Riedel's thyroiditis - difficulties in differentiating from thyroid cancer.

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Diagnosis and treatment of thyroid disorders in obese patients - what do we know?

Obesity-related changes in the composition of the body interfere with the proper functioning of the thyrotropic axis, leading to its disturbances and changes in the structure of the thyroid gland. Distinguishing what is related to obesity and what constitutes pathological changes is crucial for the proper treatment of patients. In this paper authors present a case of a patient with a diet-induced obesity, whose only abnormalities in thyroid assessment included an elevated level of thyroid stimulating hormone (TSH) and hypoechoic thyroid gland on ultrasound. Based on this clinical situation, we reviewed literature in order to establish rules regarding management of thyroid disorders in obese individuals. The most common obesity-related thyroid abnormality is an isolated increase of TSH, without clinical symptoms of hypothyroidism, defined as hyperthyrotropinaemia. In obese adults, autoimmune thyroid disease is found equally often as in the normal-weight population. Thyroid enlargement, increased risk of nodules, and decreased echogenicity, not related to autoimmunity, is frequent among obese individuals. Weight loss leads to the normalisation of TSH levels and thyroid echogenicity. Excessive weight can influence both the TSH level and ultrasound image of the thyroid gland; however, these findings can be reversed by weight reduction. Therefore, in asymptomatic obese patients elevated TSH should not be treated with thyroid hormone replacement.

Accuracy of the European Thyroid Imaging Reporting and Data System (EU-TIRADS) in the valuation of thyroid nodule malignancy in reference to the post-surgery histological results.

PURPOSE: To assess the clinical usefulness of the European Thyroid Imaging and Reporting Data System (EU-TIRADS) in the valuation of thyroid nodules malignancy in reference to post-surgery histological results. MATERIAL AND METHODS: Pre-operative ultrasound was performed in consecutive patients admitted for thyroid surgery between June 2017 and January 2018. Thyroid nodules were classified according to EU-TIRADS to five groups: 1-5. At least one fine-needle aspiration biopsy (FNAB)/patient (dominant or suspected nodule) was performed in an outpatient clinic. The final diagnosis was based on the histological result. The percentage of cancers in each EU-TIRADS group was evaluated. Finally, sensitivity, specificity, accuracy, as well as positive and negative predictive values for malignancy were assessed. RESULTS: Fifty-two patients with a total of 140 thyroid nodules (median: 3 nodules/thyroid [minimum-maximum: 1-6]) were enrolled in the study. Thyroid cancer was diagnosed in 0% (0/6) in EU-TIRADS 2; 0% (0/92) in EU-TIRADS 3; 5.9% (2/34) in EU-TIRADS 4, and 75% (6/8) in EU-TIRADS 5. In nodules assessed as EU-TIRADS ≥ 4 sensitivity, specificity, positive and negative predictive values for malignancy were, respectively: 75% (CI 95%: 40.7-93.5), 94.1% (CI 95%: 86.0-98.5), 75% (CI 95%: 40.7-93.5), and 94.1% (CI 95%: 86.0-98.5). CONCLUSIONS: EU-TIRADS is a valuable and simple tool for assessment of the risk of malignancy of thyroid nodules and demonstrates a high ultrasound correlation with histological post-surgery results. FNAB should be performed in all nodules assessed as EU-TIRADS ≥ 4, due to higher risk of malignancy.

Quality of life in Polish patients with long-lasting Parkinson's disease.

The objective of this study was to evaluate possible relationships between quality of life (QoL) of Polish patients with long-lasting Parkinson's disease and various demographic and clinical factors. The study comprised 141 patients of Movement Disorders outpatient clinics in Warsaw and Gdansk with at least 5 years of the disease duration. Mean age of patients was 68.09 +/- 8.51 years, mean duration of disease was 11.87 +/- 5.14 years. To assess the quality of life, the Parkinson's Disease Questionnaire (PDQ-39) was used. Additional questions concerned duration of disease, initial and current treatment and expenses associated with therapy. Self-perceived symptoms of depression were in our study the most important factor determining QoL. Duration of the disease and expenses related to the treatment also have a significant impact on the QoL. Patient's age and presence of dyskinesia seem to be irrelevant to the quality of life.