ABSTRACT
INTRODUCTION: Hashimoto's thyroiditis (HT) is a common autoimmune thyroid disorder, which predominantly presents as a diffuse goiter, with few studies which report HT presenting as multinodular goiter, with variable frequencies ranging from 59% to 78.6% especially from south Indian populations. This variant clinical presentation may have diagnostic challenges which require further analysis. Anti-TPO antibodies are more common (90-95%) in Hashimoto's thyroiditis than anti-TG antibodies in Hashimoto's thyroiditis. This study analyzes the clinical features and the correlation of anti-TPO levels with diffuse and multinodular forms of HT. MATERIAL AND METHODS: This study was conducted in the Department of General Surgery in a tertiary care hospital in south Tamil Nadu. Patients presenting with clinical features of a thyroid disorder were interviewed and given a detailed clinical, radiological examination and guided FNAC. Those patients diagnosed by FNAC as HT were registered and a sample of 3cc of blood was drawn for T3, T4, TSH, and anti-TPO analysis. All the data were tabulated. RESULTS AND DISCUSSION: Of the 212 patients who presented with goiters, 96 were diagnosed by FNAC as having a cytological picture suggestive of Hashimoto's thyroiditis. Of these 96 patients with HT, 46 (47.9%) were multinodular (HT-MNG), 14 (14.58%) were solitary nodules (HT-SNT), and the remaining 36 (37.5%) were diffuse goiters (HT-D). Of the 46 patients who are HT-MNG, 36.9% had elevated anti-TPO-Ab (more than 35.0U/l) and 63.1% had normal/lower values (less than 35.0U/l). But of 36 patients with HT-D, 77.7% had elevated anti-TPO-Ab levels (>35U/l). Chi square statistics was 15.8346 and the p value is 0.0005 (<.05). Eight cases of HT-D and 3 cases of HT-MNG had hyperthyroidism and 3 cases of HT-D had hypothyroidism and all other cases were in euthyroid state. CONCLUSION: Patients presenting as multinodular Hashimoto's thyroiditis have low prevalence of elevated anti-TPO-Ab than diffuse HT which suggests that multinodular form of Hashimoto's thyroiditis is a unique clinical entity with etiopathogenesis that is at variance with the diffuse form.
ABSTRACT
BACKGROUND: Sudden cardiac death (SCD) is a major cause of mortality secondary to coronary artery disease (CAD) in the industrialized societies. Although South Asians have a high prevalence of CAD, the frequency and underlying pathology of SCD among this population are unknown. METHODS: Medical records of consecutive patients presenting with unexplained sudden death (USD) in a tertiary care center were reviewed. Patients with trauma, violent deaths, positive toxicology and non-cardiac pathology were excluded to determine sudden cardiac death (SCD). Cardiac pathological findings were analyzed by autopsy. SCD rate was estimated based on census and government vital statistics for the years studied. RESULTS: During a two year period, 223 patients (mean age 55 + 10 yrs, 78.9% male, body mass index 26 + 4, 60% smokers, 39% known CAD, 46% hypertension, 43% diabetes) presented to hospital with USD. SCD was attributed to myocardial infarction (MI) in 87% of cases; 69% were acute (96% anterior MI); 76% were small/moderate infarct and 9.9% of the cohort had normal hearts. Based on official municipal vital statistics, the SCD rate in those >35 yrs of age was estimated as 39.7/100,000 with male/female ratio of 4.6. CONCLUSIONS: SCD in this south Indian city occurred predominantly in men of relatively young age and was most frequently associated with small or moderate-sized acute MI. Improved health care access, preventive measures and enhanced emergency management may reduce SCD from acute MI in this locale.
