Lymph node fine-needle aspiration washout thyroglobulin in papillary thyroid cancer: Diagnostic value and the effect of thyroglobulin antibodies.

PURPOSE: Thyroglobulin (Tg) assessment in the needle washout after fine-needle aspiration biopsy (FNAB) of a suspicious neck lymph node (LN) is known to improve the diagnostic accuracy in patients with papillary thyroid cancer (PTC). However, there is still controversy on the best diagnostic cut-off levels for FNAB-Tg and whether thyroglobulin antibody (TgAb) positivity affects FNAB-Tg. The objectives of this study were to determine (i) the diagnostic power of different cut-offs for FNAB-Tg and (ii) if serum TgAb(+) negatively affects the FNAB-Tg evaluation. METHODS: This was a retrospective cohort study analyzing PTC patients with suspicious neck LNs, in a university hospital setting, from October 2009 to October 2013. In total, 103 patients with PTC (226 LNs) undergoing ultrasound-guided FNAB for LNs were included. Cytology and FNAB-Tg levels were compared in reference to LN histopathology and the effect of TgAb(+) on FNAB-Tg levels was evaluated. RESULTS: The diagnostic accuracies of FNAB-Tg cut-off of 1 and 10 ng/mL were 94.1% and 88.2%, respectively. Raising the cut-off from 1 to 10 ng/mL led to decreased sensitivity rates (91.9% vs. 83.9%). The receiver operating characteristic curve analysis demonstrated that the best FNAB-Tg cut-off was 1.2 ng/mL. There were no LNs with an FNAB-Tg ≥ 10 ng/mL that turned out to be cytologically or histopathologically benign. FNAB-Tg levels of the histopathologically malignant LNs were similar between TgAb (+) and TgAb (-) patients (p = 0.546). Serum Tg predicted FNAB-Tg levels above 1 ng/mL (p = 0.002) and FNAB-Tg predicted malignant histopathology (p = 0.004), both independently of the TgAb status of the patient. CONCLUSIONS: FNAB-Tg ≥ 1 ng/mL has a superior diagnostic power, irrespective of TgAb (+), in PTC patients with suspected LN involvement.

A Case With Immunoassay Interferences in the Measurement of Multiple Hormones.

CONTEXT: Commonly used immunoassays are not free from interference, which can be a confounder in the interpretation of test results. We present a case with extremely high multiple hormone levels due to such interference. CASE DESCRIPTION: A 33-year-old woman with no specific symptoms had markedly elevated TSH with normal free T4 and free T3 levels. Repeated measurements revealed discordantly high TSH, ACTH, FSH, PTH, IGF-1, prolactin, ß-human chorionic gonadotropin, and calcitonin levels without the associated clinical pictures. The measurements were repeated with the same patient sample on four different analytical platforms using chemiluminescence immunoassays/electrochemiluminescence immunoassays, and the results were divergent on each platform. Serial dilutions of serum samples revealed nonlinearity, suggesting assay interference. All hormonal measurements were in the normal range when heterophile antibody blocking tubes were used. The serum of the patient was then subjected to polyethylene glycol precipitation. The post-polyethylene glycol recovery resulted in hormone levels in the normal range. The patient did not receive any medications and has been under follow-up without any signs and symptoms for 24 months. CONCLUSIONS: This report illustrates a rare case of falsely elevated hormone levels due to assay interference caused by heterophile antibodies. We point out the importance of a close collaboration between clinicians and the laboratory to avoid unnecessary clinical investigations as well as inappropriate treatments.

Hemorheological changes with strontium ranelate treatment do not seem to be related to its claimed prothrombotic effects.

Strontium ranelate is claimed to be related with increased risk of thromboembolic events. No explanation of this increased incidence of thromboembolism has been identified. However, growing evidence has clearly demonstrated the involvement of blood rheology in any thrombotic process. The aim of this study was to assess hemorheological changes with strontium ranelate treatment in elderly women with osteoporosis. This study was designed in a prospective manner. Twenty-two elderly women diagnosed with osteoporosis were included. During a 2-month treatment period, participants received strontium ranelate 2g/day. Hemorheological parameters including erythrocyte deformability, erythrocyte aggregation and plasma viscosity were measured before and after 2 months therapy with strontium ranelate. The median age of the patients was 70.0 (range=65-80) years. After 60 days of treatment, there was no statistically significant change in hemorheological parameters. None of the subjects developed clinical venous thromboembolic event (VTE) during the 2-month period of strontium ranelate treatment. Our study demonstrated that in elderly women, treatment of osteoporosis with strontium ranelate did not change hemorheological parameters over 2 months of time. However, its long-term effects on hemorheologic parameters should be evaluated further with a larger sample.

Familial Mediterranean fever and central nervous system involvement: a case series.

We conducted this study to determine familial Mediterranean fever (FMF)-associated central nervous system involvement including demyelinating lesions, stroke, and posterior reversible leukoencephalopathy syndrome (PRES). Patients with MEFV mutations were systematically reviewed through the Medical Biology Unit database. All samples sent for mutation analysis were screened for 10 common MEFV mutations. Patients with FMF and neurologic disorders according to the clinical records were invited for reevaluation. Lumbar puncture, electroencephalography, and evoked potentials were used to determine the type of neurologic involvement in selected cases. Electrocardiography, transthoracic and/or transesophageal echocardiography, and magnetic resonance imaging and/or angiography were performed to clarify the etiology of cerebrovascular disease. Of 8864 patients in the genetic testing database, 18 with neurologic signs were assessed. The mean age of patients was 31.0 +/- 11.8 years, mean age at first FMF symptom was 12.6 +/- 5.6 years, and mean age at neurologic involvement was 25.8 +/- 12.2 years. Fifty-five percent of patients were women. A homozygote MEFV mutation was detected in 16 of 18 patients (88.8%), and a homozygote M694V mutation was found in 72.2% of patients. We found 7 FMF patients with demyelinating lesions, 7 with cerebrovascular disease, and 4 with PRES. The mean interval between first FMF sign and neurologic involvement was 13.7 +/- 8.9 years in the demyelinating group, and 23.4 +/- 10.3 years in the group with cerebrovascular disease. Mean stroke age was 28.5 +/- 16.4 years. All patients in the PRES group had hypertension. Three different neurologic conditions in FMF patients were noticeable. Demyelinating lesions and cerebrovascular disease were the most common clinical presentations. Approximately 70% of patients had the homozygote M694V mutation. Neurologic involvement is rare but serious in FMF.

Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults.

BACKGROUND & AIMS: Older adults are poorly assessed for malnutrition risk although malnutrition is not an uncommon problem in this population. The aim of this study was to determine the malnutrition risk and its correlates in geriatric outpatients. METHOD: The study was performed in 2327 patients > or =65 years old who were admitted to our Geriatric Medicine outpatient clinic. Together with comprehensive geriatric assessment, nutritional assessment with short version of mini nutritional assessment test (MNA-SF) was performed. MNA-SF score < or =11 was determined as malnutrition risk. RESULTS: Mean age of patients was 72.14+/-6.11 and 1479 (63.6%) were female. Mean MNA-SF score was 12.31+/-2.18. The number of patients with MNA-SF score < or =11 was 651 (28%). Depression, haematocrit, plasma fasting glucose, albumin, erythrocyte sedimentation rate, instrumental activities of daily living scores and bone mineral density measured from total femur were found to be significantly associated with malnutrition risk. CONCLUSION: In this study malnutrition risk was detected in 651 (28%) patients. This ratio was similar to the literature. In older adults malnutrition risk is found to be increased due to majority of chronic illnesses and physical dependency. In conclusion, nutritional assessment should be a part of comprehensive geriatric assessment.

Humoral hypercalcemia of benignancy secondary to parathyroid hormone-related protein secreting uterine leiomyoma.

A 48-year-old women admitted with polyuria and polydipsia. She was found to be hypercalcemic despite suppressed parathormone (iPTH) levels. Subsequently checked parathormone related-protein (PTHrP) level was 2.5 pmol/L (expected normal level <1.3 pmol/L). An extensive workup for a malignancy revealed no abnormality, except for an uterine leiomyoma, 7.1 cm in size. Total abdominal hysterectomy and salpingo-oophorectomy were performed. After the surgical removal of uterine leiomyoma, serum calcium (9.3 mg/dL), iPTH (29.4 pg/mL), and PTHrP (<1.3 pmol/L) levels were normalized. The diagnosis of humoral hypercalcemia of benignancy secondary to PTHrP was confirmed. One month later, her calcium and iPTH levels were normal and 1 year later still remain within the normal ranges. Our case indicates that PTHrP associated hypercalcemia does not solely result from a malignant tumor. Benign tumors like uterine leiomyoma might also cause humoral hypercalcemia.