Diagnostic performance of ACR-TIRADS, Korean TIRADS, and American Thyroid Association guidelines for risk stratification of thyroid nodules: a prospective study.

BACKGROUND: In the present study, the first aim was to compare the accuracy of three guidelines in the diagnosis of thyroid nodule malignancy. The second purpose was to find sonographic features potentially associated with the risk of malignancy. METHODS: In this cross-sectional study, we prospectively recruited patients referred with a diagnosis of thyroid nodule (≥ 1 cm) for fine-needle aspiration (FNA). Sonographic features were recorded and scored according to the American Thyroid Association (ATA-2015), the American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS), and the Korean TIRADS (K-TIRADS). FNA was conducted and cytological findings were reported. RESULTS: A total of 984 thyroid nodules were ultimately included, of which 144 (14.6%) were malignant and 840 (85.4%) were benign. The accuracy of ACR-TIRADS categories TR5 and TR4/5 was 88.3% and 69.3%, respectively. This rate for ATA-2015 classes High suspicion and Intermediate suspicion/High suspicion was 87.9% and 80.4%, respectively. For K-TIRADS classes 5 and 4/5, the diagnostic accuracy was 88.0% and 80.6%, respectively. The rate of unnecessary FNA was highest with ATA-2015 and K-TIRADS guidelines (53.9% and 53.7%, respectively), followed by ACR-TIRADS (32.0%). Significant direct associations were observed between malignancy and hypoechogenicity (odds ratio [OR] 5.78), fine calcification (OR = 6.7), rim calcification (OR = 2.56), ill-defined margin (OR = 3.31), and irregular margin (OR = 6.95). CONCLUSIONS: There are different strengths of ACR-TIRADS, K-TIRADS, and ATA-2015 guidelines in the prediction of malignant thyroid nodules, and clinicians and radiologists should consider these differences in the management of thyroid nodules.

Direct correlation between serum homocysteine level and insulin resistance index in patients with subclinical hypothyroidism: Does subclinical hypothyroidism increase the risk of diabetes and cardio vascular disease together?

BACKGROUND: Subclinical hypothyroidism known as mild thyroid disorder without significant sign and symptoms. The correlation between subclinical hypothyroidism and some of cardiovascular disease risk factors such as serum lipids, homocysteine levels and also insulin resistance index is not well established and the current study was conducted to clarify this issue. METHODS AND MATERIALS: Seventy four patients with mild elevation in levels of thyroid stimulating hormone (TSH) along with normal levels of T3 and T4 were selected as patients group and 74 age and sex matched individuals were selected as healthy control group. Serum insulin, triglyceride, glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and homocysteine levels were measured. Obtained data compared between groups with independent sample t-test. For evaluation of the correlation between mentioned parameters Pearson correlation coefficient method was used. RESULTS: Serum levels of LDL-C and total cholesterol significantly increased in SCH group compared to healthy control group. Homeostatic Model Assessment of Insulin Resistance (HOM-IR) and serum homocysteine level significantly elevated in patients with SCH compared to control group. There was a significant direct correlation between HOM-IR and serum homocysteine levels in SCH patients. CONCLUSION: Subclinical hypothyroidism likely have significant effect on insulin resistance as major diabetes risk factors and also cardiovascular disease risk factors such as homocysteine. The direct correlation between HOM-IR with serum homocysteine level indicate the possible role of insulin resistance in elevation of serum homocysteine in SCH patient group.

Evaluation of immunological parameters in diabetic patients: are these patients immunodeficient?

It has been widely thought that diabetic patients are prone to infections due to hyperglycemia induced immunodeficiency; the present study was designed to examine this opinion. In diabetic patients and normal control groups T-cell reactivity to hsp-60 molecule, tetanus toxoid recall antigen (TT) and phytohemagglutinin-A (PHA) mitogen were evaluated The number of circulating IFN-γ, IL-10 and IL-13 cytokine producing cells stimulated with above antigens or mitogen as well as the serum levels of Th1/Th2 type cytokines were determined. Total serum immunoglobulins (IgG, IgA, IgM), C3, C4 and CH50 were also measured. Diabetic patients showed a positive circulating T-cell reactivity to human recombinant hsp60 However, this reactivity was significantly lower in comparison to control group (p<0.001). All other examined factors were not significantly different between diabetic and normal subjects except for the number of IFN-γ and IL-13 producing cells in response to PHA stimulation, which was higher in control gtroup (p=0.006, 0.018, respectively). The mean serum concentration of IgA in diabetic patients was 245.86 ± 115.05 mg/dl versus 192.96 ± 105.33 mg/dl in healthy control group (p<0.018). We were not able to demonstrate any substantial mitigation in cellular arms of immune reaction to some prominent T-cell antigens and mitogens, as well as, in main parameters of humoral immunity of diabetic patients, thus, the common notion of believing that patients with diabetes suffering from immunodeficiency should be revised. It is much more appropriate that "altered immunity" is applied instead of "immunodeficiency" to explain the immunity condition in this group of patients.