.45%, eclampsia at 7.53%, and placenta abruption at 7.43%. Statistical significance findings were noted as follows: Oligohydramnios [OR 0.02, CI (0.01 - 0.05), p = 0.000], placenta praevia [OR 0.08, CI (0.01 - 0.61), p = 0.015], preeclampsia [OR 13.10, CI (7.22 - 23.78), p = 0.000], placenta abruptio [OR 79.73, CI (11.07 - 574.38), p = 0.000], PIH [OR 11.95, CI (6.57 - 21.73), p = 0.005], eclampsia [OR 162.90, CI (10.08 - 2631, p = 0.000), PPROM [OR 0.03, CI (0.00 - 0.45), p = 0.012], GDM [OR 0.11, CI (0.07 - 0.17), p = 0.000], hypothyroidism [OR 0.01(0.00-0.03), p = 0.000], anemia [OR 0.18, CI (0.92-0.34), p = 0.000], ICP [OR 0.03, CI (0.00 - 0.48), p = 0.013], syphilis [OR 7.17, CI (2.14 - 24.02), p = 0.001], UTI [OR 22.55, CI (3.04 - 17.26), p = 0.002], HBV [OR 0.05, CI (0.00 - 0.86), p = 0.039] and GBS [OR 0.06, CI (0.00 - 1.11), p = 0.059].Conclusion: Highest odds for obstetrical and infection-related pregnancy complications were associated with Zambian cases. The highest odds for medical complications were associated with Chinese cases.

Aim: This study aimed to investigate the association between sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), and laboratory findings in patients presenting with the complaint of leg pain due to varicose veins.Materials and Methods: A total of 160 patients with leg pain were included in this study. Sleep quality was assessed using the PSQI, and laboratory tests were conducted to evaluate ferritin, iron, vitamin B12, Thyroid Stimulating Hormone (TSH), C-reactive protein (CRP), albumin, low-density lipoprotein (LDL), and hemoglobin levels. Statistical analyses were performed using the independent t-test or Mann-Whitney U test for continuous variables and the chi-square test for categorical variables.Results: Patients with poor sleep quality had a significantly higher prevalence of leg pain complaints compared to those with good sleep quality (p < 0.001). Females were more likely to report poor sleep quality (p = 0.006). No significant associations were found between sleep quality and age, smoking status, alcohol use, or pack/year of smoking. Patients with poor sleep quality had significantly lower ferritin levels (p = 0.008), lower albumin levels (p = 0.031), and lower hemoglobin levels (p = 0.036) compared to patients with good sleep quality. However, no significant differences were observed in other laboratory parameters.Conclusion: The findings suggest a significant association between poor sleep quality and leg pain complaints in patients with varicose veins. Lower ferritin, albumin, and hemoglobin levels in patients with poor sleep quality may indicate potential underlying mechanisms linking sleep quality and leg pain. Addressing sleep quality issues in patients with leg pain could improve overall well-being and treatment outcomes.

Calciphylaxis (CP) or uremic calcific arterial disease (CUA) is a rare, potentially fatal calcific vasculopathy characterized by calcific and thrombotic occlusion of the vessels of the subcutaneous and dermis leading to extremely painful necrotic lesions. It mainly affects patients with end-stage kidney disease (ESKD) and under long time dialysis. The only therapeutic option is represented by intravenous sodium thiosulfate. Currently, clear guidelines are lacking. We have had a good therapeutic response with doses of sodium thiosulfate in association with multidisciplinary management of the patient (vulnologist, dermatologist, nephrologist, dietitian, and cardiologist). There is limited literature on the use of DOAC therapy as a successful alternative to warfarin in patients on dialysis with calciphylaxis. The left atrial appendage closure could represent an important alternative to dicumarolics in patients with atrial fibrillation with calciphylaxis. A new perspective for the treatment of this disease is SNF472 a selective inhibitor of vascular calcification.

Background: Myxedema is an extreme manifestation seen in patients with untreated hypothyroidism. It is a lethal endocrine emergency, which arises when a precipitating cause overwhelms the compensatory mechanisms of the hypothyroid state.Objectives: This case report aims to present a case of myxedema coma secondary to cretinism. It also aims to discuss how hypothyroidism leads to hypoventilation and eventually respiratory failure, as well as to discuss the epidemiology, pathophysiology, clinical manifestation, diagnosis, and management of a child with myxedema coma.Case presentation: This is a case of a 7-year-old female, diagnosed with congenital hypothyroidism at 5 months of age, but eventually was lost to follow-up. She came back after 7 years presenting with difficulty of breathing. She was seen hypothermic, obtunded, and in severe respiratory distress. She was severely stunted and underweight with coarse facial features. Initial laboratory work-up showed elevated Thyroid Stimulating Hormone (TSH) as well as decreased tri-iodothyronine (FT3) and thyroxine (FT4). She was immediately started on levothyroxine, with noted resolution of the edema and improvement in sensorium. There was also noted improvement in the patient’s ventilation and was sent home on Continuous Positive Airway Pressure (CPAP) while asleep.Conclusion: This case highlights the importance of having a high index of suspicion of its clinical manifestations, which could lead to earlier intervention thereby preventing further complications. A multidimensional approach is essential in managing this case, as various organ systems are involved in this condition.

Background: Human Immunodeficiency Virus (HIV) and thyroid function have been described. Prevalence pattern and atherogenic status significantly differ from HIV-negative control in several studies. Unfortunately, few studies have determined the prevalence of thyroid function and lipids among Nigerians living with HIV. Objective: This study is to evaluate thyroid hormones and lipid profiles in HIV-positive subjects attending a faith-based health facility in Anambra State Nigeria.Materials and methods: The serum concentration of Thyroid Stimulating Hormone (TSH), free Triiodothyronine (fT3), triiodothyronine (T3), free Thyroxine (fT4), Thyroxine (T4), Total Cholesterol [TC], Triglyceride [TG], High-Density Lipoprotein [HDL], Low-Density Lipoprotein [LDL] and Very Low-Density Lipoprotein [VLDL] was determined in 95 HIV positive subjects which include 48 patients who were on HAART- group 1 and 47 not on HAART- group 2; and compared to 30 HIV negative controls – group 3. Results: The level of TSH and fT3 was significantly (p < 0.05) higher in group 1 participants than in group 2 and the group 3 participants. The level of T4 was significantly higher in group 2 than in group 1 and group 3 participants. The level of T3 was significantly lower in Control participants in comparison to both HAART and non-HAART participants. The prevalence of fT4 dysfunction across the groups was significantly different from each other. The total mean of Cholesterol (163.5 ± 22.7), Triglyceride (163.5 ± 22.7), and Very Low-Density Lipoprotein (14.2 ± 2.4) of the HIV-positive participants were significantly (p < 0.05) lower than that of the HIV negative participants.Conclusion: The results obtained from this study indicate that serum levels of thyroid hormones may be used as baseline periodic markers during antiretroviral therapy and many people living with HIV may benefit from supplementation if appropriate.

Thyroid cancer, characterized by the development of malignant tumors in the cells of the thyroid gland, impacts the quality of life and well-being of diagnosed patients. This article explores different aspects of this type of cancer, including everything from its typologies, incidence, causes, and risk factors to symptoms, diagnostic methods, and treatment options. Furthermore, the impact on Health-Related Quality of Life (HRQoL) is addressed, highlighting that, although the prognosis is generally favorable, patients can experience significant negative repercussions. Therefore, the need for further investigation into the priorities of psychological intervention with the population with this problem is emphasized.

The history of the origin of the medical uses of Radioiodine (RAI) has been compromised by false narratives as recently as June 2023 in the “Thyroid “article “Radioactive Iodine: A Living History”. Primary sources document Dr. Saul Hertz (1905 - 1950) as solely conceiving of the medical uses of RAI, being the first and foremost to develop the experimental data, bringing RAI from bench to bedside, and extending the use of radionuclides to diagnose and/or treat cancer and other conditions. Dr Hertz predicted and worked toward conquering cancer with other radionuclides. Saul Hertz overcame the racism of his time, a world war interrupting his first clinical study, a strong pushback from the surgeons, and unethical medical publishing practices. Today, Nuclear Medicine, Radiopharmacy, Medical Physics, and other specialties are collaborating and actively building on Saul Hertz’s enduring foundational work. 

Objective: Alazami syndrome (AS) is an infrequent genetic disorder inherited in an autosomal recessive pattern, characterized by the presence of multiple congenital abnormalities. This study explores a case of a 4-year-old girl with AS, examining symptoms, genetic factors, and treatment efficacy. Case report: A 4-year-old girl, born to consanguineous Jordanian parents, displayed dysmorphic features including low birth weight, microcephaly, hyperthyroidism, short stature, blue sclera, triangular-shaped face, deep-set eyes, narrow palpebral fissures, and a prominent forehead. Examination revealed height (92 cm) and weight (7.7 kg) below the 5th and 3rd percentiles respectively. Blood tests and renal ultrasound were normal. Whole exome sequencing (WES) identified a homozygous eight-base pair deletion within exon 5 of the LARP7 gene on chromosome 4q25, confirming the diagnosis of AS, an autosomal recessive disorder. This variant induces frameshift mutations leading to premature stop codons, suggesting a probable mechanism of illness via loss of function. Treatment involving growth monitoring and therapy led to significant improvements in height, weight, and communication skills within three months. Conclusion: We describe a rare autosomal recessive AS case due to consanguinity, with a frameshift mutation in the LARP7 gene found via WES. Our AS treatment program effectively alleviates symptoms and enhances developmental progress.

A 51-year-old female with a history of multinodular goitre presented with vomiting, abdominal discomfort, and generalized tiredness. Investigations revealed hypercalcemia (ionized calcium 1.41 mmol/L), hypokalaemia, suppressed parathyroid hormone, and significantly elevated free thyroxine (> 7.77 ng/dL) with a suppressed thyroid-stimulating hormone level consistent with hyperthyroidism. Further, the workup confirmed Graves’ disease as the underlying aetiology. Hyperthyroidism is occasionally associated with mild to moderate hypercalcemia, but severe hypercalcemia or hypercalcaemic crisis is an extremely rare complication. Prompt recognition and treatment are crucial to prevent life-threatening complications. The patient was treated with intravenous fluids, a low-calcium diet, zoledronic acid, carbimazole, and a beta-blocker, leading to improvement in her condition. This case highlights a rare occurrence of hypercalcaemic crisis in a patient with thyrotoxicosis due to Graves’ disease. Hyperthyroidism-induced hypercalcemia requires prompt recognition and multidisciplinary management involving endocrinologists, internists, and critical care specialists to prevent potentially life-threatening complications. Healthcare providers should consider the hypercalcaemic crisis in the differential diagnosis of hypercalcemia in the context of hyperthyroidism.

Familial hypocalciuric hypercalcemia (FHH) is one of the rare reasons for hypercalcemia. FHH is an autosomal dominant disease that is inheritable. The most common calcium sensitive receptors (CaSR) develop because of the inactivation of. In addition, they also develop due to the function loss of AP2S1 and GNA11. The FHH sickness is characterized by hypercalcemia, hypocalciuria, the regular or increased level of the parathyroid hormone, and normal renal function. The symptoms of hypercalcemia are usually not observed. It is often diagnosed by calculating the calcium/creatine clearance ratio of a 24-hour urine sample, and then genetically looking at it. FHH is usually a benign disorder, and when symptomatic and rarely complications develop, calcimimetics are used or parathyroidectomy can be performed. In conclusion, FHH is a benign and genetically transmitted, moderate cause of hypercalcemia. It is rare and usually asymptomatic.

An autoimmune condition known as Systemic Lupus Erythematosus (SLE) affects several systems and manifests itself in a variety of ways. It is far more common among young women who are fertile.It has been demonstrated that a mix of environmental and genetic variables may trigger immunological responses, triggering T and B cells, and leading the B cells to overproduce pathogenic autoantibodies and dysregulate cytokines, which ultimately result in harm to many organs and tissues. One feature of SLE is the presence of antibodies against cytoplasmic and nuclear antigens. An autoimmune illness is also type 1 diabetes. β-cell antibodies (Ab) and other antibodies that cause the autoimmune death of the pancreatic β-cells, which make insulin, are part of the multifactorial pathophysiology of type 1 diabetes mellitus (T1DM).Immunosuppression is the therapy for systemic lupus erythematosus (SLE), and diabetes itself compromises immunity, making infections more opportunistic. We came across an unusual instance of a patient with SLE, T1DM, hypothyroidism on immunosuppression who subsequently acquired pulmonary TB.Key phrase: Autoimmune diseases such as type 1 diabetes mellitus (T1DM) and Systemic Lupus Erythematosus (SLE).