Commenced in January 2007
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Edition: International
Paper Count: 13

Search results for: hyperthyroidism

13 Thyroid Malignancy Concurrent with Hyperthyroidism: Variations with Thyroid Status and Age

Authors: N. J. Nawarathna, N. R. Kmarasinghe, D. Chandrasekara, B. M. R. S. Balasooriya, R. A. A. Shaminda, R. J. K. Senevirathne


Introduction: Thyroid malignancy associated with hyperthyroidism is considered rare. Retrospective studies have shown the incidence of thyroid malignancy in hyperthyroid patients to be low (0.7-8.5%). To assess the clinical relevance of this association, thyroid status in a cohort of patients with thyroid malignancy were analyzed. Method: Thyroid malignancies diagnosed histologically in 56 patients, over a 18 month period beginning from April 2013, in a single surgical unit at Teaching Hospital Kandy were included. Preoperative patient details and progression of thyroid status were asessed with Thyroid Stimulating Hormone, free Thyroxin and free Triiodothyronine levels. Results: Amongst 56 patients Papillary carcinoma was diagnosed in 44(78.6%), follicular carcinomas in 7(12.5%) and 5(8.9%) with medullary and anaplastic carcinomas. 12(21.4%) were males and 44(78.6%) were females. 20(35.7%) were less than 40years, 29(51.8%) were between 40 to 59years and 7(12.5%) were above 59years. Cross tabulation of Type of carcinoma with Gender revealed likelihood ratio of 6.908, Significance p = 0.032. Biochemically 12(21.4%) were hyperthyroid. Out of them 5(41.7%) had primary hyperthyroidism and 7(58.3%) had secondary hyperthyroidism. Mean age of euthyroid patients was 43.77years (SD 10.574) and hyperthyroid patients was 53.25years(SD 16.057). Independent Samples Test t is -2.446, two tailed significance p =0.018. When cross tabulate thyroid status with Age group Likelihood Ratio was 9.640, Significance p = 0.008. Conclusion: Papillary carcinoma is seen more among females. Among the patients with thyroid carcinomas, those with biochemically proven hyperthyroidism were more among the older age group than those who were euthyroid. Hence careful evaluation of elderly hyperthyroid patients to select the most suitable therapeutic approach is justified.

Keywords: age, hyperthyroidism, thyroid malignancy, thyroid status

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12 Hyperthyroidism in a Private Medical Services Center, Addis Ababa: A 5-Year Experience

Authors: Ersumo Tessema, Bogale Girmaye Tamrat, Mohammed Burka


Background: Hyperthyroidism is a common thyroid disorder especially in women and characterized by increased thyroid hormone synthesis and secretion. The disorder manifests predominantly as Graves’ disease in iodine-sufficient areas and has increasing prevalence in iodine-deficient countries in patients with nodular thyroid disease and following iodine fortification. In Ethiopia, the magnitude of the disorder is unknown and, in Africa, due to scarcity of resources, its management remains suboptimal. Objective: The aim of this study was to analyze the pattern and management of patients with hyperthyroidism at the United Vision Medical Services Center, Addis Ababa between August 30, 2013, and February 1, 2018. Patients and methods: The study was a retrospective analysis of medical records of all patients with hyperthyroidism at the United Vision Private Medical Services Center, Addis Ababa. A questionnaire was filled out; the collected data entered into a computer and statistically analyzed using the SPSS package. The results were tabulated and discussed with literature review. Results: A total of 589 patients were included in this study. The median age was 40 years, and the male to female ratio was 1.0:7.9. Most patients (93%) presented with goiter and the associated features of toxic goiter except weight loss, sweating and tachycardia were uncommon. Majority of patients presented more than two years after the onset of their presenting symptoms. The most common physical finding (91%), as well as diagnosis, was toxic nodular goiter. The most frequent (83%) derangement in the thyroid function tests was a low thyroid-stimulating hormone, and the most commonly (94%) used antithyroid drug was a propylthiouracil. The most common (96%) surgical procedure in 213 patients was a near-total thyroidectomy with a postoperative course without incident in 92% of all the patients. Conclusion: The incidence and prevalence of hyperthyroidism are apparently on the increase in Addis Ababa, which may be related to the existing severe iodine-deficiency and or the salt iodation program (iodine-induced hyperthyroidism). Hyperthyroidism predominantly affects women and, in surgical services, toxic nodular goiter is more common than diffuse goiter, and the treatment of choice in experienced hands is a near-total thyroidectomy.

Keywords: Ethiopia, grave’s disease, hyperthyroidism, toxic nodular goiter

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11 Evaluation and Association of Thyroid Function Tests with Liver Function Parameters LDL and LDH Level Before and after I131 Therapy

Authors: Sabika Rafiq, Rubaida Mehmood, Sajid Hussain, Atia Iqbal


Background and objectives: The pathogenesis of liver function abnormalities and cardiac dysfunction in hyperthyroid patients after I131 treatment is still unclear. This study aimed to determine the effects of radioiodine I131 on liver function parameters, lactate dehydrogenase (LDH) and low-density lipoproteins (LDL) before and after I131 therapy hyperthyroidism patients. Material & Methods: A total of 52 patients of hyperthyroidism recommended for I131were involved in this study with ages ranging from 12–65 years (mean age=38.6±14.8 & BMI=11.5±3.7). The significance of the differences between the results of 1st, 2nd and 3rd-time serum analysis was assessed by unpaired student’s t-test. Associations between the parameters were assessed by Spearman correlation analysis. Results: Significant variations were observed for thyroid profile free FT3 (p=0.04), FT4 (p=0.01), TSH (p=0.005) during the follow-up treatment. Before taking I131 (serum analyzed at 1st time), negative correlation of FT3 with AST (r=-0.458, p=0.032) and LDL (r=-0.454, p=0.039) were observed. During 2nd time (after stopping carbimazole), no correlation was assessed. Two months after the administration of I131 drops, a significant negative association of FT3 (r=-0.62, p=0.04) and FT4(r=-0.61, p=0.02) with ALB were observed. FT3(r=-0.82, p=0.00) & FT4 (r=-0.71, p=0.00) also showed negative correlation with LDL after I131 therapy. Whereas TSH showed significant positive association with ALB (r=0.61, p=0.01) and LDL (r=0.70, p=0.00) respectively. Conclusion: Current findings suggested that the association of TFTs with biochemical parameters in patients with goiter recommended for iodine therapy is an important diagnostic and therapeutic tool. The significant changes increased in transaminases and low-density lipoprotein levels after taking I131drops are alarming signs for heart and liver function abnormalities and warrant physicians' attention on an urgent basis.

Keywords: hyperthyroidism, carbimazole, radioiodine I131, liver functions, low-density lipoprotein

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10 Screening of Thyroid Stimulating Hormone Using Paper-Based Lateral Flow Device

Authors: Pattarachaya Preechakasedkit, Kota Osada, Koji Suzuki, Daniel Citterio, Orawon Chailapakul


A paper-based lateral flow device for screening thyroid stimulating hormone (TSH) is reported. A sandwich immunoassay was performed using two mouse monoclonal TSH antibodies (anti-hTSH 5403 and 5404) as immobilized and labeled antibodies for capturing TSH samples. Test (anti-hTSH 5403) and control (goat anti-Mouse IgG) lines were fabricated on nitrocellulose membrane (NCM) using ballpoint pen printed with a speed of 3 cm/s and thickness setting of 1. The novel gold nanoparticles europium complex ([email protected]) was used as fluorescence label compared to conventional AuNPs label. The results obtained with this device can be visually assessed by the naked eyes and under UV hand lamps, and quantitative analysis can be performed using the ImageJ program. The limit of detection (LOD) under UV hand lamps (0.1 µIU/mL) provided 50-fold greater sensitivity than AuNPs (5 µIU/mL), which is suitable for both hypothyroidism and hyperthyroidism screening within 30 min. A linear relationship between the red intensity and the logarithmic concentrations of TSH was observed with a good correlation (R²=0.992). Furthermore, the device can be effectively applied for screening TSH in the spiked human serum with recovery range of 96.80-104.45% and RSD of 2.18-3.63%. Therefore, the developed device is an alternative method for TSH screening which provides a lot of advantages including low cost, short time analysis, ease of use, disposability, portability, and on-site measurement.

Keywords: thyroid stimulating hormone, paper-based lateral flow, hypothyroidism, hyperthyroidism

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9 The Proportion of and Factors Associated With Thyroid Dysfunction among Individuals Referred To A Tertiary Care Facility in Kabul, Afghanistan

Authors: Mohammad Naeem Lakanwall


Background:The thyroid gland, located just below the vocal cord on each side of and anterior to the trachea, is one of the main endocrine glands. Its normal weight is 15 to 20 grams in adults. The thyroid secretes two most important hormones, thyroxine and triiodothyronine, usually called T4 and T3, respectively. These hormones greatly increase the metabolic rate of the body. In addition to T3 and T4, the thyroid gland secrets calcitonin as well which is a significant hormone for calcium metabolism. Objective: The aim of this study is to estimate the proportion of and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Material and Methods: An analytical cross-sectional study design was conducted from July to Sep 2018. Blood samples were obtained, serum TSH levels were measured, and the patients were divided into three diagnostic categories according to their serum TSH concentrations. 1) Hypothyroidism 2) Hyperthyroidism 3) Normal thyroid Results: A total of 127 individuals were part of the sample for the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction and the majority of the female participants, (85%) were not pregnant in the last two years. Furthermore, 98% of participants, were non-smokers. Conclusion: The findings of the current study showed a high prevalence of thyroid dysfunctions in individuals coming to FMIC for thyroid functions tests. The findings also indicated that aging and smoking are the factors associated with thyroid dysfunctions. Further studies are needed to find out the prevalence of and factors associated with thyroid dysfunctions.

Keywords: Afghanistan, Kabul, hypothyroidism, hyperthyroidism, triiodothyronine, thyroxine

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8 Assessment of Platelet and Lymphocyte Interaction in Autoimmune Hyperthyroidism

Authors: Małgorzata Tomczyńska, Joanna Saluk-Bijak


Background: Graves’ disease is a frequent organ-specific autoimmune thyroid disease, which characterized by the presence of different kind autoantibodies, that, in most cases, act as agonists of the thyrotropin receptor, leading to hyperthyroidism. Role of platelets and lymphocytes can be modulated in the pathophysiology of thyroid autoimmune diseases. Interference in the physiology of platelets can lead to enhanced activity of these cells. Activated platelets can bind to circulating lymphocytes and to affect lymphocyte adhesion. Platelets and lymphocytes can regulate mutual functions. Therefore, the activation of T lymphocytes, as well as blood platelets, is associated with the development of inflammation and oxidative stress within the target tissue. The present study was performed to investigate a platelet-lymphocyte relation by assessing the degree of their mutual aggregation in whole blood of patients with Graves’ disease. Also, the purpose of this study was to examine the impact of platelet interaction on lymphocyte migration capacity. Methods: 30 patients with Graves’ disease were recruited in the study. The matched 30 healthy subjects were served as the control group. Immunophenotyping of lymphocytes was carried out by flow cytometry method. A CytoSelect™ Cell Migration Assay Kit was used to evaluate lymphocyte migration and adhesion to blood platelets. Visual assessment of lymphocyte-platelet aggregate morphology was done using confocal microscope after magnetic cell isolation by Miltenyi Biotec. Results: The migration and functional responses of lymphocytes to blood platelets were greater in the group of Graves’ disease patients compared with healthy controls. The group of Graves’ disease patients exhibited a reduced T lymphocyte and a higher B cell count compared with controls. Based on microscopic analysis, more platelet-lymphocyte aggregates were found in patients than in control. Conclusions: Studies have shown that in Graves' disease, lymphocytes show increased platelet affinity, more strongly migrating toward them, and forming mutual cellular conglomerates. This may be due to the increased activation of blood platelets in this disease.

Keywords: blood platelets, cell migration, Graves’ disease, lymphocytes, lymphocyte-platelet aggregates

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7 Stability Analysis for an Extended Model of the Hypothalamus-Pituitary-Thyroid Axis

Authors: Beata Jackowska-Zduniak


We formulate and analyze a mathematical model describing dynamics of the hypothalamus-pituitary-thyroid homoeostatic mechanism in endocrine system. We introduce to this system two types of couplings and delay. In our model, feedback controls the secretion of thyroid hormones and delay reflects time lags required for transportation of the hormones. The influence of delayed feedback on the stability behaviour of the system is discussed. Analytical results are illustrated by numerical examples of the model dynamics. This system of equations describes normal activity of the thyroid and also a couple of types of malfunctions (e.g. hyperthyroidism).

Keywords: mathematical modeling, ordinary differential equations, endocrine system, delay differential equation

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6 Thyroid Dysfunction in Patients with Chronic Hemodialysis

Authors: Benghezel Hichem


Thyroid dysfunction in hemodialysis subjects is represented mainly by hypothyroidism. The objective of our work is to determine the thyroid profile of our hemodialysis patients and to highlight the prevalence of different thyroid disorders. Methods: This is a retrospective study performed on a mono centric 2 months (February and March 2013) on 42 hemodialysis patients (11 male and 31 female). We made the dosage of thyroid hormones Thyrotropin (TSH) ((free thyroxin ) FT4 and free Triodothyronin ) FT3) by chemiluminescence immunoassay method on cobas 6000 Roche Diagnostics. The results: The prevalence of biological hypothyroidism was 18% (7% with a high TSH isolated and a mean +/- SD 9.44 +/- 6.29, 5% with high TSH, and with low FT4 a mean +/- SD is 8.18 +/- 0.53 for TSH and 9.69 +/- 0.22 for FT4, One patient with a high TSH, and low FT4, FT3. 4% of patients with a low T3 syndrome with a mean +/- SD of 3.93 +/- 0,3 for FT3), we notice that 5% of patients with hyperthyroidism TSH collapsed and mean +/- SD of TSH is 0.017 +/- 0,001. Conclusion: The biological Hypothyroidism is a common endocrine disorder in chronic hemodialysis.

Keywords: hypothyroidism, hemodialysis, thyréostimulin, free thyroxin, triodothyronin

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5 Non-AIDS Related Multiple Brain and Orbital Lymphoma Mimicking Meningioma: A Case Report

Authors: Eghosa Morgan, Bourtarbouch Mahjouba, Heida El Ouahabi, Poluyi Edward, Diawarra Seylan


Non-AIDS lymphoma, a type of primary central nervous system (CNS) lymphoma is an uncommon aggressive infiltrative malignant tumour involving several sites in the central nervous system, such as the periventricular region and leptomeninges. In this article, the authors presented a 26-year old man with painless progressive right exophthalmos and scalp swelling with no symptoms and signs of intracranial hypertension and hyperthyroidism. Magnetic resonance imaging (MRI) done revealed isointense masses with brilliant homogenous enhancement on contrast administration resembling a meningioma, with a dura tail – like attachment as seen in meningioma. He had surgery for the right orbital tumour and histopathological diagnosis confirmed our suspicion of lymphoma (B type). Steroid was given in the post-operative period which led to significant regression of the tumours, hence its description as ‘vanishing tumour’. He is presently receiving methotrexate-based chemotherapy and subsequently planned for radiotherapy.

Keywords: central nervous system (CNS), meningioma, non-aids lymphoma, orbital

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4 Dynamical Analysis of the Fractional-Order Mathematical Model of Hashimoto’s Thyroiditis

Authors: Neelam Singha


The present work intends to analyze the system dynamics of Hashimoto’s thyroiditis with the assistance of fractional calculus. Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis is an autoimmune disorder in which the immune system attacks the thyroid gland, which gradually results in interrupting the normal thyroid operation. Consequently, the feedback control of the system gets disrupted due to thyroid follicle cell lysis. And, the patient perceives life-threatening clinical conditions like goiter, hyperactivity, euthyroidism, hyperthyroidism, etc. In this work, we aim to obtain the approximate solution to the posed fractional-order problem describing Hashimoto’s thyroiditis. We employ the Adomian decomposition method to solve the system of fractional-order differential equations, and the solutions obtained shall be useful to provide information about the effect of medical care. The numerical technique is executed in an organized manner to furnish the associated details of the progression of the disease and to visualize it graphically with suitable plots.

Keywords: adomian decomposition method, fractional derivatives, Hashimoto's thyroiditis, mathematical modeling

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3 Frequency and Factors Associated with Thyroid Dysfunction: A Descriptive Cross-Sectional Study from a Tertiary Care Center in Kabul, Afghanistan

Authors: Mohammad Naeem Lakanwall, Jamshid Abdul-Ghafar


Background: Endocrinopathies are a commonly occurring entity, particularly those of the thyroid gland; however, there is a lack of scientific literature from Afghanistan, a country with very limited health care facilities and resources. To our best knowledge, this is the first study aimed to describe the frequency of occurrence and factors associated with thyroid dysfunction in the Afghan population. The aim of this study is to estimate the frequency and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Methods: A cross-sectional study was conducted from July to Sep 2018 at the Department of Clinical Pathology, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan. Blood samples were obtained, serum TSH levels were analyzed, and the patients were divided into three diagnostic categories according to their serum TSH concentrations: 1) hypothyroidism, 2) hyperthyroidism, 3) normal. Results: A total of 127 individuals were included in the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction. 74% of the participants in the study had normal TSH levels classified as normal thyroid function, (14%) had lower TSH levels, and (12%) higher TSH levels, classified as hyper and hypothyroid, respectively. Conclusions: The findings of the current study showed a high frequency of thyroid dysfunctions from a single center. Further large-scale studies are needed to find out the prevalence and document this entity for better health outcomes in the country.

Keywords: Afghanistan, factors, frequency, hypothyroid, hyperthyroid, thyroid, thyroid stimulating hormone

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2 Evaluation of Existence of Antithyroid Antibodies, Anti-Thyroid Peroxidase and Anti-Thyroglobulin in Patients with Hepatitis C Viral Infections

Authors: Junaid Mahmood Alam, Sana Anwar, Sarah Sughra Asghar


Chronic hepatitis or Hepatitis C viral (HCV) infection has been identified as one of the factors that could elicit autoimmune disease resulting in the development of auto-antibodies. Furthermore, HCV is implicated in contravening of forbearance to antigens, therefore, inciting auto-reactivity. In this regard, several near and past studies noted the prevalence of thyroid dysfunction and production of anti-thyroid antibodies (ATAb) such as anti-thyroid peroxidase (AntiTPO) and anti-thyroglobulin (AntiTG) in patients with HCV. Likewise, one of the etiologies of augmentation of thyroid disease is basically interferon therapy for HCV infections, for which a number of autoimmune diseases have been noted including Grave’s disease, Hishimoto thyroiditis. A prospectively case-control study was therefore carried out at department of clinical biochemistry lab services and chemical pathology in collaboration with department of clinical microbiology, at Liaquat National Hospital and Medical College, Karachi Pakistan for the period January 2015 to December 2017. Two control groups were inducted for comparison purpose, control group 1 = without HCV infection and with thyroid disorders (n = 20), control group 2 = with HCV infection and without thyroid disorders (n = 20), whereas HCV infected were n = 40 where more than half were noted to be positive for either of HCV IgG and Ag. In HCV group, patients with existing sub-clinical hypothyroidism and clinical hyperthyroidism were less than 5%. Analysis showed the presence of AntiTG in 12 HCV patients (30%), AntiTPO in 15 (37.5%) and both AntiTG and antiTPO in 10 patients (25%). Only 3 patients were found with the history of anti-thyroid auto-antibodies (7.5%) and one with parents and relatives with auto-immune disorders (2.5%). Patients that remained untreated were 12 (30%), under treatment 18 (45%) and with complete-course of treatment 10 (25%). As per review of the literature, meta-analysis of evident data and cross-sectional studies of selective cohorts (as studied in presented research), thyroid connection is designated as one of the most recurrent endocrine ailment associated with chronic HCV infection. Moreover, it also represents an extrahepatic disease in the continuum of HCV syndrome. In conclusion, HCV patients were more likely to encompass thyroid disorders especially related to development of either of ATAb or both antiTG and AntiTPO.

Keywords: Hepatitis C viral (HCV) infection, anti-thyroid antibodies, anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies

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1 A Study of The Factors Predicting Radiation Exposure to Contacts of Saudi Patients Treated With Low-Dose Radioactive Iodine (I-131)

Authors: Khalid A. Salman, Shereen Wagih, Tariq Munshi, Musaed Almalki, Safwan Zatari, Zahid Khan


Aim: To measure exposure levels to family members and caregivers of Saudi patients treated with low dose I131 therapy, and household radiation exposure rate to predict different factors that can affect radiation exposure. Patients and methods: All adult self dependent patients with hyperthyroidism or cancer thyroid referred for low dose radioactive I131 therapy on outpatient basis are included. Radiation protection procedures are given to the participant and family members in details. TLD’s were dispensed to each participant in sufficient quantity for his/her family members living in the household. TLD’s are collected at fifth days post-dispense from patients who agreed to have a home visit during which the household is inspected and level of radiation contamination of surfaces was measured. Results: Thirty-two patients were enrolled in the current study, with a mean age of 43.1± 17.1 years Out of them 25 patients (78%) are females. I131 therapy was given in twenty patients (63%) for cancer thyroid of and for toxic goiter in the remaining twelve patients (37%), with an overall mean I131 dose of 24.1 ± 7.5mCi that is relatively higher in the former. The overall number of household family members and helpers of patients are 139, out of them77 are females (55.4%) & 62 are males (44.6%) with a mean age of 29.8± 17.6. The mean period of contact with the patient is 7.6 ±5.6hours. The cumulative radiation exposure shows that radiation exposure to all family members is below the exposure constraint (1mSv), with a range of 109 to 503uSv, and a mean value of 220.9±91 uSv. Numerical data shows a little higher exposure rate for family members of those who receive higher dose of I131 (patients with thyroid cancer) and household members who spent longer time with the patient, yet, the difference is statistically insignificant (P>0.05). Besides, no significant correlation was found between the degree of cumulative exposure of the family members to their gender, age, socioeconomic standard, educational level and residential factors. In the 21 home visits all data from bedrooms, reception areas and kitchens are below hazardous limits (0.5uSv/h) apart from bathrooms that give a slightly higher reading of 0.57±0.39 uSv/h in those with cancer thyroid who receive a higher radiation dose. A statistically significant difference was found between radiation exposure rate in bathrooms used by the patient versus those used by family members only, with a mean value of exposure rate of 0.701±0.21 uSv/h and 0.17±0.82 uSv/h respectively, with a p-value of 0.018 (<0.05). Conclusion: Family members of patients treated with low dose I131 on outpatient basis have a good compliance to radiation protection instruction if given properly with a cumulative radiation exposure rate evidently beyond the radiation exposure constraints of 1 mSv. Given I131 dose, hours spent with the patient, age, gender, socioeconomic standard, educational level and residential factors have no significant correlation with the cumulative radiation exposure. The patient bathroom exhibits more radiation exposure rate, needing more strict instructions for patient bathroom use and health hygiene.

Keywords: family members, radiation exposure, radioactive iodine therapy, radiation safety

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