Study and Correlation of Clinical, Laboratory and Radiological Findings in the Diagnosis of Thyroid Disorders.

Diseases of thyroid gland are among the most abundant endocrine disorders. Both hypothyroidism and hyperthyroidism have been linked with increased risk of cardiovascular disease and adverse effects of thyrotoxicosis in terms of osteoporosis risk is well established. Early diagnosis and treatment is the cornerstone of management of thyroid disorders. Anti-TPO antibody are useful markers for the detection of autoimmune thyroid disease while ultrasonography is the modality of choice for characterization of thyroid disease.Our study aims to review the relationship between clinical,laboratory and USG findings in the diagnosis of thyroid disorders. MATERIAL: An observational prospective study was conducted in a tertiary health care centre for a period of 18 months.Adult patients with symptoms of thyroid disease and deranged FT3/FT4/TSH were included. Anti-TPO antibody was done using ELISA.Chi-square was used to compare data with p-value <0.05 was considered to be significant. OBSERVATION: Total 150 patients were analysed out of which 23 were males and 127 were females. Maximum patients were found in 31-45year age group. Subclinical hypothyroidism was noted in 50% patients followed by overt hypothyroidism (21.3%),overt hyperthyroidism (21.3%) and subclinical hyperthyroidism (6%). Most common symptom of subclinical hypothyroidism was fatigue. 62% patients were positive for Anti-TPO antibody,out of which 90% were females and rest were males. The most common USG finding was diffuse thyroid disease(51.3%), followed by normal USG(19.3%),thyroiditi s(11.3%),multinodular goitre(10%) and single nodule(6%). Among those patients with diffuse thyroid disease on USG,85% patients had positive Anti-TPO antibody levels. CONCLUSION: According to the present study, Anti-TPO antibody has been statistically associated with thyroid disease. Diffuse hypoechogenecity on USG is statistically associated with positive Anti -TPO antibody and thus have a major role in diagnosing etiology and predicting prognosis of patients with thyroid disorders.

Saphenous nerve to posterior tibial nerve transfer: A new approach to restore sensations of sole in diabetic sensory polyneuropathy.

BACKGROUND: Loss of sensations in the sole following diabetic sensorimotor polyneuropathy (DSPN) leads to diabetic foot ulcers and its sequelae. We hypothesized that sensory reinnervation of sole by transfer of saphenous nerve (SN) to sensory fascicles of posterior tibial nerve (PTN) in these patients may reverse the neuropathy. METHODS: This prospective interventional case series included patients with advanced DSPN and intact sensory supply of SN. PTN was neurotized by transfer of SN nerve in the tarsal tunnel and postoperatively sensations of the sole were tested. Any existing ulcers on sole were noted and their healing was monitored. FINDING: A total of 17 patients (22 feet), 9 male and 8 female, were included. Seven patients had ulcers in the feet. At 6 months follow-up all patients developed protective sensation in the sole. The average 2 PD improved from 60 mm to 45.5 mm, average vibration perception improved from 34.12 V to 24.33, Medical Research Council (MRC) score improved from S0 in 12 feet and S1 in 10 feet to S3+ in 13 feet, S3 in 5 feet, and S2 in 2 feet at 6 months along with healing of ulcers in all 7 feet. INTERPRETATION: Transfer of SN to PTN for sensory neurotization is an innovative and simple option to prevent complications of DSPN. This procedure has the potential to change the natural history of DSPN.