Hypothyroidism following thyroid surgery

Postsurgical hypothyroidism and its incidence has not been fully investigated. In this study, the incidence of hypothyroidism and its possible risk factors at Shariati Hospital was assessed. One hundred and two patients with benign thyroid diseases, who had undergone thyroidectomy, were investigated with regards to thyroid function profile during period of one year after the operation every three months with post-operative sample as the baseline. Hypothyroidism was developed in 36 patients [35.2%] on average 5 +/- 3.2 months after surgery. Factors such as increased age, operation type, histopathologic type, underlying disease, lymphocytic infiltration and use of levothyroxine before surgery were associated with the increased incidence of hypothyroidism. It seems that use of indicators such as Graves' disease and lymphocytic infiltration in pathologic specimens should be helpful in projecting the potential occurrence of hypothyroidism in patients undergoing thyroidectomy

[Evaluation of retinoblastoma expression in benign and malignant thyroid neoplasms]

Several factors are involved in the thyroid tumourigenic process. The role of Retinoblastoma [Rb] tumor suppressor gene mutation in thyroid carcinogenesis has been discussed. In this study we investigated the expression of Retinoblastoma gene in thyroid neoplasms and its association with clinical and histological findings, to evaluate its ability in distinguishing benign and malignant thyroid neoplasms and as a prognostic factor. The present cross sectional study investigated Avidin - Biotin immunohistochemistry using the Dako Rb - 1 clone in a series of 200 formalin - fixed, paraffin - embedded thyroid lesions, including 39 benign and 161 malignant neoplasms. Nuclear immunoreactivity in more than 10% of tumor cells was assessed as positive. Rb was positive in 74.2% of follicular adenoma, 87.5% of hurthle cell adenoma, 46.2% of papillary carcinoma, 66.7% of follicular carcinoma, 29.4% of medullary carcinoma and 50% of anaplastic carcinoma. Overall Rb nuclear immunoreactivity was observed in 76.9% of benign tumors and 45.9% of malignant lesions. No significant difference in Rb expression between follicular adenoma and follicular carcinoma was seen; also no association was found between Rb expression and invasiveness in malignant tumors. The results of this study indicate that Rb gene expression in benign thyroid tumors is significantly higher than in malignant ones [P=0.001], an association observed particularly in women. Rb gene inactivation is likely to play a role in malignant evolution of thyroid neoplasms and considering female predominance in thyroid tumors, Rb immunohistochemistry can potentially aid in the distinction between benign and malignant thyroid tumors in conjunction with morphology, but it is not helpful in differentiation between follicular adenoma and follicular carcinoma

[Expression of Nm23 marker in benign and malignant thyroid neoplasms immunohistochemical]

Several prognostic factors affect the outcome of thyroid carcinomas including tumor stage and distant metastases. Nm23 is a metastasis suppressor gene and has a crucial role in the control of metastatic potential of several carcinomas. The aim of our study is to evaluate expression of nm23 marker in benign and malignant thyroid neoplasms using the immunohistochemistry method and to elucidate its relationship with tumor size, vascular or capsular invasion and lymph node involvement. In a descriptive study, 200 paraffin blocks comprising of 38 benign and 162 malignant thyroid neoplasms stained with nm23 marker were studied. Cytoplasmic staining in more than 10% of cells was considered as positive. The relationship between nm23 and tumor size, vascular or capsular invasion, lymph node involvement was analysed using SPSS 11.5 software [p=0.05]. There was 40% positive incidence of nm23 in follicular adenoma, 87.5% in hurthle cell adenoma, 67.2% in papillary carcinoma, 66.7% in follicular carcinoma, and 64.7% in medullary carcinoma. In follicular adenoma, frequency of nm23 positive tumors was directly correlated to tumor size [p=0.04]. There are no statistically significant correlation between nm23 and tumor size, vascular or capsular invasion or lymph node involvement in malignant thyroid neoplasms. In papillary and medullary carcinoma, negative predictive value of nm23 for lymphnode involvement was over 80%. Also in follicular carcinoma, sensitivity and negative predictive value of nm23 for vascular invasion were approximately 90%. Lack of significant correlation between nm23 and tumor invasiveness [and probably metastasis] factors, demonstrate that although nm23 is a potentially metastasis suppressor gene, whereas in many other tumors it may play a different role in thyroid neoplasms, a role which necessitates further studies to be conducted

Frequency of hypothyroidism and factors affecting it in HIV-infected patients in Tehran, Iran [2004]

A wide spectrum of endocrine abnormalities including thyroid dysfunction has been observed in HIV-infected patients with different results. This study was conducted to determine the frequency of thyroid dysfunction and to identify factors affecting the development of hypothyroidism in HIV-infected patients. Free T4, FT3, TSH, and thyroglobulin levels of 88 HIV-infected patients receiving care at UT counseling center for Behavioral Disorders in Tehran, an out patient referral center, were measured and data on their age, sex, body weight, BMI, history of opium and injection addictions, duration of HIV infection, disease stage, history of opportunistic infection or malignancy, CD4 cell count, antiretroviral treatment with antiretroviral drugs [HAART], receipt of other drugs [TMP-SMX, antituberculosis drugs, and steroids], and hepatitis C virus Co-infection were collected. Inclusion of the subjects was simply random. 17% of subjects had hypothyroidism; 1.1% had overt hypothyroidism; 2.3% subclinical hypothyroidism and 13.6% had low FT4 levels. The multivariate analysis showed that none of the studied factors were associated with the development of hypothyroidism. As none of the above-mentioned factors are not associated with the development of hypothyroidism, hypothyroidism should be considered in HIV-infected patients

Diagnosis of pendred syndrome: MRI versus other traditional criteria

Background and purpose: Pendred syndrome, defined traditionally as the constellation of goiter, sensori-neural hearing loss and positive perchlorate discharge test. Since the relatively newer approaches to the diagnosis of this syndrome, as MRI and genetic and/or molecular analysis are much more expensive and complicated than the traditional approaches, we planned to study the value and reliability of MRI as the sole, or adjunctive diagnostic approach to the syndrome

Materials and methods: We presumed the classic triad is still the most widely accepted gold standard, and compared MRI findings in six such defined patients with six seemingly incomplete forms with goiter and hearing loss, but with negative Perchlorate discharge test

Results: There were a sensitivity and specificity of 83.3% and 66.7%, respectively for MRI in patients fulfilling all three criteria and 66.7% and 100% for sensitivity and specificity in the group lacking perchlorate test positivity

Conclusion: Although MRI can not replace the holistic approach, In [partial] cases with equivocal findings, and in the evaluation of relatives of the patients MRI may be considered as a valuable diagnostic adjunct

Evalution of the relationship between vitamin d receptor gene polymorphism [FOK I] and thyroid cancer

Background and purpose: Vitamin D is an antiproliferative agent against cancer cells and regulates cell differentiation. It acts via Vitamin D Receptor [VDR]. The VDR gene contains a Start Colon Polymorphism [SCP] that can be detected with the restriction enzyme Fok I. Previous studies report an association of SCP and some diseases and some suggest that this polymorphism alters VDR function. As no studies so far have reported the association between Fok I genotype in Thyroid cancer, this study is intended to determine the association of Fok I polymorphism of VDR with thyroid cancer risks in Iranian population

Methods and Materials: 58 patients with papillary carcinoma, 13 patients with follicular carcinoma and 82 controls participated in a case-control study. A PCR-RFLP method used to determine VDR gene polymorphism in start codon characterized by the restriction enzyme Fok I. 95% confidence intervals and odds ratio were calculated for testing the relationship between Fok I polymorphism and thyroid cancer

Results: The odds ratio for the Fok I polymorphism on thyroid cancer was 0.39 [95% CI, 0.12-1.27] witch signifies no relationship between this polymorphism and the ris of thyroid cancer

Conclusion: As no relationship was found between this polymorphism and thyroid cancer, other genetic or environmental factors may be considered in thyroid cancer

Non-functioning pituitary adenoma: clinicopathological study of 85 cases

Background and Purpose: Pituitary adenomas without clinically active hypertension are termed as non-functioning adenoma [NFPA]. These tumors represent about one quarter of all pituitary tumors. Immunohistochemical methods are the gold standard methods of identifying them. The Ki-67 is a nuclear antigen detected by the monoclonal antibody MIB-1, whose labeling index [LI] is considered as a marker of normal and abnormal cell proliferation

Methods and Materials: In this clinicopathological study, 85 cases of NFPAs were analyzed immunohistochemically

Results: MIB-1 LI was measured in all surgical specimens, which was higher than 5% only in 5 cases. Also, 18 cases were immunoactive to one or two adenohypophysial hormones

Conclusion: NFPAs comprise several pathologically different types of tumors, some of which are potentially hormone producing tumors. However, probable defects in hormone secretion may be the cause of not increasing the adenohypophysial hormone levels in the serum and consequent syndromes

Metastatic follicular thyroid carcinoma with spinal cord compression: a case report

Background and Purpose: Spinal cord compression due to metastasis, as the initial presentation of follicular thyroid carcinoma, is quite uncommon. In this article, we report one case of well-differentiated thyroid carcinoma which has led to the compression of the spinal cord

The patient: The case we report here is a man of 53 years old, with increasing neck pain, paraplegia and urinary incontinence. Magnetic resonance imaging of the neck revealed a mass which had destructed C5 with extension to C6

Conclusion: Histopathology examination demonstrated the metastasis of a well-differentiated follicular carcinoma of thyroid. Therefore, the metastatic lesion of the thyroid carcinoma should be considered in any case of spinal cord compression

Epidemiologic feature of thyroid cancer based on cancer registry data system

This study was undertaken to define the epidemiological aspects of thyroid carcinoma in Iran, an area of endemic iodine deficiency nearly until recently. The Tehran Cancer Institute Data System Registry [TCIDSR] was used to identify patients with different histological types of thyroid cancer [TC] in Iran. Data were analyzed from 438 thyroid cancer cases identified by the TCIDSR in 1998-99. Disease prevalence was calculated by age, time and place. The TCIDSR recorded 438 primary malignancies of the thyroid gland: papillary, follicular, medullary, and anaplastic carcinomas accounted for 67.1%, 10.7%, 5.3% and 4.3% of cases, respectively. The remaining 12.6% was classified as OD [other diagnoses]. The prevalence of TC was the highest in Farsis population. The age range of patients was 8-85 yr. Mean patient age was 44.52 +/- 17.03 yr [mean +/- SD] overall, 47.74 +/- 18.10 yr in male patients and 43.04 +/- 16.34 in female patients. Anaplastic [6.5% vs. 3.3%] and medullary [10.0% vs. 3.0%] cancers were more common in men than women. Against expectation for an iodine-deficient area, the frequency distribution of tumours in our study was closer to that seen in iodine-rich areas. Additional research on the risk factors for thyroid cancer-genetic, ethnic, geographic and environmental is needed to explain the high incidence of PTC overall, and among Farsis population in particular, in Iran