Current Issue : January-March
Volume : 2023
Issue Number : 1
Articles : 7 Articles
Background: Florida Firefighters experience a higher risk of thyroid cancer than non-firefighters. This study examines
whether the histologic types and tumor stage of thyroid cancer is different among firefighters compared to other
Methods: Eligible cases were firefighters (n = 120) identified in a linkage of Florida Cancer Data System (FCDS)
registry records (1981–2014) and Florida State Fire Marshal’s Office employment and certification records, and nonfirefighters
classified into: blue-collar (n = 655), service (n = 834), white-collar (n = 4,893), and other (n = 1,789). Differences
in thyroid histologic type (papillary, follicular, and rare/other less common forms of thyroid cancer), tumor stage,
and age at diagnosis were evaluated using multinomial logistic regression models comparing blue-collar, service,
white-collar, and other occupational groups with firefighters. Univariate odds ratios as well as odds ratios adjusted for
age, gender, race, tumor stage, and year of diagnosis (aOR) and 95% confidence intervals (95%CI) were reported.
Results: Service (aOR = 4.12; 95%CI: 1.25—13.65), white-collar (aOR = 3.51; 95%CI: 1.08—11.36), and blue-collar
(aOR = 4.59; 95%CI: 1.40—15.07) workers had significantly higher odds of being diagnosed with rare histologic types
of thyroid cancer vs papillary type compared to firefighters. Service (aOR = 0.42; 95%CI: 0.27—0.66), white-collar
(aOR = 0.39; 95%CI: 0.26—0.59), blue-collar (aOR = 0.36; 95%CI: 0.23—0.56), and other (aOR = 0.34; 95%CI: 0.22—0.53)
occupational groups have a significantly lower odds of being diagnosed with rare vs papillary type at a younger age
(30—49 years) vs 50—69 years compared to firefighters. However, stage at diagnosis was not significantly different
among occupational groups.
Conclusion: Firefighters diagnosed with thyroid cancer experience a higher odds of papillary compared to rare
histologic types of thyroid cancer relative to other workers; there is no evidence of an increased odds of late-stage
diagnosis in firefighters relative to other worker groups. Firefighters may benefit from routine screening and active
surveillance of suspected thyroid tumors especially given the excellent treatment outcomes available for those diagnosed
with early-stage papillary thyroid tumors....
Background: Type 2 diabetes mellitus (T2DM) is a well-known independent risk factor for non-alcoholic fatty liver
disease (NAFLD). However, research exploring the association between blood glucose management and the risk of
NAFLD status in subjects without diabetes was insufficient. This study aimed to explore the association of glycated
hemoglobin (HbA1c) with NAFLD status and the severity of liver steatosis and fibrosis in non-diabetic people.
Methods: A cross-sectional analysis was conducted on 2998 non-diabetic American adults using data from the
National Health and Nutrition Examination Survey (NHANES) 2017–2018 cycle. We used multivariable logistic regression
models to evaluate the association between HbA1c and NAFLD status and the severity of liver steatosis and
fibrosis. Interaction and stratified analyses were additionally performed.
Results: The multivariate regression analyses showed that HbA1c was associated independently with NAFLD status
in all the models (model1: OR = 2.834, 95%CI: 2.321, 3.461; model 2: OR = 2.900, 95%CI: 2.312, 3.637 and model 3:
OR = 1.664, 95%CI: 1.284, 2.156). We further performed the interaction and stratified analyses and discovered a significant
interaction between HbA1c and BMI (Pinteraction < 0.05). Finally, a robust link was shown between HbA1c level
and the severity of liver steatosis, which was mainly significant in the prediabetes group, while the correlation was not
significant in HbA1c level and severity of liver fibrosis after controlling for all the potential confounders.
Conclusions: We concluded that HbA1c level was positively correlated to the risk of developing NAFLD in a large
non-diabetic American population. Moreover, HbA1c level was associated with the severity of liver steatosis in subjects
with prediabetes, suggesting that routine screening for HbA1c among individuals with prediabetes is necessary....
SARS-CoV-2 infection induces the dysfunction of many organs including the thyroid gland through the role of ACE2 receptors as
well as the consequences of the cytokine storm. Thyroid diseases such as subacute thyroidism, Graves’ disease, thyrotoxicosis, and
Hashimoto’s thyroiditis have been documented in patients with SARS-CoV-2 infection. However, there are limited reports about
the consequences of SARS-CoV-2 infection-related thyroid complications. We describe a case of man who was admitted to the
emergency department due to repeated lower limb weakness since diagnosed with COVID-19. He had refractory hypokalemia and
was treated with potassium replacement therapy for 2 months. However, the complaints continued. The patient has no history of
thyroid disease, yet the laboratory result showed hyperthyroidism. Accordingly, he received oral thiamazole. As the laboratory
parameters of the thyroid hormones improved, potassium levels returned to normal and the limb weakness stopped. This unusual
thyroid complication should be considered in SARS-CoV-2 infection. The prompt diagnosis and appropriate therapy can reduce
the burden of the disease....
Strain elastography (SE) determines the level of tissue stiffness and thus helps in the
diagnosis and differentiation of various pathologies. This paper aims to study the elastographic
differences between healthy thyroid parenchyma and ones affected by chronic autoimmune thyroiditis
(CAT) in children. We included in our study 52 children diagnosed with CAT and 22 children with
no thyroid pathology. After clinic examination and biological tests, an ultrasound was performed
followed by SE using a Hitachi Preirus machine with a 5–15 multi-frequency linear probe. The
mean strain ratio (SR) values were significantly lower in the control group compared with the CAT
group (0.68 ± 0.2 vs. 1.19 ± 0.25; p < 0.0001). A mean value above 0.9 was found predictive for
CAT with 84.62% Sensitivity(Se), 95.45% Specificity (Sp), 97.8% Positive Predictive Value (PPV),
72.4% Negative Predictive Value (NPV), and area under receiver operating characteristic (AUROC),
0.9. No differences were found between the two thyroid lobes. Also, we found no differences
between girls and boys. Out of the 52 children with CAT, 39 were on therapy with levothyroxine. No
differences were found between SR values in preexisting hypothyroid cases compared to euthyroid
cases (1.24 ± 0.26 vs. 1.18 ± 0.25; p = 0.4615). Our results show that SE is a useful examination
technique of children diagnosed with CAT, in accordance with other studies conducted on adults.
This study lays the foundation for elastographic examination among children....
Background. Cushing’s disease (CD) recurrence in pregnancy is thought to be associated with estradiol fluctuations during
gestation. CD recurrence in the immediate postpartum period in a patient with a documented dormant disease during pregnancy
has never been reported. Case Report. A 30-year-old woman with CD had improvement of her symptoms after transsphenoidal
resection (TSA) of her pituitary lesion. She conceived unexpectedly 3 months postsurgery and had no symptoms or biochemical
evidence of recurrence during pregnancy. After delivering a healthy boy, she developed CD 4 weeks postpartum and underwent a
repeat TSA. Despite repeat TSA, she continued to have elevated cortisol levels that were not well controlled with medical
management. She eventually had a bilateral adrenalectomy. Discussion. CD recurrence may be higher in the peripartum period,
but the link between pregnancy and CD recurrence and/or persistence is not well studied. Potential mechanisms of CD recurrence
in the postpartum period are discussed below. Conclusion. We describe the first report of recurrent CD that was quiescent during
pregnancy and diagnosed in the immediate postpartum period. Understanding the risk and mechanisms of CD recurrence in
pregnancy allows us to counsel these otherwise healthy, reproductive-age women in the context of additional family planning....
Resistance to Thyroid Hormone (RTH) is a rare form of hormone resistance
secondary to changes in the genes encoding thyroid hormone receptors. The
two subtypes, Pituitary RTH (PRTH) and Generalized RTH (GRTH), cause
clinically distinguishable patient presentations. In PRTH, typically only the
pituitary gland is resistant to thyroid hormone (TH) while the rest of the
body maintains sensitivity. Selective pituitary resistance to thyroid hormone
results in dysregulation of thyroid hormone homeostasis with clinical presentation
as either euthyroid or hyperthyroidism. PRTH is characterized by
elevated thyroid hormone levels with an elevated or inappropriately normal
TSH concentration. Herein we describe a case report of a 70-year-old woman
who complained of weight loss of over 35 lbs., palpitations, jitters, hair loss,
diarrhea, fatigue, muscle weakness, etc. over 6 months, thus, indicating the
presence of iatrogenic hyperthyroidism while receiving levothyroxine 175 ug
daily prescribed by her primary care provider because of a reported history of
“Graves disease” treated by radioactive iodine ablation of the thyroid several
years ago. The daily dose of levothyroxine had been increased gradually at an
interval of 3 months over a year because of persistent elevation of serum TSH
level. Laboratory tests revealed markedly elevated Free T4, Free T3 and TSH
levels, along with low concentrations of all lipid fractions, serum creatinine
and urea nitrogen levels, indicating TSH induced hyperthyroidism or PRTH.
Further testing documented a mutation of thyroid hormone receptor beta
gene 2 confirming presence of PRTH. We believe that the initial diagnosis of
Graves Disease was erroneous and I-131 ablation further confounded and
missed the diagnosis of PRTH. Thus, the purpose of this report is to report a patient with PRTH and describe potential pitfalls in diagnosis and management
of this rare disorder....
Background: Previous studies have been reported that vitamin D deficiency increased the risk of metabolic syndrome
(MetS). Nonetheless, the exact mechanisms underlying this association is unclear. Besides, inflammation and
deregulation of adipokines secretion have been recognized as pivotal factors that contribute to the pathogenesis of
these conditions. Therefore, we assessed whether serum vitamin D status is associated with serum levels of adipokines
and inflammatory markers in these patients.
Methods: This case-control study was carried out among 65 patients with MetS who had vitamin D insufficiency
(cases) and 130 MetS patients who had vitamin D sufficiency (controls). Cases and controls were recruited from
among those referred to health centers in Zabol County, Iran. Vitamin D insufficiency was regarded as a serum
25-hydroxyvitamin D [25(OH)D] concentration below 30 ng/ml. Serum concentrations of leptin, adiponectin, visfatin,
and resistin and also adiponectin/leptin ratio along with serum levels of interleukin 6 (IL-6), IL-10 and tumor necrosis
factor-alpha (TNF-α), were evaluated.
Results: Serum levels of leptin, resistin, and TNF-α were significantly higher, whereas, serum adiponectin and adiponectin/
leptin ratio were significantly lower in cases than the controls. There was no significant difference in serum
visfatin, IL-6, and IL-10 between the groups. Serum levels of 25(OH)D were inversely correlated with leptin, resistin, and
TNF-α in both unadjusted models and after adjustment for potential confounders.
Conclusion: Our findings indicated that vitamin D insufficiency in MetS patients is associated with increased inflammation
and serum adipokine abnormalities which may be associated with developing metabolic complications in
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