Publications (60) View all
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Dataset: Long term outcomes DTC SGPGIMS Lucknow India
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Article: Prevalence of Hypothyroidism in Benign Breast Disorders and Effect of Thyroxine Replacement on the Clinical Outcome
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ABSTRACT: BackgroundThe aim of this study was to determine the prevalence of hypothyroidism in patients with benign breast disorders (BBD). We then asked if thyroxine replacement in hypothyroid patients has any impact on the clinical outcome of the BBD. MethodsThis prospective study included 201 women with BBD. None of the included patients had previously suspected hypothyroidism. Clinical, laboratory, and follow-up details of the patients were noted. Baseline serum thyroxine, thyroid-stimulating hormone (TSH), and prolactin estimation was done in all cases. Thyroid peroxidase antibody (TPOAb) estimation was done in hypothyroid patients and/or patients with a goiter. In addition to the standard conservative management protocol, hypothyroid patients were given thyroxine replacement therapy. Their response to treatment was assessed at 3-month intervals. The clinical outcomes of euthyroid and hypothyroid groups were compared. ResultsThe mean age of the patients was 34±8years, and the mean length of follow-up was 13.0±4.2months. The overall prevalence of hypothyroidism was 23.2% (nipple discharge 37%, mastalgia 23%, lump/lumpiness 17.4%). The rate of hypothyroidism and the mean serum TSH concentration were significantly higher among patients with nipple discharge than among those with mastalgia (P=0.001) or a lump (P=0.01). In all, 39% of hypothyroid women had TSH concentrations >10mIU/l, and 53% had an elevated TPOAb titer. BBD symptoms were alleviated in 83% of the hypothyroid patients with only thyroxine replacement. The final clinical outcomes of hypothyroid patients with nipple discharge and mastalgia were significantly better than that of their euthyroid counterparts (P=0.028 and 0.001, respectively); no significant difference was noted in patients with lumpiness (P=0.144). ConclusionsAll women with BBD should be screened for hypothyroidism because the prevalence of hypothyroidism is high among this group and correction of hypothyroidism results in significant clinical improvement of BBD in most of these patients.World Journal of Surgery 04/2012; 33(10):2087-2093. · 2.36 Impact Factor -
Article: Adrenal Incidentalomas: Experience in a Developing Country
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ABSTRACT: BackgroundThe incidence of adrenal incidentalomas is rising worldwide. There is a concern about malignancy in large incidentalomas. There are few published articles from developing countries on this entity. The aim of this study was to analyze the clinical presentation, functional status, and final diagnosis of adrenal incidentalomas and, in particular, to look into the incidence of adrenal cortical carcinoma (ACC) in large adrenal incidentalomas managed at a tertiary referral hospital in northern India. MethodsThis is a retrospective study (January 1991–December 2005) of 59 patients with adrenal incidentaloma managed at our department. The mean tumor diameter was 7.8±4.0cm. In all cases, clinical details, radiology findings, laboratory findings, intervention details, histology findings, and follow-up data were noted. Six patients in which the mass was ultimately found to arise from extra-adrenal tissue were excluded from final analysis ResultsMean age of the patients was 46±12years (M:F=1:1.1). The incidentaloma measured more than 3cm in 91% of cases and more than 6cm in 70% of cases. The clinical scenarios leading to detection of incidentaloma included abdominal (56.6%), genitourinary (24.5%), and systemic complaints (15.1%) and routine medical checkup (3.7%). Most of cases were found by ultrasonography (n=41), and remaining by CT scan (n=10), and MRI (n=2). The incidence of functioning tumors was 41.5% (hypercatecholinism 37.7 % and hypercortisolism 1.9%). Forty-nine patients were operated on. The important final pathology included ACC (7.5%), pheochromocytoma (PCC) (43%), adrenal cysts (13.2%), myelolipoma (11.3%), and inflammatory lesions (9.4%). ConclusionIn our experience, the incidence of PCC was high among large adrenal incidentalomas while that of ACC was lower than expected. Inflammatory lesions contribute to a significant number of cases of incidentaloma in developing countries. Adrenalectomy is a justified procedure for large incidentalomas, although the concern may not always be an underlying malignancy.World Journal of Surgery 04/2012; 32(8):1802-1808. · 2.36 Impact Factor -
Article: Assessment of swallowing function impairment in patients with benign goiters and impact of thyroidectomy: a case control study.
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ABSTRACT: Swallowing-related quality of life (QoL) in patients with benign thyroid goiters is not much studied. The aim of this study was to assess swallowing function impairment in patients with benign goiters, compare it to a control population, and also find the impact of thyroidectomy and various factors on the outcome of swallowing function. We performed a prospective case-control study from September 2009 to September 2011 which consisted of 124 patients who were to undergo primary thyroid surgery and 100 age- and sex-matched controls. A translated and validated modified swallowing quality-of-life (SWAL-QOL) questionnaire was used to assess patients' perception of dysphagia. Presurgery scores of patients and controls and pre- and postsurgery scores (>6 months after surgery) of patients were compared. The mean age of males and females in the control and patient groups were 37.7 vs. 39.5 years and 37.4 vs. 39.8 years, respectively. Twelve patients (9.7%) complained of dysphasia at presentation. Sixty-three patients (50.8%) underwent total thyroidectomy and 61 (49.2%) had hemithyroidectomy at the time of initial evaluation, 75, 23.4, and 1.6% of patients were euthyroid, hyperthyroid, and hypothyroid, respectively. Presurgery scores of patients in all of the 11 domains of the SWAL-QOL were lower compared to those of controls. Comparing separately with the matched controls, females had significant differences in nine domains (except for sleep and fatigue) of the SWAL-QOL questionnaire but males did not. Postoperatively, both male and female patients showed significant improvement in the scores of all the domains. Female gender, hyperthyroidism, thyroid nodularity, retrosternal extension, procedure, and weight of the resected specimen were the factors associated with significant improvement in various domains. Dysphagia seems to be an underestimated problem in patients with benign goiters. Uncomplicated thyroidectomy results in significant improvement in swallowing-related QoL irrespective of patient profile and extent of thyroidectomy.World Journal of Surgery 03/2012; 36(6):1293-9. · 2.36 Impact Factor -
Article: Medullary thyroid cancer: clinico-pathological profile and outcome in a tertiary care center in North India.
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ABSTRACT: Recent advances in genetic screening have ushered in a new era in diagnosis and management of medullary thyroid cancer (MTC). However, the same is not true for a resource-poor country, where clinicians are still struggling to diagnose and adequately manage this relatively uncommon thyroid malignancy. We hereby present our experience of managing MTC at a tertiary care referral center in North India. This was a retrospective study conducted between January 1990 and July 2009. Demographics, clinical profiles, details of surgical procedures, and follow-up records were reviewed. A total of 71 patients with MTC were identified. Mean age of this group was 39.9±14.1 years, and men outnumbered women 1.7:1. Some 84.5% of patients had seemingly sporadic MTC, and 15.5% had familial MTC (MEN2a=14.1%, MEN 2b=1.4%). All patients had a thyroid nodule at the time of presentation. Mean tumor diameter was 4.9 cm. Cervical lymphadenopathy, mediastinal lymphadenopathy, extrathyroidal invasion, and distant metastases were present in 59%, 7.2%, 10%, and 4.2% of patients, respectively. Staging showed that 4.8% of patients were stage I, 17.5% stage II, 14.3% stage III, and 63.6% stage IV. Treatment was as follows: 92.6% of patients had total thyroidectomy (primary or secondary); 67.6% central compartment lymph node dissection, 62.3% lateral cervical lymph node dissection, and 7.2% trans-sternal mediastinal lymph node dissection performed. Some 66.7% of patients suffered from persistent hypercalcitoninemia, and 11.4% of those underwent reoperation. The 5-year and 10-year overall survival (OS) was 74.6% and 58%, respectively. The majority of the patients with MTC presented at stage IVa, contributing to the high rate of persistent hypercalcitoninemia. Despite a policy of observation and intervening only in overtly symptomatic patients with persistent hypercalcitoninemia, overall survival (OS) in our study was comparable to other series, reinforcing the belief that persistent hypercalcitoninemia has an indolent course in most patients.World Journal of Surgery 06/2011; 35(6):1273-80. · 2.36 Impact Factor
