Ethem Turgay Cerit

Ultrasound-guided thyroid nodule fine-needle biopsies--comparison of sample adequacy with different sampling techniques, different needle sizes, and with/without onsite cytological analysis.

INTRODUCTION The aim of this study was to compare the diagnostic adequacy of thyroid samples obtained by aspiration or capillary biopsy techniques, with 22 or 27 gauge needles, and with or without on-site cytological analysis (OCA). MATERIAL AND METHODS Four hundred patients with thyroid nodules underwent ultrasound (US)-guided fine-needle biopsies. Patients were divided into eight groups according to needle size (22 vs. 27 gauge), biopsy technique (aspiration vs. capillary), and whether or not OCA was performed. Sample adequacy rates were calculated for each group and subgroups and compared using chi-square tests. RESULTS When all nodes were evaluated (n = 400), the adequacy rate was significantly greater with the capillary than with the aspiration technique (97% vs. 91.5%, p = 0.032) and when OCA was than was not performed (97% vs. 91.5%, p = 0.032). When only solid nodules were evaluated (n = 205) the adequacy rate was also significantly greater with the capillary than with the aspiration technique (98.9% vs. 89.7%, p = 0.008) and when OCA was than was not performed (97.9% vs. 89.6%, p = 0.014). In contrast, the adequacy rate was similar for 22 and 27 gauge needles (94.2% vs. 93.1%, p = 0.733). CONCLUSIONS Optimal results were obtained with the capillary technique and OCA. The capillary technique and OCA should be the preferred approach in thyroid nodule biopsy, optimising adequacy rates and patient comfort.

Proprotein convertase subtilisin/kexin type 9 (PCSK9), soluble lectin-like oxidized LDL receptor 1 (sLOX-1) and ankle brachial index in patients with differentiated thyroid cancer.

The cardiovascular effects of short-term overt hypothyroidism are not well known. We investigated proprotein convertase subtilisin/kexin type 9 (PCSK9), soluble lectin-like oxidized LDL receptor 1 (sLOX-1) and the ankle brachial index (ABI) in thyroid cancer patients with short-term overt hypothyroidism due to thyroid hormone withdrawal (THW). Twenty-one patients requiring radioactive iodine (RAI) ablation or scanning and 36 healthy control subjects were enrolled. Patients were evaluated in the subclinical thyrotoxic phase when they were on suppressive levothyroxine therapy and in the overt hypothyroid phase due to THW for four weeks. PCSK9, sLOX-1, lipids and ABI were measured in the patient and control groups. Total cholesterol, LDL cholesterol, triglycerides and Apo B levels were increased in short overt hypothyroidism compared with the control group (p<0.001). PCSK9 levels increased before THW and after THW in the patients compared to control group (p<0.001, p=0.004, respectively). sLOX-1 levels were not different between patients with short term overt hypothyroidism and control group (p=0.27). ABI was found to be significantly decreased in patients with thyroid cancer before and after THW compared to control group (p=0.04, p=0.002 respectively). PCSK9 levels were correlated negatively with ABI (r=-0.38, p=0.004). In conclusion; our study demonstrated that patients with differentiated thyroid cancer both before and after THW which is a short term overt hypothyroid phase, had increased PCSK9 levels and decreased ABI. Short term overt hypothyroidism also leads to increased HDL, LDL, total cholesterol, Apo A and Apo B levels.

Serum Total Sialic Acid Level is Elevated in Hypothyroid Patients as an Atherosclerotic Risk Factor

Serum total sialic acid (TSA) concentration is regarded as an indicator of the risks of atherosclerosis and cardiovascular diseases. The association between SA levels and atherosclerosis risk factors has not been assessed in patients with thyroid diseases.

A Case Report of Bilateral Adrenal Sarcomatoid Carcinoma.

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Sarcomatoid adrenal carcinoma is even more aggressive type of ACC. Bilateral malignant adrenal tumors are extremely rare except for those that represent metastasis from an extra-adrenal organ. Here we report a 53-year-old woman who presented with abdominal pain and weight loss. Abdominal computed tomography revealed bilateral adrenal masses and a mass in her liver. Surgical specimens showed pleomorphic tumor cells with epithelial and spindle cell morphology and immunohistochemical staining was compatible with sarcomatoid carcinoma. Sarcomatoid adrenal carcinoma should be kept in mind during the management of bilateral adrenal masses.

Metastatic Papillary Thyroid Carcinoma Arising from Thyroglossal Duct Cysts

ABSTRACT Objective: We report a rare case of a patient who developed papillary thyroid carcinoma (PTC) arising from thyroglossal duct cysts (TGDCs) with lateral lymph node metastasis who had a normal thyroid gland and benign central compartment lymph nodes. Methods: We present a case with metastatic PTC arising from TGDC together with a brief review of the relevant literature. Results: A 38-year-old man patient was admitted with a cystic lesion in the midline of his neck. There was also an easily palpable lymph node on the left neck, which was suspected of being metastatic PTC on ultrasonography (USG). There was no nodule in the thyroid gland. A fine-needle aspiration cytology of the lymph node was positive for metastases of PTC. We performed an excision of the cystic lesion and total thyroidectomy with the central and left neck lymph node dissection. The cystic lesion pathology was reported as PTC, 10 mm in size. There was a metastatic lymph node in the lateral left neck compartment (regions III–IV), 7 c...

Nodüler Guatr Nedeniyle Opere Edilen Olguların Ultrasonografi ve Tiroid İnce İğne Aspirasyon Biyopsi Özellikleri

Amac : Tiroid nodullerinin degerlendirilmesinde klinik ozelliklerin yanisira tiroid ince igne aspirasyon biyopsisi (IIAB) ve ultrasonografi maligniteyi predikte etmede kullanilan yontemlerdir. Ozellikle follikuler neoplazi ve onemi belirsiz atipi gibi indetermine lezyonlarda cerrahi karari verebilmek icin tiroid IIAB’nin yanlis negatif ve yanlis pozitiflik insidanslarinin bilinmesi onemlidir. Bu calismadaki amacimiz histolojik olarak malign oldugu saptanan tiroid nodullerinin ultrasonografik ozelliklerini incelemek ve yapilan tiroid IIAB’nde saptanan indetermine sitolojilerin histopatoloji korelasyonlarini degerlendirmektir. Yontemler: Ocak 2010-Ocak 2012 tarihleri arasinda noduler guatr nedeni ile tiroidektomi yapilan 154 hastanin demografik ozellikleri, sitoloji ve histopatoloji sonuclari, nodullerin ultrasonografik ozellikleri, operasyon oncesi TSH degerleri retrospektif olarak degerlendirildi. Bulgular: Calismaya dahil edilen hastalarin 104 (%67,5)’unun histopatoloji sonucunun benign, 50’sinin ise (%32,5) malign oldugu goruldu. Iki grup arasinda yas ve cinsiyet acisindan fark saptanmadi. Histopatoloji sonucu benign olan gruptaki hastalarin TSH duzeylerinin malign gruba gore anlamli dusuk oldugu goruldu. Bu calismada klinigimizde yapilan tiroid IIAB’nin sensitivitesi %90.7, spesifitesi %72.2 , pozitif prediktif degeri %62.7, negatif prediktif degeri ise %93.8 olarak hesaplandi. Tiroid IIAB’nin tanisal dogruluk degeri %78.5 olarak bulundu. Calismamizda Onemi Belirsiz Atipi sikligi %7 olarak hesaplandi ve bu lezyonlarin %25’inin histopatolojik olarak malign olduklari bulundu . Ultrasonografik ozellikler degerlendirildiginde; malign histopatolojinin bagimsiz risk faktorleri hipoekojenite (OR=2.3 p<0.05), mikrokalsifikasyon varligi (OR=2.5 p<0.05) ve periferal ve santral kanlanma (OR=11 p<0,05) olarak bulundu. Sonuc: Calismamizdaki insidental tiroid nodullerinin sitoloji ve histopatoloji sonuclari literaturle uyumludur. Hipoekoik, mikrokalsifikasyon iceren ve periferal ve santral kanlanma paterni gosteren nodullerin malign olma olasiligi daha fazla bulunmustur.

Destructive thyroiditis followed by hypothyroidism associated with infliximab therapy.

OBJECTIVE To present the rare case of a patient who developed destructive thyroiditis accompanied by transient thyrotoxicosis resulting from infliximab therapy for the treatment of psoriasis. METHODS The clinical presentation and management of a case with infliximab-associated thyroiditis is described with a brief review of the literature. RESULTS A 57-year-old male who suffered from psoriasis was treated with infliximab therapy for 4 years. Thyroid function tests were normal before infliximab therapy. When the patient presented in our clinic, he had thyrotoxicosis and was using propylthiouracil. A 99m Technetiumpertechnetate thyroid scintigraphy scan showed no visualization of either thyroid lobe or decreased thyroid iodine uptake. Thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody (anti-TPO Ab) and thyroglobulin antibody (anti-Tg Ab) were negative. Thyroid ultrasonography revealed a heterogeneous thyroid gland without nodules. After stopping propylthiouracil therapy, we advised monitoring of his thyroid function tests in the following weeks, and infliximab therapy for psoriasis was continued. Four weeks later, his thyroid function tests showed an elevated TSH level with normal levels of free triiodothyronine and thyroxine (FT3 and FT4, respectively), and levothyroxine treatment was administered to the patient. Thyroid function tests normalized after levothyroxine treatment. One year later, infliximab therapy was stopped because of clinical remission. Simultaneously, levothyroxine treatment was also stopped. His thyroid function tests were normal 6 weeks after the cessation of levothyroxine treatment. CONCLUSION To our knowledge, the present report is the third infliximab-associated thyroid disorder case. Periodic follow-up of thyroid function tests is necessary during infliximab therapy.