Amyloid goiter is a very rare manifestation of amyloidosis. Here, we describe the case of a 40-year-old male, who presented with upper airway obstructive symptoms including hoarseness and breathing ...difficulty, to highlight the clinical and pathological features of secondary amyloidosis of the thyroid gland and the difficulties in making a preoperative diagnosis. The patient had previously been wounded in the war in Bosnia, which resulted in the right kidney being surgically removed. Further, he had undergone two surgical interventions on both hips due to osteomyelitis and was on a chronic dialysis program due to a progressively poor left kidney function that had eventually resulted in complete loss of renal function. Thyroid function tests were normal, and the patient clinically was euthyroid; biochemical investigations were within normal limits. Results from sonography, computed tomography scan of the neck, scintigraphy and fine-needle aspiration cytology were nondiagnostic. Therefore, a thyroid biopsy was carried out, and amyloid deposits were found. After preoperative work-up, total thyroidectomy was performed with no complications. We conclude that amyloid goiter may have no major impact on thyroid function even when a substantial amount of amyloid has replaced the normal thyroid parenchyma, as was the case in our patient. Amyloid goiter should be suspected in all patients with a progressive, rapidly growing bilateral thyroid enlargement with concomitant inflammatory processes or in patients undergoing hemodialysis treatment.
Psoriasis is a chronic skin ailment which can be connected with an increased occurrence of other illnesses, including the metabolic syndrome.
A prospective study has been conducted which included 70 ...patients affected by psoriasis, both genders, older than 18 years. Average age being 47,14 (SD=±15,41) years, from that there were 36 men or 51,43 and 34 women or 48,57%. The average duration of psoriasis was 15,52 (SD= ±12,54) years. For purposes of diagnosing the metabolic syndrome, the criteria of National Cholesterol Education Program Adult Treatment Panel III, (NCEP ATP III) were used. For purposes of detecting the severity and spread of psoriasis, Psoriasis Area and Severity Index (PASI) was used.
The incidence of metabolic syndrome in patients with psoriasis was 38,57%. Average values of PASI score were 16,65. The increase in values of PASI score and metabolic syndrome were statistically highly connected. (r=0,3, p=0,0001).
Psoriasis is connected with metabolic syndrome, there is a positive correlation between the severity of psoriasis and frequency of metabolic syndrome.
Most important in the evaluation of thyroid thyroid disease is to differentiate a disease that is treated medically from a disease that requires surgical treatment. In preoperative differentiation of ...a malignant from a benign lesion are used different diagnostic methods (US, scintigraphy, FNAC, MRI).
The aim of the study was to determine the diagnostic value of fine needle aspiration cytology (FNAC) and serum thyroglobulin antibodies (TgAb) values in individual cytological categories.
The prospective study included 100 patients with scintigraphic cold thyroid nodules divided into two groups. The first group consisted of 50 patients with histopathological verified benign nodules and the second group of 50 patients with histopathological verified benign nodules. Demographic datas, FNAC findings, TgAb levels and final histopathological findings were recorded. FNAC with ultrasound (US) guidance was performed by the so-called Free hand technique. TgAtb values were estimated by the radio-immunity assay (RIA) method.
In patients with histopathological findings of a benign nodule, 20 patients had a cytological finding of a colloidal nodule, 18 patients had a cellular nodule, 12 had a finding of follicular neoplasm. In patients with a histopathological finding of the malignant nodule, 9 patients had a cytological finding of a colloidal nodule, 8 had a cellular nodule, 21 follicular neoplasm and 12 patients had cancer. FNAC had a sensitivity of 66%, specificity of 76%, a positive predictive value of 73%, a negative predictive value of 69%. The highest preoperative serum TgAb values were in patients with cytologic findings of cancer, and the lowest in the cellular nodule.
The finding of FNAC together with serum TgAb values contributes to better diagnosis and selection of patients requiring surgery.
The aim of this paper was to evaluate the incidence of thyroid gland diseases in relation to age, sex, existing associated symptoms and thyroxine and thyroid-stimulating hormone levels, in ...correlation with morphological characteristics and corresponding clinical diagnosis for thyroid gland.
Retrospective research was conducted in the period 1-Dec-2017 to 31-Dec-2017 and included a total of 500 subjects of both sexes aged 1 to 80 years. All subjects had clinical examination, which included anamnestic data, palpatory examination of thyroid gland, as well as functional status of thyroid gland.
The results of the research have shown that majority of subjects were females (78.6% vs. 21.4%). The largest number of subjects was in the age group 41 to 60 years. The average age of females was 43.22 years and 42.86 for males. The most common associated symptom for both sexes was related to cardiovascular system disorder (61.2%). Subclinical hypothyroidism was the most prevalent thyroid gland disease (12.8%), while diffuse enlargement of thyroid gland (4.60 %) was the most common in morphological classification. The mean value for free thyroxine for the overall sample was 14.39 pmol/L and 3,4 mlU/L for thyroid-stimulating hormone. Thyroid-stimulating hormone levels were highest in the age group 41-60 years (p=0.043).
The overall incidence of thyroid gland diseases was 18.57% for females and 13.08% for males. Free thyroxine levels were highest in thyroid gland with nodular changes and subclinical hypothyroidism (p=0.0001). Thyroid-stimulating hormone levels had the highest value in a thyroid gland with diffuse changes and subclinical hypothyroidism (p=0.0001).
It has been reported in recent years that elevated thyroglobulin antibody (TgAb) values can be associated with thyroid malignancy. The aim of this study is to determine whether serum TgAb have a ...predictive role in thyroid cancer in patients with thyroid nodules. The crossed study included 100 patients with scintigraphic cold thyroid nodules divided in two groups. Demographic data, TgAb levels and final histopathological findings were recorded. The first group consisted of 50 patients with histopathological verified malignant nodules and the second group of 50 patients with histopathological verified benign nodules. TgAb were estimated by the radio-immunity assay (RIA) method. The median of TgAb in the group with benign nodules were 14.3 (10-32) IU / mL and in the group with malignant nodules 42.9 (13-156) IU / mL. TgAb values were significantly higher in patients with malignant nodules (p = 0.02 The increase in values of TgAb by 1 IU / mL increased the risk for malignancy by 0.7%. The cut-off for TgAb of > 35 IU / mL discriminates between diagnosis of the malignant and benign thyroid nodule. TgAb of > 35 IU / mL, with a sensitivity of 56% and a specificity of 78%, was found to be a limit value for predicting malignant thyroid lesion. TgAb serum values were predictor of malignant thyroid lesion and their preoperative measurement in combination with other risk factors could assist in preoperative diagnosis in patients with cytological indeterminant thyroid nodules.
Bosnia and Herzegovina (B&H) is one of the Eastern European countries with lacking data on thyroid cancer (TC) epidemiology. We aimed to assess the incidence of TC in Tuzla Canton of B&H during a ...10-year period (1999-2008). We retrospectively evaluated 65000 hospital records of both inpatients and outpatients with possible thyroid symptoms residing in Tuzla Canton of B&H (total of 496280 inhabitants) between 1999 and 2008. Patients with histological proof of TC were included in study. Incidence rates were calculated with age standardisation using European standard population. Trends in incidence were evaluated as moving three-year averages. During observed period 117 patients met the diagnostic criteria for TC with male to female ratio of 1:4.85. Median age of all cases was 51 years (interquartile range: 41 to 60) with men in average 9 years older than women at the time of diagnosis. The mean annual standardized incidence was found to be 2.30/10(5) (% 95 CI = 1.38-3.22) inhabitants ranging from 1.0 to 3.2 per 10(5). The average crude incidence in men was 0.82/10(5) and 3.83/10(5) in women. The prevalence of TC, at the end of the observed period was found to be 23.58/10(5) (% 95 CI = 19.3-27.58). There is a slight decline of incidence in our region during the observed period, but with the increase in the latest years of the study. This increase is probably the result of combination of various factors, mainly the better detection of new cases due to wider availability of diagnostics. Based on depicted trends, we believe that in the future years, TC incidence in our region will continue to rise.
To investigate hospital morbidity and incidence of colorectal cancer (CRC) in the Tuzla Canton between 2000 and 2004, as well as mortality incidence and degree of disease progression.
A total of 383 ...patients were enrolled in this study, all of them with CRC. Pathohistological analyses were performed in all patients after colonoscopy. Afterwards, the patients underwent surgery and obtained material was also pathohistologically analyzed in order to perform the Astler-Coller classification and the classification of the location of CRC.
In the period 2000-2004 in the Tuzla Canton there were 383 newly diagnosed patients with CRC. The average age of the patients was 62 ± 12 years, and the incidence was equally distributed per genders. Rectal tumour was noted in 145 (37.9%) patients, and in 238 (62.1%) tumor was found elsewhere in the colon. Average incidence of the CRC was 15.73/100,000, with a dramatic increase in incidence in 2003 of 27.40/100,000. The average mortality incidence during the study was 6.89/100,000, and the largest number of the patients (339, 88.6%) was in an advanced stage of the disease.
There has been a significant increase in the number of newly detected cases of CRC in the Tuzla Canton during 2000- 2004, which implies the need for initiating a National Early CRC Detection Programme.
Pathology of thyroid nodules is present in all ages and it is frequently encountered in clinical practice. Thyroid nodules do not represent a single disease, but they are the clinical manifestation ...of a wide range of different thyroid diseases.
The objective of this study is to evaluate the frequency and localization of malignancy in solitary scintigraphic cold nodules, as well as the sensitivity, specificity and diagnostic accuracy of FNAB in comparison with histopathological findings.
The study was included 49 patients with palpatory findings of the solitary nodule located in the both lobes or isthmus of thyroid gland. All subjects underwent the scintigraphy and FNAB, followed by a cytologic results that was compared to the final histopathological diagnosis, after surgery.
The study results show that the highest number of solitary nodules (81,6%) is localized in the lower pole of the both lobes of the thyroid gland. The cytologic results were benign 8 cases, malignant in 23 and indeterminate (follicular neoplasm) in 18 cases. The highest number of thyroid cancer is histopathologically confirmed in the patients with cytological diagnosis of follicular neoplasms, i.e. follicular cancer is found in 66.7% and papillary cancer is found in 33.3% of subjects. The most common cancer is papillary cancer found in 61,2%. Since the pathohistological diagnosis of all our patients responded to cancer, it was done indirect statistical evaluation of the diagnostic sensitivity of cytological method in the estimation of malignant thyroid lesion, which was 83,7%.
FNAB is a highly sensitive method in the diagnostics of malignant thyroid lesions with the sensitivity Se=83,7%. The highest number of thyroid cancer is histopathologically confirmed in the patients with cytological diagnosis of follicular neoplasm (66.7%). The highest number of patients had a cytological diagnosis of papillary cancer.
Malignant tumors of the thyroid gland account for about 1% of thenewly diagnosed malignant tumors each year, and their incidence inwomen is twice the incidence in men. According to the WHO ...classification (2004) thyroid tumors are divided into: carcinoma of the thyroid, adenoma and similar tumors, and other thyroid tumors which include: teratomas, angiosarcomas, paragangliomas and others, as well as primary lymphomas and plasmacytomas. Primary thyroid lymphomasare defined as lymphomas which originate in the thyroid gland. This study presents the case of a 68-year-old patient with a thyroid lymphoma, which caused compression of the airways. In the patientpresented there was reduced activity of the thyroid gland. The dominant symptoms were: breathing difficulties, hoarse voice and the enlargement of the thyroid. An ultrasound examination was performedbefore surgery on the neck, which showed a multinodular thyroid,with compromised and compressed trachea to the right and rear. Anemergency surgical procedure was performed to reduce the tumor.Pathohistological diagnosis confirmed diffuse large B cell lymphoma.The aim of the study was to present a patient with a thyroid lymphoma, who had previously not had any immunological changes to the gland,that is, she had not had any chronic lymphocyte thyroiditis, but due to the compressive syndrome it was necessary to perform an emergencysurgical procedure to reduce the tumor.
Vitamin D deficiency is a global health problem. Its deficiency has been reported to be associated with different autoimmune diseases.
The aim of this study was to evaluate the relationship between ...vitamin D level and thyroid antibodies in autoimmune hypothyroidism.
A total number of 150 individuals were enrolled in this study. They were divided into the fallowing groups: group I included 50 patients with autoimmune thyroid disease (AITD), group II included 50 patients without autoimmune thyroid disease. Group III included 50 apparently healthy participants representing a control group. All participants underwent a detailed clinical examination and laboratory tests including, 25 (OH) vitamin D, thyroid-stimulating hormone (TSH) and thyroid autoantibodies assessment, including anti-thyroid peroxidase antibodies (anti-TPO) and anti-thyroglobulin antibodies (anti-TG).
Serum levels of 25 (OH) vitamin D recorded a highly significant difference between the studies groups (20,76±6,31 ng/ml in group I vs. 24,37±9,05ng/ml in group II vs. 24,57±6,45ng/ml in group III, p<0,01). Moreover, there was a highly significant difference between patients with AITD and patients without AITD (20,76±6,31ng/ml vs. 24,37±9,05ng/ml, respectively; p<0,01). The concentration of anti-TPO and anti-TG antibodies were statistically significant higher in patients with vitamin D deficiency (p< 0,001). Serum TSH were significantly higher in group I (p< 0,001).
Significantly low levels of vitamin D were documented in patients with AITD that were related to the presence of anti-thyroid antibodies and higher level thyroid-stimulation hormone (TSH), suggesting the involvement of vitamin D in the pathogenesis of AITD and the advisability of supplementation.
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