Aleksandra Hernik

Unexpected conversion from hypothyroidism to an euthyroid state due to Graves' disease in a patient with an ectopic thyroid.

A 15-year-old woman was diagnosed with hypothyroidism and unilateral ectopic thyroid. Levothyroxine treatment was introduced; however, the patient was non-compliant and took the medication irregularly. When she presented to an endocrinologist at the age of 30, she had not been using levothyroxine for at least 6 months. Surprisingly, she was clinically and biochemically euthyroid. Due to decreased echogenicity on ultrasound examination, enhanced vascularization on Color Doppler examination and increased concentration of anti-TSH receptor autoantibodies, she was diagnosed with Graves’ disease. Eventually, she underwent total thyroidectomy due to diagnosis of follicular neoplasm in fine-needle aspiration biopsy of the focal lesion found in the thyroid gland. To our knowledge, our patient is the first described with ectopic thyroid, presenting a nodular variant of Graves’ disease and no signs of orbitopathy, who was initially hypothyroid and became euthyroid in the course of autoimmune thyroid disease.

Ghrelin as a potential molecular marker of adrenal carcinogenesis: In vivo and in vitro evidence

Adrenal tumours belong to one of the most prevalent neoplasms. It is a heterogeneous group with different aetiology, clinical manifestation and prognosis. Its histopathologic diagnosis is difficult and identification of differentiation markers for tumorigenesis is extremely valuable for diagnosis.

Thyroid ectopy — diagnostic and therapeutic challenges before and in the era of TSH neonatal screening

Despite TSH screening in newborns is currently conducted in most developed countries, patients with thyroid ectopy born before the procedure was introduced or those in whom the screening failed to establish diagnosis, might still appear. In the paper we revise the current state of knowledge regarding the clinical presentation, diagnosis and treatment of patients with thyroid ectopy. As an example, we report diagnostic and therapeutic difficulties in our three patients with thyroid ectopy remaining undiagnosed and untreated during early childhood. Introduction of neonatal screening for congenital hypothyroidism does not guarantee that all patients with thyroid ectopy will be correctly diagnosed and properly treated due to the possibility of falsely negative result of TSH screening or lack of compliance from parents. Visualization of an ectopic thyroid on ultrasound examination may be challenging for unexperienced sonographists; muscles in the thyroid bed may be misdiagnosed as heterogeneous and hypoechogenic thyroid gland with features suggesting autoimmune thyroid disease. Thyroid scintiscan is crucial for confirmation of the diagnosis of thyroid ectopy. In conclusion, hypothyroidism due to thyroid developmental anomaly should be taken into consideration in case of hypothyroidism and normal thyroid autoantibodies in a patient at any age.

Red cell distribution width — a new marker for exacerbation of heart failure in patients with hypothyroidism following radioiodine therapy

INTRODUCTION Cardiovascular diseases constitute a major cause of health problems and death in developed countries across the world. The increased value of the index of distribution of red blood cells volume (RDW) may be a prognostic marker in patients diagnosed with chronic heart failure (CHF). Hypothyroid patients present higher RDW values if compared to healthy controls. Taking into consideration that RDW might be both affected by thyroid status and CHF, we decided to determine the effect of concomitant hypothyroidism following radioiodine therapy (RIT) and CHF on hematological parameters. MATERIALS AND METHODS Patients with toxic nodular goiter and heart failure with concomitant anemia were included. Patients underwent treatment with radioiodine before the planned heart transplant or pacemaker implantation (combined ICD/CRT-D). After RIT patients were divided into the three subgroups: with overt hypothyroidism (TSH ≥ 10µIU/mL, Group I), subclinically hypothyroid patients (TSH 4.3-9.0 µIU/mL, Group II) and with high-normal level of TSH (2.6-4.2 µIU/mL, Group III). RESULTS Significant correlation between TSH and RDW was observed (r=0.46; P < 0.0001) after RIT, whereas no correlation between serum TSH levels and TIBC and Fe was observed. In Group I significant correlation between TSH and RDW (r= 0.48; P = 0.002) after RIT was observed, whereas in two other subgroups there were no significant correlation. CONCLUSIONS Subclinical hypothyroidism or high-normal levels of TSH did not affect RDW in a significant manner in the studied population. Our results demonstrates that overt hypothyroidism may contribute to deterioration of CHF reflected in changes of RDW value. < p > < /p >.

A diabetic patient with suppurative thyroiditis due to Salmonella enterica complicated by acute kidney injury

131 A 61 ‐year ‐old woman presented with sore throat and fever (up to 39.8°C), without cough, rhinitis, or diarrhea. She had obesity (body mass index, 33.3 kg/m2), chronic atrial fibrillation treat‐ ed with acenocoumarol and digoxin, hypertension for the past 14 years (well controlled with ramipril and spironolactone),2 and well ‐controlled type 2 diabetes (glycated hemoglobin, 5.5%) for the past 3 years (treated with metformin and gliclazide). Her medical history was negative for thyroid and renal disorders. Initially, she was consulted by a laryngologist, who performed an ultrasound examination of the neck. It demonstrated a mixed solid and cys‐ tic lesion (47 × 40 × 42 mm). Empirical therapy with clindamycin was introduced (600 mg twice daily), and the patient was referred to the depart‐ ment of endocrinology. On admission, she was weak and dehydrated. She reported a weight loss of 22 kg (from 117 kg to 95 kg) in the previous month. A physical ex‐ amination revealed restricted, swollen, tender, and painful lesion in the lower part of the neck (FIGURE 1A). Laboratory tests indicated inflamma‐ tion, acute kidney injury, and hyperthyroidism (Supplementary material online, Table S1). Fine‐ ‐needle aspiration biopsy (FNAB) of the lesion was performed. A cytological examination revealed the presence of inflammatory cells, while micro‐ biological tests identified Salmonella enterica sub‐ sp. enterica as a pathogenic factor. Blood and stool cultures were both negative for Salmonella. Due to acute kidney injury, noncontrast computed to‐ mography of the neck was performed (FIGURE 1B). During hospitalization, the patient received adequate therapy for acute kidney injury, which was most probably iatrogenic and induced by clindamycin therapy. Intravenous antibiotic The incidence of acute bacterial thyroiditis is es‐ timated at 0.1% of thyroid gland conditions re‐ quiring surgical treatment. The main pathogen causing acute thyroiditis is Staphylococcus aureus, while Salmonella enterica is extremely rare.1 CLINICAL IMAGE