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Journal Cover European Thyroid Journal
   Full-text available via subscription Subscription journal
     ISSN (Print) 2235-0640 - ISSN (Online) 2235-0802
     Published by Karger Homepage  [104 journals]
  • Reply on the Letter by Stott et al. ‘The Dilemma of Treating
           Subclinical Hypothyroidism: Risk that Current Guidelines Do More Harm than
    • Abstract:
      Eur Thyroid J 2014;3:139-140
  • Iodophilic Synchronous Phalangeal and Choroidal Metastasis from Follicular
           Thyroid Carcinoma: A Case Report and Review
    • Abstract: Background: Follicular thyroid cancers constitute 15-20% of all thyroid tumors. The usual mode of dissemination is via the hematogenous route. The most common sites of distant metastasis are to the lungs and bones. Objective: A case is presented to demonstrate the unusual presentation of follicular cancer with synchronous digital (distal phalanx of the little finger) and choroidal metastasis that was responsive to radioiodine treatment. Case Report: A 54-year-old female presented with swelling over the terminal part of the left little finger with thyromegaly. Investigations revealed metastasis from follicular thyroid cancer to the little finger along with pulmonary metastases. She underwent total thyroidectomy with central compartment clearance followed by 131I therapy. Subsequent follow-up demonstrated complete regression of the digital metastasis and partial regression of the choroidal metastasis which was evaluated after the radioiodine scan that picked up the choroidal metastasis. Conclusion: Follicular thyroid cancers can rarely spread to unusual sites like the digits and choroid. This report highlights the synchronous presentation of digital and choroidal metastasis which responded to 131I therapy. © 2014 European Thyroid Association Published by S. Karger AG, Basel
      Eur Thyroid J 2014;3:134-136
  • The Dilemma of Treating Subclinical Hypothyroidism: Risk that Current
           Guidelines Do More Harm than Good
    • Abstract:
      Eur Thyroid J 2014;3:137-138
  • Development and Application of a Novel Sensitive Immunometric Assay for
           Calcitonin in a Large Cohort of Patients with Medullary and Differentiated
           Thyroid Cancer, Thyroid Nodules, and Autoimmune Thyroid Diseases
    • Abstract: Background: Serum calcitonin (sCT) is a useful biomarker for medullary thyroid cancer (MTC). Consensus has not been reached concerning sCT measurements in the evaluation of nodular thyroid disease (NTD). Objective and Methods: We developed a new immunofluorometric assay for sCT and have validated it in samples from 794 patients [203 with MTC, 205 with autoimmune thyroid disease (ATD), 248 with NTD, 80 with differentiated thyroid cancer (DTC) ‘free of disease', 58 with chronic renal failure (CRF)] and 178 normal individuals, including samples after pentagastrin tests and samples from the washout of 92 FNA procedures in patients with NTD or MTC. We also compared some samples from patients with low or high calcitonin levels using both this assay and the Nichols Institute Diagnostics (NID) assay. Results: The assay's analytical sensitivity was 1.0 pg/ml. Considering MTC patients prior to surgery, the cut-off values for the 95% reference range were 11.1 pg/ml for males and 5.5 pg/ml for females and employing the ROC curve were 18.4 pg/ml for males and 7.8 pg/ml for females. sCT in patients with MTC was strongly correlated with disease status. Patients with NTD and ATD did not present false-positive results. sCT measurements were significantly correlated with age (excluding MTC and CRF). The NID test had a strong correlation with our assay. A hook effect was observed only with concentrations >200,000 pg/ml. Conclusions: We developed a novel sCT assay and validated it in healthy subjects, as well as in a large cohort of patients with MTC, NTD, ATD, DTC, and CRF. © 2014 European Thyroid Association Published by S. Karger AG, Basel
      Eur Thyroid J 2014;3:117-124
  • Subclinical Hypothyroidism and Pregnancy: The Intersection of Science, the
           Art of Medicine, and Public Health Policy
    • Abstract:

  • The TRHR Gene Is Associated with
           Hypothalamo-Pituitary Sensitivity to Levothyroxine
    • Abstract: Background: Thyroidectomized patients need variable doses of levothyroxine (LT4) to obtain target thyroid-stimulating hormone (TSH) levels. Individual feedback set-points have been hypothesized and the influence of several genes in the regulation of the pituitary-thyroid axis has been demonstrated. Objectives: We hypothesized that genetic variants of the TRHR gene could be associated with a different hypothalamo-pituitary sensitivity to thyroid hormone feedback. Methods: We retrospectively analyzed 84 thyroidectomized patients with no residual thyroid function and undetectable thyroglobulin levels. Patients were evaluated under LT4 resulting in TSH levels detectable but
  • 2014 European Thyroid Association Guidelines for the Management of
           Subclinical Hypothyroidism in Pregnancy and in Children
    • Abstract: This guideline has been produced as the official statement of the European Thyroid Association guideline committee. Subclinical hypothyroidism (SCH) in pregnancy is defined as a thyroid-stimulating hormone (TSH) level above the pregnancy-related reference range with a normal serum thyroxine concentration. Isolated hypothyroxinaemia (defined as a thyroxine level below the 2.5th centile of the pregnancy-related reference range with a normal TSH level) is also recognized in pregnancy. In the majority of SCH the cause is autoimmune thyroiditis but may also be due to iodine deficiency. The cause of isolated hypothyroxinaemia is usually not apparent, but iodine deficiency may be a factor. SCH and isolated hypothyroxinaemia are both associated with adverse obstetric outcomes. Levothyroxine therapy may ameliorate some of these with SCH but not in isolated hypothyroxinaemia. SCH and isolated hypothyroxinaemia are both associated with neuro-intellectual impairment of the child, but there is no evidence that maternal levothyroxine therapy improves this outcome. Targeted antenatal screening for thyroid function will miss a substantial percentage of women with thyroid dysfunction. In children SCH (serum TSH concentration >5.5-10 mU/l) normalizes in >70% and persists in the majority of the remaining patients over the subsequent 5 years, but rarely worsens. There is a lack of studies examining the impact of SCH on the neuropsychological development of children under the age of 3 years. In older children, the evidence for an association between SCH and impaired neuropsychological development is inconsistent. Good quality studies examining the effect of treatment of SCH in children are lacking. © 2014 European Thyroid Association Published by S. Karger AG, Basel

  • Simple Core-Needle Biopsy for Thyroid Nodule, Complicated Tinnitus
    • Abstract: Background: Fine-needle aspiration is the procedure of choice for evaluating thyroid nodules. Core-needle biopsy (CNB) is not included in the American Thyroid Association recommendations for evaluating such nodules. CNB complications are classically bleeding and hematomas. To our knowledge, no case of arteriovenous fistula (AVF) secondary to a CNB has been reported, nor has any case of tinnitus secondary to a post-CNB AVF. Objectives: To make the clinician aware of possible vascular complications caused by CNB and the possibility of difficult pathology reading caused by previous CNB. Methods: A 44-year-old female is described who was referred to our tertiary care center for left-sided pulsatile tinnitus. She did report having had a CNB right before the tinnitus appeared. Conventional angiography demonstrated a focal AVF originating from the left vertebral artery, with reflux to the left vertebral venous plexus. A 6-mm stent was placed over the site of the fistula via an endovascular approach, which solved both the radiological and clinical documented problems. Moreover, CNB greatly complicated pathology reading once total thyroidectomy was later performed. The suspected area of invasion was an artifact due to the previous biopsies. Conclusion: Although many authors recommend a CNB as an alternative modality in cases of inconclusive cytology with fine-needle aspiration, it is not in the American Thyroid Association recommendations. In cases of iatrogenic AVFs caused by a CNB, angiography is recommended both as a diagnostic and therapeutic modality. Stenting the fistula with an endoprosthesis can correct the problem immediately. © 2014 European Thyroid Association Published by S. Karger AG, Basel

  • Recombinant Human Thyrotropin Use Resulting in Ovarian Hyperstimulation:
           An Unusual Side Effect
    • Abstract: A 43-year-old female was administered recombinant human thyrotropin-α (Thyrogen®; Genzyme Corp., Cambridge, Mass., USA) before a fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan as part of an evaluation of thyroid cancer recurrence. She was administered two doses of Thyrogen only 4 weeks before for stimulated thyroglobulin measurement. The PET/CT scan demonstrated enlarged ovaries which on subsequent conservative follow-up resolved. This transient hyperstimulated state of the ovaries was presumed to be related to Thyrogen injections received twice within a space of a month. Thyrogen is being increasingly used for raising the level of thyroid-stimulating hormone (TSH), besides thyroid hormone withdrawal for suspected recurrence of differentiated thyroid carcinoma. Ovarian hyperstimulation has been reported as an iatrogenic complication for in vitro fertilization with the presence of human chorionic gonadotropin being invariably associated. Transient gestational thyrotoxicosis has been reported to be related to promiscuous activation of the thyrotropin receptor by chorionic gonadotropin. In our case it is possible that due to the promiscuous stimulation, thyrotropin caused a follicle-stimulating hormone (FSH)-like action resulting in ovarian hyperstimulation. The reason behind this could be the shared sequence identity of the hormone-binding domains of TSH and FSH receptors, or some mutation in the FSH receptor. In conclusion, our case highlights a potential side effect of administering Thyrogen in females of the reproductive age group. © 2014 European Thyroid Association Published by S. Karger AG, Basel

  • Letter regarding the Paper by Pearce et al. Entitled ‘2013 ETA
           Guideline: Management of Subclinical Hypothyroidism'
    • Abstract:
      Eur Thyroid J
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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