ResearchPad - benign-thyroid-disease-and-health-disparities-in-thyroid-ii Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[SUN-416 Fatigue and Quality of Life Among Thyroid Cancer Survivors]]> BACKGROUND Fatigue among thyroid cancer survivors is an important issue that needs to be appreciated and managed appropriately. Although several studies have reported potential factors that might be related to postoperative fatigue, the associations have yet to be inconclusive. The purpose of the present study was to estimate the prevalence of clinical fatigue in patients with papillary thyroid carcinoma and to reveal predictive factors, including their quality of life. METHODS A cross-sectional survey was conducted on patients with papillary thyroid carcinoma. Patients who underwent non-curative surgery, or those with recurrent or metastatic PTC, or those with other malignancies were excluded. The primary outcome was fatigue measured by the Cancer Fatigue Scale (CFS), and the secondary outcome was quality of life (QoL) quantified using the SF-36 v2. The following explanatory variables were collected; gender, age, employment status, marital status, co-morbidities, time since initial surgery, types of surgery, replacement of thyroid hormone, use of radioactive iodine, and the level of thyrotropin. The prevalence of clinical fatigue was estimated with the cut-off value of 18/19 of the CFS score. Correlations between the CFS score and the explanatory variables were examined using uni-variable analyses as well as multi-variable analysis. RESULTS Three hundred twenty-one patients participated in the survey. Of them, 258 respondents (80%) were female. The median age was 58 years, and the median time from initial surgery was 6.4 years. The mean and the standard deviation of the CFS score were 17.9 and 9.3, respectively (range: 0-48). The prevalence of clinical fatigue was 42% [95%CI: 36-47%]. Among the variables explored, having a job and scores of the mental component summary, the physical component summary, and the role/social component summary of the SF-36 were inversely associated with the CFS score in both uni- and multivariable analyses. CONCLUSION Postoperative fatigue was common in thyroid cancer survivors. Patients with a job and better QoL, in particular, those with good mental health, maybe at low-risk of developing the burden.

<![CDATA[SUN-414 Tyrosine Kinase Inhibitors Induced Thyroid Dysfunction: An Experience from a Tertiary Care Hospital]]> Tyrosine kinase inhibitors (TKI) belong to a new class of molecular multi-targeted anticancer therapy which targets different growth factor receptors and hence attenuates cancer cell survival and growth. TKI-induced thyroid dysfunction is recognized as a common adverse effect of treatment., but the onset of thyroid dysfunction is variable. This study analysed correlation between initiation of TKIs and the onset of thyroid dysfunction in non-thyroid cancers patients without any background thyroid dysfunction.


This was a retrospective cohort study to evaluate thyroid dysfunction in adult patients (n=227, M:F=153:74) with non-thyroidal cancers treated with TKIs. Patients having pre-existing thyroid disease including euthyroid goitres were excluded. Demographic, clinical, and cancer treatment data were collected. Thyroid function tests (TFTs) were done prior to initiation, at 2 months, 6 months and at 1 year. TFTs were classified as euthyroid (thyrotropin [TSH] normal), subclinical (SCH; TSH 5-10 mIU/L, or higher TSH if free thyroxine normal), or overt hypothyroidism (OH; TSH >10 mIU/L, low free thyroxine, or requiring replacement).


Of the 227 patients in the study, OH occurred in 57 patients (25.1%)(M:F = 19:38) and SCH occurred in 89 patients (39.2%) (M:F=39:50) with TKI therapy at the end of 12 months. 37 patients (M:F=13:24) developed OH in first 6 months after initiation of TKIs. Female patients were more likely to have OH in the first 6-month period following TKIs irrespective of type of TKI or the cancers. SCH was also more common after 2 months in female patients (n=23) (M:F=6:17) but the conversion of SCH to OH was more common in male patients at the end of 12 months. The symptoms were variable and most the patients did have any thyroid specific symptoms. After adjustment for age, sex, cancer type, cancer stage, performance status, and type of TKI, OH remained significantly associated with survival at 1-year (hazard ratio=0.461; p<0.0001), whereas SCH did not (hazard ratio=0.591; p=0.165). Analysis of hypothyroid patients (SCH and OH) with TSH >5 and <10 mIU/L stratified by hormone replacement status showed improved survival associated with hormone replacement, although 1 year follow-up is too short to comment on overall survival rates.


New onset hypothyroidism, both OH and SCH is common in non-thyroidal cancer patients treated with TKI. SCH is more common after 2 months and OH after 6 months following TKI initiation. Female sex is more predisposed to develop thyroid dysfunction irrespective of underlying cancer or type of TKI used but male patients progressed to OH at the end of 12 months.

<![CDATA[SUN-431 Case Finding Versus Routine Screening of Thyroid Dysfunction in Pregnancy]]> <![CDATA[SUN-432 Utilizing Patient Online Forums to Capture Experiences and Perceptions Associated with the Use of Desiccated Thyroid Extract]]> <![CDATA[SUN-419 Monitoring Thyroid Function Tests in Patients on Lithium: Adherence to Recommended Guidelines and Comparison of Practice Patterns in a Health Care System]]> <![CDATA[SUN-418 Patterns of Thyroid Disease in Basrah, Iraq. Retrospective Study]]> <![CDATA[SUN-428 Rural India Embracing Advanced Techniques in MIS:- A Series of 20 Cases of Thyroid Surgeries by Transoral Endoscopic Thyroidectomy-Vestibular Approach (TOETVA) Technique with Respect to Acceptance of Progressive Surgeries Using Advanced Technologies, Techniques by Rural Patients and it’s Safety & Feasibility in Small Setup Hospital in Rural India]]> AbstractAims & ObjectivesTransoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) an alternative surgical technique for thyroid surgery is slowly gaining widespread popularity.Majority of TOETVA surgeries are performed in Tertiary Care institutes. It’s safety & Feasibility in small setup hospitals has not been reported until now. The key challenges in Indian Rural healthcare sector are Lack of Quality Infrastructure, Dearth of qualified medical functionaries and NonAccess to basic medicines and medical facilities thwarts its reach to population in rural India. Indian Health Care sector is a self-pay market. Lack of awareness & affordability being a challenge with patients they remain apprehensive in acceptance of Advanced Technology or newer Techniques.This series is an attempt to study A shift in acceptance of progressive surgeries using Advanced Technologies & Techniques by Rural Patients and its Safety & Feasibility in Smaller operative setups in rural India.MethodsProper patient selection along with proper instrumentation & OT setup helped complete the procedures without any major complication.Advanced Instrumentation along with essential Operation Theatre setup were utilised for performing Total of 20 TOETVA procedures.For successful execution of TOETVA surgeries extensive Training Programs were furnished to equip stakeholder teams with respective Skill, Knowledge & Attitude sets.Organisational SWOT Analysis & Competency mapping contributed to strategise a helping approach to Educate & Influence stakeholders.ResultsTotal 20 patients were operated by TransOral Endoscopic Thyroidectomy - Vestibular (TOETVA) Technique from May 2018 till September 2019.Three SubTotal Thyroidectomies & 16 Hemithyroidectomies were performed. One patient was operated for Thyroglossal cyst.Increased awareness about a need to Improve on competence of Empathy & Accountability, Pursuit of Quality Care & Inculcating Cost-Effective use of the results of relevant research in regular functions.ConclusionsThere is a noticeable paradigm Shift in acceptance of rural patients as well as of rural paramedical staff that these surgeries which require Advanced Technology & Innovative Techniques are easily Accessible & Executable without undue cost burden with utmost safety at their own vicinity even in the small setup hospitals.This study aids to recommend Feasibility & Safety of TOETVA even for small setup of hospitals in Rural India. ]]> <![CDATA[SUN-420 Spontaneous Changes in TSH Levels After Thyroidectomy During Long-Term Follow-Up]]>


Spontaneous serum TSH variations during levothyroxine replacement therapy and multiple dose changes in athyreotic patients seem to be frequent in clinical practice.

To describe the rate and extent of spontaneous serum TSH variations in patients after total thyroidectomy for differentiated thyroid cancer (DTC) in real-life practice, and the number of resulting levothyroxine (LT4) dose adjustments.

Data of DTC patients were prospectively collected at a single referral center between January 2005 and May 2019. TSH and fT4 serum levels, LT4 dose and formulation, and concomitant medications were recorded at 1, 3, and 12 months after primary treatment (surgery ± radioiodine therapy), and then yearly; the data were retrospectively evaluated for this study. Visit at one month was used to tailor LT4 dose and was not considered into the data analysis. Patients with structural evidence of disease or during pregnancy were excluded.

Data of 2883 evaluations (472 patients) were collected; at baseline, the median age was 49.7 years, 73.5% were females. The LT4 formulation administered at baseline were tablets (84.9%), liquid solution (11.4%), or soft-gel capsule (3.7%). Overall, in 27.5% of clinical evaluation with unchanged levothyroxine dose (341/1243), there were meaningful spontaneous TSH variations (defined as delta TSH > 1.5 mcUI/ml) at yearly follow-up visit. It is clinically significant: in 6.6% of visits, overt thyrotoxicosis was recorded. Furthermore, the treating clinicians decided to change the LT4 dose in 37.1% of cases. These figures were not significantly higher in the first years, and a rate above 25% persist even after ten years of follow-up. The median maintenance dose needed was 1.61 (interquartile range [IQR] 1.41-1.92) mcg/Kg/day for tablets, 1.54 (IQR 1.39-1.79) mcg/Kg/day for liquid solution, and 1.46 (IQR 1.23-1.71) mcg/Kg/day for soft-gel capsules. After correction for daily dose, there was no difference in the rate of TSH variations > 1.5 mcUI/ml, or in the absolute value of median delta of TSH between the three formulations. In 20.1% of patients, the LT4 formulation was changed during the follow-up: it was more common in patients with a known gastroenteric disease (OR 1.76, p=0.03).

TSH spontaneous variations and dose adjustments are very common in patients after total thyroidectomy, even during long-term follow-up: wide variations happen in more than 1/4 of all visits, and dose changes are needed in more than 1/3 of all evaluations. We were more inclined to change LT4 formulation in patients with known interference in LT4 absorption: however, no difference in TSH variations was recorded between users of three different formulations, even if soft-gel capsules seem to have a lower maintenance dose.

<![CDATA[SUN-426 The Impact from AJCC 8Th Edition Staging System on Thyroid Cancer Outcomes by Race And Ethnicity]]> <![CDATA[SUN-417 Long Working Hours Are Associated with Hypothyroidism: A Cross-Sectional Study with Population-Representative Data]]> <![CDATA[SUN-430 A Prospective Clinical Trial on the Efficacy of Lithium as Adjuvant Therapy to Radioiodine in the Treatment of Hyperthyroidism (Railit Study)]]> <![CDATA[SUN-425 Indiscriminate Thyroid Function Testing on Acute Hospital Admissions Reveals a High Abnormality Rate Requiring Follow Up]]> <![CDATA[SUN-412 Graves’ Disease Displayed as a Risk Factor of Vertebral Fracture Even in Premenopausal Women]]> <![CDATA[SUN-413 Thyroid Stimulating Hormone Levels Amongst Reproductive Age Latinas: Findings from the ELLAS Study]]> 4.5) at the time of their study visit, compared to 1.7% and 7.4% overall. 0.2% had TSH > 10. Among those without a known history of thyroid disease, 1.3% had TSH < 0.45 and 6.7% had TSH > 4.5 at their visit. BMI, body fat %, and country of birth were not associated with TSH levels, but there was a small yet significant effect of age on TSH (p=0.009).Conclusion: In this US cohort of Hispanic women of reproductive age, we observed a high prevalence of thyroid dysfunction in those without pre-existing disease. In women with a known thyroid condition, the prevalence of abnormal TSH values was also high, representing both under- and over-treatment with thyroid hormone. Screening for thyroid disease in this population is important and presents a potential opportunity for intervention in an often underserved population. ]]> <![CDATA[SUN-409 Subclinical Hypothyroidism in Hospitalized Patients with Chronic Heart-Failure or Chronic Renal-Failure Is Most Probably Not Due to Thyroid Disease]]> <![CDATA[SUN-410 Reverse T3 in Patients with Hypothyroidism, Helpful or a Waste of Time?]]> <![CDATA[SUN-424 Treatment of Antithyroid Drug-Induced Agranulocytosis with Granulocyte Colony-Stimulating Factor: A Meta-Analysis]]> 0.5 x 109/L. Data were treated as continuous data, obtaining the standard mean difference through a Forrest Plot using the Review Manager 5.3 application. Results: Five of the studies were non-concurrent cohort, while one was a randomized clinical trial. The duration of the studies was from 1970s to 2014. Age range of the population was from 8 to 87 years old, with more females. G-CSF dose ranged from 75 to 300ug/day, injected subcutaneously or intramuscularly. Primary outcome measured common to all the studies included hematologic recovery. Five of the six studies showed shorter number of days to hematologic recovery for the treatment group compared to the control group (with a standardized mean difference of 1 day, confidence interval (CI) of 0.45 to 1.54). Conclusion: Exogenous G-CSF administration in ATD agranulocytosis contributed to faster hematologic recovery in terms of days, shortening recovery by a mean of 1 day.References:1. Tamai, H., et al. Treatment of methimazole-induced agranulocytosis using recombinant human granulocyte colony-stimulating factor (rhG-CSF). J Clin Endocrinol Metab.1993;77(5):1356-1360.2. Andres, E., et al. Haematopoietic growth factor in antithyroid-drug-induced agranulocytosis. Q J Med. 2001;94:423-428.3. Fukata, S., Kuma, K., Sugawara, M. Granulocyte colony-stimulating factor (G-CSF) does not improve recovery from antithyroid drug-induced agranulocytosis: a prospective study. Thyroid. 1999;9(1):29-31.4. Tajiri, J., Noguchi, S. Antithyroid drug-induced agranulocytosis: how has granulocyte colony-stimulating factor changed therapy? Thyroid. 2005;15(3):292-297.5. Watanabe, N., et al. Antithyroid drug-induced hematopoietic damage: a retrospective cohort study of agranulocytosis and pancytopenia involving 50,385 patients with Graves’ disease. J Clin Endocrinol Metab. 2012;97(1):E49-E53.6. Clauna-Lumanta, M.M., Yao, C., Bolinao, J.F. The effects of GCSF on the recovery time and duration of hospitalization in patients with anti-thyroid drug-induced agranulocytosis in a tertiary hospital. JAFES. 2016;31(2):131-136. ]]> <![CDATA[SUN-415 Is ‘’Visceral Adiposity Index’’ a Better Indicator of Metabolic Syndrome in Patients with Thyroid Nodules?]]> 0.05 for all).VAI was significantly higher in the patient group than the control group (p <0.05, median VAI value 4.07 (IQR: 2.27-5.91); 2.97 (IQR: 2.03-4.29), respectively). According to the NCEP ATP III, the number of people with metabolic syndrome was significantly higher in the patient group than the control group (p =0.004). There was no significant difference between waist circumference, body fat percentage, visceral fat rating, BMI, waist-hip ratio and waist-height ratio between patient and control groups (p> 0.05 for all).VAI values were similar in patients according to size, shape, structure, echogenicity, limits, vascularity and presence of calcification of nodules (p>0.05 for all). In all of participants, according to VESINC sonographic scoring system, VAI score was significantly higher in person with heterogeneous thyroid parenchyma than homogeneous (p=0.03). And, those with parenchymal infiltration had significantly higher VAI than those without (p=0.001). However, VAI was similar in terms of parenchymal echogenicity and presence of cyst (p>0.05 for all).There was no significant correlation between VAI and TSH, Ft3, fT4, anti-TPO, anti-TG, total thyroid volume and number of nodule (p> 0.05).In our study, we demonstrated that metabolic syndrome is more common in patients with thyroid nodules. While VAI values were significantly different between the two groups, we found no significant difference in terms of other metabolic syndrome parameters. Therefore, VAI may be a better indicator of metabolic syndrome in patients with thyroid nodules. ]]> <![CDATA[SUN-423 Impact of Hyperthyroidism and Its Treatment on the Outcome of Mental Health, Occupational Functioning and Quality of Life - a Prospective Study]]>


Hyperthyroidism is known to be associated with psychiatric symptoms such as anxiety and depression, impartment of functioning and poor quality of life (QOL).

It was intended to study the outcome of anxiety, depression, ability to work and QOL following the treatment of hyperthyroidism in endocrine clinic.

In a prospective study, all newly referred hyperthyroidism patients with fully supressed TSH (<0.004 mIU/L) were followed up three monthly for more than a year. Besides the thyroid status and clinical assessment, they were assessed using Patient Health Questionnaire (PHQ)-9 for depression, Generalised Anxiety Disorder (GAD)-7 questionnaire for anxiety; EuroQoL (ED5D) for QOL and Work and Social Adjustment Scale (WSAS) to measure functional impairment.

There were 177 participants (77.9% females), with a mean age of 50.1±15.6 years (range 16-86). Majority (88.7%) were having Grave’s disease and 11.3% had thyroid nodular disease; 10.2% had recurrent hyperthyroidism. At the baseline, anxiety was considered severe in 27.7%; similarly depression was moderately severe in 13.7% and severe in 14.9%. Although these decreased over time, considerable proportions continued to have these symptoms even after a year of treatment. A little over a quarter (26.6%) had beta-blockers at baseline and 9.0% had antidepressants; these proportions decreased reflecting symptomatic improvement. Proportions not-working changed from 28% to 18.2% within a year. WSAS suggested that the proportion with significant impairment changed from 46.7% to 34.6% (mean score change from 11.6 to 5.1). The EuroQoL mean score was 59.6 at the initial assessment which increased gradually to over 80. Most of these outcome parameters correlated with the improvement in thyroid status; however for many patients, mental health symptoms and functional impairments continued even after the thyroid tests became normal.

Considerable proportion of patients with hyperthyroidism had anxiety, depression, functional impartment and poor quality of life; most of which improved with the course of anti-thyroid treatment; however a considerable proportion continued to have symptoms and impairments even after a year. This suggests the need for additional psychiatric intervention, probably early in the treatment to decrease the morbidity and improve QOL. Use of specific screening measures for psychiatric symptoms in the endocrinology clinics may be useful.


(1) Demet et al, Arch Med Res. 2002 Nov-Dec;33(6):552-6.

<![CDATA[SUN-422 Risk Factors Associated with Thyroid Nodules in Type 2 Diabetes]]>


: To determine risk factors associated with the presence of thyroid nodules in patients with type 2 diabetes

: A case control prospective study, matched 1:1, according to age, sex and smoking habit was conducted. Patients with type 2 diabetes were recruited from the Endocrinology Service of Cayetano Heredia Hospital, Lima-Perú. Clinical evaluation, laboratory tests and thyroid ultrasound were performed to indentify patients with type 2 diabetes with and without thyroid nodules. The association was evaluated by calculating Odds ratios (OR) by conditional multivariate logistic regression techniques.

: 83 patients with type 2 diabetes and thyroid nodule and 83 patients with type 2 diabetes without thyroid nodule; were obtained. The risk factors associated with the presence of thyroid nodules in patients with type 2 diabetes were HbA1c (OR= 4.12, P= 0.002), BMI (OR= 1.13, P 0.030) and TSH (OR= 3.27, P= 0.0001), with cut-off points according to ROC curve of HbA1c ≥ 8%, TSH in the normal upper limit ≥ 2.3 μIU / mL and BMI ≥ 27 kg / m2. Patients with type 2 diabetes and thyroid nodule had higher values of blood glucose, thyroid volume, abdominal and neck circumference; greater frequency of acantosis nigricans and acrochordons compared to controls.

: The risk factors associated with the presence of thyroid nodules in patients with type 2 diabetes were HbA1c, BMI and TSH, with cut-off points according to ROC curve of HbA1c ≥ 8%, TSH in the normal upper limit ≥ 2.3 μIU / mL and BMI ≥ 27 kg / m2.